Development of clinical indicators for performance measurement and improvement: an HMO/purchaser collaborative effort

This article describes a collaborative effort between a major health care purchaser, three area health maintenance organizations, and a state Medicaid agency to develop clinical indicators as the basis for a comparison database. Some of the difficulties in developing a "common yardstick" of quality and value are candidly discussed.     

Application of polymerase chain reaction for the correlation of Salmonella serovars recovered from greyhound feces with their diet

The polymerase chain reaction was employed to correlate Salmonella serovars isolated from fecal material of greyhounds suffering from gastroenteritis with those isolated from the diet fed to the greyhounds prior to onset of diarrhea. Kennels around the Abilene, Kansas, area were contacted and supplied with materials needed to collect a portion of the diet each day. With the onset of diarrhea, the kennels were instructed to ship the fecal material and diet from the previous 10 days to the laboratory for testing. Forty-one fecal samples and corresponding diets were screened for Salmonella, Clostridium perfringens, Campylobacter jejuni, Staphylococcus aureus, Staphylococcus intermedius, and pathogenic (piliated) Escherichia coli by direct culture using standard procedures. The fecal material was also screened for coronavirus and parvovirus using electron microscopy. Thirty-five "normal" fecal samples were screened for all of the above mentioned microorganisms as a control. In addition, the fecal material was screened for E. coli verotoxins I and II and clostridial enterotoxins. A total of 61 Salmonella isolates were recovered from the 41 samples of feces and diet submitted for testing; 31 were recovered from the feces and 30 from the diet. Four Salmonella isolates were recovered from the normal fecal samples. Results obtained by PCR, plasmid profiles, antigenic analysis, and antibiogram profiles indicated that 16 of the 31 isolates recovered from the fecal material were the same strain as that recovered from the diet.     

Studies on antigenic relationship between grass- and cult. rye pollens by skin-test, RAST and RAST-inhibition-test in patients with pollinosis (author's transl)

Skin tests on patients suffering from pollinosis suggest frequently an antigenic relationship between various grass and cult. rye pollens. This problem was further studied using both, RAST and RAST inhibition test. The tests were performed with commercial grass pollen discs as well as with self-prepared disc labeled with cult. rye pollens and a combination of various grass antigens. Good agreement was found between self-made and commercial (single antigen) grass pollen discs (95.9%). RAST and skin test correlated also extremely well (92.3%). Mutual inhibition between grass and cult. rye pollens was measured by RAST inhibition test using self-prepared discs. High antigenic relationship between grass and cult. rye pollens was found, however, it could be demonstrated that the antibody pattern varies and contains "grass specific" antibodies.     

The turnover and distribution of labelled corticosterone during post-natal development of the duckling (Anas platyrhynchos)

During 6 months of post-natal development in the laboratory, the weight of the adrenal gland relative to body weight decreases exponentially. In the 3 day-old duckling a single intravenous dose of labelled corticosterone becomes distributed in a very large apparent volume and an "extracellular" pool that is greater than the extracellular fluid volume and the pattern of disappearance of labelled hormone from plasma is biphasic. Later during development the volumes of distribution decrease and the biphasic pattern of disappearance becomes less distinct until at 6 months only one phase of disappearance can be detected with confidence. No significant change in plasma corticosterone concentration occurs during this period of development in the laboratory. Estimations of the corticosterone secretory rates, however, indicate that whereas the adrenal weight-specific rate os secretion increases during the first 3 weeks and declines therafter, the bodyf weight-specific secretory rate continues to decline throughtout the period of increasing body weight.     

Microstructure of direct current and pulse magnetron sputtered Cr-B coatings

Chromium diboride thin films possess desirable combinations of properties (such as high hardness, wear resistance, chemical inertness, high thermal and electrical conductivity), which are attractive for a wide range of potential industrial applications. However, these properties depend strongly on the deposition process and parameters. Investigation of the resultant coating structures could explain certain differences between them, giving important information about the characteristics of the deposition process (which in this particular case is a recently developed method involving magnetron sputtering of loosely packed blended powder targets) and pointing out directions for improvement.In this paper, Cr-B coatings deposited by direct current (DC) and DC-pulse magnetron sputtering of loosely packed blended powder targets are characterised by transmission electron microscopy (TEM) techniques (electron diffraction and bright-field/dark-field imaging). The structures of the coatings deposited with different parameters are investigated and compared, and the effect of oxygen contamination on the structure is discussed.Coatings with an extremely fine, nanocolumnar structure were observed. DC sputter deposited (and generally non-stoichiometric) Cr-B coatings exhibit a short range ordered ‘zone T’ microstructure, while DC-pulse deposited stoichiometric CrB₂ coatings are dense and defect-free, crystalline and show strong preferred orientation.A small amount of contamination by oxygen of the interfacial sub-layers (due to the target material being a powder) of the DC-pulse magnetron sputter deposited stoichiometric CrB₂ (and near-stoichiometric CrB) coatings was found to affect the structure by suppressing nanocolumnar growth and promoting equiaxed, nanometer-sized grains, close to the coating/substrate interface. The majority of the coating however remained nanocolumnar.     

Fecal Coliform Removal within a Marshland Upwelling System Consisting of Scatlake Soils

The marshland upwelling system (MUS) was installed on private camps in the Grand Bay National Estuarine Research Reserve, Moss Point, Mississippi. The system was evaluated for its effectiveness in removing fecal coliforms from settled, raw wastewater. A suite of studies was performed at flow rates of 1.9, 2.8, and 5.5 L/min and an injection frequency of 30 min every 3 h to investigate fecal coliform removal. An additional study was performed at a flow rate of 2.8 L/min and an injection frequency of 15 min every hour. Overall, the MUS consistently maintained fecal concentrations below effluent regulatory standards for shellfish harvesting waters (14 most probable number of colonies per 100 mL). Mean influent concentrations of 55,269±2,218,016 colony forming units (CFU)/100 mL were reduced to effluent counts of 2.7±14.07 CFU/100 mL (observed in the 1.5 m wells). Three- to four-log reductions in influent counts were observed over the initial 1.4 vector?m from the injection well. The overall removal followed a first-order decay relationship with respect to vector distance, resulting in removal rate constants ranging from 5.6 to 6.6/m and predicted surface concentrations approaching 0 CFU/100 mL. The 2.8 L/min for 30 min every 3 h treatment provided the best effluent quality.     

Mixed Methods Research Designs in Counseling Psychology.

With the increased popularity of qualitative research, researchers in counseling psychology are expanding their methodologies to include mixed methods designs. These designs involve the collection, analysis, and integration of quantitative and qualitative data in a single or multiphase study. This article presents an overview of mixed methods research designs. It defines mixed methods research, discusses its origins and philosophical basis, advances steps and procedures used in these designs, and identifies 6 different types of designs. Important design features are illustrated using studies published in the counseling literature. Finally, the article ends with recommendations for designing, implementing, and reporting mixed methods studies in the literature and for discussing their viability and continued usefulness in the field of counseling psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of the measurement frequency on the elastic anisotropy of fibre laminates

Static tests and ultrasonic measurements (2.25 MHz) have been carried out on a series of composite laminates of glass fibres in a polypropylene matrix. A range of angle ply laminates were prepared for this study, with laminate angles θ of ±0, 10, 20, 30 and 40^∘. The high frequency measurements were made using the ultrasonic immersion technique, which allows the determination of a complete set of the elastic constants of a material. The relationship between the ultrasonically determined elastic constants of the angle ply laminates was found to be in excellent agreement with theoretical predictions, as previously validated for carbon fibre/epoxy angle ply laminates. A comparison between the ultrasonic and statically measured values was made for two of the angle ply laminates (θ = 0 and 20^∘). It was found that the static values were lower than those measured at ultrasonic frequency, particularly those constants that were more matrix dominated (for example the transverse moduli of the laminates). Measurements on a pure polypropylene sample at both testing frequencies confirmed that the change in matrix properties with frequency was the cause of this difference. The change in properties with test frequency is likely to be much larger in this system than in other composite materials because the glass transition temperature of polypropylene is close to ambient temperature. Dynamic mechanical tests (1 Hz) were carried out on a sample of pure polypropylene to assess this effect. We also give an appropriate method of estimating the dependence of glass transition temperature on frequency. The results for polypropylene are compared with those for other commonly used polymer matrix materials: epoxy resin, nylon and polyetheretherketone (PEEK): DMTA measurements were also made on these samples. The effect of test frequency on matrix properties, for the glass/PP laminates, was further investigated by examining the relationship of the Poisson's ratios with laminate angle using a mixture of ultrasonic experiments and theoretical predictions. Previously we have shown that the degree of anisotropy between the reinforcing fibre and the matrix phase is paramount in determining whether the material will show a negative Poisson's ratio at a critical laminate angle. The ultrasonic measurements carried out in this study on the glass/PP laminates showed a minimum in one of the Poisson's ratio at a laminate angle of 32°, but the value did not become negative. However, theoretical predictions showed that for a static frequency measurement (1 Hz), where the matrix is softer and hence the anisotropy of each laminate ply is higher, the laminate will show a negative Poisson's ratio with a minimum at a laminate angle of around 28°.