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1.
All leaders in health care today are charged with the responsibility of transforming present practices into new and different ones that are needed for the future. The structural side of transforming is ultimately easier than the human side. However, the most frequent failures come from not concentrating sufficiently on the behavioral side of the change. Structural and psychological change must occur simultaneously and embrace each other for best results. 相似文献
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Stirman Shannon Wiltsey; DeRubeis Robert J.; Crits-Christoph Paul; Brody Pamela E. 《Canadian Metallurgical Quarterly》2003,71(6):963
To determine the extent to which published randomized controlled trials (RCTs) of psychotherapy can be generalized to a sample of community outpatients, the authors used a method of matching information obtained from outpatient charts to inclusion and exclusion criteria from published RCT studies. They found that 80% of the patients in their sample who had diagnoses represented in the RCT literature were judged eligible for at least 1 published RCT; however, 58% of the patients had primary diagnoses such as adjustment disorder or dysthymia, which were not represented in the existing psychotherapy outcome literature. The most common reasons that patients in their sample did not match with published RCTs for psychotherapy are listed, and the implications of these findings for research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 相似文献
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KM Borow A Neumann RM Lang D Ehler B Valentine-Bates A Wolff K Friday M Murphy 《Canadian Metallurgical Quarterly》1993,21(4):939-949
BACKGROUND: Alveolar macrophages from patients with sarcoidosis were analyzed for their ability to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin-1-beta (IL-1-beta), and interleukin-6 (IL-6). RESULTS: Constitutive release of all three monokines in these patients was concomitantly increased in the active state of disease in comparison with inactive sarcoidosis or healthy control subjects. Alveolar macrophages from patients with inactive sarcoidosis compared with cells from healthy subjects showed increased spontaneous secretion of TNF-alpha and IL-6 only, whereas the constitutive release of IL-1-beta was similar as in healthy volunteers. In vitro stimulation of alveolar macrophages from healthy control subjects with lipopolysaccharide or pokeweed mitogen led to a time- and dose-dependent enhanced secretion of TNF-alpha, IL-1-beta, and IL-6. In a similar manner, with corresponding cells from patients with sarcoidosis the secretion of all three cytokines could be further increased by stimulation with lipopolysaccharide or pokeweed mitogen. CONCLUSIONS: The data presented indicate that an increased release of TNF-alpha, IL-1-beta, and IL-6 correlates to disease activity and may play a critical part in the pathogenesis of sarcoidosis. 相似文献
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K Shannon P Stapleton X Xiang A Johnson H Beattie F El Bakri B Cookson G French 《Canadian Metallurgical Quarterly》1998,36(10):3105-3110
Representative isolates from 10 distinct extended-spectrum beta-lactamase-producing strains of Klebsiella pneumoniae that caused hospital outbreaks in the United Kingdom from 1991 to 1994 were examined for relationships between their enzymes and plasmids. The beta-lactamases were identified by a combination of isoelectric focusing and gene sequencing. SHV-2 beta-lactamase was produced by isolates from four outbreaks, SHV-5 was involved in three, and SHV-4, TEM-15, and TEM-26 were involved in one outbreak each. All of the extended-spectrum beta-lactamases were encoded by self-transmissible plasmids, with sizes ranging from about 70 to 160 kb. No similarities between the restriction digest patterns of the extended-spectrum beta-lactamase-encoding plasmids were detected, except to some extent between those that produced TEM-15 and TEM-26. Thus, outbreaks of hospital infection with these organisms in the United Kingdom from 1991 to 1994 involved distinct organisms and resistance plasmids and appeared to be unrelated. 相似文献
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M Shannon 《Canadian Metallurgical Quarterly》1998,106(6):313-316
Childhood lead poisoning is characteristically a disease that occurs between the second and third years of life, generally resulting from the child's ingestion of lead-based paint or dust. However, lead poisoning may also appear in the first year of life. The case of a 4-month-old infant is reported in which the preparation of infant formula in a lead-soldered samovar (urn) resulted in venous blood lead levels as high as 46 microg/dl. The samovar had been brought into the United States by the parents while on a visit to Iran. The infant was placed on chelation therapy with parenteral CaNa2EDTA followed by oral meso-2,3-dimercaptosuccinic acid (DMSA) and d-penicillamine. This resulted in a rapid and substantial reduction in the blood lead level. Lead poisoning in infancy may have unusual etiologies such as in utero transmission of lead by lead-poisoned women. Because sources of lead poisoning in infancy may be unusual, a detailed environmental investigation may be necessary to identify the exact source. Children exposed to lead in the first 2 years of life have a special vulnerability to the neurotoxicity of lead, with the risk of enduring developmental handicaps. Continued public health initiatives to remove lead from the environment, in conjunction with routine lead screening of young children, will be key in meeting the goal of the Centers for Disease Control and Prevention to eliminate childhood lead poisoning by the year 2011. 相似文献
8.
Various examples of composite titania-based nanostructured materials exhibiting cooperative functionalities between different active components are presented. The fabrication of these integrated composite materials is based on one-pot supramolecular templating techniques combined with acidic sol-gel chemistry. The defined 3-D nanoscale organization and integration of various functional components results in advanced optoelectronic and photonic applications such as visible light sensitization of mesoporous titania photocatalysts with cadmium sulfide nanocrystals acting as sensitizing integral part of the mesopore wall structure, narrow bandwidth emission from rare earth ion activated nanocrystalline mesoporous titania films, and mirrorless lasing in dye-doped hybrid organic/inorganic mesostructured titania waveguides. 相似文献
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Cooperative adaptive cruise control(CACC)vehicles are intelligent vehicles that use vehicular ad hoc networks(VANETs)to share trafc information in real time.Previous studies have shown that CACC could have an impact on increasing highway capacities at high market penetration.Since reaching a high CACC market penetration level is not occurring in the near future,this study presents a progressive deployment approach that demonstrates to have a great potential of reducing trafc congestions at low CACC penetration levels.Using a previously developed microscopic trafc simulation model of a freeway with an on-ramp—created to induce perturbations and trigger stop-and-go trafc,the CACC system s efect on the trafc performance is studied.The results show signifcance and indicate the potential of CACC systems to improve trafc characteristics which can be used to reduce trafc congestion.The study shows that the impact of CACC is positive and not only limited to a high market penetration.By giving CACC vehicles priority access to high-occupancy vehicle(HOV)lanes,the highway capacity could be signifcantly improved with a CACC penetration as low as 20%. 相似文献
10.
An important criterium in selecting species for alley cropping is themineralization pattern of their prunings. This study determined effects of 5years of hedgerow pruning applications on soil organic C and total N at threelocations in Haiti and mineralization patterns from soil amended with theprunings during an incubation using micro-lysimeters. Soils (0–5cm) under 5 hedgerows were collected at each site and analyzed fororganic C and total N. In the laboratory, ground leaves and stems (<1cm diameter) of the hedgerow species were mixed with soil at ratesof 3 and 1.5 Mg ha–1, respectively, andaerobically incubated in the dark at 25 °C. A non-amended soilwas used as control. Soils were leached to determine mineral N at 1, 3, 7, 14,28, 42, 84 and 120 days of incubation. Evolved CO2 was measuredfollowing each leaching procedure. At the calcareous site, application ofprunings from Leucaena leucocephala (Lam.) De Wit andDelonix regia (Boj. ex Hook. Raf.) resulted in 23 and 13%higher soil N than the control, respectively, after 5 years. There were nodifferences in total N at the other sites but soil N was highest underLeucaena hybrid and Acaciaangustissima (Mill.) Kuntze, respectively at the basaltic and highelevation sites. Soils under D. regia (calcareous) andA. angustissima and Leucaena hybrid(high elevation) had higher organic C than the respective controls. Carbon andNmineralization and C turnover were highest when soils were amended with leavesof Leucaena diversifolia (Schlecht.) Benth (calcareous andbasaltic soils) and A. angustissima (high elevation) andlowest in non-amended control soils. Stem-amended soils showed differences in Cmineralization for calcareous and high elevation soils whereas N mineralizationwas similar among treatments within sites. Carbon and N mineralization (highelevation soil) correlated positively with N concentrations of leaf prunings.Amendments with leaf prunings increased soil C and N mineralization andturnoverrates, suggesting greater nutrient availability for the crop during a shortperiod than in non-amended control soils. 相似文献