Regionalization and the underuse of angiography in the Veterans Affairs Health Care System as compared with a fee-for-service system.

Background: Policies to concentrate or regionalize invasive procedures at high-volume medical centers are under active consideration. Such policies could improve outcomes among those who undergo procedures while increasing their underuse among those who never reach such centers. We compared the underuse of needed angiography after acute myocardial infarction in a traditional Medicare fee-for-service system with underuse in the regionalized Department of Veterans Affairs (VA) health care system.

Post-acute service use following acute myocardial infarction in the elderly.

This exploratory study examined the extent to which factors beyond characteristics of the patient, such as discharging hospital attributes and State factors, contributed to variations in post-acute services use (PASU) in a cohort of elderly Medicare patients following acute myocardial infarction (AMI). Thirty-seven percent of this cohort received PAS within 30 days of discharge and home health care was the most common type of service used. Patient severity of illness at hospital discharge, for-profit ownership of the discharging hospital, and discharging hospital provision of home health services were shown to be important predictors of PASU.

Superfluorescent rayleigh scattering from suspensions of dielectric particles.

We demonstrate that superfluorescent scattering of light can occur when laser light is incident on a collection of dielectric Rayleigh particles suspended in a viscous medium. Using a linear stability analysis, an expression for the spatiotemporal evolution of the scattered (probe) field is derived. An approximate condition for the progression of the interaction into the nonlinear regime is deduced and it is shown that, in the nonlinear regime, the scattered field intensity shows the characteristic quadratic dependence on particle density expected from a superfluorescent or superradiant process, once the effects of pump depletion are accounted for.

Effect of botulinum toxin A on the autonomic nervous system of the rat lower urinary tract.

Purpose: The magnitude and duration of the effects of botulinum toxin A on acetylcholine (ACh) and norepinephrine release from the bladder and urethra of rats were measured using a radiochemical method.

Materials And Methods: Saline (sham treatment) or botulinum toxin A was injected into the bladder (50 microl.) or urethra (30 microl.

A research agenda for bridging the 'quality chasm.'.

Realizing the vision of the IOM's landmark report, Crossing the Quality Chasm, will require new knowledge to support new policy and management. This paper lays out a research agenda that must be pursued if the health care system is to bridge the quality chasm. Based on a consensus process involving leading health care researchers and authorities, the paper highlights knowledge gaps and research directions in five areas identified by the Quality Chasm report as critical to its goals of building organizational supports for change; applying evidence to health care delivery; developing information technology; aligning payment policies with quality improvement; and preparing the workforce.

Influence of morphology on the near-infrared spectra of mycelial biomass and its implications in bioprocess monitoring.

Bioprocesses that employ mycelial microorganisms are commercially important. The application of optical techniques for the measurement of biomass in such processes is limited by the morphological heterogeneity exhibited by the mycelial microorganism employed. We investigated the influence of morphology on the near-infrared (NIR) spectra of the biomass of Streptomyces fradiae, a filamentous microorganism, by studying the spectra of mycelial suspensions that were manipulated to generate a range of morphological forms.

Physiological responses of chemostat cultures of Aspergillus niger (B1-D) to simulated and actual oxidative stress.

The physiological responses of chemostat cultures of the filamentous fungus, Aspergillus niger (B1-D) to simulated and actual oxidative stress, imposed respectively by addition of exogenous menadione (MD; a superoxide radical generating reagent) and gassing the culture with oxygen enriched air (25%, 50%, 75%, and 100% [v/v]), were examined. Changes in the levels of intracellular superoxide anions and defensive enzyme activities, such as catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx), were monitored, together with glutathione and respiratory activity in both the dynamic phase and when a new steady state was established. Culture response to MD addition was distinct from that upon exposure to enriched oxygen conditions, in that MD caused elevated levels of intracellular protein, whereas oxygen enrichment caused reduced protein content, especially at low dilution rates.

Impact of cardiac service availability on case-selection for angiography and survival associated with angiography.

Objective: To examine whether availability of cardiac services at the admitting hospital affects case-selection for angiography and one-year survival following angiography, within groups of patients who have similar clinical need for angiography according to published criteria.

Study Setting: Elderly Medicare beneficiaries (37,788) discharged with a diagnosis of acute myocardial infarction (AMI) from hospitals in seven U.S.

Modulational instability arising from collective Rayleigh scattering.

It is shown that under certain conditions a collection of dielectric Rayleigh particles suspended in a viscous medium and enclosed in a bidirectional ring cavity pumped by a strong laser field can produce a new modulational instability transverse to the wave-propagation direction. The source of the instability is collective Rayleigh scattering i.e.

Anthropogenic CO2 uptake by the ocean based on the global chlorofluorocarbon data set.

We estimated the oceanic inventory of anthropogenic carbon dioxide (CO2) from 1980 to 1999 using a technique based on the global chlorofluorocarbon data set. Our analysis suggests that the ocean stored 14.8 petagrams of anthropogenic carbon from mid-1980 to mid-1989 and 17.

Morphological and enzymatic responses of a recombinant Aspergillus niger to oxidative stressors in chemostat cultures.

Continuous chemostat cultures of a recombinant strain of Aspergillus niger (B1-D), engineered to produce the marker protein hen egg white lysozyme, were investigated with regard to their susceptibility to oxidative stress. The culture response to oxidative stress, produced either by addition of exogenous hydrogen peroxide (H(2)O(2)) or by high dissolved oxygen tension (DOT), was characterised in terms of the activities of two key defensive enzymes: catalase (CAT) and superoxide dismutase (SOD). Since the morphology is so critical in submerged fungal bioprocesses, the key morphological indices were analysed using a semi-automated image analysis system.

Use of at-line and in-situ near-infrared spectroscopy to monitor biomass in an industrial fed-batch Escherichia coli process.

One of the key goals in bioprocess monitoring is to achieve real-time knowledge of conditions within the bioreactor, i.e., in-situ.

Effect of aged garlic extract on caspase-3 activity, in vitro.

In neurodegeneration, such as Alzheimer's disease (AD), apoptosis results in the loss of valuable neurons. A key mechanism in apoptosis is the activation of caspase-3. Caspase-3 activity first becomes detectable early in apoptosis, continues to increase as cells undergo apoptosis, and rapidly declines in late stages of apoptosis.

Understanding individual and small area variation in the underuse of coronary angiography following acute myocardial infarction.

Background: Underuse of coronary angiography is common among patients with acute myocardial infarction (AMI) and the magnitude of underuse varies across geographic areas.

Objectives: To examine the influence of patient demographic, clinical and hospital characteristics on underuse of coronary angiography, and the contribution of these factors to variation in underuse across geographic regions.

Research Design: Cohort study using data from the Cooperative Cardiovascular Project.

Ataxia and paroxysmal dyskinesia in mice lacking axonally transported FGF14.

Fibroblast growth factor 14 (FGF14) belongs to a distinct subclass of FGFs that is expressed in the developing and adult CNS. We disrupted the Fgf14 gene and introduced an Fgf14(N-beta-Gal) allele that abolished Fgf14 expression and generated a fusion protein (FGF14N-beta-gal) containing the first exon of FGF14 and beta-galactosidase. Fgf14-deficient mice were viable, fertile, and anatomically normal, but developed ataxia and a paroxysmal hyperkinetic movement disorder.

Self-amplified coherent spontaneous emission in the planar wiggler free-electron laser.

Coherent spontaneous emission (CSE) is a potentially important self-generated source of seed radiation in a free-electron laser (FEL) amplifier. A model is derived that describes CSE at the fundamental resonant frequency and its harmonics in a planar wiggler FEL. The subsequent self-amplification of the CSE is investigated in the nonlinear regime for a FEL amplifier configuration.

Use of cholesterol-lowering therapy by elderly adults after myocardial infarction.

Background: Use of cholesterol-lowering drugs reduces mortality and adverse cardiac events among people aged 65 to 75 years with coronary heart disease, but previous studies have shown that most patients have not received this treatment.

Methods: We conducted a telephone survey during 1999 and 2000 of 815 Medicare beneficiaries aged 65 to 74 years hospitalized for an acute myocardial infarction in California, Florida, Massachusetts, New York, or Pennsylvania during 1994 and 1995. Outcome measures included use of cholesterol-lowering drugs, beliefs about the importance of lowering cholesterol levels, and knowledge of personal cholesterol levels, adjusting for demographic and clinical factors using logistic regression.

The autolysis of industrial filamentous fungi.

Fungal autolysis is the natural process of self-digestion of aged hyphal cultures, occurring as a result of hydrolase activity, causing vacuolation and disruption of organelle and cell wall structure. Previously, authors have considered individual aspects of fungal lysis, in terms of either an enzyme, a process or an organism. This review considers both the physiology and morphology of fungal autolysis, with an emphasis on correlations between enzymological profiles and the morphological changes occurring during culture degeneration.

Staging of neuroblastoma at imaging: report of the radiology diagnostic oncology group.

Purpose: To compare the accuracies of computed tomography (CT), magnetic resonance (MR) imaging, and bone scintigraphy in staging disease in patients with neuroblastoma.

Materials And Methods: Ninety-six children with newly diagnosed neuroblastoma were enrolled in a multicenter prospective cohort study. CT, MR, and bone scintigraphy were used to evaluate tumor stage.

Use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction.

Objective: To assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction.

Design: Telephone survey and administrative data.

Setting: National managed-care company.

Toward comparable nursing data: American Nurses Association criteria for data sets, classification systems, and nomenclatures.

The American Nurses Association has long recognized the need for nursing to participate in the development of national healthcare data sets and standardized terminologies suitable for implementation in computer-based systems. In 1989, the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice was established to make policy recommendations related to nursing data needs. A primary function of the committee was the development of criteria for "recognition" of nursing language systems toward the goal of a Unified Nursing Language System.

Comparison of use of medications after acute myocardial infarction in the Veterans Health Administration and Medicare.

Background: There is concern that care provided in the Veterans Health Administration (VA) may be of poorer quality than non-VA health care. We compared use of medications after acute myocardial infarction in the VA with that in non-VA healthcare settings under fee-for-service (FFS) Medicare financing.

Methods And Results: We used clinical data from 2486 VA and 29 249 FFS men >65 years old discharged with a confirmed diagnosis of acute myocardial infarction from 81 VA hospitals and 1530 non-VA hospitals.