The lack of an effective detection method for lung circulating tumor cells (CTCs) presents a substantial challenge to elucidate the value of CTCs as a diagnostic or prognostic indicator in lung cancer, particularly in nonsmall cell lung cancer (NSCLC). In this study, we prepared a capture surface exploiting strong multivalent binding mediated by poly(amidoamine) (PAMAM) dendrimers to capture CTCs originating from lung cancers. Given that 85% of the tumor cells from NSCLC patients overexpress epidermal growth factor receptor (EGFR), anti-EGFR was chosen as a capture agent. Following in vitro confirmation using the murine lung cancer cell lines (ED-1 and ED1-SC), cyclin E-overexpressing (CEO) transgenic mice were employed as an in vivo lung tumor model to assess specificity and sensitivity of the capture surface. The numbers of CTCs in blood from the CEO transgenic mice were significantly higher than those from the healthy controls (on average 75.3 ± 14.9 vs 4.4 ± 1.2 CTCs/100 μL of blood, p < 0.005), indicating the high sensitivity and specificity of our surface. Furthermore, we found that the capture surface also offers a simple, effective method for monitoring treatment responses, as observed by the significant decrease in the CTC numbers from the CEO mice upon a treatment using a novel anti-miR-31 locked nucleic acid (LNA), compared to a vehicle treatment and a control-LNA treatment (p < 0.05). This in vivo evaluation study confirms that our capture surface is highly efficient in detecting in vivo CTCs and thus has translational potential as a diagnostic and prognostic tool for lung cancer.

There is prolific evidence of a commitment to diversifying student and faculty populations in academic medicine, but far less evidence of its effectiveness. The social justice underpinning of this commitment is important and must continue to undergird diversity and inclusion efforts. In today's environment of pinched resources, however, moral arguments alone will not suffice. What the diversity and inclusion movement needs for the 21st century is to apply rigorous empirical methods to understanding the most effective and efficient interventions to contribute to institutional excellence.The collection of diversity and inclusion articles in this month's issue of Academic Medicine is quite comprehensive and speaks to a range of audiences, from those who consider themselves experts on diversity and inclusion to the casual and interested reader. This robust collection will afford diversity practitioners, institutional leaders, and policy influencers with greater insight into what defines an effective diversity strategy.The academic medicine community cannot derive top value from diversity efforts, however, until practitioners, deans, CEOs, and policy makers begin operating with a shared framework for success. The excellence imperative facing our medical schools and teaching hospitals calls for improved precision in decision making and resource deployment to drive sustainable outcomes, which in turn requires a strong degree of alignment among all involved parties.

Oxygen vacancy levels are monitored during the oxidation of CO by CeO(2-δ) nanorods and Au-CeO(2-δ) nanorods, nanocubes, and nanopolyhedra by using Raman scattering. The first-order CeO(2) F(2g) peak near 460 cm(-1) decreases when this reaction is fast (fast reduction and relatively slow reoxidation of the surface), because of the lattice expansion that occurs when Ce(3+) replaces Ce(4+) during oxygen vacancy creation. This shift correlates with reactivity for CO oxidation. Increases in the oxygen deficit δ as large as ~0.04 are measured relative to conditions when the ceria is not reduced.

A label-free electrochemical immunosensor was successfully developed for sensitively detecting carbohydrate antigen 19-9 (CA19-9) as a cancer marker. To achieve this, a series of bimetallic cerium and ferric oxide nanoparticles embedded within the mesoporous carbon matrix (represented by CeO₂/FeO_x@mC) was obtained from the bimetallic CeFe-based metal organic framework (CeFe-MOF) by calcination at different high temperatures. The formed CeO₂ or FeO_x nanoparticles were uniformly distributed within the highly graphitized mesoporous carbon matrix at the calcination temperature of 500 °C (represented by CeO₂/FeO_x@mC₅₀₀). However, the obtained nanoparticles were aggregated into large size when calcined at the temperatures of 700 and 900 °C. The CA 19-9 antibody can be anchored to the CeO₂/FeO_x@mC network through chemical absorption between carboxylic groups of antibody and CeO₂ or FeO_x by ester-like bridging. The CeO₂/FeO_x@mC₅₀₀-based immunosensor displayed superior sensing performance to the pristine CeFe-MOF, CeO₂/FeO_x@mC₇₀₀- and CeO₂/FeO_x@mC₉₀₀-based ones. Electrochemical impedance spectroscopy results showed that the developed immunosensor exhibited an extremely low detection limit of 10 μU·mL^-1 (S/N = 3) within a wide range from 0.1 mU·mL^-1 to 10 U·mL^-1 toward CA 19-9. It also illustrated excellent specificity, good reproducibility and stability, and acceptable application analysis in the human serum solution which was diluted 100-fold with 0.01 M PBS solution (pH 7.4) and spiked with different amounts of CA19-9. Consequently, the proposed electrochemical immunosensor is capable enough of determining CA 19-9 in clinical diagnostics.

Density functional theory was used to study the CO oxidation catalytic activity of CeO(2)-supported Au nanoparticles (NPs). Experimental observations on CeO(2) show that the surface of CeO(2) is enriched with oxygen vacancies. We compare CO oxidation by a Au(13) NP supported on stoichiometric CeO(2) (Au(13)@CeO(2)-STO) and partially reduced CeO(2) with three vacancies (Au(13)@CeO(2)-3VAC). The structure of the Au(13) NP was chosen to minimize structural rearrangement during CO oxidation. We suggest three CO oxidation mechanisms by Au(13)@CeO(2): CO oxidation by coadsorbed O(2), CO oxidation by a lattice oxygen in CeO(2), and CO oxidation by O(2) bound to a Au-Ce(3+) anchoring site. Oxygen vacancies are shown to open a new CO oxidation pathway by O(2) bound to a Au-Ce(3+) anchoring site. Our results provide a design strategy for CO oxidation on supported Au catalysts. We suggest lowering the vacancy formation energy of the supporting oxide, and using an easily reducible oxide to increase the concentration of reduced metal ions, which act as anchoring sites for O(2) molecules.

The Worldwide innovative Networking in personalized cancer medicine (WIN) initiated by the Institute Gustave Roussy (France) and The University of Texas MD Anderson Cancer Center (USA) has dedicated its 3rd symposium (Paris, 6-8 July 2011) to discussion on gateways to increase the efficacy of cancer diagnostics and therapeutics (http://www.winconsortium.org/symposium.html).Speakers ranged from clinical oncologist to researchers, industrial partners, and tools developers; a famous patient was present: Janelle Hail, a 30-year breast cancer survivor, founder and CEO of the National Breast Cancer Foundation, Inc. (NBCF).The p-medicine consortium found this venue a perfect occasion to present a poster about its activities that are in accordance with the take home message of the symposium.In this communication, we summarize what we presented with particular attention to the interaction between the symposium's topic and content and our project.

Citrus is a genus belonging to the Rutaceae family and includes important crops like orange, lemons, pummelos, grapefruits, limes, etc. Citrus essential oils (CEOs) consist of some major biologically active compounds like α-/β-pinene, sabinene, β-myrcene, d-limonene, linalool, α-humulene, and α-terpineol belonging to the monoterpenes, monoterpene aldehyde/alcohol, and sesquiterpenes group, respectively. These compounds possess several health beneficial properties like antioxidant, anti-inflammatory, anticancer, etc., in addition to antimicrobial properties, which have immense potential for food applications. Therefore, this review focused on the extraction, purification, and detection methods of CEOs along with their applications for food safety, packaging, and preservation. Further, the concerns of optimum dose and safe limits, their interaction effects with various food matrices and packaging materials, and possible allergic reactions associated with the use of CEOs in food applications were briefly discussed, which needs to be addressed in future research along with efficient, affordable, and "green" extraction methods to ensure CEOs as an ecofriendly, cost-effective, and natural alternative to synthetic chemical preservatives.

This study designed a simplistic, efficient, and greener procedure to synthesize CeO₂-CNTs. The analysis of structural and morphological characteristics of nano-composites has been done with regard to different procedures (e.g., EDX, XRD, & FESEM). In addition, simultaneous detection of ascorbic acid (AA), dopamine (DA), uric acid (UA) and acetaminophen (AC) has been examined at the modified glassy carbon electrode with CeO₂-CNTs nano-composites. The surface area and electron transfer speed of the interplay between neuro-transmitters and electrode may be efficiently enhanced due to the existence of CeO₂ nano-particles on CNTs surfaces. Moreover, electro-chemical behavior of electrodes has been dealt with by differential pulse voltammetry (DPV), impedance analysis (EIS), and cyclic voltammetry (CV). Acceptable linear response of AA, DA, UA and AC respectively have been ranged 0.01-900.0 μM, 0.01-700.0 μM, 0.01-900.0 μM, and 0.01-900.0 μM with determination limits (S/N = 3) of 3.1 nM, 2.6 nM, 2.4 nM and 4.4 nM. Ultimately, this procedure was used with successful results for determining AA, DA, UA and AC in real specimens, which suggested probable uses in other sensing studies.

OBJECTIVE

The aim of this article was (i) to define the chemical constituents of Cinnamomum zeylanicum essential oil (CEO), (ii) to compare the antimicrobial activity of CEO with triple antibiotic paste (TAP) and calcium hydroxide [Ca(OH)2] on planktonic and biofilm Enterococcus faecalis; and (iii) to compare the cytotoxicity of these medicaments on L929 fibroblasts.

METHODS

Gas chromatography-mass spectrometry was used to define the constituents of CEO. Zone of inhibition, minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-kill tests were performed. Further, 108 human teeth were infected with E. faecalis and treated with the medicaments for 1, 7, and 14 days. Cytotoxicity was assessed by exposing L929 fibroblasts to the medicaments.

RESULTS

Cinnamaldehyde was the main component of CEO. Triple antibiotic paste had the greatest zone of inhibition and the smallest MIC and MBC. Triple antibiotic paste and CEO eradicated planktonic E. faecalis after 4 and 24 hours, while Ca(OH)2 failed to achieve 100% killing after 24 hours. Cinnamomum zeylanicum essential oil and TAP eradicated biofilm E. faecalis after 7 and 14 days, but Ca(OH)2 could not eliminate E. faecalis after 14 days. Cinnamomum zeylanicum essential oil was the most biocompatible medicament.

CONCLUSIONS

Cinnamomum zeylanicum essential oil is an efficient antibacterial agent against planktonic and biofilm E. faecalis and it was cytocompatible to L929 fibroblasts. Therefore, CEO has the potential to be used as an antimicrobial agent in root canal treatment.

The effects of cinnamon essential oil (CEO) and Tween 80 addition on the structural, physical, antioxidant and antimicrobial properties of the pullulan-based edible films were investigated in this study. The results demonstrated that the incorporation of CEO in pullulan-based composite films decreased their tensile strength, transparency, water content and water vapor permeability, but considerably increased the antioxidant and antimicrobial properties. The films with 12% CEO exhibited the strongest antioxidant and antimicrobial capacities. With regard to the influences of Tween 80 on the films, SEM micrographs indicated that the submicroscopic micelle formed in the films by the addition of Tween 80. Tween 80 improved the stability of the composite films and reduced the loss of CEO, but weakened the physical properties including transparency and water barrier properties.

In today's highly competitive and extremely complex global economy, organizational leaders at all levels are facing unprecedented challenges. Yet, some seem to be handling the pressure better than others. Utilizing 4 samples of CEOs/presidents/top (n = 205), middle (n = 183), and junior (n = 202) managers, as well as 107 entrepreneurs, using Structural Equation Modeling we tested the direct effect that their level of mindfulness (heightened awareness) and the mediating effect of their psychological capital (i.e., hope, efficacy, resilience, and optimism) may have on their mental well-being. In all 4 samples, mindfulness was found to be negatively related to various dysfunctional outcomes such as anxiety, depression, and negative affect of the managerial leaders and burnout (i.e., emotional exhaustion and cynicism) of the entrepreneurs. For all 4 samples, the model with psychological capital mediating the effects of mindfulness on dysfunctional outcomes fit the data best. The study limitations, future research and practical implications of these findings conclude the article.

This article reports on an examination of the relationships between chief executive officer (CEO) personality, transformational and transactional leadership, and multiple strategic outcomes in a sample of 75 CEOs of Major League Baseball organizations over a 100-year period. CEO bright-side personality characteristics (core self-evaluations) were positively related to transformational leadership, whereas dark-side personality characteristics (narcissism) of CEOs were negatively related to contingent reward leadership. In turn, CEO transformational and contingent reward leadership were related to 4 different strategic outcomes, including manager turnover, team winning percentage, fan attendance, and an independent rating of influence. CEO transformational leadership was positively related to ratings of influence, team winning percentage, and fan attendance, whereas contingent reward leadership was negatively related to manager turnover and ratings of influence.

Highly uniform and well-dispersed CeO(2) and CeO(2):Eu(3+) (Sm(3+), Tb(3+)) nanocrystals were prepared by a nonhydrolytic solution route and characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), X-ray photoelectron spectra (XPS), UV/vis absorption, and photoluminescence (PL) spectra, respectively. The result of XRD indicates that the CeO(2) nanocrystals are well crystallized with a cubic structure. The TEM images illustrate that the average size of CeO(2) nanocrystals is about 3.5 nm in diameter. The absorption spectrum of CeO(2):Eu(3+) nanocrystals exhibits red-shifting with respect to that of the undoped CeO(2) nanocrystals. Under the excitation of 440 nm (or 426 nm) light, the colloidal solution of the undoped CeO(2) nanocrystals shows a very weak emission band with a maximum at 501 nm, which is remarkably enhanced by doping additional lanthanide ions (Eu(3+), Tb(3+), Sm(3+)) in the CeO(2) nanocrystals. The emission band is not due to the characteristic emission of the lanthanide ions but might arise from the oxygen vacancy which is introduced in the fluorite lattice of the CeO(2)nanocrystals to compensate the effective negative charge associated with the trivalent ions.

New packaging materials based on biopolymers are gaining increasing attention due to many advantages like biodegradability or existence of renewable sources. Grouping more antimicrobials agents in the same packaging can create a synergic effect, resulting in either a better antimicrobial activity against a wider spectrum of spoilage agents or a lower required quantity of antimicrobials. In the present work, we obtained a biodegradable antimicrobial film that can be used as packaging material for food. Films based on chitosan as biodegradable polymer, with ZnO and Ag nanoparticles as filler/antimicrobial agents were fabricated by a casting method. The nanoparticles were loaded with citronella essential oil (CEO) in order to enhance the antimicrobial activity of the nanocomposite films. The tests made on Gram-positive, Gram-negative, and fungal strains indicated a broad-spectrum antimicrobial activity, with inhibition diameters of over 30 mm for bacterial strains and over 20 mm for fungal strains. The synergic effect was evidenced by comparing the antimicrobial results with chitosan/ZnO/CEO or chitosan/Ag/CEO simple films. According to the literature and our preliminary studies, these formulations are suitable as coating for fruits. The obtained nanocomposite films presented lower water vapor permeability values when compared with the chitosan control film. The samples were characterized by SEM, fluorescence and UV-Vis spectroscopy, FTIR spectroscopy and microscopy, and thermal analysis.

Keywords: Ag nanoparticles; ZnO; antimicrobial packaging; chitosan; citronella essential oil.

During the last decade green synthesized cerium oxide nanoparticles (CeO₂ NPs) attracted remarkable interest in various fields of science and technology. This review, explores the vast array of biological resources such as plants, microbes, and other biological products being used in synthesis of CeO₂ NPs. It also discusses their biosynthetic mechanism, current understandings, and trends in the green synthesis of CeO₂ NPs. Novel therapies based on green synthesized CeO₂ NPs are illustrated, in particular their antimicrobial potential along with attempts of their mechanistic elucidation. Overall, the main objective of this review is to provide a rational insight of the major accomplishments of CeO₂ NPs as novel therapeutics agents for a wide range of microbial pathogens and combating other diseases.

Keywords: antimicrobial; biomedical; cerium oxide; green synthesis; infections; nanoparticles; nanotechnology.

Use of engineered metal oxide nanoparticles in a plethora of biological applications and custom products has warned about some possible dose-dependent cytotoxic effects. Macrophages are key components of the innate immune system used to study possible toxic effects and internalization of different nanoparticulate materials. In this work, ultra-high resolution field emission scanning electron microscopy (FE-SEM) was used to offer new insights into the dynamical processes of interaction of nanomaterials with macrophage cells dosed with different concentrations of metal oxide nanoparticles (CeO(2), TiO(2) and ZnO). The versatility of FE-SEM has allowed obtaining a detailed characterization of processes of adsorption and endocytosis of nanoparticles, by using advanced analytical and imaging techniques on complete unstained uncoated cells, including secondary electron imaging, high-sensitive backscattered electron imaging, X-ray microanalysis and stereoimaging. Low voltage BF/DF-STEM confirmed nanoparticle adsorption and internalization into endosomes of CeO(2) and TiO(2), whereas ZnO develop apoptosis after 24 h of interaction caused by dissolution and invasion of cell nucleus. Ultra-high resolution scanning electron microscopy techniques provided new insights into interactions of inorganic nanoparticles with macrophage cells with high spatial resolution.

OBJECTIVE

To examine the effect of reengineering on the competitive position of hospitals. Although many promises have been made regarding outcomes of process reengineering, little or no research has examined this issue. This article provides an initial exploration of the direct effects of reengineering on the competitive cost position of hospitals and the modifying effects of implementation factors.

METHODS

Obtained for primary data from a 1996/1997 national survey of hospital restructuring and reengineering sponsored by the American Hospital Association and the Leonard Davis Institute for Health Economics. Responses from approximately 30 percent of all U.S. acute care hospitals with 100 or more inpatient beds in metropolitan service areas were combined with American Hospital Association annual survey and InterStudy HMO data in this study.

METHODS

A first-difference multivariate regression was utilized to examine the effects of reengineering and other explanatory variables on the change in the cost position of a hospital's expenses per adjusted patient day relative to its market's costs per adjusted patient day.

METHODS

The survey of hospital restructuring and reengineering was mailed to hospital chief executive officers. The CEOs identified reengineering and restructuring hospital activities over the previous five years. The extensiveness and components of reengineering and internal restructuring were identified and used in the empirical analysis.

RESULTS

Results suggest that reengineering without integrative and coordinative efforts may damage an organization's cost position. The use of steering committees, project teams, codification of the change process, and executive involvement in core changes modifies the results of reengineering to improve an organization's competitive position.

CONCLUSIONS

In a national sample of hospitals, reengineering alone was not found to improve the relative cost-competitive position. Organizations attempting to improve their cost competitiveness must consider the way in which change is implemented. This research suggests that the process of change may be as important as the change instrument. Additional research is needed to explore differences between early and late adopters.

Cerium oxide nanoparticles (CeO₂ NPs) have potential application for use in biomedical and in various consumer products. However, it is largely unclear whether CeO₂ NPs have effects on male reproductive function.

In this study, male mice were examined for toxicity, if any, following chronic oral administration of CeO₂ NPs for 32 days. In each animal, epididymides were examined for sperm motility and DNA integrity. Bloods were tested for testosterone levels. Testicular tissues were collected to determine the element Ce content, the daily sperm production (DSP), marker enzymes such as ACP, G6PD, γ-GT and SDH, mRNA expression levels of steroidogenesis genes Star, P450scc, P450c17, 3β-Hsd, and 17β-Hsd, as well as steroidogenic factor-1 (SF-1) gene/protein levels.

The results showed that CeO₂ NPs (20 mg/kg and 40 mg/kg) increased the element Ce content in testis, the testis histopathological patterns and sperm DNA damage whereas decreased the testis weight, DSP and sperm motility. There were also remarkable reduction in testosterone levels and marker enzymes activities, down-regulated mRNA expression levels of several steroidogenesis genes such as Star, P450scc, P450c17, 3β-Hsd, and 17β-Hsd, as well as altered gene and protein expressions of SF-1.

These results reveal the male reproductive toxicity of chronic exposure of CeO₂ NPs in mice, hinting that the utilization of CeO₂ NPs need to be carefully evaluated about their potential reproductive toxicity on the human health.

BACKGROUND

In this study, ocular surface changes and tear film functions in patients with pseudoexfoliative glaucoma (PEXG) and pseudoexfoliation (PEX) syndrome were evaluated.

METHODS

This study is a randomized, double-blind and prospective study. Conjunctival impression cytology, tear film break-up time (TFBUT) test and basal Schirmer test (BST) were performed on 45 eyes of 45 subjects with PEXG (group I), 48 eyes of 48 subjects with PEX syndrome (group 2) and 50 eyes of 50 normal subjects (group 3). Impression cytology was graded 0-III based on the shape, eosinophilic-staining cytoplasm and nucleocytoplasmic ratio of the epithelial cells, and the shape, quantity and Periodic Acid Schiff-positive cytoplasm of the goblet cells.

RESULTS

Impression cytology grading scores were 6.7% grade 0, 15.6% grade I, 37.7% grade II and 40% grade III in group 1, 6.3%, 18.7%, 43.8% and 31.2% in group 2 and 38%, 36.0%, 20% and 6% in group 3, respectively. The scores in groups 1 and 2 were significantly higher than in group 3 (P = 0.001, chi(2) = 39.84). The mean values of TFBUT of groups 1, 2 and 3 were 5.91 +/- 3.27, 7.39 +/- 4.82, 10.96 +/- 3.81 s and the mean values of BST were 7.82 +/- 3.56, 9.04 +/- 4.60 and 12.50 +/- 5.25 mm/5 min, respectively. The values of TFBUT and BST were lower in groups 1 and 2 than in group 3 (P = 0.001).

CONCLUSIONS

The conjunctival changes in PEX and PEXG patients recorded in this study may explain the existence of tear film abnormalities in these patients. It has been shown that PEXG and PEX syndrome cause conjunctival surface changes and reduction of tear film functions.

This study describes a sago starch-based film by incorporation of cinnamon essential oil (CEO) and nano titanium dioxide (TiO₂-N). Different concentrations (i.e., 0%, 1%, 3%, and 5%, w/w) of TiO₂-N and CEO (i.e., 0%, 1%, 2%, and 3%, v/w) were incorporated into sago starch film, and the physicochemical, barrier, mechanical, and antimicrobial properties of the bionanocomposite films were estimated. Incorporation of CEO into the sago starch matrix increased oxygen and water vapor permeability of starch films while increasing TiO₂-N concentration decreased barrier properties. Moisture content also decreased from 12.96% to 8.04%, solubility in water decreased from 25% to 13.7%, and the mechanical properties of sago starch films improved. Sago starch bionanocomposite films showed excellent antimicrobial activity against Escherichia coli, Salmonella typhimurium, and Staphylococcus aureus. Results also showed that incorporation of TiO₂-N and CEO had synergistic effects on functional properties of sago starch films. In summary, sago starch films incorporated with both TiO₂-N and CEO shows potential application for active packaging in food industries such as fresh pistachio packaging.

Encapsulation of clove essential oil (CEO) by chitosan nanoparticles (ChNPs) was performed, using an emulsion-ionic gelation technique to improve the antifungal efficacy of CEO. The mass ratios of chitosan (Ch) to tripolyphosphate (TPP), 1:1, for unloaded ChNPs and 1:1:1 for Ch to TPP to CEO, for CEO-loaded ChNPs (CEO-ChNPs), were selected as optimum formulations based on dynamic light scattering and ultraviolet-visible spectroscopy. The presence of CEO in optimum CEO-ChNPs, was evidenced by Fourier transform infrared spectroscopy. Particle size distribution, of around 40 and 100 nm for the most optimum unloaded and oil-loaded ChNPs, was obtained by field emission-scanning electron microscopy. In vitro release studies of CEO-ChNPs revealed a controlled release during 56 days. The nano-encapsulated CEO demonstrated a superior performance against Aspergillus niger, isolated from spoiled pomegranate, compared with ChNPs and free oil. Therefore, this study revealed that CEO-ChNPs can be used as a promising natural fungicide in agriculture and food industry.

Aim: To demonstrate synthesis of cerium oxide nanoparticles (CeO₂ NPs) by a green method using Hyphaene thebaica, and investigate their therapeutic applications. Materials & methods: Structural, vibrational and luminescent properties were established using x-ray diffraction, Fourier transformed infrared spectroscopy, Raman spectroscopy, ultraviolet absorption spectroscopy, selected area electron diffraction, electron microscopy and photolumincence spectroscopy. Therapeutic properties were established using different in vitro assays. Results: CeO₂ NPs were determined to be crystalline in nature with a grain size of approximately 14 nm. They had characteristic Ce-O vibration at 481 cm^-1. Photoluminescence spectra revealed broad bands at 463 and 600 nm. ζ potential was recorded as -17.2 mV. Potent antimicrobial and antiviral properties with hemocompatibility were reported. Conclusion: Biosynthesized CeO₂ NPs revealed multifunctional therapeutic properties.

BACKGROUND

Hospitals must make a profit to ensure their continued existence. The observed rises in case numbers and case-mix indices lead us to suspect that the admission, treatment, and discharge of patients are now being influenced not just by purely medical factors, but also by economic considerations with a view toward making a profit-i.e., that decision-making has become partially commercialized. In this study, we investigated whether doctors and hospital chief executive officers (CEOs) share this perception of their professional environment.

METHODS

In a qualitative study, doctors and hospital CEOs were interviewed. The survey was carried out in two waves over the period 2013-2016. 22 pilot interviews, 41 guided interviews, 3 focus groups, 1 written expert questionnaire and 1 workshop discussion were conducted. Responses were evaluated according to the "grounded theory" of the social sciences.

RESULTS

Some of the doctors' and CEOs' perceptions of the patient-care situation differed markedly from each other. The CEOs mentioned the need for a profit orientation and stressed that they obeyed the legal requirement not to have any direct influence on medical decision-making, while acknowledging that physicians' actions might be influenced indirectly. The doctors, on the other hand, reported feeling increasing pressure to consider the economic interests of the hospital when making decisions about patient care, leading not only to overtreatment, undertreatment, and incorrect treatment, but also to ethical conflicts, stressful situations, and personal frustration.

CONCLUSIONS

The doctors' responses indicate that the current economic framework conditions and the managers of hospitals are currently influencing medical care to the detriment of the patients, physicians, and nurses. It is important to acknowledge that economic pressure on hospitals can undermine the independence of medical decision-making. The dilemmas facing doctors and hospital CEOs should be openly discussed. The economic framework conditions and steering concepts should be changed as suggested by these findings.

Deliberative processes are beginning to take effect in the public health sector. Public health organizations have a critical role in fostering local deliberation during the planning and implementation of community health efforts. The chief executive officer (CEO) of eight national public health constituent organizations were provided background readings about deliberation and its potential role in community public health planning. They were then interviewed about their prior knowledge of public health deliberation, impressions and thoughts about deliberation's role in public health, whether they could identify constituents using the approach, and the best method of disseminating information on deliberation. Information provided by stakeholders was analyzed to gauge the understanding and implementation of public deliberation. Four main themes emerged from the interviews including: general awareness and attitudes about public deliberation, barriers to deliberation, words of caution when using the deliberative approach, and dissemination of deliberation. Each of the CEOs interviewed favored deliberative approaches in public health planning that would ensure that the community's voice is present in the decision-making process. However, there are certain limitations to the approach that must be addressed before the full benefits of public engagement can be obtained in public health.