Infectious laryngotracheitis (ILT) is a highly infectious respiratory disease that causes morbidity and mortality in commercial chickens. Despite the use of attenuated vaccines, ILT outbreaks have been described in broiler and long-lived birds. Molecular approaches, including polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing, are used to characterize ILT viruses (ILTVs) detected in vaccinated and unvaccinated geographical regions. As part of an ILT control program implemented in a region of commercial layer production, samples of conjunctiva, trachea, and trigeminal ganglia were collected from chickens in a vaccinated and quarantined region over a period of 8 years after initiation of vaccination. To determine the origin of new ILT outbreaks in unvaccinated regions, samples collected from ill chickens were also analyzed. Chicken embryo origin (CEO) vaccine viruses and the Bastos field strain were detected circulating in healthy chickens in the vaccinated region. CEO strains and field viruses molecularly related to the Bastos strain were also detected outside of the quarantined region in chickens showing clinical signs of ILT. This study reveals the persistence and circulation of a wild field strain, despite the intensive use of tissue culture origin (TCO) and CEO vaccines in a quarantined region. Spreading of CEO viruses to unvaccinated regions and the capacity of this virus to establish latent infections and cause severe outbreaks were also observed.

A method of fluorescent nanoparticle-based indirect immunofluorescence assay using either fluorescence microscopy or flow cytometry for the rapid detection of pathogenic Escherichia coli O157:H7 was developed. The dye-doped silica nanoparticles (NPs) were synthesized using W/O microemulsion methods with the combination of 3-aminopropyltriethoxysilane (APTES) and fluorescein isothiocyanate (FITC) and polymerization reaction with carboxyethylsilanetriol sodium salt (CEOS). Protein A was immobilized at the surface of the NPs by covalent binding to the carboxyl linkers and the surface coverage of Protein A on NPs was determined by the Bradford method. Rabbit anti-E. Coli O157:H7 antibody was used as primary antibody to recognize E. coli O157:H7 and then antibody binding protein (Protein A) labeled with FITC-doped silica NPs (FSiNPs) was used to generate fluorescent signal. With this method, E. Coli O157:H7 in buffer and bacterial mixture was detected. In addition, E. coli O157:H7 in several spiked background beef samples were measured with satisfactory results. Therefore, the FSiNPs are applicable in signal-amplified bioassay of pathogens due to their excellent capabilities such as brighter fluorescence and higher photostability than the direct use of conventional fluorescent dyes.

The myeloid-derived suppressor cell (MDSC)-mediated immunosuppressive tumor microenvironment (TME), where tumor hypoxia counts for much, has greatly compromised the outcome of cancer immunotherapy. Here, we demonstrated a strategy for selectively clearing intratumoral MDSCs. Specifically, 2-[2-[2-chloro-3-[(1,3-dihydro-3,3-dimethyl-1-propyl-2H-indol-2-ylidene)ethylidene]-1-cyclohexen-1-yl]ethenyl]-3,3-dimethyl-1-propylindolium iodide (IR-780) and metformin (Met) were coloaded into mesoporous silica nanoparticles (MSNs) with CeO₂ as the gatekeepers. Controlled release of cargos was achieved upon etching CeO₂ with endogenous H₂O₂. Apart from the drug release, oxygen (O₂) was also generated in this process. Importantly, the engagement of Met significantly inhibited mitochondrial respiration, thus working like an O₂ economizer. Consequently, the populations and functions of tumor-infiltrated MDSCs were both dramatically reduced through selective alleviation of hypoxia at tumor sites, thus contributing to boosted immune responses. Additionally, the accumulated O₂ enhanced IR780-mediated photodynamic therapy, which synergistically strengthened the antitumor efficacy of the platform. To the best of our knowledge, this is the first time to employ an O₂-generated and -economized nanoplatform for selectively anergizing MDSC-mediated immunosuppression. We expect that this strategy will shed new light on the clinical cancer immunotherapy treatment.

Keywords: hypoxia; myeloid-derived suppressor cells; nanoparticles; oxygen economization; oxygen generation.

Given that basal levels of reactive oxygen species (ROS) are higher in cancer cells, there is a growing school of thought that endorses pro-oxidants as potential chemotherapeutic agents. Intriguingly, cerium oxide (CeO₂) nanoparticles can manifest either anti- or pro-oxidant activity as a function of differential pH of various subcellular localizations. In an acidic pH environment, for example, in extracellular milieu of cancer cells, CeO₂ would function as a pro-oxidant. Based on this concept, the present study is designed to investigate the pro-oxidant activities of CeO₂ in human colorectal carcinoma cell line (HCT 116). For comparison, we have also studied the effect of ceria nanoparticles on human embryonic kidney (HEK 293) cells. Dose-dependent viability of cancerous as well as normal cells has been assessed by treating them independently with CeO₂ nanoparticles of different concentrations (5-100 μg/mL) in the culture media. The half maximal inhibitory concentration (IC₅₀) of nanoceria for HCT 116 is found to be 50.48 μg/mL while that for the HEK 293 cell line is 92.03 μg/mL. To understand the intricate molecular mechanisms of CeO₂-induced cellular apoptosis, a series of experiments have been conducted. The apoptosis-inducing ability of nanoceria has been investigated by Annexin V-FITC staining, caspase 3/9 analysis, cytochrome c release, intracellular ROS analysis, and mitochondrial membrane potential analysis using flow cytometry. Experimental data suggest that CeO₂ treatment causes DNA fragmentation through enhanced generation of ROS, which ultimately leads to cellular apoptosis through the p53-dependent mitochondrial signaling pathway.

The optimum formulation and ultrasonic condition for fabrication of cinnamon essential oil (CEO) nanoemulsion were determined using Response Surface Methodology (RSM). The CEO nanoemulsions were formed using an ultrasonic bath (43 kHz at power output of 210 W) and an ultrasonic probe (24 kHz at power of 400 W). Probe ultrasonication outperformed bath ultrasonication since it produced nanoemulsions with smaller droplet size, narrower size distribution as measured using polydispersity index (PDI), and higher viscosity. The influences of sonication time of 180.23-351.77 s, temperature of 4.82-45.18 °C, and Tween® 80 concentration of 1-3% w/w on the droplet size, PDI, and viscosity were investigated using RSM based on Box-Behnken design (BBD). The RSM revealed that the sonication time of 266 s, temperature of 4.82 °C, and Tween® 80 of 3% w/w produced the optimum CEO nanoemulsion with droplet size of 65.98 nm, PDI of 0.15, and viscosity of 1.67 mPa.s. Moreover, the optimum nanoemulsion had good stability in terms of droplet size and PDI when storing at 4, 30, and 45 °C for 90 days. The antifungal activity of the optimum CEO nanoemulsion was then investigated against Aspergillus niger, Rhizopus arrhizus, Penicillium sp., and Colletotrichum gloeosporioides in comparison to CEO coarse emulsion. The results showed that the CEO nanoemulsion had better antifungal activity than coarse emulsion of CEO.

BACKGROUND

There is widespread evidence of the purported benefits of employee organizational commitment (EOC) and its impact on both individual and organizational performance. This study contributes to this literature by providing a unique insight into this relationship, focusing on the interrelationship between EOC with hospital performance and the role of the provision of adequate facilities in eliciting EOC.

OBJECTIVE

The aim of this study was to introduce and empirically examine a new theoretical model in which it is argued that the performance of hospitals with regard to the provision of adequate facilities (medical facilities, support facilities, and staff resources) influences the level of EOC, which in turn influences hospital performance with regard to patient care and operational effectiveness.

METHODS

To examine the interrelationships between the provision of adequate facilities, EOC, and hospital performance, the study utilizes a survey of hospital managers.

RESULTS

The findings support the theoretical model, with the provision of support facilities and staff resources positively indirectly associated with both patient care and operational effectiveness through their impact on EOC.

CONCLUSIONS

The findings highlight the importance of providing adequate facilities and EOC within hospitals and suggest that CEOs and general managers should try to enhance the provision of such resources in an attempt to elicit EOC within their hospitals.

CONCLUSIONS

The findings suggest that managers should try to enhance their provision of adequate facilities in order to elicit EOC and enhance hospital performance. With regard to medical facilities, they should consider and incorporate the latest technology and up-to-date equipment. They should also provide adequate staff resources, including appropriate numbers of beds, nurses, and doctors, to prevent "fatigue" (West, 2001, p. 41) and provide adequate support facilities.

Fundamental and quantitative understanding of the interactions between nanoparticles and plant leaves is crucial for advancing the field of nanoenabled agriculture. Herein, we systematically investigated and modeled how ζ potential (-52.3 mV to +36.6 mV) and hydrodynamic size (1.7-18 nm) of hydrophilic nanoparticles influence delivery efficiency and pathways to specific leaf cells and organelles. We studied interactions of nanoparticles of agricultural interest including carbon dots (CDs, 0.5 and 5 mg/mL), cerium oxide (CeO₂, 0.5 mg/mL), and silica (SiO₂, 0.5 mg/mL) nanoparticles with leaves of two major crop species having contrasting leaf anatomies: cotton (dicotyledon) and maize (monocotyledon). Biocompatible CDs allowed real-time tracking of nanoparticle translocation and distribution in planta by confocal fluorescence microscopy at high spatial (∼200 nm) and temporal (2-5 min) resolution. Nanoparticle formulations with surfactants (Silwet L-77) that reduced surface tension to 22 mN/m were found to be crucial for enabling rapid uptake (<10 min) of nanoparticles through the leaf stomata and cuticle pathways. Nanoparticle-leaf interaction (NLI) empirical models based on hydrodynamic size and ζ potential indicate that hydrophilic nanoparticles with <20 and 11 nm for cotton and maize, respectively, and positive charge (>15 mV), exhibit the highest foliar delivery efficiencies into guard cells (100%), extracellular space (90.3%), and chloroplasts (55.8%). Systematic assessments of nanoparticle-plant interactions would lead to the development of NLI models that predict the translocation and distribution of nanomaterials in plants based on their chemical and physical properties.

Keywords: agriculture; carbon dots; cerium oxide nanoparticles; crops; silica nanoparticles; surfactant.

Neurotrauma is one of the most serious traumatic injuries, which can induce an excess amount of reactive oxygen and nitrogen species (RONS) around the wound, triggering a series of biochemical responses and neuroinflammation. Traditional antioxidant-based bandages can effectively decrease infection via preventing oxidative stress, but its effectiveness is limited to a short period of time due to the rapid loss of electron-donating ability. Herein, we developed a nanozyme-based bandage using single-atom Pt/CeO₂ with a persistent catalytic activity for noninvasive treatment of neurotrauma. Single-atom Pt induced the lattice expansion and preferred distribution on (111) facets of CeO₂, enormously increasing the endogenous catalytic activity. Pt/CeO₂ showed a 2-10 times higher scavenging activity against RONS as well as 3-10 times higher multienzyme activities compared to CeO₂ clusters. The single-atom Pt/CeO₂ retained the long-lasting catalytic activity for up to a month without obvious decay due to enhanced electron donation through the Mars-van Krevelen reaction. In vivo studies disclosed that the nanozyme-based bandage at the single-atom level can significantly improve the wound healing of neurotrauma and reduce neuroinflammation.

Determining both cation and oxygen sublattices of grain boundaries is essential to understand the properties of oxides. Here, with scanning transmission electron microscopy, electron energy-loss spectroscopy, and first-principles calculations, both the Ce and oxygen sublattices of a (210)Σ5 CeO(2) grain boundary were determined. Oxygen vacancies are shown to play a crucial role in the stable grain boundary structure. This finding paves the way for a comprehensive understanding of grain boundaries through the atomic scale determination of atom and defect locations.

A 70-year-old man, who was recently diagnosed with sclerosing mesenteritis following an abdominal biopsy, presented with an acute onset of left upper eyelid swelling, moderate ptosis, mild chemosis and restriction of movements. A computed tomography scan showed an enlarged lateral rectus muscle with surrounding soft tissue changes. A diagnosis of orbital inflammation manifesting as myositis was made and the patient was commenced on high-dose prednisolone, which showed a rapid response. It is believed that this may be a new association similar to that previously reported with retroperitoneal fibrosis and orbital inflammation.

OBJECTIVE

The high prevalence of diabetic retinopathy (21-36%) and 2 yearly reviews recommended by the National Health and Medical Research Council for diabetics with no retinopathy creates a considerable burden for review in rural and regional Australia. Screening for diabetic retinopathy using telemedicine has significant implications. If effective, such a tool would have an impact on finance and resource allocation. The purpose of the study was to establish if telemedicine could distinguish clinically significant macular oedema (CSME) from eyes free of this form of disease.

METHODS

A study population with representative examples of normal fundi and the different grades of retinopathy was chosen from existing records. The specificity and sensitivity of telemedicine diagnosis was compared with fundus photography and examination by an experienced ophthalmologist as a 'gold standard', in a blinded manner. Real-time telemedicine assessment was performed with live video and audio connections with the transmitting and receiving units set in different areas of the ophthalmology department. The transmission end consisted of a video camera mounted on a slit lamp and the receiving unit consisted of a 21'' LCD monitor. A video conference link was established using three ISDN lines capable of 128 kb per second transfer per line allowing for a total of 348 kb per second when utilizing all three lines for high resolution images. Fundus photographs were taken with a Zeiss FF 450 Plus Digital imaging system.

RESULTS

For telemedicine, sensitivity was 38% (95% CI, 35-40%) and specificity was 95% (95% CI, 91-99%). For photography, sensitivity was 75% (95% CI, 71-79%) and specificity was 95% (95% CI, 91-99%).

CONCLUSIONS

In this pilot study, sensitivity of detection of CSME by photography was considerably better than for live-link telemedicine. This study tends to confirm the continued superiority of examination of the patient by an experienced ophthalmologist as the best method of screening for CSME, a sight threatening form of diabetic retinopathy.

BACKGROUND

Past research has documented rural physician and health care professional shortages.

OBJECTIVE

Rural hospital chief executive officers' (CEOs') reported shortages of health professionals and perceptions about recruiting and retention are compared in Illinois and Arkansas.

METHODS

A survey, previously developed and sent to 28 CEOs in Illinois, was mailed to 110 CEOs in Arkansas. Only responses from rural CEOs are presented (Arkansas n = 39 and Illinois n = 22).

RESULTS

Physician shortages were reported by 51 CEOs (83.6%). Most reported physician shortages in Arkansas were for family medicine, internal medicine, cardiology, obstetrics-gynecology, general surgery, and psychiatry. Most reported physician shortages in Illinois were for family medicine, obstetrics-gynecology, orthopedic surgery, internal medicine, cardiology, and general surgery. Additionally, registered nurses and pharmacists were the top 2 allied health professions shortages. Multivariate analysis (factor and discriminant analyses) examined community attributes associated with ease of recruiting physicians. Six factors were identified and assessed as to their importance in influencing ease of recruitment, with the state included in the model. Three factors were identified as discriminating whether or not physician recruitment was easy: community supportive for family, community cooperates and perceives a good future, and community attractiveness.

CONCLUSIONS

Similarities in shortages and attributes influencing recruitment in both states suggest that efforts and policies in health professions workforce development can be generalized between regions. This study further reinforces some important known issues concerning retention and recruitment, such as the importance of identifying providers whose preferences are matched to the characteristics and lifestyle of a given area.

Several aspects of quality of care at one chain of freestanding ambulatory health care walk-in centers were evaluated. Those areas for which data were available--medical record review, physician credentials, and patient satisfaction--suggest that for primary acute episodic care, HSMMI walk-in centers provided care comparable to that which would have been received in traditional health care settings. In fact, HSMMI offices were found to be similar in organizational structure and appeared very much like private physicians' offices in management, staffing, patient flow, and physician performance. The corporation's QA program evolved from a series of informal managers' meetings (in 1986), to a detailed and structured program involving a CEO and regional medical directors by the end of 1990. The exact way in which HSMMI's new emphasis on formal quality-of-care assessment and assurance will affect patient care will be seen as the program fully matures. The issue of the proper relationship between money and medicine remains a problem. As health services organizations are increasingly influenced by market forces and consumers have ever-higher expectations, patients and physicians alike want to be sure that high-quality health care remains the first priority. Although this is an issue for all providers, it is much more visible in proprietary offices, making physicians as well as the public uneasy. For this reason, HSMMI's burden of proof regarding quality may be higher--particularly within the medical community--than the burden on traditional private practice physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

This study examines the impact of hospital participation in multi-institutional arrangements on formal relationships between hospital governing boards and chief executive officers (CEOs) and between governing boards and hospital medical staffs. Hypotheses are derived from Mintzberg's general theory of organizational design and are tested using combined data from three American Hospital Association Surveys of nonfederal, short-term hospitals. Analysis results provide considerable support for the study hypotheses. CEOs were found in general to have more formal influence in decisionmaking but also were more likely to be held accountable for performance standards in those hospitals that are part of multi-institutional arrangements. In addition, analyses using both 1976 and 1982 survey data indicate that hospital participation in multi-institutional arrangements is associated with lower levels of formal involvement of the medical staff in institutional decisionmaking. Relationships, for the most part, remain unchanged after the introduction of statistical controls for hospital size. One important issue raised by these findings is the possible impact on hospital performance of less participation by medical staff in the governance of hospitals whose boards are either responsible for multiple hospitals or accountable to higher organizational authority.

A new type of bilayered photoanodes with cubic CeO(2) nanoparticles as mirror-like scattering thin layers was prepared via a screen-printing technique for dye-sensitized solar cells (DSSCs). The light harvesting efficiency was significantly enhanced due to the mirror-like light scattering effect, resulting in noticeable ∼17.8% improvement of light-to-electric conversion efficiency.

BACKGROUND

The Ministry of Health and Long-Term Care mandated a rapid and thorough change in the delivery of cancer services in Ontario to integrate ambulatory services offered by Cancer Care Ontario (CCO) with the inpatient services of affiliated hospitals. The CCO Surgical Oncology Program held a strategic planning retreat to establish the basis upon which to implement surgery-specific changes.

METHODS

Participants completed a pre-retreat survey. Based on survey results, the retreat was organized around 4 themes: role of the Surgical Oncology Program; knowledge transfer; funding for cancer surgery; and research priorities. These topics were discussed in small breakout groups and by the entire assembly.

RESULTS

Retreat participants (n = 55) included hospital CEOs, vice-presidents of cancer services, surgeons from cancer centres and community hospitals, academic chairs of surgery, clinician researchers and managers from CCO. Responses to the pre-retreat survey (n = 38) and recommendations made by retreat participants showed strong support for the Surgical Oncology Program to take a leadership role in the development and monitoring of quality indicators, research related to cancer surgery and the creation of regional communities of practice. Funding mechanisms for cancer surgeons and hospitals performing cancer surgery were also highlighted.

CONCLUSIONS

The Surgical Oncology Program used the results to develop a strategic plan that was approved by retreat participants and the board of the CCO. The program has embarked on a multifaceted approach to facilitate, monitor and report on the organization and delivery of cancer surgery in Ontario.

Employers can choose from lots of tools when they want to encourage employees to work together toward a new corporate goal. One of the rarest managerial skills is the ability to understand which tools will work in a given situation and which will misfire. Cooperation tools fall into four major categories: power, management, leadership, and culture. Choosing the right tool, say the authors, requires assessing the organization along two critical dimensions: the extent to which people agree on what they want and the extent to which they agree on cause and effect, or how to get what they want. The authors plot on a matrix where various organizations fall along these two dimensions. Employees represented in the lower-left quadrant of the model, for example, disagree strongly both about what they want and on what actions will produce which results. Those in the upper-right quadrant agree on both dimensions. Different quadrants call for different tools. When employees share little consensus on either dimension, for instance, the only methods that will elicit cooperation are "power tools" such as fiat, force, and threats. Yugoslavia's Josip Broz Tito wielded such devices effectively. So did Jamie Dimon, current CEO of J.P. Morgan Chase, during the bank's integration with Bank One. For employees who agree on what they want but not on how to get it--think of Microsoft in 1995--leadership tools, such as vision statements, are more appropriate. Some leaders are blessed with an instinct for choosing the right tools--Continental Airlines' Gordon Bethune, General Electric's Jack Welch, and IBM's Lou Gerstner are all examples. Others can use this framework to help select the most appropriate tools for their circumstances.

Cleveland Clinic's enterprise performance management program offers proof that comparisons of actual performance against strategic objectives can enable healthcare organization to achieve rapid organizational change. Here are four lessons Cleveland Clinic learned from this initiative: Align performance metrics with strategic initiatives. Structure dashboards for the CEO. Link performance to annual reviews. Customize dashboard views to the specific user.

The four etheno adducts of vinyl chloride formed in DNA, 1,N6-ethenoadenine (epsilonA), 3,N4-ethenocytosine, 1,N2-ethenoguanine and N2,3-ethenoguanine were previously reported to be released from DNA by a family of enzymes in the base-excision repair pathway (Dosanjh et al., Proc. Natl Acad. Sci. USA, 91, 1024-1028, 1994; Hang et al., Carcinogenesis, 17, 155-157, 1996; Hang et al., Proc. Natl Acad. Sci. USA, 94, 12869-12874, 1997). Adducts excised from DNA by glycosylases are usually excreted in urine and have been reported to be potential biomarkers of DNA damage in exposed individuals. In this study, we report the detection of epsilonA in the urine of rats exposed to chloroethylene oxide (CEO) using immunoaffinity columns made with specific monoclonal antibodies for enrichment, followed by quantitation by HPLC with fluorescence detection. Chemical analysis of urine samples revealed the presence of a compound chromatographically identical to authentic epsilonA standard. This compound was confirmed by mass spectral analysis. EpsilonA was present in urine of control and CEO-treated rats, with the latter having up to 50-fold greater amounts. The cumulative excretion of epsilonA reached a plateau between 24 and 48 h post-exposure. While it is clear that CEO treatment results in increased excretion of epsilonA, the exact source of the adduct is unknown. When rats were administered epsilonA i.v., approximately 10% of the administered dose was excreted in urine. This research demonstrates that urinary excretion of epsilonA may be a potential biomarker for in vivo alkylation of DNA and nucleotide pools.

BACKGROUND

Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery.

OBJECTIVE

To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years.

METHODS

Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions.

RESULTS

The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits.

CONCLUSIONS

CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.

The current economic crisis is not just another rough spell. Today's mix of urgency, high stakes, and uncertainty will continue even after the recession ends. The immediate crisis--which we will get through with policy makers' expert technical adjustments--sets the stage for a sustained, or even permanent, crisis, a relentless series of challenges no one has encountered before. Instead of hunkering down and relying on their familiar expertise to deal with the sustained crisis, people in positions of authority--whether they are CEOs or managers heading up a company initiative--must practice what the authors call adaptive leadership. They must, of course, tackle the underlying causes of the crisis, but they must also simultaneously make the changes that will allow their organizations to thrive in turbulent environments. Adaptive leadership is an improvisational and experimental art, requiring some new practices. Like Julie Gilbert, who overcame internal resistance to reorient Best Buy toward female purchasers, adaptive leaders get things done to meet today's challenges and then modify those things to thrive in tomorrow's world. They also embrace disequilibrium, using turbulence as an opportunity to build crucial new capacities, as Paul Levy did to rescue Beth Israel Deaconess Medical Center from a profound financial crisis. Finally, adaptive leaders, such as Egon Zehnder, the founder of an executive search firm, draw out the leadership skills that reside deep in the organization, recognizing the interdependence of all employees and mobilizing everyone to generate solutions.

OBJECTIVE

To identify factors that may influence the implementation of acute pain management guidelines in hospital settings.

METHODS

Two questionnaire surveys.

METHODS

Healthcare Association of New York State, Albany, NY.

METHODS

The surveys were administered to 220 hospitals in New York State regarding their acute pain management practices and resources available. One survey was addressed to each hospital's chief executive officer (CEO) and the second survey was addressed to the clinical director of the Department of Anesthesiology or Acute Pain Service. The barriers and incentives to guideline implementation identified by CEOs were analyzed using factor analysis. Logistic regression was employed to determine predictors of guideline implementation by linking the CEOs' survey data with the clinical directors' report of guideline usage.

RESULTS

According to clinical directors, only 27% of the responding hospitals were using a published pain management practice guideline. Factors predictive of guideline implementation include resource availability and belief in the benefits of using guidelines to improve quality of care or to achieve economic/legal advantages. Guideline implementation, however, does not necessarily include applying all key elements recommended by the federal Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) guideline. For example, a collaborative, interdisciplinary approach to pain control was used in only 42% of the hospitals, and underutilization of nonpharmacologic therapies to control pain was widespread. Resource availability, particularly staff with expertise in pain management and existence of a formal quality assurance program to monitor pain management, was significantly predictive of compliance with key guideline elements.

CONCLUSIONS

Resource availability significantly influences the implementation of pain management practice guidelines in hospital settings. Implementation is often incomplete because various factors affect the feasibility of individual guideline elements and may explain the varying results that guidelines have had on clinical practices.

The Zr doping in CeO(2) may change the reduction properties and therefore the redox properties of CeO(2). Using first-principles density functional theory with the inclusion of on-site Coulomb interaction for a 96-atom supercell, these effects are studied by comparing the differences in atomic structures, electronic structures, and reduction energies of the doped CeO(2) and those of the nondoped CeO(2). It is found that (1) Zr doping of the ceria structure results in important modifications involving nonequivalent O atoms; (2) the oxygen anions (still four-coordinated) next to the doping center show considerably lower reduction energies (by 0.6 eV) and larger displacements ("higher mobilities"); (3) an O vacancy is most easily created close to the Zr centers, therefore the Zr-doping centers might serve as nucleation centers for vacancy clustering; and (4) the electrons left by the released oxygen localize on two Ce cations neighboring the vacancy, which results in the reduction of two Ce(4+) ions.

Physical-chemists, (micro)biologists, and ecologists need to conduct meaningful experiments to study the environmental risk of engineered nanomaterials with access to relevant mechanistic data across several spatial and temporal scales. Indoor aquatic mesocosms (60L) that can be tailored to virtually mimic any ecosystem appear as a particularly well-suited device. Here, this concept is illustrated by a pilot study aimed at assessing the distribution of a CeO₂-based nanomaterial within our system at low concentration (1.5 mg/L). Physico-chemical as well as microbiological parameters took two weeks to equilibrate. These parameters were found to be reproducible across the 9-mesocosm setup over a 45-day period of time. Recovery mass balances of 115 ± 18% and 60 ± 30% of the Ce were obtained for the pulse dosing and the chronic dosing, respectively. This demonstrated the relevance of our experimental approach that allows for adequately monitoring the fate and impact of a given nanomaterial.