Balance the Paradox between Limited Health Resources and Growing Demands for Medical Services

Health institutions in the People＇s Republic of China are under considerable challenge. Innovations in management systems may support the challenge to increase both efficiency and effectiveness. The balanced scorecard （BSC） is one such innovation. We have used a model to explore the factors that may impact the diffusion of the BSC in Chinese government hospitals. In particular, we concentrate on three factors - the outer context, the nature of the innovation and the communication and influence. The outer context and the nature of the innovation do provide an inducement to implement a BSC. The strength of the communication and influence may affect the level of take-up. However, we recognise that they may choose ＂the BSC not for any apparent technical excellence but for the legitimation that Western management practices may bring to local managers.     

Recent advances in aerial gamma-ray surveying

Aerial gamma-ray surveying uses NaI(Tl) detectors mounted in small aircraft to measure gamma radiation, emitted from the earth's surface. The data are collected as gamma-ray spectra, typically with 1 s counting times, from which are derived K, U and Th concentrations in the ground. Applications of aerial surveying include geological mapping for mineral exploration, soil mapping for agriculture, pollution studies and location of lost sources. Recent advances in applying statistical methods to the spectral data have resulted in large reductions in the noise levels in the surveys. Some of the methods available to do this include noise adjusted singular value decomposition (NASVD) [Proceedings of Exploration 97: Fourth Decennial International Conference on Mineral Exploration (1997) 753] and maximum noise fraction (MNF) and enhanced MNF (eMNF) [Explor. Geophys. 31 (2000) 73]. These methods, in general, apply normalization for variance to the spectra, use a principal component method to obtain the "significant" components of the data and reconstruct cleaned spectra, which are then processed in a standard manner to get radionuclide concentrations. However, they differ in the detail of the application and thus give slightly different results. In this paper, the application of noise reduction methods to various synthetic surveys is used to examine the strengths and weaknesses of the methods. In tests where there are high correlations between U and Th, the eMNF method performs best although the results are improved by prior clustering of the data by the Th/U ratio. If the data show no correlations, then the effectiveness of all the noise removal methods is reduced. If a data set is small (<1500 spectra), then MNF appears to be the better method. Consideration of the various tests suggests an optimum process whereby spectra are sorted into groups by the Th/U ratio of areas identified in a standard processing and then cleaned by eMNF or MNF, depending on the number of spectra in each group.     

Retrospective exposure assessment in a chemical research and development facility

The objective of this exposure assessment was to reconstruct cumulative historical exposures for workers who have been exposed to multiple chemicals and chemical groups to better understand a cluster of brain cancers within a research and development lab. Chemicals of interest, including acrylates, bis-chloromethyl ether (BCME), chloromethyl methyl ether (CMME), isothiazolones and nitrosoamines, were selected on the basis of the plausibility of penetrating the blood-brain barrier and the uniqueness of the chemical's biological activity.In a complicated exposure setting such as a chemical R&D facility, multiple exposure estimation methods were needed. First, similarly exposure groups (SEGs) were created for these materials based on department group, time period of the department's existence and function associated with job titles. A probabilistic framework for assessing exposures was developed using Bayesian analysis of historical monitoring data, mathematical exposure modeling and professional judgments of current and former industrial hygienists at the facility were used to reconstruct the exposure history for acrylates, BCME and CMME for each SEG over the time period of interest. Since sufficient measurement data for isothiazolones and nitrosoamines were not available, the exposure histories for each SEG for these chemicals were estimated. This was done using objective formaldehyde levels and subjective employee interviews. The interviews assessed workplace determinants of exposure as distinct surrogates for estimating inhalation and dermal exposures. The exposure assessments by these methods were compared against each other to estimate the potential for exposure misclassification. A job exposure matrix (JEM) was constructed that contained the exposures obtained from above multiple approaches for each of these chemical groups for each SEG for each year of interest. The combination of methods used in this work is a unique and potentially helpful framework that can be used in analogous workplace settings involving multiple exposures with incomplete objective measurement information.     

Decompression syndrome and the evolution of deep diving physiology in the Cetacea

Whales repetitively dive deep to feed and should be susceptible to decompression syndrome, though they are not known to suffer the associated pathologies. Avascular osteonecrosis has been recognized as an indicator of diving habits of extinct marine amniotes. Vertebrae of 331 individual modern and 996 fossil whales were subjected to macroscopic and radiographic examination. Avascular osteonecrosis was found in the Oligocene basal odontocetes (Xenorophoidea) and in geologically younger mysticetes, such as Aglaocetus [a sister taxon to Balaenopteridae + (Balaenidae + Eschrichtiidae) clade]. These are considered as early "experiments" in repetitive deep diving, indicating that they independently converged on their similar specialized diving physiologies.     

Raman spectroscopic documentation of Oligocene bladder stone

Discovery of a fossil (30–35 million-year-old) urolith from Early Oligocene deposits in northeastern Colorado provides the earliest evidence for the antiquity of bladder stones. These are spherical objects with a layered phosphatic structure and a hollow center. Each layer is composed of parallel crystals oriented perpendicular to the surface. Macroscopic and microscopic examination and X-ray diffraction analysis, along with comparison with 1,000 contemporary uroliths, were used as evidence in the confirmation of this diagnosis. Raman microspectroscopy verified the presence of organic material between layers, confirming its biologic origin.     

Water quality in rice-growing watersheds in a Mediterranean climate

Rice (Oryza sativa L.) agriculture is estimated to cover 161 million ha of land on Earth, with 10% grown in temperate regions. Currently there are strong concerns about surface water nutrient pollution, and the purpose of this study was to determine the impacts of temperate rice cultivation on nutrient dynamics at the small watershed scale. Over the course of the 2008 growing season (May through September), bi-weekly grab samples were collected from outlets of 11 agricultural subwatersheds in California. Samples were analyzed for NO₃-N, NH₄-N, PO₄-P, K, and dissolved organic nitrogen (DON) concentrations, and the average values across all subwatersheds and sampling dates were 0.22, 0.031, 0.047, 1.36, and 0.32 mg L⁻¹, respectively. Linear mixed effects analysis was used to evaluate the magnitude of relationships between nutrient concentration and flux and subwatershed characteristics (i.e. percent soil clay and organic matter, percent rice area, irrigation water reuse, subwatershed discharge, irrigated area, and time, measured as the day in the growing season). For all nutrients, flux decreased over time and increased with discharge. Concentrations of K and DON were highest at the start and end of the growing season. Concentrations of NH₄-N were near non-detect levels, with the exception of a peak in mid-July, which corresponds to when many growers top-dress rice fields with N fertilizer. Nitrate-N concentration and flux decreased with percent rice area, whereas PO₄-P concentrations increased with percent rice area, indicating that rice area should be considered in future watershed-scale studies of nutrient discharge. In all subwatersheds, the discharge loads of K were smaller than surface water input loads, while NO₃-N, NH₄-N, PO₄-P, and DON discharge loads exceeded input loads when total growing season discharge was greater than 3500-6600 m³ ha⁻¹. This implies that the management of subwatershed discharge can be used to control nutrient export from rice-growing areas.     

Disability among adults injured in motor-vehicle crashes in the United States

INTRODUCTION: Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries. METHOD: We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older. RESULTS: More than 1.2 million adults were living in their homes with the disabling effects of motor-vehicle crash-related injuries in 1995. The prevalence of crash-related disability was highest for persons in their mid-life years, ages 35-64. Half of the respondents had sustained the injuries more than 5 years before the interview. Forty-one percent of working-aged individuals reported being unable to work because of their disability. CONCLUSIONS: Because crash-related disability is most prevalent during the mid-life years, quality of life and productivity may be affected for decades. These findings highlight the personal and societal burden associated with motor-vehicle crash-related disability in the United States.     

Spondyloarthropathy in vertebrae of the aquatic Cretaceous snake <Emphasis Type="Italic">Lunaophis aquaticus</Emphasis>, and its first recognition in modern snakes

Inflammatory arthritis is documented for the first time in snakes. Ossification of the intervertebral capsule and zygapophyseal joints resulting in segmental vertebral fusion was observed in the aquatic Cretaceous snake Lunaophis aquaticus. Such pathologic alterations are pathognomonic for the spondyloarthropathy form of inflammatory arthritis. A survey of 2144 snakes in recent collections, performed to identify Holocene prevalence, revealed only two occurrences in extant snakes. The findings in Bitis gabonica and Elaphe taeniura were indistinguishable from those noted in Lunaophis aquaticus and identical to those previously recognized in modern varanids. The pathology likely represents a form of reactive arthritis related to enteropathic infection. While the disease probably did not affect general locomotion, its vertebral column position may have compromised mating.