224 research outputs found
Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study
<p>Abstract</p> <p>Background</p> <p>Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States.</p> <p>Methods</p> <p>We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions.</p> <p>Results</p> <p>We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers.</p> <p>Conclusion</p> <p>Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care.</p
Independent Component Analysis of the Effect of L-dopa on fMRI of Language Processing
L-dopa, which is a precursor for dopamine, acts to amplify strong signals, and dampen weak signals as suggested by previous studies. The effect of L-dopa has been demonstrated in language studies, suggesting restriction of the semantic network. In this study, we aimed to examine the effect of L-dopa on language processing with fMRI using Independent Component Analysis (ICA). Two types of language tasks (phonological and semantic categorization tasks) were tested under two drug conditions (placebo and L-dopa) in 16 healthy subjects. Probabilistic ICA (PICA), part of FSL, was implemented to generate Independent Components (IC) for each subject for the four conditions and the ICs were classified into task-relevant source groups by a correlation threshold criterion. Our key findings include: (i) The highly task-relevant brain regions including the Left Inferior Frontal Gyrus (LIFG), Left Fusiform Gyrus (LFUS), Left Parietal lobe (LPAR) and Superior Temporal Gyrus (STG) were activated with both L-dopa and placebo for both tasks, and (ii) as compared to placebo, L-dopa was associated with increased activity in posterior regions, including the superior temporal area (BA 22), and decreased activity in the thalamus (pulvinar) and inferior frontal gyrus (BA 11/47) for both tasks. These results raise the possibility that L-dopa may exert an indirect effect on posterior regions mediated by the thalamus (pulvinar)
Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality
The new enclosures: critical perspectives on corporate land deals
The contributions to this collection use the tools of agrarian political economy to
explore the rapid growth and complex dynamics of large-scale land deals in recent
years, with a special focus on the implications of big land deals for property and
labour regimes, labour processes and structures of accumulation. The first part of
this introductory essay examines the implications of this agrarian political
economy perspective. First we explore the continuities and contrasts between
historical and contemporary land grabs, before examining the core underlying
debate around large- versus small-scale farming futures. Next, we unpack the
diverse contexts and causes of land grabbing today, highlighting six overlapping
mechanisms. The following section turns to assessing the crisis narratives that
frame the justifications for land deals, and the flaws in the argument around there
being excess, empty or idle land available. Next the paper turns to an examination
of the impacts of land deals, and the processes of inclusion and exclusion at play,
before looking at patterns of resistance and constructions of alternatives. The
final section introduces the papers in the collection.ESR
Between vigilantism and bureaucracy:Improving our understanding of police work in Nigeria and South Africa
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