Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Effects of solar radiation pressure and Aerodynamic forces on satelliteattitude Dynamics and their utilization for Control: a survey

The environmcnl exerts an important inJuence on the pefirmance of space systems. A brief rel'iew of mo.s/ of the studies, pre.~ented over the past eightem years, relating to the influence ar7d the possible utilization of thc solar radiation pressure &d aero&namic forces, with particular reference to attitude dynamics and control qf satellites is presented here. The semi-passive stabilizers employing rhese forces show p~qmise of long life, low power and economic sjsfems, which though slower in response, compare we1I wit11 the octiw coi~trollers. It is felt that mud more attention is necessary to the actual implema~tution of these ideas and devices: some of which me quite ingenious und unique.

Analysis of the beta-glucoside utilization (bgl) genes of Shigella sonnei: evolutionary implications for their maintenance in a cryptic state

The pattern of expression of the genes involved in the utilization of aryl beta-glucosides such as arbutin and salicin is different in the genus Shigella compared to Escherichia coli. The results presented here indicate that the homologue of the cryptic bgl operon of E. coli is conserved in Shigella sonnei and is the primary system involved in beta-glucoside utilization in the organism. The organization of the bgl genes in 5. sonnei is similar to that of E. coli; however there are three major differences in terms of their pattern of expression. (i) The bglB gene, encoding phospho-beta-glucosidase B, is insertionally inactivated in 5. sonnei. As a result, mutational activation of the silent bgl promoter confers an Arbutin-positive (Arb(+)) phenotype to the cells in a single step; however, acquiring a Salicin-positive (Sal(+)) phenotype requires the reversion or suppression of the bglB mutation in addition. (ii) Unlike in E. coli, a majority of the activating mutations (conferring the Arb(+) phenotype) map within the unlinked hns locus, whereas activation of the E. coli bgl operon under the same conditions is predominantly due to insertions within the bglR locus. (iii) Although the bgl promoter is silent in the wild-type strain of 5. sonnei (as in the case of E. coli), transcriptional and functional analyses indicated a higher basal level of transcription of the downstream genes. This was correlated with a 1 bp deletion within the putative Rho-independent terminator present in the leader sequence preceding the homologue of the bglG gene. The possible evolutionary implications of these differences for the maintenance of the genes in the cryptic state are discussed.

A preliminary investigation into the effects of a sex-reversal androgen, methyltestosterone, on food utilization and growth of Sarotherodon niloticus (L) fry

Three groups of Sarotherodon niloticus fry were fed for 8 weeks on diets either treated with 17- & methyltestosterone (MT), alcohol (CA), or untreated (CO). Growth rate and food utilization in the different groups were compared. Results indicate that the best growth, Feed Conversion Ratio (FCR), Protein Efficiency Ratio (PER) and Mean Growth Rate (MGR) were obtained with the MT diet. There was no significant difference (P 0.05) in growth and food utilization of the CA and CO fry, nor in the mortality rate of the 3 treatments. The androgen, methyltestosterone promotes growth and protein anabolism without producing toxic effects in S. niloticus

Effects of fish-meal, cow blood-meal, and sorghum diets on food utilization and growth of cage cultured Sarotherodon niloticus

The growth responses and feed utilization of Sarotherodon niloticus held in metal cages in a pond and fed diets containing fish-meal, cow blood-meal or sorghum was studied. Results indicate that the best growth, feed conversion and protein efficiency ratio were obtained with the diet containing 60% fish-meal. The growth performance of fish on 40% fish-meal, and 40% and 60% blood meal were not significantly different, and were quite close to the performance with 60% fish-meal. The growth and food utilization of fish on 84% sorghum diet was significantly lower than the rest. The Caged fish without supplemental feeding had a light gain in weight. All fish with supplemental feeding appeared healthy. It is concluded that cow blood meal at 40% or 60% inclusion in diet can adequately replace fish-meal in S. niloticus supplemental diet in pond culture

Effect of dietary carbohydrate sources on growth performance and utilization for gibel carp (Carassius auratus gibelio) and Chinese longsnout catfish (Leiocassis longirostris Gunther)

The nutritional function of monosaccharides, disaccharides and polysaccharides for omnivorous gibel carp and carnivorous Chinese longsnout catfish were investigated and the ability of these two species to utilize carbohydrates was compared. For each species, triplicate groups of fish were assigned to each of five groups of isoenergetic and isonitrogenous experimental diets with different carbohydrate sources: glucose, sucrose, dextrin, soluble starch (acid-modified starch) and alpha-cellulose. The carbohydrates were included at 60 g kg(-1) in Chinese longsnout catfish diets and at 200 g kg(-1) in gibel carp diets. A growth trial was carried out in a recirculation system at 27.8 +/- 1.9 degrees C for 8 weeks. The results showed that fish with different food habits showed difference in the utilization of carbohydrate sources. For gibel carp, better specific growth rate (SGR) and feed efficiency (FE) were observed in fish fed diets containing soluble starch and cellulose, but for Chinese longsnout catfish, better SGR and FE were observed in fish fed diets containing dextrin and sucrose. Apparent digestibility coefficient of dry matter (ADC(d)) and apparent digestibility coefficient of energy (ADC(e)) were significantly affected by dietary carbohydrate sources in gibel carp. ADC(d) and ADC(e) significantly decreased as dietary carbohydrate complexity increased in Chinese longsnout catfish except that glucose diet had medium ADC(d) and ADC(e). In both species, no significant difference of apparent digestibility coefficient of protein was observed between different carbohydrate sources. Dietary carbohydrate sources significantly affected body composition, and liver phosphoenolpyruvate carboxykinase (PEPCK), pyruvate kinase (PK), glucose 6-phosphate dehydrogenase (G6PD) and malic enzyme (ME) activities also varied according to dietary carbohydrate complexity. Fish with different food habits showed different abilities to synthesize liver glycogen, and the liver glycogen content in gibel carp was significantly higher than in Chinese longsnout catfish. The influence of carbohydrate source on gluconeogenesis and lipogenesis was also different in the two fish species.

Optimization of control parameters for petroleum waste composting

Composting is being widely employed in the treatment of petroleum waste. The purpose of this study was to find the optimum control parameters for petroleum waste in-vessel composting. Various physical and chemical parameters were monitored to evaluate their influence on the microbial communities present in composting. The CO2 evolution and the number of microorganisms were measured as the activity of composting. The results demonstrated that the optimum temperature, pH and moisture content were 56.5 - 59.5 degreesC, 7.0 - 8.5 and 55 % - 60%, respectively. Under the optimum conditions, the removal efficiency of petroleum hydrocarbon reached 83.29% after 30 days composting.

Effect of feeding strategy and carbohydrate source on carbohydrate utilization by white sturgeon (Acipenser transmontanus) and hybrid tilapia (Oreochromis niloticus X O-aureus)

Two 8-week growth trials were conducted to determine the effect of continuous (CF) versus 2 meals day(-1) (MF) feeding and 30% starch versus 30% glucose diets on the carbohydrate utilization of 9.0-g white sturgeon and 0.56-g hybrid tilapia. The two trials were conducted under similar conditions except that sturgeon were kept at 18.5 degrees C in a flow-through system and tilapia were kept at 26 degrees C in a recirculating system. Significantly (P less than or equal to 0.05) higher specific growth rate (SGR), feed efficiency (FE), protein efficiency ratio (PER), body lipid content and liver glucose-6-phosphate dehydrogenase (G6PDH) and 6-phosphogluconate dehydrogenase (6PGDH) activities were observed in the CF than MF sturgeon. Only SGR, FE and PER were higher in sturgeon fed the starch than the glucose diets. Only higher liver G6PDH and malic enzyme (ME) activities were observed in the CF than MF tilapia but higher SGR, FE, PER and liver G6PDH, 6PGDH and ME activities were observed in tilapia fed the starch diet than those fed the glucose diet. This suggested that carbohydrate utilization by sturgeon was more affected by feeding strategy whereas tilapia was more affected by carbohydrate source. Furthermore, white sturgeon can utilize carbohydrates better than hybrid tilapia regardless of feeding strategy and carbohydrate source.

Thermokinetic investigation of effect of temperature on optimum NaCl concentration for petroleum bacterial growth

The power-time curves of growth of three strains of petroleum bacteria at different NaCl concentrations at 40.0 and 50.0 degreesC have been determined by using a 2277 Thermometric Thermal Activity Analyser. An equation of a power-time curve, ln[alphaP(K)/P(t) - 1] = ln[(alphaK - N-0)/N-0] - alphakt, was established based on the generalized logistic equation, where P(t) is the thermal power at time t, K the carrying capacity, P-K = P0K, P-0 the thermal power of one cell, N-0 the bacterial population at time zero, alpha = (k - D)/k. The method of four observed points with the same time interval was used to calculate the value of P-K. The growth rate constant k and the death rate constant D were calculated. The NaCl concentration of optimum growth rate of petroleum bacteria at 40.0 and 50.0 degreesC, respectively, have been obtained according to the curves k - D versus NaCl concentration, which are 0.26, 0.54 and 0.57 mol l(-1) for B-1, B-2 and B-3, respectively, at 50.0 degreesC, 0.26, 0.55 and 0.56 mol l(-1) for B-1, B-2 and B-3, respectively, at 40.0 degreesC. The results indicated that the effect of temperature on NaCl concentration of optimum growth rate was small. (C) 2002 Elsevier Science B.V. All rights reserved.

Investigation of platinum utilization and morphology in catalyst layer of polymer electrolyte fuel cells

Platinum utilization in the gas-diffusion catalyst layer and thin-film catalyst layer is investigated. The morphology of PTFE and Nafion in a simulated catalyst layer is examined by scanning electronmicroscopy (SEM) and transmission electron microscopy (TEM). The results show that the platinum utilization of the thin-film catalyst layer containing only Pt/C and Nafion is 45.4%. The low utilization is attributed to the fact that the electron conduction of many catalyst particles is impaired by some thick Nafion layers or clumps. For the gas-diffusion (E-TEK) electrode, the platinum utilization is mainly affected by the proton conduction provided by Nafion. The blocking effect of PTFE on the active sites is not serious. When the electrode is sufficiently impregnated with Nafion by an immersion method, the platinum utilization can reach 77.8%. Transmission electron micrographs reveal that although some thick Nafion layers and clumps are observed in the Pt/C + Nafion layer, the distribution of Nafion in the catalyst layer is basically uniform. The melted PTFE disperses in the catalyst layer very uniformly. No large PTFE clumps or wide net-like structure is observed. The reactant gas may have to diffuse evenly in the catalyst layer. (C) 1999 Elsevier Science S.A. All rights reserved.

Stable isotope probing analysis of the influence of liming on root exudate utilization by soil microorganisms

Rhizosphere microorganisms play an important role in soil carbon flow, through turnover of root exudates, but there is little information on which organisms are actively involved or on the influence of environmental conditions on active communities. In this study, a (CO2)-C-13 pulse labelling field experiment was performed in an upland grassland soil, followed by RNA-stable isotope probing (SIP) analysis, to determine the effect of liming on the structure of the rhizosphere microbial community metabolizing root exudates. The lower limit of detection for SIP was determined in soil samples inoculated with a range of concentrations of C-13-labelled Pseudomonas fluorescens and was found to lie between 10(5) and 10(6) cells per gram of soil. The technique was capable of detecting microbial communities actively assimilating root exudates derived from recent photo-assimilate in the field. Denaturing gradient gel electrophoresis (DGGE) profiles of bacteria, archaea and fungi derived from fractions obtained from caesium trifluoroacetate (CsTFA) density gradient ultracentrifugation indicated that active communities in limed soils were more complex than those in unlimed soils and were more active in utilization of recently exuded C-13 compounds. In limed soils, the majority of the community detected by standard RNA-DGGE analysis appeared to be utilizing root exudates. In unlimed soils, DGGE profiles from C-12 and C-13 RNA fractions differed, suggesting that a proportion of the active community was utilizing other sources of organic carbon. These differences may reflect differences in the amount of root exudation under the different conditions.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

Timing of di-ammonium phosphate addition to fermenting chardonnay must : effect on nitrogen utilization, ethyl-carbamate formation, and CAR1 expression by yeast /

The maximum amount of ethyl carbamate (EC), a known animal carcinogen produced by the reaction of urea and ethanol, allowed in alcoholic beverages is regulated by legislation in many countries. Wine yeast produce urea by the metabolism of arginine, the predominant assimilable amino acid in must. This action is due to arginase (encoded by CARl). Regulation of CARl, and other genes in this pathway, is often attributed to a well-documented phenomenon known as nitrogen catabolite repression. The effect of the timing of di-ammonium phosphate (DAP) additions on the nitrogen utilization, regulation of CARl, and EC production was investigated. A correlation was found between the timing of DAP addition and the utilization of nitrogen. When DAP was added earlier in the fermentations, less amino nitrogen and more ammonia nitrogen was sequestered from the media by the cells. It was also seen that early DAP addition led to more total nitrogen being used, with a maximal difference of ~25% between fermentations where no DAP was added versus addition at the start of the fermentation. The effect of the timing ofDAP addition on the expression of CARJ during fermentation was analyzed via northern transfer and the relative levels of CARl expression were determined. The trends in expression can be correlated to the nitrogen data and be used to partially explain differences in EC formation between the treatments. EC was quantified at the end of fermentation by GC/MS. In Montrachet yeast, a significant positive correlation was found between the timing of DAP addition, from early to late, and the final EC concentration m the wine (r = 0.9226). In one of the fermentations, EC levels of 30.5 ppb was foimd when DAP was added at the onset of fermentation. A twofold increase (69.5 ppb) was observed when DAP was added after 75% of the sugars were metabolized. When no DAP was added, the ethyl carbamate levels are comparable at a value of 38 ppb. In contrast, the timing of DAP additions do not affect the level EC produced by the yeast ECU 18 in this manner. The study of additional yeast strains shows that the effect of DAP addition to fermentations is strain dependent. Our results reveal the potential importance of the timing of DAP addition to grape must with respect to EC production, and the regulatory effect of DAP additions on the expression of genes in the pathway for arginine metabolism in certain wine yeast strains.

lntemet utilization and academic activities of faculty members in the universities of Kerala : an analytical study

This thesis Entitled Internet Utilization and Academic Activities of Faculty Members in the Universities of kerala: an analytical study. Today, scientific research is throwing up new discoveries, inventions and vistas by the hour. We are witnessing a veritable knowledge explosion. It is important for members of university faculty members to keep abreast of it for giving up-t-date information to their students about the new development in the subject of their study. The internet is an invaluable tool for achieving it. Most of the universities have sufficient internet facility, but the accessibility to all the faculty members is not adequate. University Libraries also provides standard supplementary service in the internet area. This study indicates differential level of awareness and utilization of the internet services by the faculty members in the areas of teaching, research and publication. However the overall impression is that the awareness and utilization is inadequate. This point to the urgent need to devise programs and schemes to promote internet utilization among the faculty members. The suggestions indicate the key areas that deserve attention by policy makers and administrators. Thanks to the internet, every new development in every field of study is just a click away for faculty members, research scholars and students.

Effect of energy and protein supplementation on phosphorus utilization in lactating dairy cows

Two experiments were undertaken in which grass silage was used in conjunction with a series of different concentrate types designed to examine the effect of carbohydrate source, protein level and degradability on total dietary phosphorus (P) utilization with emphasis on P pollution. Twelve Holstein-Friesian dairy cows in early to mid-lactation were used in an incomplete changeover design with four periods consisting of 4 weeks each. Phosphorus intake ranged from 54 to 80 g/day and faecal P represented the principal route by which ingested P was disposed of by cows, with insignificant amounts being voided in urine. A positive linear relationship between faecal P and P intake was established. In Experiment 1, P utilization was affected by dietary carbohydrate type, with an associated output of 3.3 g faecal P/g milk P produced for all treatments except those utilizing low degradable starch and low protein supplements, where a mean value of 2.8 g faecal P/g milk P was observed. In Experiment 2, where two protein levels and three protein degradabilities were examined, the efficiency of P utilization for milk P production was not affected by either level or degradability of crude protein (CP) but a significant reduction in faecal P excretion due to lower protein and P intake was observed. In general, P utilization in Experiment 2 was substantially improved compared to the Experiment 1, with an associated output of 1.8 g faecal P/g milk P produced. The improved utilization of P in Experiment 2 could be due to lower P content of the diets offered and higher dry matter (DM) intake. For dairy cows weighing 600 kg, consuming 17-18 kg DM/day and producing about 25 kg milk, P excretion in faeces and hence P pollution to the environment might be minimized without compromising lactational performance by formulating diets to supply about 68 g P/day, which is close to recent published recommended requirements for P.