The Hospital Study of the City of Houston and Harris County

In 1941 the Texas Legislature appropriated $500,000 to the Board of Regents of the University of Texas to establish a cancer research hospital. The M. D. Anderson Foundation offered to match the appropriation with a grant of an equal sum and to provide a permanent site in Houston. In August, 1942 the Board of Regent of the University and the Trustees of the Foundation signed an agreement to embark on this project. This institution was to be the first one in the medical center, which was incorporated in October, 1945. The Board of Trustees of the Texas Medical Center commissioned a hospital survey to: - Define the needed hospital facilities in the area - Outline an integrated program to meet these needs - Define the facilities to be constructed - Prepare general recommendations for efficient progress The Hospital Study included information about population, hospitals, and other health care and education facilities in Houston and Harris County at that time. It included projected health care needs for future populations, education needs, and facility needs. It also included detailed information on needs for chronic illnesses, a school of public health, and nursing education. This study provides valuable information about the general population and the state of medicine in Houston and Harris County in the 1940s. It gives a unique perspective on the anticipated future as civic leaders looked forward in building the city and region. This document is critical to an understanding of the Texas Medical Center, Houston and medicine as they are today. SECTIONS INCLUDE: Abstract The Abstract was a summary of the 400 page document including general information about the survey area, community medical assets, and current and projected medical needs which the Texas Medical Center should meet. The 123 recommendations were both general (e.g., 12. “That in future planning, the present auxiliary department of the larger hospitals be considered inadequate to carry an added teaching research program of any sizable scope.”) and specific (e.g., 22. That 14.3% of the total acute bed requirement be allotted for obstetric care, reflecting a bed requirement of 522 by 1950, increasing to 1,173 by 1970.”) Section I: Survey Area This section basically addressed the first objective of the survey: “define the needed hospital facilities in the area.” Based on the admission statistics of hospitals, Harris County was included in the survey, with the recognition that growth from out-lying regional areas could occur. Population characteristics and vital statistics were included, with future trends discussed. Each of the hospitals in the area and government and private health organizations, such as the City-County Welfare Board, were documented. Statistics on the facilities use and capacity were given. Eighteen recommendations and observations on the survey area were given. Section II: Community Program This section basically addressed the second objective of the survey: “outline an integrated program to meet these needs.” The information from the Survey Area section formed the basis of the plans for development of the Texas Medical Center. In this section, specific needs, such as what medical specialties were needed, the location and general organization of a medical center, and the academic aspects were outlined. Seventy-four recommendations for these plans were provided. Section III: The Texas Medical Center The third and fourth objectives are addressed. The specific facilities were listed and recommendations were made. Section IV: Special Studies: Chronic Illness The five leading causes of death (heart disease, cancer, “apoplexy”, nephritis, and tuberculosis) were identified and statistics for morbidity and mortality provided. Diagnostic, prevention and care needs were discussed. Recommendations on facilities and other solutions were made. Section IV: Special Studies: School of Public Health An overview of the state of schools of public health in the US was provided. Information on the direction and need of this special school was also provided. Recommendations on development and organization of the proposed school were made. Section IV: Special Studies: Needs and Education Facilities for Nurses Nursing education was connected with hospitals, but the changes to academic nursing programs were discussed. The needs for well-trained nurses in an expanded medical environment were anticipated to result in significant increased demands of these professionals. An overview of the current situation in the survey area and recommendations were provided. Appendix A Maps, tables and charts provide background and statistical information for the previous sections. Appendix B Detailed census data for specific areas of the survey area in the report were included. Sketches of each of the fifteen hospitals and five other health institutions showed historical information, accreditations, staff, available facilities (beds, x-ray, etc.), academic capabilities and financial information.

An evaluation of the centers for Medicare & Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program

Objective: This dissertation evaluated three aspects of the Centers for Medicare and Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program (HACPOA program) to produce three journal articles for publication. ^ Methods: All payer admission records from state inpatient databases from Arizona, New Jersey and Washington states were analyzed for the year 2008. However some analyses required a sample of adult only Medicare patients in the first two studies. California's inpatient data (2004 – 2010) was also analyzed in the third study to examine the reporting and non-payment program elements' impact on the incidence of hospital acquired conditions. ^ Results: Majority diagnoses reported in inpatient prospective payment systems hospitals were present on admission. However, some diagnoses are still coded as "not present on admission" and "insufficient documentation to determine whether or not conditions are present on admission or not". This is important because it reveals that hospital complications still occur in hospitals. Hospital fall and trauma injuries were the most common hospital acquired conditions observed in this study. Predictors of hospital fall injuries include age, gender, number of diagnoses, number of procedures, number of chronic conditions while predictors of hospital trauma injuries include number of e-codes, number of diagnoses and the presence of chronic conditions on a patient's admission records. Finally, the implementation of the present on admission reporting requirement increased reports of certain hospital acquired conditions while the non-payment policy element in the Hospital Acquired Conditions program reduced the incidence of hospital fall and trauma injuries in particular. ^ Conclusion: The implementation of the Hospital Acquired Conditions and Present on Admission Indicator Reporting program has made the state inpatient database a more useful source of data capable of now identifying hospital complications. The reporting and nonpayment program elements in the HACPOA program have also impacted the incidence of hospital acquired conditions. ^

State rate -setting in conjunction with Medicare prospective payment: The effects of the Maine program

Maine implemented a hospital rate-setting program in 1984 at approximately the same time as Medicare started the Prospective Payment System (PPS). This study examines the effectiveness of the program in controlling cost over the period 1984-1989. Hospital costs in Maine are compared to costs in 36 non rate-setting states and 11 other rate-setting states. Changes in cost per equivalent admission, adjusted patient day, per capita, admissions, and length of stay are described and analyzed using multivariate techniques. A number of supply and demand variables which were expected to influence costs independently of rate-setting were controlled for in the study. Results indicate the program was effective in containing costs measured in terms of cost per adjusted patient day. However, this was not true for the other two cost variables. The average length of stay increased during the period in Maine hospitals indicating an association with rate-setting. Several supply variables, especially the number of beds per 1,000 population were strongly associated with the cost and use of hospitals. ^

Entramado de politicidad en un ámbito estatal de trabajo : La experiencia de los trabajadores del Hospital Provincial Neuquén (2005-2013)

La presente investigación analiza el entramado de politicidad en un ámbito estatal de trabajo, a partir de la experiencia de los trabajadores del Hospital Provincial Neuquén Dr. Castro Rendón (HN) entre los años 2005 y 2013. Se propone un abordaje relacional que atienda a la configuración y redefinición de los escenarios de disputa, retomando la perspectiva de Norbert Elías. Se ha diseñado una estrategia metodológica cualitativa basada en la realización de observaciones participantes, entrevistas semi-estructuradas en profundidad y en el análisis de materiales gráficos. Se realizó un muestreo teórico de tipo no probabilístico, y las unidades de la muestra fueron seleccionadas de acuerdo a criterios relativos a la participación política y a las características de las labores hospitalarias. Los principales hallazgos de esta tesis refieren a la conceptualización de los ámbitos estatales de trabajo. Se los caracteriza como espacios donde se relacionan y se expresan múltiples grupos, resaltando los procesos socio-culturales que están implicados en las disputas políticas de los trabajadores. Se analizan la articulación entre demandas sectoriales y la disputa más general por la gestión de las políticas públicas, las regulaciones especiales que legislan el trabajo hospitalario, las distintas temporalidades de los conflictos, la vinculación con organizaciones externas, la jerarquización del espacio laboral, y la permeabilidad de lo estatal y lo no-estatal. Estos resultados permiten aportar de manera más general a las teorías sociológicas de la acción colectiva en lo que respecta a la utilización de las categorías de clase y a las identidades de los trabajadores

La cancelación de la vía oligárquica de la gran irrigación en México: Sinaloa (1908-1936)

El objetivo de este trabajo es mostrar las posibilidades que ofrece la documentación conservada en el Archivo Histórico del Agua para aproximarse a la cuestión de la creciente implicación del Estado mexicano en el proceso de modernización agraria, a través de la política de fomento a la irrigación, durante la primera parte del siglo XX. Para alcanzar esta meta partimos de la caracterización del modelo agroexportador implementado en México entre 1877 y 1930. Después sintetizamos la evolución del sector agropecuario en el estado de Sinaloa durante ese mismo periodo. Seguidamente, se enfatizan las expectativas iniciales que tuvo la oligarquía sobre la gran irrigación en Sinaloa a partir del estudio, fundamentalmente macroeconómico, de las tres empresas que suscribieron un contrato de subvención con el gobierno federal a fines del Porfiriato. Y, por último, a partir del seguimiento de estos mismos casos, se hacen claros los motivos que nos permiten entender la progresiva pérdida de legitimidad, tras el período revolucionario de 1910, de ese modelo modernizador del agro "desde arriba" con apoyo público hasta su quiebra final.

Entramado de politicidad en un ámbito estatal de trabajo : La experiencia de los trabajadores del Hospital Provincial Neuquén (2005-2013)

La presente investigación analiza el entramado de politicidad en un ámbito estatal de trabajo, a partir de la experiencia de los trabajadores del Hospital Provincial Neuquén Dr. Castro Rendón (HN) entre los años 2005 y 2013. Se propone un abordaje relacional que atienda a la configuración y redefinición de los escenarios de disputa, retomando la perspectiva de Norbert Elías. Se ha diseñado una estrategia metodológica cualitativa basada en la realización de observaciones participantes, entrevistas semi-estructuradas en profundidad y en el análisis de materiales gráficos. Se realizó un muestreo teórico de tipo no probabilístico, y las unidades de la muestra fueron seleccionadas de acuerdo a criterios relativos a la participación política y a las características de las labores hospitalarias. Los principales hallazgos de esta tesis refieren a la conceptualización de los ámbitos estatales de trabajo. Se los caracteriza como espacios donde se relacionan y se expresan múltiples grupos, resaltando los procesos socio-culturales que están implicados en las disputas políticas de los trabajadores. Se analizan la articulación entre demandas sectoriales y la disputa más general por la gestión de las políticas públicas, las regulaciones especiales que legislan el trabajo hospitalario, las distintas temporalidades de los conflictos, la vinculación con organizaciones externas, la jerarquización del espacio laboral, y la permeabilidad de lo estatal y lo no-estatal. Estos resultados permiten aportar de manera más general a las teorías sociológicas de la acción colectiva en lo que respecta a la utilización de las categorías de clase y a las identidades de los trabajadores

La cancelación de la vía oligárquica de la gran irrigación en México: Sinaloa (1908-1936)

El objetivo de este trabajo es mostrar las posibilidades que ofrece la documentación conservada en el Archivo Histórico del Agua para aproximarse a la cuestión de la creciente implicación del Estado mexicano en el proceso de modernización agraria, a través de la política de fomento a la irrigación, durante la primera parte del siglo XX. Para alcanzar esta meta partimos de la caracterización del modelo agroexportador implementado en México entre 1877 y 1930. Después sintetizamos la evolución del sector agropecuario en el estado de Sinaloa durante ese mismo periodo. Seguidamente, se enfatizan las expectativas iniciales que tuvo la oligarquía sobre la gran irrigación en Sinaloa a partir del estudio, fundamentalmente macroeconómico, de las tres empresas que suscribieron un contrato de subvención con el gobierno federal a fines del Porfiriato. Y, por último, a partir del seguimiento de estos mismos casos, se hacen claros los motivos que nos permiten entender la progresiva pérdida de legitimidad, tras el período revolucionario de 1910, de ese modelo modernizador del agro "desde arriba" con apoyo público hasta su quiebra final.

Sedimentary lipids and palynomorphs of sediment core ABC26 from the Eastern Mediterranean

Selective degradation of organic matter in sediments is important for reconstructing past environments and understanding the carbon cycle. Here, we report on compositional changes between and within lipid classes and kerogen types (represented by palynomorph groups) in relation to the organic matter flux to the sea floor and oxidation state of the sediments since the early Holocene for central Eastern Mediterranean site ABC26. This includes the initially oxic but nowadays anoxic presapropelic interval, the still unoxidised lower part of the organic rich S1 sapropel, its postdepositionally oxidised and nowadays organic-poor upper part as well as the overlying postsapropelic sediments which have always been oxic. A general ~ 2.3 times increase in terrestrial and marine input during sapropel formation is estimated on the basis of the total organic carbon (TOC), pollen, spore, dinoflagellate cyst, n-alkane, n-alkanol and n-alkanoic acid concentration changes in the unoxidised part of the sapropel. The long-chain alkenones, 1,15 diols and keto-ols, loliolides and sterols indicate that some plankton groups, notably dinoflagellates, may have increased much more. Apart from the terrestrial and surface water contributions to the sedimentary organic matter, anomalous distributions and preservation of some C23-C27 alkanes, alkanols and alkanoic acids have been observed, which are interpreted as a contribution by organisms living in situ. Comparison of the unoxidised S1 sapropel with the overlying oxidised sapropel and the organic matter concentration profiles in the oxidised postsapropelic sediments demonstrates strong and highly selective aerobic degradation of lipids and palynomorphs. There seems to be a fundamental difference in degradation kinetics between lipids and pollen which may be possibly related with the absence of sorptive preservation as a protective mechanism for palynomorph degradation. The n-alkanes, Impagidinium, and Nematosphaeropsis are clearly more resistant than TOC. The n-alkanols and n-carboxylic acids are about equally resistant whereas the pollen, all other dinoflagellate cysts and other lipids appear to degrade considerably faster, which questions the practice of normalising to TOC without taking diagenesis into account. Selective degradation also modifies the relative distributions within lipid classes, whereby the longer-chain alkanes, alcohols and fatty acids disappear faster than their shorter-chain equivalents. Accordingly, interpretation of lipid and palynomorph assemblages in terms of pre- or syndepositional environmental change should be done carefully when proper knowledge of the postdepositional preservation history is absent. Two lipid-based preservation proxies are tested the diol-keto-ol oxidation index based on the 1,15C30 diol and keto-ols (DOXI) and the alcohol preservation index (API) whereby the former seems to be the most promising.

Entramado de politicidad en un ámbito estatal de trabajo : La experiencia de los trabajadores del Hospital Provincial Neuquén (2005-2013)

La presente investigación analiza el entramado de politicidad en un ámbito estatal de trabajo, a partir de la experiencia de los trabajadores del Hospital Provincial Neuquén Dr. Castro Rendón (HN) entre los años 2005 y 2013. Se propone un abordaje relacional que atienda a la configuración y redefinición de los escenarios de disputa, retomando la perspectiva de Norbert Elías. Se ha diseñado una estrategia metodológica cualitativa basada en la realización de observaciones participantes, entrevistas semi-estructuradas en profundidad y en el análisis de materiales gráficos. Se realizó un muestreo teórico de tipo no probabilístico, y las unidades de la muestra fueron seleccionadas de acuerdo a criterios relativos a la participación política y a las características de las labores hospitalarias. Los principales hallazgos de esta tesis refieren a la conceptualización de los ámbitos estatales de trabajo. Se los caracteriza como espacios donde se relacionan y se expresan múltiples grupos, resaltando los procesos socio-culturales que están implicados en las disputas políticas de los trabajadores. Se analizan la articulación entre demandas sectoriales y la disputa más general por la gestión de las políticas públicas, las regulaciones especiales que legislan el trabajo hospitalario, las distintas temporalidades de los conflictos, la vinculación con organizaciones externas, la jerarquización del espacio laboral, y la permeabilidad de lo estatal y lo no-estatal. Estos resultados permiten aportar de manera más general a las teorías sociológicas de la acción colectiva en lo que respecta a la utilización de las categorías de clase y a las identidades de los trabajadores

La cancelación de la vía oligárquica de la gran irrigación en México: Sinaloa (1908-1936)

El objetivo de este trabajo es mostrar las posibilidades que ofrece la documentación conservada en el Archivo Histórico del Agua para aproximarse a la cuestión de la creciente implicación del Estado mexicano en el proceso de modernización agraria, a través de la política de fomento a la irrigación, durante la primera parte del siglo XX. Para alcanzar esta meta partimos de la caracterización del modelo agroexportador implementado en México entre 1877 y 1930. Después sintetizamos la evolución del sector agropecuario en el estado de Sinaloa durante ese mismo periodo. Seguidamente, se enfatizan las expectativas iniciales que tuvo la oligarquía sobre la gran irrigación en Sinaloa a partir del estudio, fundamentalmente macroeconómico, de las tres empresas que suscribieron un contrato de subvención con el gobierno federal a fines del Porfiriato. Y, por último, a partir del seguimiento de estos mismos casos, se hacen claros los motivos que nos permiten entender la progresiva pérdida de legitimidad, tras el período revolucionario de 1910, de ese modelo modernizador del agro "desde arriba" con apoyo público hasta su quiebra final.

Physical properties and hexachlorocyclohexane concentrations of sea-ice, water and ice algae samples, eastern Beaufort Sea

We present evidence that both geophysical and thermodynamic conditions in sea ice are important in understanding pathways of accumulation or rejection of hexachlorocyclohexanes (HCHs). a- and g-HCH concentrations and a-HCH enantiomer fractions have been measured in various ice classes and ages from the Canadian High Arctic. Mean a-HCH concentrations reached 0.642 ± 0.046 ng/L in new and young ice (<30 cm), 0.261 ±0.015 ng/L in the first-year ice (30-200 cm) and 0.208 ±0.045 in the old ice (>200 cm). Mean g-HCH concentrations were 0.066 ± 0.006 ng/L in new and young ice, 0.040 ±0.002 ng/L in the first-year ice and 0.040 ±0.007 ng/L in the old ice. In general, a-HCH concentrations and vertical distributions were highly dependent on the initial entrapment of brine and the subsequent desalination process. g-HCH levels and distribution in sea ice were not as clearly related to ice formation processes. During the year, first-year ice progressed from freezing (accumulation) to melting (ablation). Relations between the geophysical state of the sea ice and the vertical distribution of HCHs are described as ice passes through these thermodynamic states. In melting ice, which corresponded to the algal bloom period, the influence of biological processes within the bottom part of the ice on HCH concentrations and a-HCH enantiomer fraction is discussed using both univariate and multivariate approaches.

Geochemistry of sediments from the Eastern Cape Basin

Sediment cores retrieved in the Benguela coastal upwelling system off Namibia show very distinct enrichments of solid phase barium at the sulfate/methane transition (SMT). These barium peaks represent diagenetic barite (BaSO4) fronts which form by the reaction of upwardly diffusing barium with interstitial sulfate. Calculated times needed to produce these barium enrichments indicate a formation time of about 14,000 yr. Barium spikes a few meters below the SMT were observed at one of the investigated sites (GeoB 8455). Although this sulfate-depleted zone is undersaturated with respect to barite, the dominant mineral phase of these buried barium enrichments was identified as barite by scanning electron microscopy (SEM). This is the first study which reports the occurrence/preservation of pronounced barite enrichments in sulfate-depleted sediments buried a few meters below the SMT. At site GeoB 8455 high concentrations of dissolved barium in pore water as well as barium in the solid phase were observed. Modeling the measured barium concentrations at site GeoB 8455 applying the numerical model CoTReM reveals that the dissolution rate of barite directly below the SMT is about one order of magnitude higher than at the barium enrichments deeper in the sediment core. This indicates that the dissolution of barite at these deeper buried fronts must be retarded. Thus, the occurrence of the enrichments in solid phase barium at site GeoB 8455 could be explained by decreased dissolution rates of barite due to the changes in the concentration of barite in the sediment, as well as changes in the saturation state of fluids. Furthermore, the alteration of barite into witherite (BaCO3) via the transient phase barium sulfide could lead to the preservation of a former barite front as BaCO3. The calculations and modeling indicate that a relocation of the barite front to a shallower depth occurred between the last glacial maxium (LGM) and the Pleistocene/Holocene transition. We suggest that an upward shift of the SMT occurred at that time, most likely as a result of an increase in the methanogenesis rates due to the burial of high amounts of organic matter below the SMT.

Avian occupancy probabilities, vegetation structure, and presence of Northern Bobwhite (Colinus virginianus) in eastern and central Oklahoma (2009-2011)

Changes in land use and land cover throughout the eastern half of North America have caused substantial declines in populations of birds that rely on grassland and shrubland vegetation types, including socially and economically important game birds such as the Northern Bobwhite (Colinus virginianus; hereafter bobwhites). As much attention is focused on habitat management and restoration for bobwhites, they may act as an umbrella species for other bird species with similar habitat requirements. We quantified the relationship of bobwhites to the overall bird community and evaluated the potential for bobwhites to act as an umbrella species for grassland and shrubland birds. We monitored bobwhite presence and bird community composition within 31 sample units on selected private lands in the south-central United States from 2009 to 2011. Bobwhites were strongly associated with other grassland and shrubland birds and were a significant positive predictor for 9 species. Seven of these, including Bell's Vireo (Vireo bellii), Dicksissel (Spiza americana), and Grasshopper Sparrow (Ammodramus savannarum), are listed as species of conservation concern. Species richness and occupancy probability of grassland and shrubland birds were higher relative to the overall bird community in sample units occupied by bobwhites. Our results show that bobwhites can act as an umbrella species for grassland and shrubland birds, although the specific species in any given situation will depend on region and management objectives. These results suggest that efficiency in conservation funding can be increased by using public interest in popular game species to leverage resources to meet multiple conservation objectives.

Biogenic silica and silicic acid benthic fluxes of a North-eastern Atlantic Abyssal Locality

Within the framework of the EU-funded BENGAL programme, the effects of seasonality on biogenic silica early diagenesis have been studied at the Porcupine Abyssal Plain (PAP), an abyssal locality located in the northeast Atlantic Ocean. Nine cruises were carried out between August 1996 and August 1998. Silicic acid (DSi) increased downward from 46.2 to 213 µM (mean of 27 profiles). Biogenic silica (BSi) decreased from ca. 2% near the sediment-water interface to <1% at depth. Benthic silicic acid fluxes as measured from benthic chambers were close to those estimated from non-linear DSi porewater gradients. Some 90% of the dissolution occurred within the top 5.5 cm of the sediment column, rather than at the sediment-water interface and the annual DSi efflux was close to 0.057 mol Si/m**2/yr. Biogenic silica accumulation was close to 0.008 mol Si/m**2/yr and the annual opal delivery reconstructed from sedimentary fluxes, assuming steady state, was 0.065 mol Si/m**2/yr. This is in good agreement with the mean annual opal flux determined from sediment trap samples, averaged over the last decade (0.062 mol Si/m**2/yr). Thus ca. 12% of the opal flux delivered to the seafloor get preserved in the sediments. A simple comparison between the sedimentation rate and the dissolution rate in the uppermost 5.5 cm of the sediment column suggests that there should be no accumulation of opal in PAP sediments. However, by combining the BENGAL high sampling frequency with our experimental results on BSi dissolution, we conclude that non-steady state processes associated with the seasonal deposition of fresh biogenic particles may well play a fundamental role in the preservation of BSi in these sediments. This comes about though the way seasonal variability affects the quality of the biogenic matter reaching the seafloor. Hence it influences the intrinsic dissolution properties of the opal at the seafloor and also the part played by non-local mixing events by ensuring the rapid transport of BSi particles deep into the sediment to where saturation is reached.

Miocene planktonic foraminifera from the eastern equatorial Pacific

Neogene calcareous sediments were recovered at 11 sites along two north-south transects in the eastern equatorial Pacific Ocean during Ocean Drilling Program (ODP) Leg 138. An overview of planktonic foraminifer distribution in these sediments was presented in Mayer, Pisias, Janecek, et al. (1992) based on a preliminary examination of core-catcher samples. In general, the preservation state of the foraminifers is poor throughout most of the sedimentary sequences, making this microfossil group here of much less value for biostratigraphy than other microfossil groups. Pliocene-Pleistocene planktonic foraminifers from several sites have been analyzed in great detail for their oxygen and carbon isotope composition in various high-resolution studies (Farrell et al., this volume; Mix et al., this volume; Ravello et al., this volume; Shackleton et al., this volume). Planktonic foraminiferal datums of biostratigraphic value have been identified in several of these studies. This report presents planktonic foraminiferal distribution in selected Miocene sediments.