Numbers of coliforms, Escherichia coli, F-RNA phage, rotavirus, bovine enteric calicivirus and presence of non-O157 STEC on commercial vacuum packaged beef.

The numbers of coliforms, Escherichia coli, F-RNA coliphages, bovine enteric calicivirus (BEC) and rotavirus (RV) and presence of non-O157 shiga toxigenic E. coli (STEC) were determined on commercial vacuum packaged beef subprimals at the retail level from swabs obtained from the entire surfaces of 150 cuts that originated from federally and provincially registered plants. The prevalence and log mean numbers of E. coli were higher in provincially registered plants than in federally registered plants; 64% vs 20%, respectively, and -0.3 vs -1.22 log cfu/100 cm(2), respectively. In contrast, the prevalence and mean log numbers of F-RNA coliphages were lower for the provincially registered plants than for the federally registered plants; 31% vs 68% and -0.86 vs -0.13 log cfu/100 cm(2), respectively. One E. coli sample tested positive for stx2 and eae. F-RNA coliphages associated with human origin (GII/GIII) were detected in 12% and 30% of samples that originated from provincially and federally registered plants, respectively. RV RNA was detected in 4% of samples while BEC RNA was not detected. Although the infectivity of RV is unknown, the presence of viable F-RNA coliphages suggests that consumers could potentially be at risk when consuming undercooked meat that is contaminated with RV.

Empathetic maturity: theory of moral point of view in clinical relations.

The article describes a cognitive structural theory of how nurses conceive or understand the personhood of patients. The theory postulates three levels that have the properties of cognitive structures. The third and highest level is held to be a meta-ethical theory of the moral structure of care. For nurses operating with level-III understanding, critiques of justice and care-based ethics are further held to be synthesized within.

Policy implications of the biological model of mental disorder.

The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or 'truth' of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The nature of mental phenomena has been debated throughout history, without consensus. Several critiques of the biological model are offered to encourage enquiring scepticism. The policy implications discussed are political conservatism, broadened rationales for forced treatment, utility in managed care, and the use of medical necessity criteria to allocate treatment.

High-level expression of eukaryotic polypeptides from bacterial chromosomes.

Attractive economics and short development timelines have often been cited as reasons for using bacteria to express eukaryotic proteins on a commercial scale. Nevertheless, routine techniques for bacterial expression of heterologous proteins are beset by a variety of technical and legal difficulties. In particular, the use of plasmids to express foreign proteins, popular promoter systems, protein fusion partners, and histidine tags and the recovery of proteins from inclusion bodies are affected by a host of issued patents. Chromosomally encoded leaderless fusions (CELF) offer a variety of technical and legal advantages over existing bacterial expression systems. In this study, we show that CELF can be used to produce a wide assortment of eukaryotic proteins at 10-liter fermentation scale.

Clinically based managed mental health care.

Managed care models are on a continuum in terms of the amount of clinical involvement of the managed care agent. Managed care constitutes a fundamental shift in provider-reimburser relations. In the literature problems with managed care are identified and examined in the context of this shifting relationship. Models at three points on the continuum of clinical involvement are reviewed with regard to the identified problems, including two models with full clinical involvement. It is predicted that clinically based models will flourish and replace models with less clinical involvement because full clinical involvement solves many problems associated with other models.

A descriptive survey of management and operations at selected sports medicine centers in the United States.

No uniform guidelines for operations or accreditation standards for sports medicine center were available and, at the time of this study, little information on the management and operation of sports medicine centers was available in the literature. The purpose of the study was to determine the management structure and function of selected sports medicine centers in the United States. Questionnaires were mailed to 200 randomly selected centers throughout the United State from a directory of sports medicine centers published in Physician and Sportsmedicine (1992) to gather descriptive information on eight areas, including 1) general background, 2) staffing, 3) services, facilities, and equipment, 4) billing, collections, and revenue, 5) clientele, caseloads, and referrals, 6) ownership and financing, 7) school and club outreach contracts, and 8) marketing strategies and future trends. A total of 71 surveys (35.5%) were returned in the allotted time frame. Data were analyzed using ranges, means, medians, modes, and percentages. Results yielded several conclusions about sports medicine centers. Nearly all (93%) of the centers employed physical therapists; physical therapists were clinical directors at 70.2% of centers; orthopaedists were most often medical directors; rehabilitation was the most frequently offered service (93%); physical therapy produced the highest revenue; sports injuries accounted for a mean 34.5% of patients, who were mostly recreational or high school athletes between 13-60 years of age; primary shareholders were most often physical therapists or physicians; most were involved in outreach services for schools; marketing strategies primarily involved communication with referral sources; and managed care was identified most frequently as a trend affecting the future of sports medicine centers. Findings identified common aspects of sports medicine centers and may assist in establishing guidelines for operations or accreditation of sports medicine centers.

Provider choice: essential to autonomy or advertising gimmick?

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for autonomy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty. Patients attempting to choose the best practitioner do not have data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge. The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery system.

Ethical cautions in the use of outcomes for resource allocation in the managed care environment of mental health.

Increasingly, resources are being allocated through competitive contracting based on outcome data. This context for outcome research renews ethical concern about the nature of outcome data in the field of mental health. The epistemology of mental illness creates special concerns regarding outcome measurement. Ethical cautions specific to six types of outcome measurement are reviewed: utilization, clinician reports, patient reports, objective measures of diagnostic entities, objective measures of functioning and multifactor research. Brief guidelines are offered for addressing ethical cautions. Also discussed are the difficulty in defining good outcomes and a social obligation to future generations that may be better addressed through process measurements.

A treatment-team model of managed mental health care.

Many models of managed care have been criticized as inflexible and intrusive, including those in which decisions about level of care are made by third-party reviewers, in-house staff, or other clinicians not involved in the patient's treatment. The treatment-team model of managed care, which has been implemented in the emergency psychiatric service of a midsized, non-profit community hospital in a metropolitan area, addresses these criticisms. Major features of the model are in-person assessment by a clinician who acts as the managed care agent; immediate accessibility of this clinician; referral services with a broad range of intensity, including crisis intervention; and participation of the managed care clinician on the treatment team. The advantages of this model include the incentive to employ qualified managed care clinicians and an increased ability to provide individualized services. Limitations of the model include the diffusion of decision-making power within the treatment team, the potential for overuse of emergency services by primary providers, and the potential for the managed care agent to lose decision-making power due to personal or systems issues.

The ethical considerations of managed care in mental health treatment.

1. Managed care as a cost-cutting technique is becoming increasingly prevalent; one reason for its growth is the increasing number of people covered by health maintenance organizations and preferred provider organizations. 2. Ethical areas of concern raised by managed care include restrictions on patient autonomy of choice of treatment and treatment site; relationship between the nurse as a managed care agent and the patient; patient responsibility in treatment decisions made through managed care; and denial, curtailment, or alteration of access to treatment based on compliance. 3. Managed care is a tool to conserve and equitably distribute care resources. To be certain that managed care performs this function equitably, the profession must continue to examine managed care in the light of biomedical ethics.

Populations vulnerable to the ethics of caring.

This paper presents the argument that any patient population which can be perceived as being culpable for the pain they are in is vulnerable to the ethics of caring. First, both the ethics of caring and justice are reviewed, and the inadequacies of each, with regard to nursing, are discussed. The problems of the ethics of caring are demonstrated empirically and with interviews done by the author. Then the impacted populations are reviewed. The conclusion presents an emerging vision of synthesis between the moral concepts of caring and justice.

Cultural practices of Hispanics: implications for the prevention of AIDS.

PIP: Hispanic Americans have one of the highest rates of HIV seroprevalence among all ethnics groups in the US, with high rates being especially noticeable among women and children. Were it known which cultural factors have the most influence on whether Hispanics engage in high-risk behavior for HIV transmission, prevention interventions could be targeted accordingly. To that end, this study was mounted to identify which Hispanic cultural factors relate to condom use. 117 males and 73 females aged 17-56 years of mean age 25.67 were surveyed in Washoe county, Nevada. These mostly young adults had recently immigrated to the western US. It was initially posited that fate orientation, male- female relationships, family relationships, machismo behavior, and religion would have equal influence with respect to condom use. Analysis found that condom use was largely associated with and determined by men who are the principal buyers of condoms. A machismo attitude toward protecting women by using condoms was also associated with condom use. Neither fate orientation with respect to AIDS, nor religion were important determinants of condom use, even though 86.5% of the respondents were Catholic. The degree to which respondents adhered to traditional Hispanic cultural values was influenced by the degree of education and acculturation. On the basis of these findings, the authors suggest targeting AIDS prevention messages to males, while emphasizing the protection of women through condom use. They also suggest that both education and acculturation levels be assessed before implementing prevention programs.^ieng

Controversies in nursing ethics: a historical review.

The author critiques the dialectic between justice-based ethics and an ethic of caring from a historical perspective (by analogy with the dialectic between agape and friendship). Justice-based ethics have been problematic for nursing because of the decontextualized approach. The ethic of caring is problematic because caring, being contextual, is particularistic and therefore can be based on morally irrelevant factors, such as liking. There is a tradition of writing which seeks to reconcile the particularistic obligations of friendship with the moral duty to all others equally. Ideas from the following authors are reviewed for relevance to nursing: Aristotle, Aelred of Rievaulx, Augustine, John Cassian, Cicero, George Berkeley, Immanuel Kant, Michel de Montaigne, Jeremy Taylor and Max Weber. The authors concludes by noting that both sides of the dialectic are synthesized in the lived experience of individuals. A synthesis in thought is called for on this basis.

Laparoscopic cholecystectomy: cost analysis.

Recently laparoscopic cholecystectomy (LC) has become an accepted alternative to the traditional open cholecystectomy (OP). The purpose of this study was to compare laparoscopic cholecystectomy to open cholecystectomy with respect to four variables: (a) operative time, (b) length of hospital stay, (c) total hospital cost, and (d) morbidity and mortality rates. The most recent 200 LCs performed at HCA West Side Hospital were selected for comparison in the study. Demographic data, including age and sex were collected for all patients. The medical record for each patient was then reviewed to obtain the study variables. A control group of 200 patients undergoing elective open cholecystectomy over the same period was selected. Complications occurred in 12 patients (6.0%) in the LC group with one postoperative mortality. Nineteen patients (9.5%) suffered complications in the OC group with no operative mortality. The difference between the two groups was not statistically significant. The average length of operation (recorded in minutes) in the OC group was 87.79 (SD +/- 20.69) as compared to 103.78 (SD +/- 29.01) in the LC group. This difference proved to be slight, but significantly greater (p < 0.0001). The average length of stay (recorded in days) in the OC group was 4.43 (SD +/- 1.29) versus 1.13 (SD +/- .93) in the LC group. Again, the difference proved to be statistically significant (p < 0.0001). The corrected average total hospital charge from OC was $3,006 (SD +/- 755) versus $2,312 (SD +/- 484) for LC, a difference that was statistically significant (p < 0.0001). Laparoscopic cholecystectomy is a safe, effective, and cost-efficient alternative to open cholecystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Outpatient laparoscopic laser cholecystectomy.

Laparoscopic laser cholecystectomy has been performed clinically in the United States since 1988. After refinement of the technique, the procedure was offered on an outpatient basis. Eighty-three patients underwent laparoscopic laser cholecystectomy during the study period. Thirty-seven (45%) had the procedure as an outpatient. Younger patients were more suited for the outpatient procedure and those without previous surgery were more likely to have the procedure done as an outpatient. Weight, operating time, and gallbladder pathology were similar, although patients with acute inflammation of the gallbladder were more likely to require hospitalization. The primary reason for patient admission was patient preference.

A versatile and easily fabricated mouthstick.

More and more handicapped individuals may be seeking dental treatment. Treatment may include construction of special devices to help these patients lead more productive and fulfilling lives. A mouthstick has been designed that can be constructed from readily available parts. The versatility and decreased cost of the mouthstick make it readily available to these needy patients.