Developmental factors that influence sow longevity.

The length of adult sow life is now recognized as both an economic and a welfare concern. However, there are no consistent definitions to measure sow longevity. This study assessed 6 different descriptions of longevity and determined their relationship with developmental performance factors. Longevity definitions included stayability (probability of a sow producing 40 pigs or probability of her reaching 4 parities), lifespan (number of parities a female has accumulated before culling), lifetime prolificacy (number of pigs born alive during the productive lifetime of a female), herd life (time from first farrowing to culling), and pigs produced per day of life. Data consisted of 14,262 records of Yorkshire females from both nucleus and multiplication herds across 21 farms from 4 seedstock systems. Within a subset of the data, information was available on the litter birth record of the female and her growth and composition data. Therefore, data were subdivided into 2 data sets, consisting of 1) data A, data from the farrowing records of a female, and 2) data B, data A and information from the litter birth record of a female and the growth and backfat data from a female. A Cox proportional hazards model was used to determine the relationship of developmental factors and first farrowing record with longevity. Those factors that were significantly (P < 0.0001) associated with longevity, regardless of definition, were age at first farrowing, litter size at first farrowing and last farrowing, number of stillborn in the first litter, adjusted 21-d litter weight of the first litter, herd type, backfat, and growth. Within a contemporary group, fatter, slower growing gilts had a decreased risk of being culled. Additionally, sows that had more pigs born alive, fewer stillborn pigs, and heavier litters at 21 d of lactation in their first litter had a decreased risk of being culled. Furthermore, sows from nucleus herds experienced a greater risk of being culled. Many factors affected longevity, regardless of definition. Pork producers can implement management protocols that can extend the productive life of breeding females, resulting in improved profitability and animal welfare.

Quantitative trait locus mapping in an F2 Duroc x Pietrain resource population: II. Carcass and meat quality traits.

Pigs from the F(2) generation of a Duroc x Pietrain resource population were evaluated to discover QTL affecting carcass composition and meat quality traits. Carcass composition phenotypes included primal cut weights, skeletal characteristics, backfat thickness, and LM area. Meat quality data included LM pH, temperature, objective and subjective color information, marbling and firmness scores, and drip loss. Additionally, chops were analyzed for moisture, protein, and fat composition as well as cook yield and Warner-Bratzler shear force measurements. Palatability of chops was determined by a trained sensory panel. A total of 510 F(2) animals were genotyped for 124 microsatellite markers evenly spaced across the genome. Data were analyzed with line cross, least squares regression interval, mapping methods using sex and litter as fixed effects and carcass weight or slaughter age as covariates. Significance thresholds of the F-statistic for single QTL with additive, dominance, or imprinted effects were determined on chromosome- and genome-wise levels by permutation tests. A total of 94 QTL for 35 of the 38 traits analyzed were found to be significant at the 5% chromosome-wise level. Of these 94 QTL, 44 were significant at the 1% chromosome-wise, 28 of these 44 were also significant at the 5% genome-wise, and 14 of these 28 were also significant at the 1% genome-wise significance thresholds. Putative QTL were discovered for 45-min pH and pH decline from 45 min to 24 h on SSC 3, marbling score and carcass backfat on SSC 6, carcass length and number of ribs on SSC 7, marbling score on SSC 12, and color measurements and tenderness score on SSC 15. These results will facilitate fine mapping efforts to identify genes controlling carcass composition and meat quality traits that can be incorporated into marker-assisted selection programs to accelerate genetic improvement in pig populations.

Quantitative trait loci mapping in an F2 Duroc x Pietrain resource population: I. Growth traits.

Pigs from the F(2) generation of a Duroc x Pietrain resource population were evaluated to discover QTL affecting growth and composition traits. Body weight and ultrasound estimates of 10th-rib backfat, last-rib backfat, and LM area were serially measured throughout development. Estimates of fat-free total lean, total body fat, empty body protein, empty body lipid, and ADG from 10 to 22 wk of age were calculated, and random regression analyses were performed to estimate individual animal phenotypes representing intercept and linear rates of increase in these serial traits. A total of 510 F(2) animals were genotyped for 124 micro-satellite markers evenly spaced across the genome. Data were analyzed with line cross, least squares regression, interval mapping methods using sex and litter as fixed effects. Significance thresholds of the F-statistic for single QTL with additive, dominance, or imprinted effects were determined at the chromosome- and genome-wise levels by permutation tests. A total of 43 QTL for 22 of the 29 measured traits were found to be significant at the 5% chromosome-wise level. Of these 43 QTL, 20 were significant at the 1% chromosome-wise significance threshold, 14 of these 20 were also significant at the 5% genome-wise significance threshold, and 10 of these 14 were also significant at the 1% genome-wise significance threshold. A total of 22 QTL for the animal random regression terms were found to be significant at the 5% chromosome-wise level. Of these 22 QTL, 6 were significant at the 1% chromosome-wise significance threshold, 4 of these 6 were also significant at the 5% genome-wise significance threshold, and 3 of these 4 were also significant at the 1% genome-wise significance threshold. Putative QTL were discovered for 10th-rib and last-rib backfat on SSC 6, body composition traits on SSC 9, backfat and lipid composition traits on SSC 11, 10th-rib backfat and total body fat tissue on SSC 12, and linear regression of last-rib backfat and total body fat tissue on SSC 8. These results will facilitate fine-mapping efforts to identify genes controlling growth and body composition of pigs that can be incorporated into marker-assisted selection programs to accelerate genetic improvement in pig populations.

Reengineering clinical psychiatry in academic medical centers: processes and models of change.

Managed care poses a major threat to the future of clinical psychiatry in academic settings. High costs and an aversion to the business aspects of service delivery have left academic departments at a disadvantage in the marketplace. However, numerous departments have attempted to adapt to the current health care environment. On the basis of a review of these efforts, the authors identify the processes of change and seven models of change being employed to reengineer psychiatry within academic medical centers. The models are labeled transform, build, manage, buy, partner or affiliate, sell or lease, and consult. The authors discuss the strengths and weaknesses of these efforts and suggest three approaches to establishing the unique value of academic clinical services for purchasers and for the public. The first is to enhance productivity and clinical effectiveness through greater integration of clinical care, research, and training. The second is to take a leadership role in managing care, and the third is to advance the integration of behavioral health care with primary medical care and other specialties in the medical center.

Understanding managed behavioral health care.

Managed care can be understood from an historical perspective as a reaction to perceived abuses by providers or an extension of earlier efforts to manage care in the public sector. It can be viewed as a young and emerging force--a fourth party to the health care transaction--that is rapidly progressing through a series of generations that redefine the approach to organizing and delivering services. And finally, because managed care emerges with so many faces, consumers and providers can perhaps best understand its implementation in a specific state or community by examining the multiple dimensions, such as those outlined herein, on which these initiatives vary. Until the forms and functions are more uniform, no simple definition of managed care will exist.

Psychiatric residency training, managed care, and contemporary clinical practice.

Managed care has transformed the health care environment that residents encounter on completion of their training. Unfortunately, residency education has not kept pace with changes in the field, leaving graduates inadequately prepared. The authors identify necessary changes in the residency training tasks of instilling values, imparting required knowledge, building core skills, selecting appropriate training sites, and offering a diversity of instructors and supervisors. They also discuss the obstacles that have impeded the evolution of academic clinical services and clinical training. They suggest strategies of change that may lead to more relevant educational programs that provide residents with a balanced perspective on the strengths and weaknesses of both traditional and contemporary approaches to delivering care.

The case against outpatient commitment.

Among individuals with severe mental illness, a small proportion commit violent acts. Since these individuals are often not engaged in ambulatory treatment, there has been a move in the states to legislate and implement outpatient commitment programs. The American Psychiatric Association Council on Psychiatry and Law has issued a Resource Document that supports the use of mandatory outpatient treatment. The purpose of this article is to challenge the logic and legitimacy of using the courts to force treatment compliance of individuals who are neither incompetent by legal standards nor at imminent risk of harming themselves or others.

Ten dimensions of public-sector managed care.

Managed care in the public sector remains a poorly defined concept. It is currently understood largely through case examples, an approach of limited usefulness because each managed care initiative is shaped by local forces and is constantly changing. The authors describe ten key dimensions on which such initiatives vary and suggest that they can be used to examine essential characteristics of the initiatives and core differences between them. The dimensions are objectives, scope, organizational structures and authority, enrollment, benefit package, strategies for managing utilization, best practices, financing, quality management and outcomes measurement, and the impact of the initiative on the public mental health system. Using these dimensions to assess existing initiatives, the authors conclude that most focus on one principal dimension to the exclusion of other critical dimensions. The authors argue for a comprehensive approach to planning and implementing managed care projects that should ultimately lead to better care for public-sector populations.

Services for mentally ill homeless persons: street-level integration.

The key elements of a systems integration approach to delivery of human services are reviewed in terms of their application to services for mentally ill homeless persons. The example of a mental health outreach project illustrates the service- and systems-integrating influences of clinical case management with this population, and the ability of a "bottom-up" street-level approach to improve coordination and service accessibility for clients in general is discussed.

Organizational development strategies for integrating mental health services.

The recent debates about health care reform have focused attention on the need to develop organized systems of care capable of delivering comprehensive services which are coordinated or integrated. Achieving service integration has emerged as a central and pressing objective in most mental health systems in response to existing difficulties with fragmentation of care. However, attempts at service integration often fail at the implementation stage as provider agencies zealously guard their organizational boundaries and struggle with each other for power and control. In this article, the authors formulate an organizational development approach to service integration that focuses on reducing the rigid maintenance of agency boundaries by developing informal networks among staff of local provider agencies. Eight strategies, drawn from the research literature on services integration and recently implemented by a local mental health authority, are described as potential tools for use by systems managers in accomplishing these goals.

Managed care, health care reform, and academic psychiatry.

Although the process of national health care reform has slowed, state-based reform initiatives and market forces driven by managed care are dramatically reconfiguring the health care environment This decentralized process of health care reform poses numerous threats to academic departments of psychiatry, which must develop strategic plans to cope with the changes. The authors outline the effects of health care reform on clinical service, education, and research and discuss strategies of response in each domain, including examples from their department at Yale University. An active response to health care reform provides academic departments of psychiatry an opportunity to participate in shaping the future of psychiatry while reorganizing their teaching and research programs. (Academic Psychiatry 1997;21:72-85).

Defining managed care in public-sector psychiatry.

Although managed care is an established force in the private sector, there is growing interest and experimentation with this concept in the public sector. This interest has been generated by the increased demand for services, the shrinking resource base due to cutbacks in state budgets, and the fragmentation of care that has accompanied the shift from a centralized, hospital-based model to a decentralized, community-based model for treating individuals with serious mental illness. But despite this interest, no consensus exists about the form or functions of managed care in the public arena. Simply importing private-sector versions of managed care is inadequate given the substantial differences in the patient population and service delivery mechanisms. The authors present a functional analysis of managed care in the public sector. Drawing on their conceptualization of managed care, they outline a functional approach to evaluating the strengths and weaknesses of treatment systems, innovations such as privatization and capitation, and recent health care reform proposals.

The evolution of mental health services: partial hospitalization as a case example.

Controversy exists regarding the current status, merits, and future of partial hospitalization. Originally conceptualized as one of the least restrictive modalities for treating acutely ill or highly impaired individuals in the community, these functions increasingly are being addressed by rehabilitation programs and assertive or intensive outpatient treatments. At the same time, third-party payers, such as managed-care firms, are extending coverage for the partial-hospital modality. We use the current debates about the merits of this modality to identify potential forces that impede and promote the evolution of mental health services. Specifically, we use this case example to illustrate four prevailing myths about the manner in which services evolve.

The promise of partial hospitalization: a reassessment.

In this review of trends in partial hospitalization since 1987, the authors provide a brief overview of the field, summarize recent research findings, examine the data on the growth of partial hospitals, and outline recent changes in public- and private-sector use of this treatment modality. Support for intermediate and long-term partial hospitalization is diminishing rapidly, while support for short-term partial hospitalization as an alternative to inpatient care is increasing in the private sector and diminishing in the public sector. The future for partial hospitals seems uncertain, as the treatment functions of these programs are being assumed by psychosocial and vocational rehabilitation programs and assertive community treatment teams. In light of these trends, the authors recommend new directions for partial hospital research involving comparisons between short-term day hospitalization and intensive outpatient interventions.

Overnight hospitalization of acutely ill day hospital patients.

As the trend toward community-based treatment of the seriously mentally ill has continued, partial hospital programs have admitted an increasing number of highly symptomatic individuals. As a result, patient crises occur more often in these programs, and staff have had to develop novel crisis intervention strategies that do not rely on standard hospital care. One such strategy involves the use of "overnight hospitalization" or a "backup bed" to provide temporary safety and clinical management with the goal of returning the patient to the partial hospital within 24 hr. Given the lack of data on this intervention the present study was designed to provide further information about the implementation and effectiveness of this clinical strategy. The authors outline the rationale and procedures for a backup bed system and provide data on outcome that is drawn from an examination of backup bed utilization in a public-sector mental-health setting over a 1-year period. Clinical implications of the findings for future use of overnight hospitalization with partial hospital patients are reviewed.