Enhancing Physician Managerial Capabilities: Partnership between Medicine and Business.

This article was migrated. The article was marked as recommended. Background Physicians are typically appointed to leadership roles within health care organizations on the basis of individual accomplishments in research, education, and/or clinical care. However, these types of achievements seldom provide the requisite management capabilities to lead within health organizations. In this manuscript, we described our initial experience in developing an in-house program to provide current and aspiring physician leaders with the managerial capabilities to enhance the quality of health care delivery within their respective organization. Methods In a partnership established between a Medical School and a Business School, we designed two series of weekend workshops to provide current and aspiring physician leaders with the financial capabilities to assist them in their future healthcare leadership careers. This course was then expanded to a Management Principles for Physician workshop with open enrollment to physicians at all levels. Baseline demographics and participant evaluations of each course were recorded. In the open enrollment Management Principles for Physician workshop, we examined the relationship between participant background and their course evaluations as well as their areas of interest for further training. Results All 3 workshops received excellent evaluations by participants. The positive impact of the open enrollment program, based on participants' self-evaluations, was the highest in female physicians, as well as early to mid-career physicians. Additionally, physicians who do not currently hold leadership positions and those who are leading at Divisional levels were the most interested in further training in finance. Conclusion In summary, this series of workshops demonstrated the feasibility of an in-house physician leadership program and yielded important information for the design of future leadership development curriculum.

Quantification of wastewater sludge dewatering.

Quantification and comparison of the dewatering characteristics of fifteen sewage sludges from a range of digestion scenarios are described. The method proposed uses laboratory dewatering measurements and integrity analysis of the extracted material properties. These properties were used as inputs into a model of filtration, the output of which provides the dewatering comparison. This method is shown to be necessary for quantification and comparison of dewaterability as the permeability and compressibility of the sludges varies by up to ten orders of magnitude in the range of solids concentration of interest to industry. This causes a high sensitivity of the dewaterability comparison to the starting concentration of laboratory tests, thus simple dewaterability comparison based on parameters such as the specific resistance to filtration is difficult. The new approach is demonstrated to be robust relative to traditional methods such as specific resistance to filtration analysis and has an in-built integrity check. Comparison of the quantified dewaterability of the fifteen sludges to the relative volatile solids content showed a very strong correlation in the volatile solids range from 40 to 80%. The data indicate that the volatile solids parameter is a strong indicator of the dewatering behaviour of sewage sludges.

Dry stacking of wastewater treatment sludges.

Drying pans are used during wastewater treatment (WWT) to store, stabilise and dry residual solids. The pans are filled with sludge that dries via exposure to sunshine and wind. We propose that drying pans be operated based on dry stacking principles, a technique with proven success in the mineral processing industry. The implementation of the dry stacking technique requires very little in the way of additional engineering beyond a conventional drying pan. By applying the sludge in thin layers, the sludge naturally forms its own stack with an angle that is dependent on the consistency of the material. The benefits of dry stacking are that the slope allows instantaneous run-off of rainfall and supernatant, allowing operation throughout the year rather than seasonally. The layering approach also maximises the evaporation achieved in the available deposition area compared to filling the pans sequentially. A series of laboratory tests were carried out on samples from Melbourne Water's Western Treatment Plant in Werribee, Australia, to provide validation of the dry stacking concept for WWT sludges. Rheological tests showed that samples had appropriate flow properties to form stacks. Drying and re-wetting tests on the samples indicated that a sloped, partially dry sludge sheds rainfall, depending on the slope, cake dryness and amount of rainfall. Local rainfall data was used to estimate a potential increase in pan throughput of 65%-140% due to dry stacking. The greatest improvements were predicted to occur during wetter years. In combination, the results indicated that dry stacking has the potential to dramatically improve the performance of WWT sludge drying pans.

Direct force measurement between bio-colloidal Giardia lamblia cysts and colloidal silicate glass particles.

Force-separation measurements between Giardia lamblia cysts and an inorganic oxide (silicate glass) have been obtained by using an atomic force microscope (AFM). The cysts are compressible on the scale of the loads applied during force measurement, with the surface compressibility expressed in terms of an interfacial spring constant (K(int)). The force of interaction prior to this Hookean region, on approach, is long-range and repulsive. The long-range force has been compared to models of the electrical double layer as well as an electrosteric layer. The comparison has led to the conclusion that the cyst surface can be described as a polyelectrolyte brush at intermediate separations (5-115 nm from linear compliance) with an electrical double layer often observed at larger separations. The dependence of the interaction force on surface retraction suggests that tethering between the cyst and siliceous surface can occur. The variation of the interaction with pH and upon variation with ionic strength has also been assessed. The information gained from the measurement of the interaction between G. lamblia and this model sandlike surface informs water treatment processes. Similar studies have been performed by us for the Cryptosporidium parvum (C. parvum) oocyst system to which this work is compared.

Assessing attitudes toward electronic prescribing adoption in primary care: a survey of prescribers and staff.

BACKGROUND: Using survey instruments to assess physicians' attitudes toward electronic health record (EHR) adoption has been an ongoing area of research. No instrument has emerged for widespread use. OBJECTIVE: We used a theoretically-based, 37-question survey instrument to assess attitudes toward electronic (e-) prescribing adoption in the context of an existing EHR. Our objective was to elicit information to inform strategies to maximise adoption. METHODS: The instrument assesses attitudes in four domains: finesse, intent to use technology, perceived usefulness and perceived ease of use. Two additional questions ask about computer use at home and self-assessed computer knowledge. We administered the instrument to prescribers and staff at three primary care sites between 2005 and 2007. Each site represented a unique transition from paper-based or partial (Phase 1) to full (Phase 2) e-prescribing use. RESULTS: Fifty-nine prescribers (82% response) and 58 staff (50% response) completed the survey. At the paper-based site, domain scores increased significantly from Phase 1 to Phase 2 for intent to use technology for both prescribers (4.8 to 5; P<0.04) and staff (4 to 5; P<0.03); and for perceived usefulness for staff (3.7 to 4.6; P<0.02). For prescribers, significant associations (P<0.05) were found between computer use at home for professional use and each domain score; and between computer knowledge and three of the four domains. Self-assessed computer knowledge was consistently rated as intermediate, vs novice or expert. CONCLUSIONS: Domain scores improved. Prescribers' self-assessment of computer use at home and computer knowledge predicted attitudes toward adoption. This instrument may be useful in tailoring strategies for successful adoption.

The role of hydrostatic pressure on developmental stages of Pomatoceros lamarcki (Polychaeta: Serpulidae) exposed to water accommodated fractions of crude oil and positive genotoxins at simulated depths of 1000-3000 m.

The effect of high hydrostatic pressures on the ecotoxicological profile of pollutants is an unexplored research area. Using Pomatoceros lamarcki as a surrogate organism for this eco-barotoxicological study, it was found that in a 48 h larval bioassay with water accommodated fractions (WAF) of crude oil of up to 15.1 mg L(-1) (total hydrocarbon content) and hydrostatic pressures up to 300 bar (3000 m), an additive response was found (p < 0.001) rather than any synergism (p = 0.881). Comprehensive cytogenetic analysis of 6-h (15 degrees C) embryos exposed to WAF (0.19 mg L(-1)) at 100 bar showed no effects on mitotic fidelity or cell division rate over the 1 bar treatment. However, embryo's treated with the clastogen mitomycin-c at 100 bar exhibited a significant increase in mitotic aberrations over 1 bar treated as was the case with hypo/hypersaline treatments (p < 0.05). Conversely, an increase in hydrostatic pressure actually reduced the effects of spindle inhibition by the aneugen colchicine (p < 0.05).

Assessing dewatering performance of drinking water treatment sludges.

A comparison of the dewaterability of a range of water treatment plant sludges has been completed through computation of dewatering performance indicators for a diaphragm filter press. Real parameter data, obtained from the characterisation of alum and ferric sludges, generated under precisely controlled conditions, was used for input to a phenomenological model. Comparisons of dewaterability based on throughput curves largely agree with previous analysis of the underlying parameter data. The difference in approach provides a quantification of benefit. Greater throughputs and output concentrations are predicted at the lowest coagulant doses and at pH approximately 6. Typical industrial cloth resistances consistently reduce throughput by a factor of 3-7, but the assessment of relative benefit is shown to be insensitive to this parameter. Quantitative agreement of the predictions with observed performance can be attained. Finally, the twin effects of solids loading and dewaterability are assessed together, showing that each has a significant influence on the required filter surface area. This quantification shows that high coagulant doses adversely affect both of these aspects, leading to filter area requirements larger than might otherwise be expected.

Multi-scale Cryptosporidium/sand interactions in water treatment.

Owing to its widespread occurrence in drinking water supplies and its significant resistance to environmental stresses, Cryptosporidium parvum is regarded as one of the most important waterborne microbial parasites. Accordingly, a substantial research effort has been aimed at elucidating the physical, chemical and biological factors controlling the transport and removal of Cryptosporidium oocysts in natural subsurface environments and drinking water treatment facilities. In this review, a multi-scale approach is taken to discuss the current state-of-knowledge on Cryptosporidium-sand interactions at a nano-scale, bench-scale and field-scale relevant to water treatment operations. Studies conducted at the nano-scale and bench-scale illustrate how techniques based on the principles of colloid and surface chemistry are providing new insights about oocyst-sand interactions during transport of Cryptosporidium oocysts in granular porous media. Specifically, atomic force microscopy and impinging jet experiments reveal the importance of oocyst surface biomolecules in controlling Cryptosporidium/sand interactions by a mechanism of steric hindrance. Traditional bench-scale column transport studies conducted over a broad range of experimental conditions highlight the role of physicochemical filtration and physical straining in the removal of oocysts from the pore fluid. Such experiments have also been used to evaluate the influence of biofilms formed on grain surfaces and the presence of natural organic matter on oocyst-sand interactions. Whilst filtration studies conducted at the plant-scale have been useful for evaluating the effectiveness of various materials as surrogates for Cryptosporidium oocysts, at this macro-scale, little could be learnt about the fundamental mechanisms controlling oocyst-sand interactions. This review of the literature on Cryptosporidium-sand interactions at different length scales points to the importance of combining studies at the plant-scale with well-controlled investigations conducted at the nano- and bench-scales. Furthermore, because oocyst surface properties play an important role in controlling the extent of interaction with sand surfaces, a thorough discussion of Cryptosporidium oocyst characteristics and electrical properties is presented.

The effects of hydrostatic pressure change on DNA integrity in the hydrothermal-vent mussel Bathymodiolus azoricus: implications for future deep-sea mutagenicity studies.

Comet and agarose gel electrophoresis (AGE) assays were used to show that haemocytes (blood cells) and gill tissues of vent mussels, Bathymodiolus azoricus, are sensitive to hydrostatic pressure change, but can repair DNA damage induced by retrieval from 840 m to the sea surface. In contrast, animals collected from 1700 m survived for only a few days in the laboratory, which was reflected in their poor DNA quality. These findings support the hypothesis of a physiological barrier to survival around 1000-1500 m depth, which these results show affects both vent and non-vent species alike. Based on in vitro experimental exposures to hydrogen peroxide and MMC, vent mussels appear to have sensitivities to the environmental mutagens that are not significantly different from those of coastal mussels.

Toxic vents and DNA damage: first evidence from a naturally contaminated deep-sea environment.

Levels of DNA strand breakage were measured, using the comet assay, in cells from vent mussels, Bathymodiolus azoricus, from three contrasting vent fields on the mid Atlantic Ridge. Different levels of DNA damage were recorded in untreated mussels, shortly after collection, and it was animals from the shallowest, and less active, Menez Gwen vent field (840-m depth), which showed the greatest amount of damage. In contrast to animals from two deeper and putatively more toxic sites, Menez Gwen animals went on to repair this damage and were able to survive under laboratory conditions at 1 bar pressure for several months. Animals from the two deeper sites showed both higher levels of initial mortality and a much reduced capacity for survival at 1 bar. The differences in DNA damage levels at the time of collection were interpreted as an expression of differences in cell viability/enzyme activity rather than a reflection of any differences in their natural environmental conditions. Small B. azoricus showed a capacity to repair DNA damage, whereas this ability appeared to be lacking in large individuals. By reproducing at a relatively early age, the deep-sea vent fauna may be able to resist the toxic effects of its environment by exploiting this natural, stage specific capacity to repair damaged DNA.

Marine invertebrate eco-genotoxicology: a methodological overview.

The last 25 years have seen major advances in the field of mammalian genotoxicology, particularly with the advent of molecular methods, some of which have spilled over into the relatively new field of eco-genotoxicology, which aims to evaluate the impact of contaminants on the natural biota. Unlike mammalian genotoxicology, where the focus is centred on a limited number of model species, efforts in the marine field have generally lacked coordination and focus, with the result that progress has been somewhat slow and fragmented. However, it is recognized that at the DNA and chromosome levels, marine invertebrates express qualitatively similar types of induced damage to that found in higher organisms (e.g. point mutations, strand breaks and chromosomal aberrations). Given that many of these species (bivalve molluscs, crustaceans, polychaete worms, etc.) are linked directly or indirectly to the human food chain, this is an important reason why one should be concerned about their exposure to environmental mutagens and carcinogens, particularly as many of these organisms have the capacity to (i) transform these agents to biologically active metabolites and (ii) accumulate toxicants in their cells and tissues at concentrations several orders of magnitude above that found in the environment. This review covers the advantages and limitations of those cytogenetic and molecular assays that have been used to address the question of genotoxicity in the cells and early life stages of selected marine invertebrate species. It concludes with the recommendation for the adoption of standardized test procedures, leading to a tiered approach in future eco-genotoxicity testing.

Oocysts of Cryptosporidium parvum and model sand surfaces in aqueous solutions: an atomic force microscope (AFM) study.

Oocysts of C. parvum have been associated with several waterborne outbreaks of gastro-enteric disease. Currently, one of the main barriers to oocyst contamination of drinking waters is provided by sand-bed filtration. In this study an atomic force microscope (AFM) has been used to measure the force of interaction between oocysts of C. parvum and a model sand surface (silicate glass). The AFM force curves have been compared and contrasted with the corresponding electrical potentials obtained from electrophoretic measurements (zeta). It has been found that the surface of C. parvum oocysts possesses a hairy layer, most likely a result of surface proteins extending into solution. The hairy layer imposes a steric repulsion between the oocyst and sand surface, in addition to any electrostatic repulsion. The hairy layer collapsed to varying extents in the presence of dissolved calcium and dissolved organic carbon, indicating that the oocysts may be more readily adsorbed onto the model sand surface under these conditions. Conversely, as the two surfaces are pulled apart, the occasional attachment of oocyst surface proteins to the model sand surface can result in adhesion. The AFM results offer new insights into the oocyst surface of C. parvum, and the mechanism of interaction with model sand surfaces under conditions relevant to sand-bed filtration.

Numerical chromosomal aberrations in the early life-history stages of a marine tubeworm, Pomatoceros lamarckii (Polychaeta: Serpulidae).

The marine environment provides a sink for a host of toxic chemicals, directly or inadvertently, released as a result of human activity. Some of these chemicals have the potential to act as aneugens, substances that cause numerical chromosomal aberrations (NCAs). NCAs are one of the most important classes of genetic abnormality and are implicated in a variety of deleterious effects, including premature ageing, birth defects and cancer. Clearly, any increase in the incidence of these agents in the marine environment poses a risk to the indigenous biota and its predators, including man. In this paper, we describe our recent success with applying the fluorescence in situ hybridisation technique (FISH) to detect NCAs in the interphase cell nuclei of Pomatoceros lamarckii, a common rocky shore invertebrate. Given the lack of requirement for any detailed cytogenetic knowledge, the method holds considerable promise for laboratory and field studies in general, and should lend itself to automated screening protocols, where large numbers of cells can be screened rapidly, for example, using a flow cytometer. When exposed either under acute or chronic (viz. adult) exposure conditions, colchicine and di-butylphthalate (DBP) (a widely-used plasticiser), two recognised aneugens, induced significant increases in the levels of NCAs, in the dose range 1 x 10(-6)-5 x 10(-6) M, in both four to eight cell embryo stages and 24 h-old larvae. In keeping with the severely debilitating effects of this class of agent, an inverse correlation was observed between the induced levels of NCAs and larval fitness based on the results of a standard 48-h larval bioassay.

Effects of cadmium on nuclear integrity and DNA repair efficiency in the gill cells of Mytilus edulis L.

Although the effects of heavy metals on marine invertebrate species are well studied in term of their toxicity and bioaccumulation, less is known about their genotoxicity. The aim of this investigation was to assess the DNA damaging potential of cadmium (Cd) in an important pollution sentinel organism, the mussel Mytilus edulis. Cadmium is one of the most toxic and widespread heavy metals found in the marine environment, and is a recognised carcinogen in mammals. Based on the results of the comet assay (alkaline single cell gel electrophoresis), Cd was found not to be genotoxic in mussel gill cells under acute and chronic exposure conditions, whereas pre-exposure to low concentrations of Cd was found to enhance the genotoxicity of another mutagen, hydrogen peroxide (H2O2). The effects of H2O2 were normally reversible when cells were transferred to clean saline buffer. However, in cells that had been pre-treated with Cd, in vivo or in vitro, we observed a decrease in this post-treatment DNA repair. The effects of Cd were reversed by zinc which suggests that the inhibitory effect of Cd on DNA repair was due to the displacement of zinc ions from active sites on proteins involved in the repair process (a property already described for mammals). Moreover, since Cd inhibits or delays the onset of apoptosis (programmed cell death), this removes one of the main defence mechanisms responsible for protecting the organism against neoplasia. There appears to be a close similarity between the effects of Cd on marine molluscs and mammals.