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Procurement
Kinds of Procurement Terms modified by Procurement Selected AbstractsCOMPETITION AND COST OVERRUNS IN PROCUREMENT,THE JOURNAL OF INDUSTRIAL ECONOMICS, Issue 4 2007JUAN-JOSÉ GANUZA Most cases of cost overruns in public procurement are related to important changes in the initial project design. This paper provides a rationale for the observed pattern in public procurement of underinvestment in design specification. We propose a two-stage model in which the sponsor first decides how much to invest in design specification and auctions the project to horizontally differentiated contractors. After the contract has been awarded and implemented, the sponsor and contractor receive new information about the optimal project design and renegotiate the contract to accommodate changes in the initial project's design. We show that the sponsor's optimal strategy is to underinvest in design specification, which makes significant cost overruns likely. Since no such underinvestment occurs when contractors are not horizontally differentiated, cost overruns are seen to arise as a consequence of lack of competition in the procurement market. [source] OLDOWAN RAW MATERIAL PROCUREMENT AND USE: EVIDENCE FROM THE KOOBI FORA FORMATION,ARCHAEOMETRY, Issue 1 2009D. R. BRAUN Raw material availability has been shown to be a major factor affecting the material culture of Oldowan tool users. Studies of artefact provenance often focus on site-specific raw material availability. Here, we use data from primary and secondary sources of raw material to develop a model of basin-scale stone availability in the eastern Turkana Basin, during the KBS and Okote Members of the Koobi Fora Formation. ED-XRF was used as a method of characterizing raw material sources and artefacts using trace elements. This model is applied to the site of FxJj 50 to investigate transport and discard patterns. [source] The Impacts of Supermarket Procurement on Farming Communities in India: Evidence from Rural KarnatakaDEVELOPMENT POLICY REVIEW, Issue 4 2010Bill Pritchard The rapid expansion of supermarket retailing, with its impact on farmer communities, represents a contentious part of India's recent economic development. This article reports on three districts of Karnataka, where a survey of 78 farmers supplying fruits and vegetables to Reliance Fresh, a leading supermarket chain, reveals low levels of vertical co-ordination, a lack of written contracts, and highly competitive environments, with the quality parameters used by supermarkets specifying only a limited set of conditions. These findings suggest that supermarket-led restructuring in India has not yet reached a stable institutional situation. [source] Collusive Market Sharing and Corruption in ProcurementJOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 4 2006Ariane Lambert-Mogiliansky This paper investigates links between corruption and collusion in procurement. A first-price multiple-object auction is administered by an agent who has legal discretion to allow for a readjustment of (all) submitted offers before the official opening. The agent may be corrupt, that is, willing to "sell" his decision in exchange for a bribe. Our main result shows that the corrupt agent's incentives to extract rents are closely linked with that of a cartel of bidders. First, collusive bidding conveys value to the agent's decision power. Second, self-interested abuse of discretion to extract rents (corruption) provides a mechanism to enforce collusion. A second result is that package bidding can facilitate collusion. We also find that with corruption, collusion is more likely in auctions where firms are small relative to the market. Our main message to auction designers, competition authorities and criminal courts is that risks of collusion and of corruption must be addressed simultaneously. Some other policy implications for the design of tender procedures are discussed. [source] Understanding Buyer and Supplier Power: A Framework for Procurement and Supply CompetenceJOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 2 2001Andrew Cox [source] Human leukocyte antigen and adult living-donor liver transplantation outcomes: An analysis of the organ procurement and transplantation network database,LIVER TRANSPLANTATION, Issue 10 2007S. Simona Jakab Human leukocyte antigen (HLA) compatibility has no clinically significant impact in cadaveric liver transplantation. Less is known regarding living-donor liver transplantation (LDLT). Our prior analysis of the Organ Procurement and Transplantation Network (OPTN) database suggested a higher graft failure rate in patients who underwent LDLT from donors with close HLA match. We further investigated the effect of HLA-A, -B, and -DR matching on 5-yr graft survival in adult LDLT by analyzing OPTN data regarding adult LDLT performed between 1998 and 2005. We evaluated associations between 5-yr graft survival and total, locus-specific, and haplotype match levels. Separate analyses were conducted for recipients with autoimmune (fulminant autoimmune hepatitis, cirrhosis secondary to autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis) or nonautoimmune liver disease. Multivariable Cox proportional hazard models were used to evaluate interactions and adjust for potential confounders. Among 631 patients with available donor/recipient HLA data, the degree of HLA match had no significant effect on 5-yr graft survival, even when analyzed separately in recipients with autoimmune vs. nonautoimmune liver disease. To be able to include all 1,838 adult LDLTs, we considered a first-degree related donor as substitute for a close HLA match. We found no difference in graft survival in related vs. unrelated pairs. In conclusion, our results show no detrimental impact of close HLA matching on graft survival in adult LDLT, including in recipients with underlying autoimmune liver disease. Liver Transpl 13:1405,1413, 2007. © 2007 AASLD. [source] Redrawing organ distribution boundaries: Results of a computer-simulated analysis for liver transplantationLIVER TRANSPLANTATION, Issue 8 2002Richard B. Freeman MD For several years, the Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) Liver and Intestinal Transplantation Committee has been examining effects of changes and proposed changes to the liver allocation system. The Institute of Medicine recently recommended that the size of liver distribution units be increased to improve the organ distribution system. Methods to achieve this and the potential impact on patients and transplant centers of such a change are evaluated in this study. In hypothetical scenarios, we combined geographically contiguous organ procurement organizations (OPOs) in seven different configurations to increase the size of liver distribution units to cover populations greater than 9 million persons. Using the UNOS Liver Allocation Model (ULAM), we examined the effect of 17 different organ allocation sequences in these proposed realignments and compared them with those predicted by ULAM for the current liver distribution system by using the following primary outcome variables: number of primary liver transplantations performed, total number of deaths, and total number of life-years saved. Every proposed new liver distribution unit plan resulted in fewer primary transplantations. Many policies increased the total number of deaths and reduced total life-years saved compared with the current system. Most of the proposed plans reduced interregional variation compared with the current plan, but no one plan consistently reduced variation for all outcome variables, and all reductions in variations were relatively small. All new liver distribution unit plans led to significant shifts in the number of transplantations performed in individual OPOs compared with the current system. The ULAM predicts that changing liver distribution units to larger geographic areas has little positive impact on overall results of liver transplantation in the United States compared with the current plan. Enlarging liver distribution units likely will result in significant shifts in organs across current OPO boundaries, which will have a significant impact on the activity of many transplant centers. [source] The Circulatory System: Blood Procurement, AIDS, and the Social Body in ChinaMEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2006Kathleen Erwin The market for blood thrived in China for more than a decade, preying on rural villagers desperate for cash. Profit motives and unhygienic collection created an AIDS epidemic, where now up to 80 percent of adults in some villages are HIV infected. Today, illegal blood banks continue to operate in some areas. Moreover, better screening and blood testing do little to address the underlying cultural reluctance to give blood. This article examines what is at stake for blood donors in the circulation of blood through both the physical and the social bodies in China today. I argue that public health and social policy solutions require consideration of the symbolic meanings of blood and the body, kin relations, and gift exchange. China's HIV-contaminated blood procurement crisis demands a critical reexamination of the hidden processes embedded in a "circulatory system" that has inseparably bound the "gift of life" and a "commodity of death." [source] Pediatric living donor lobar lung transplantationPEDIATRIC TRANSPLANTATION, Issue 7 2006Stuart C. Sweet Abstract:, Living donor lobar lung transplantation (LDLLT) was developed in order to mitigate the growing competition for deceased donor (DD) lungs and resultant increase in waiting list mortality. Because each of the two donor lobes serves as an entire lung for the recipient, donors who are taller than the recipient are preferred. Therefore LDLLT is particularly well suited for pediatric recipients for whom adults serve as donors. Although long-term outcomes after LDLLT reported by the Organ Procurement and Transplantation Network (OPTN) are worse compared with DD recipients, overall pediatric outcomes as well as single center reports from the most experienced programs are more promising. Particularly encouraging are the findings that bronchiolitis obliterans (OB) is less frequent or less severe in LDLLT recipients in comparison to DD recipients. Moreover, outcomes may be improved by careful selection of donors to ensure adequately sized donor lobes and minimization of infectious risks. Although no donor deaths have been reported, there is a moderate risk of significant short-term complications. Long-term follow-up has not been reported. The use of LDLLT has decreased in recent years, and the recent change by the OPTN to an urgency/benefit allocation system for DD lungs in patients 12 yr and older may further reduce the demand. Nonetheless, we anticipate that LDLLT will continue to be utilized in select circumstances, particularly in children under 12 where access to DD organs remains challenging. [source] Genetic Diversity in Restoration Materials and the Impacts of Seed Collection in Colorado's Restoration Plant Production IndustryRESTORATION ECOLOGY, Issue 3 2007Sierra L. Smith Abstract The ever increasing demand for native plants and seed for use in restoration and revegetation has created a sizable industry. The large-scale production and planting of native plants have given rise to a suite of ecological concerns including collection impacts, genetic diversity, and provenance. This study examines the practices and beliefs of 12 restoration plant production companies in Colorado with regard to arising ecological issues and identifies where further research is needed. We found that native seed collection in Colorado was largely unregulated and unmonitored and impacts were unknown. Maintaining genetic diversity in restoration materials is costly and does not have universal support. The use of provenance material (or local ecotypes) was hotly contested with strong and sound arguments on both sides of the issue. Procurement of pure ecotypes was difficult because of the variety of institutions involved in production and complications such as artificial selection and cross-pollination. [source] Expanding the Criteria of Organ Procurement from Donors with Prostate Cancer: The Application of the New Italian GuidelinesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2010A. D'Errico-Grigioni Prostate cancer (CaP) represents the most prevalent malignancy in men more than 60-year-old, posing a problem in organ procurement from elderly subjects. However, most of the currently diagnosed CaP are low-grade and intraprostatic, with low metastatic risk, and there is recent evidence that most patients are overdiagnosed. The Italian National guidelines about organ acceptance from neoplastic donors changed in March 2005, extending the pool of potential candidates with CaP and introducing the function of a second opinion expert. Between 2001 and February 2005, 40 candidate donors with total PSA,10 and/or positive digital rectal examination underwent histopathological analysis of the prostate: 15 (37.5%) donors harboured CaP, and 25 (62%) were judged at ,standard risk'. After the introduction of the new guidelines in 2005, the second opinion expert judged at ,standard risk' 48 of 65 donors, while 17 of 65 needed histopathological analysis. Four (6.2%) donors harboured CaP, and 61 (94%) where judged at ,standard risk', with a significant increase of donated and actually transplanted organs. The application of the new guidelines and the introduction of a second opinion expert allowed a significant extension of the ,standard risk' category also to CaP patients, decreasing the histopathological examinations and expanding the donor pool. [source] Database Comparison of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) and the SRTR U.S. Transplant Registry,AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010B. W. Gillespie Data submitted by transplant programs to the Organ Procurement and Transplantation Network (OPTN) are used by the Scientific Registry of Transplant Recipients (SRTR) for policy development, performance evaluation and research. This study compared OPTN/SRTR data with data extracted from medical records by research coordinators from the nine-center A2ALL study. A2ALL data were collected independently of OPTN data submission (48 data elements among 785 liver transplant candidates/recipients; 12 data elements among 386 donors). At least 90% agreement occurred between OPTN/SRTR and A2ALL for 11/29 baseline recipient elements, 4/19 recipient transplant or follow-up elements and 6/12 donor elements. For the remaining recipient and donor elements, >10% of values were missing in OPTN/SRTR but present in A2ALL, confirming that missing data were largely avoidable. Other than variables required for allocation, the percentage missing varied widely by center. These findings support an expanded focus on data quality control by OPTN/SRTR for a broader variable set than those used for allocation. Center-specific monitoring of missing values could substantially improve the data. [source] Heart Transplantation in the United States, 1999,2008AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010M. R. Johnson This article features 1999,2008 trends in heart transplantation, as seen in data from the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). Despite a 32% decline in actively listed candidates over the decade, there was a 20% increase from 2007 to 2008. There continues to be an increase in listed candidates diagnosed with congenital heart disease or retransplantation. The proportion of patients listed as Status 1A and 1B continues to increase, with a decrease in Status 2 listings. Waiting list mortality decreased from 2000 through 2007, but increased 18% from 2007 to 2008; despite the increase in waiting list death rates in 2008, waiting list mortality for Status 1A and Status 1B continues to decrease. Recipient numbers have varied by 10% over the past decade, with an increased proportion of transplants performed in infants and patients above 65 years of age. Despite the increase in Status 1A and Status 1B recipients at transplant, posttransplant survival has continued to improve. With the rise in infant candidates for transplantation and their high waiting list mortality, better means of supporting infants in need of transplant and allocation of organs to infant candidates is clearly needed. [source] Geographic Variation in End-Stage Renal Disease Incidence and Access to Deceased Donor Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010A. K. Mathur The effect of demand for kidney transplantation, measured by end-stage renal disease (ESRD) incidence, on access to transplantation is unknown. Using data from the U.S. Census Bureau, Centers for Medicare & Medicaid Services (CMS) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) from 2000 to 2008, we performed donation service area (DSA) and patient-level regression analyses to assess the effect of ESRD incidence on access to the kidney waiting list and deceased donor kidney transplantation. In DSAs, ESRD incidence increased with greater density of high ESRD incidence racial groups (African Americans and Native Americans). Wait-list and transplant rates were relatively lower in high ESRD incidence DSAs, but wait-list rates were not drastically affected by ESRD incidence at the patient level. Compared to low ESRD areas, high ESRD areas were associated with lower adjusted transplant rates among all ESRD patients (RR 0.68, 95% CI 0.66,0.70). Patients living in medium and high ESRD areas had lower transplant rates from the waiting list compared to those in low ESRD areas (medium: RR 0.68, 95% CI 0.66,0.69; high: RR 0.63, 95% CI 0.61,0.65). Geographic variation in access to kidney transplant is in part mediated by local ESRD incidence, which has implications for allocation policy development. [source] Specific Unwillingness to Donate Eyes: The Impact of Disfigurement, Knowledge and Procurement on Corneal DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010M. Lawlor Although willingness, attitudes and beliefs surrounding solid-organ donation have been extensively investigated, much less is known about corneal donation. Despite evidence that a substantial number of families who agree to multiorgan donation also specifically refuse corneal donation, it is unclear why this occurs and what can be done to increase rates of corneal donation. We conducted a survey of 371 Australian adults regarding their views on corneal donation. Although willingness to donate corneas generally reflected a person's willingness to donate all of one's organs, unwillingness to donate corneas appeared to be due to other factors. Specifically, decisions not to donate appear to be driven by a range of concerns surrounding disfigurement. The survey also provides eye banks with reassurance about the acceptability of whole globe procurement, and recognition that research into blindness is a highly valued part of corneal donation. Finally, the survey identifies that many individuals see benefit in having their family engaged in the decision-making process, suggesting that decisions about donation are more complex than a simple appeal to the autonomy of the deceased. [source] Donor Screening for Human T-cell Lymphotrophic Virus 1/2: Changing Paradigms for Changing Testing CapacityAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010D. R. Kaul Organ Procurement and Transplant Network (OPTN) policy currently requires the testing of all potential organ donors for human T-cell lymphotrophic virus (HTLV)-1/2. Most Organ Procurement Organizations (OPO) use the Abbott HTLV-I/HTLV-II Enzyme Immunoassay (EIA). This assay will no longer be manufactured after December 31, 2009; the only commercially available FDA-licensed assay will be the Abbott PRISM HTLV-I/II assay which poses many challenges to OPO use for organ donor screening. As a result, screening donors for HTLV-1/2 in a timely manner pretransplant after December 31, 2009 will be challenging. The true incidence of HTLV-1 in United States (U.S.) organ donors is not well described but appears to be low (,0.03,0.5%). HTLV-1 is associated with malignancy and neurological disease; HTLV-2 has not been convincingly associated with disease in humans. Donors that are HTLV-1/2 seropositive are infrequently used despite most results being either false positive or resulting from HTLV-2 infection. There is urgent need to encourage the development of assays, instruments and platforms optimized for organ donors that can be used to screen for transmissible disease in donors; these must have appropriate sensitivity and specificity to identify all infections while minimizing organ loss through false positive testing. [source] Transplantation of Kidneys from Donors at Increased Risk for Blood-Borne Viral Infection: Recipient Outcomes and Patterns of Organ UseAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009P. P. Reese Kidney transplantation from deceased donors classified as increased risk for viral infection by the Centers for Disease Control (CDC) is controversial. Analyses of Organ Procurement and Transplantation Network (OPTN) data from 7/1/2004 to 7/1/2006 were performed. The primary cohort included 48 054 adults added to the kidney transplant wait list. Compared to receiving a standard criteria donor (SCD) kidney or remaining wait-listed, CDC recipients (HR 0.80, p = 0.18) had no significant difference in mortality. In a secondary cohort of 19 872 kidney recipients at 180 centers, SCD (reference) and CDC (HR 0.91, p = 0.16) recipients had no difference in the combined endpoint of allograft failure or death. Among centers performing >10 kidney transplants during the study period, the median proportion of CDC transplants/total transplants was 7.2% (range 1.1,35.6%). Higher volume transplant centers were more likely to use CDC kidneys compared to low and intermediate volume centers (p < 0.01). An analysis of procured kidneys revealed that 6.8% of SCD versus 7.8% of CDC (p = 0.13) kidneys were discarded. In summary, center use of CDC kidneys varied widely, and recipients had good short-term outcomes. OPTN should collect detailed data about long-term outcomes and recipient viral testing so the potential risks of CDC kidneys can be fully evaluated. [source] The Riskiest Job in Medicine: Transplant Surgeons and Organ Procurement TravelAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009M. J. Englesbe Transplant surgeons are exposed to workplace risk due to the urgent nature of travel related to organ procurement. A retrospective cohort study was completed using data from the Scientific Registry of Transplant Recipients and the National Transportation Safety Board. A web-based survey was administered to members of the American Society of Transplant Surgeons. The survey response rate was 38% (281/747). Involvement in ,1 procurement-related travel accident was reported by 15% of respondents; surgeons reported 61 accidents and 11 fatalities. Air travel was used in 26% of procurements and was involved in 56% of accidents. The risk of fatality while traveling on an organ procurement flight was estimated to be 1000 times higher than scheduled commercial flight. Involvement in a ,near miss accident' was reported by 80.8%. Only 16% of respondents reported feeling ,very safe' while traveling. Procurement of organs by the geographically closest transplant center would have reduced the need for air travel (>100 nautical miles) for lung, heart, liver and pancreas procurement by 35%, 43%, 31% and 49%, respectively (p < 0.0001). These reductions were observed in each Organ Procurement and Transplantation Network region. Though these data have important limitations, they suggest that organ procurement travel is associated with significant risk. Improvements in organ procurement travel are needed. [source] ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009D. J. Reich The American Society of Transplant Surgeons (ASTS) champions efforts to increase organ donation. Controlled donation after cardiac death (DCD) offers the family and the patient with a hopeless prognosis the option to donate when brain death criteria will not be met. Although DCD is increasing, this endeavor is still in the midst of development. DCD protocols, recovery techniques and organ acceptance criteria vary among organ procurement organizations and transplant centers. Growing enthusiasm for DCD has been tempered by the decreased yield of transplantable organs and less favorable posttransplant outcomes compared with donation after brain death. Logistics and ethics relevant to DCD engender discussion and debate among lay and medical communities. Regulatory oversight of the mandate to increase DCD and a recent lawsuit involving professional behavior during an attempted DCD have fueled scrutiny of this activity. Within this setting, the ASTS Council sought best-practice guidelines for controlled DCD organ donation and transplantation. The proposed guidelines are evidence based when possible. They cover many aspects of DCD kidney, liver and pancreas transplantation, including donor characteristics, consent, withdrawal of ventilatory support, operative technique, ischemia times, machine perfusion, recipient considerations and biliary issues. DCD organ transplantation involves unique challenges that these recommendations seek to address. [source] Donor-Derived Disease Transmission Events in the United States: Data Reviewed by the OPTN/UNOS Disease Transmission Advisory CommitteeAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009M. G. Ison Donor-derived disease transmission is increasingly recognized as a source of morbidity and mortality among transplant recipients. Policy 4.7 of the Organ Procurement and Transplantation Network (OPTN) currently requires reporting of donor-derived events. All potential donor-derived transmission events (PDDTE) reported to OPTN/UNOS were reviewed by the Disease Transmission Advisory Committee (DTAC). Summary data from January 1, 2005,December 31, 2007, were prepared for presentation. Reports of PDDTE have increased from 7 in 2005, the first full year data were collected, to 60 in 2006 and to 97 in 2007. More detailed information is available for 2007; a classification system for determining likelihood of donor-derived transmission was utilized. In 2007, there were four proven and one possible donor-derived malignancy transmissions and four proven, two probable and six possible donor-derived infectious diseases transmissions. There were nine reported recipient deaths attributable to proven donor transmissions events arising from eight donors during 2007. Although recognized transmission events resulted in significant morbidity and mortality, transmission was reported in only 0.96% of deceased donor donations overall. Improved reporting, through enhanced recognition and communication, will be critical to better estimate the transmission risk of infection and malignancy through organ transplantation. [source] The Neckline Donor Incision: Our Preferred Approach for Deceased Donor Organ ProcurementAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009M. D. Jendrisak No abstract is available for this article. [source] Heart Transplantation in the United States, 1998,2007AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009J. D. Vega This article highlights trends in heart transplantation from 1998 to 2007, using data from the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). The number of candidates actively awaiting heart transplantation has declined steadily, from 2525 in 1998 to 1408 in 2007, a 44% decrease. Despite this decline, a larger proportion of patients are listed as either Status 1A or 1B, likely secondary to increased use of mechanical circulatory support. During this time, the overall death rate among patients awaiting heart transplantation fell from 220 to 142 patients per 1000 patient-years at risk; this likely reflects better medical and surgical options for those with end-stage heart failure. This trend was noted across all racial groups, both sexes, all disease etiologies (retransplantation excepted) and all status groups. Recipient numbers were relatively stable over the past decade. In 2007, 2207 transplants were performed, although the proportion of patients transplanted as Status 1A shifted from 34% to 50%. A trend toward transplanting more patients above 65 years of age was seen. Adjusted patient (and graft) survival at 3 months, 1, 5 and 10 years after transplantation has gradually, but significantly, improved during the same period; current patient survival estimates are 93%, 88%, 74% and 55%, respectively. [source] Innovations in the Assessment of Transplant Center Performance: Implications for Quality ImprovementAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009D. A. Axelrod Continuous quality improvement efforts have become a central focus of leading health care organizations. The transplant community has been a pioneer in periodic review of clinical outcomes to ensure the optimal use of limited donor organs. Through data collected from the Organ Procurement and Transplantation Network (OPTN) and analyzed by the Scientific Registry of Transplant Recipients (SRTR), transplantation professionals have intermittent access to specific, accurate and clinically relevant data that provides information to improve transplantation. Statistical process control techniques, including cumulative sum charts (CUSUM), are designed to provide continuous, real-time assessment of clinical outcomes. Through the use of currently collected data, CUSUMs can be constructed that provide risk-adjusted program-specific data to inform quality improvement programs. When retrospectively compared to currently available data reporting, the CUSUM method was found to detect clinically significant changes in center performance more rapidly, which has the potential to inform center leadership and enhance quality improvement efforts. [source] The Evolution and Direction of OPTN Oversight of Live Organ Donation and Transplantation in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009R. S. Brown For more than 20 years, the Organ Procurement and Transplantation Network (OPTN) has developed policies and bylaws relating to equitable allocation of deceased donor organs for transplantation. United Network for Organ Sharing (UNOS) operates the OPTN under contract with the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Until recent years, the OPTN had little defined authority regarding living donor organ for transplantation except for the collection of data relating to living donor transplants. Beginning with the implementation of the OPTN Final Rule in 2000, and continuing with more recent announcements, the OPTN's role in living donation has grown. Its responsibilities now include monitoring of living donor outcomes, promoting equity in nondirected living donor transplantation and ensuring that transplant programs have expertise and established protocols to promote the safety of living donors and recipients. The purpose of this article is to describe the evolving mandates for the OPTN in living donation, as well as the network's recent activities and ongoing efforts. [source] Development of the New Lung Allocation System in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p2 2006T. M. Egan This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities. [source] Direction of the Organ Procurement and Transplantation Network and United Network for Organ Sharing Regarding the Oversight of Live Donor Transplantation and Solicitation for OrgansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2006F. L. Delmonico The Organ Procurement and Transplantation Network (OPTN) operated by United Network for Organ Sharing (UNOS) has taken recent steps to address public solicitation for organ donors and its oversight of live donor transplantation. This report provides the direction of the OPTN regarding deceased donor solicitation. The OPTN has authority under federal law to equitably allocate deceased donor organs within a single national network based upon medical criteria, not upon one's social or economic ability to utilize resources not available to all on the waiting list. The OPTN makes a distinction between solicitations for a live donor organ versus solicitations for directed donation of deceased organs. As to live donor solicitation, the OPTN cannot regulate or restrict ways relationships are developed in our society, nor does it seek to do so. OPTN members have a responsibility of helping protect potential recipients from hazards that can arise from public appeals for live donor organs. Oversight and support of the OPTN for live donor transplantation is now detailed by improving the reporting of live donor follow-up, by providing a mechanism for facilitating anonymous live kidney donation, and by providing information for potential live kidney donors via the UNOS Transplant LivingSM website. [source] Laparoscopic Procurement of Kidneys with Multiple Renal Arteries is Associated with Increased Ureteral Complications in the RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2005Jonathan T. Carter This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side. [source] PETROGRAPHIC AND STABLE ISOTOPE ANALYSES OF LATE CLASSIC ULÚA MARBLE VASES AND POTENTIAL SOURCES*ARCHAEOMETRY, Issue 1 2006C. LUKE Ulúa marble vases from the Ulúa Valley of northwestern Honduras are a hallmark luxury good from Late Classic (ad 600,900) Mesoamerica. Archaeological and stylistic data point to centralized production at one site, Travesía. This paper analyses stable isotope and petrographic data from the vases and three potential procurement areas. The results indicate that the vases were produced from one primary source with one, potentially two, secondary sources. Procurement patterns most probably corresponded to contemporary communication routes. The results clearly indicate that a multi-method approach is necessary for sourcing marble from Honduras. [source] Motivations, Job Procurement, and Job Satisfaction Among Current and Former Ultrasound FellowsACADEMIC EMERGENCY MEDICINE, Issue 6 2010James H. Moak MD Abstract Objectives:, Over the past decade, emergency medicine ultrasound (US) fellowships have proliferated, yet there are no published data describing employment trends among fellowship graduates. This study sought to assess factors motivating emergency physicians to pursue an US fellowship and to characterize their employment and job satisfaction after graduation. Methods:, An electronic survey was conducted of US fellows and graduates representing all 35 known fellowship programs. Non-responders were contacted at 2 weeks to encourage participation. Primary outcome measurements were the importance of factors motivating individuals to pursue an US fellowship (as rated on a numeric scale), job satisfaction among US fellowship graduates, the proportion of respondents practicing in academic versus community hospitals, clinical hours per week, and the rate of procurement of one's top choice of job after graduation. The chi-square test or Fisher's exact test was used for categorical variables, and the Mann-Whitney U-test was used to compare continuous variables between two groups. Results:, Of 170 invitations sent, 10 were undeliverable. The response rate was 61%; 74 graduates and 23 fellows completed the survey. Enhancing job opportunities, enjoyment of US, long-term job satisfaction and gaining skills not learned in residency rated highest as reasons for pursuing an US fellowship. Among graduates, 20% are satisfied with their current job, while 78% are very satisfied or extremely satisfied. Nearly one-third of graduates (31%) work primarily in non-academic hospitals, while only 9% of current fellows aspire to work in non-academic settings in the future. There was no difference in job satisfaction between academic- and community-based graduates. In comparison to those graduating in previous years, fellows graduating in 2008 were less likely to get their top job (97% vs. 75.0%, p = 0.018). Conclusions:, Job satisfaction is high among US fellowship graduates and is unrelated to academic versus community affiliation. Three-fourths of recent graduates obtain their top choice of job upon completion of fellowship. ACADEMIC EMERGENCY MEDICINE 2010; 17:644,648 © 2010 by the Society for Academic Emergency Medicine [source] The introduction of environmental requirements for trucks and construction vehicles used in road maintenance contracts in SwedenCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 2 2005Charlotta Faith-Ell Abstract This paper examines the development and implementation of environmental requirements for trucks and construction vehicles in Swedish road maintenance contracts. The process in which the road administration involved relevant organizations in the development of a model for emission-based payment for the vehicles was analysed in a participatory study. Intentions behind the requirements were investigated using interviews and questionnaires. The results point to the importance of actively involving, informing and training all relevant parties. Transparency towards sub-contractors and the public is needed to justify the requirements. The payment model, based on environmental performance, is also suggested for use in other types of requirement in road maintenance contracts. To make green procurement an effective policy instrument, the model needs further development, e.g. systematic information, training of clients and contractors, and follow-up of the requirements. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source] | |||||||||||||||||||||||||