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Many Concerns (many + concern)
Selected AbstractsAnatomy of Failure: Bush's Decision-Making Process and the Iraq WarFOREIGN POLICY ANALYSIS, Issue 3 2009David Mitchell The Bush administration's decision-making process leading to the invasion of Iraq in 2003 has been singled out for its many shortcomings: failure of intelligence; lack of debate concerning options; an insufficient invading force; and poor postwar planning. Contrary to the administration's claim that no one foresaw the difficulties of waging a war in Iraq, many concerns about the challenges the United States would face were raised inside and outside of government. Yet, none of this information had a significant effect on the decision-making process. This paper develops a decision-making model that integrates elements from the individual to the organizational level and explains how important information was marginalized, leading to a poor policy outcome. The model illustrates how the combined effects of the president's formal management style, anticipatory compliance on the part of key players, bureaucratic politics, and the intervening variable of the 9/11 terrorist attacks contributed to a defective decision-making process. [source] Living without aprotinin: the results of a 5-year blood saving program in cardiac surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009M. RANUCCI Background: After 20 years of regular use in cardiac surgery patients, aprotinin has recently been withdrawn from the market due to many concerns about its safety. For a number of reasons aprotinin has not been available in Italy since 1998. The present study presents an aprotinin-free treatment protocol applied at our institution during the last 5 years, and aims to verify the results of this protocol in terms of allogeneic blood product transfusions, postoperative blood loss and surgical re-exploration rate. Methods: Retrospective study on 7988 consecutive patients who underwent cardiac surgery during the years 2003,2007. All the patients received specific hemostasis/coagulation management based on (a) routine use of tranexamic acid, (b) heparin dose,response monitoring, thromboelastography, platelet (PLT) function analysis in a select population of patients, and (c) use of fresh frozen plasma (FFP), PLTs, and desmopressin according to the hemostasis/coagulation profile. Data retrieved from the institutional database were quantity of packed red cells (PRCs), FFP, PLT transfusion rate, blood loss in the first 12 postoperative hours, and surgical re-exploration rate. Results: PRCs were transfused in 40.4% of patients (with higher rates for selected high-risk subpopulations), FFP in 12.9% and PLTs in 2.6%. Surgical re-exploration rate was 3.7%. With respect to historical controls, a significant reduction of PRCs and FFP transfusions was obtained using closed circuits, point of care coagulation tests, and combination of the two. Conclusion: This aprotinin-free blood saving program is an effective strategy for allogeneic blood products transfusion containment. [source] Privatizing Medicaid-Funded Mental Health Services: Trading Old Political Challenges for New OnesAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2002Matthew N. I. Oliver States have aggressively pursued privatizing the management of Medicaid-funded mental health services. Although privatized managed care addresses many concerns, it brings several challenges. This article evaluates the impact of privatization on Medicaid-funded mental health services and highlights several contracting issues that should be considered to ensure high-quality mental health care. [source] Acute stroke therapy with tissue plasminogen activator (tPA) since it was approved by the U.S. Food and Drug Administration (FDA),ANNALS OF NEUROLOGY, Issue 1 2009Justin A. Zivin MD Tissue plasminogen activator (tPA) for acute ischemic stroke was approved by the U.S. Food and Drug Administration (FDA) in 1996. Since then it has been severely underutilized. At the time when most practitioners were first being exposed to the literature concerning tPA, there were many concerns about safety and the restrictions on use were quite onerous. Since then a good deal of further work has been done to loosen the restrictions and allay concerns about the risks. The true risk to benefit ratio is far better than is generally realized. Now it is mostly economic problems related to the costs of constantly supplying emergency care that is limiting access. Furthermore, in the current litigious environment, failure to treat is likely to be a more hazardous course of action than legal exposure due to poor outcomes. It must be emphasized that the drug is quite safe and highly effective, and current utilization rates are unacceptably low. Ann Neurol 2009;66:6,10 [source] Hepatic transcription response to high-fat treatment in mice: Microarray comparison of individual vs. pooled RNA samplesBIOTECHNOLOGY JOURNAL, Issue 9 2010Gyeong-Min Do Abstract Microarray analysis is an important tool in studying gene expression profiles in genomic research. Despite many concerns raised, mRNA samples are often pooled in microarray experiments to reduce the cost and complexity of analysis of transcript profiling. This study reports the results of microarray experiments designed to compare effects of pooling RNA samples and its impact on identifying profiles of mRNA transcripts and differentially expressed genes (DEGs) in the liver of C57BL/6J mice fed normal and high-fat diet. Pearson's correlation coefficient of transcripts between pooled and non-pooled RNA samples was 0.98 to 1.0. The impact of pooled vs. non-pooled RNA samples was also compared by number of transcripts or DEGs. Agreement of significant genes between pooled and non-pooled sets was fairly desirable based on t -test <0.05 and/or signal intensity ,2-fold. Biological process profile and the correlation coefficiency of fold change in the hepatic gene transcripts between pooled and non-pooled samples were also higher than 0.97. This suggests that pooling hepatic RNA samples can reflect the expression pattern of individual samples, and that properly constructed pools can provide nearly identical measures of transcription response to individual RNA sample. [source] | ||||||||||