Unmanaged Systems Research Articles

Ethical challenges in the managed practice of obstetrics and gynecology

Obstetrics and gynecology has been transformed from a fee-for-service, unmanaged system to a prepaid managed system. This change poses significant ethical challenges, which we address. We show that obstetrician-gynecologists and medical institutions are moral co-fiduciaries of female and pregnant patients, that the obstetrician-gynecologist should be economically disciplined without capitulating to managed care, and that managed care organizations have an obligation to support the medical education and research from which they benefit.

Varlations in Length of Hospital Stay for Infants in Intensive Care Nurseries in the Philadelphia Region. 828

A chart audit was conducted at 28 intensive care nurseries in the Philadelphia region. All infants studied were insured by a medical assistance health maintenance organization. Hospitals were grouped by level of care and location. A total of 3 academic affiliate (A), 13 community (C), 6 rural (R) and 6 university (U) hospitals were audited for a recent 1 year period. Each audited hospital's charts were analyzed for length of hospital stay (LOS), and infants were placed in one of 30 groups as defined as an identified category of patients utilizing weight and disease process. LOS for each infant was compared against the National Perinatal Information Center (NPIC) data base. NPIC is a diverse payor mix, and severity of illness is not controlled. The difference between LOS and that predicted by the NPIC data are potential days saved (days saved). Data for charts reviewed (n), hospital days (hosp days), average LOS (ALOS), NPIC ALOS, and days saved are: Table Days saved also varied markedly between hospitals within the same classification. This analysis reveals the unwarranted variation in length of stay characteristic of unmanaged systems of care. A management plan is now in process to define the causes of variation. Supported by Paidos Health Management Systems, Inc.

Water Rights in Texas

Allocation of water in Texas evolved historically over several centuries into an essentially unmanageable system. Water management has progressed significantly in recent years with the transition of riparian rights to a surface-water permit system. Although the “law of the biggest pump” still governs, pressure for ground-water regulation continues to intensify. Water rights have become a major consideration in water-resources development and management in the state. This paper describes the Texas experience in allocating water resources among many competing users. The evolution of the water-rights system is outlined, and key issues remaining to be resolved are noted. The strategies adopted and the complexities encountered in Texas are representative of other states as well.

Concepts of Carrying Capacity and Substitution Ratios: A Systems Viewpoint

Usefulness of the concepts of carrying capacity and species substitution ratios in natural resource management has been limited by single objectives and single management options implicit in their definitions. When applied to livestock, they have been further limited by poor conceptualization of the animal-unit concept often used to quantify them. A systematic approach to the animal-unit concept logically leads to concepts of livestock carrying capacity and livestock substitution ratios compatible with the multiple objectives and multiple management options characteristic of range livestock systems. This paper develops simplified multi-objective concepts of carrying capacity and substitution ratios, and discusses their interpretation and application in agroecological systems. Also discussed is the applicability of these concepts to describe components other than livestock in managed and unmanaged systems. Some thoughts are presented on abstraction and simplification of concepts.

Evaluation of defatted cocoa cake as a direct feed in the monosex culture of Tilapia guineensis (Pisces:Cichlidae)

Defatted cocoa cake, a by-product of the cocoa fermentation process, was evaluated as a direct feed in the monosex culture of Tilapia guineensis (Dumeril) stocked at 10 000/ha in 160-m 2 earthen ponds. Experimental yield trials were compared with two types of controls: a locally manufactured fish diet and an unmanaged system. A completely random design was used with three treatments replicated three times and lasting 120 days. Survival of the fish ranged from 90.21 to 93.13%. At harvest, average net yields were 2310.00, 1707.50 and 1133.13 kg/ha from the fish diet treatment, cocoa cake treatment and unmanaged system, respectively. Feed conversion values (based on dry matter inputs) averaged 5.12 and 2.30 for the fish fed the cocoa cake and fish diet, respectively. Analysis of the stomach contents of fish from the experimental pond showed that cocoa cake was utilized directly as feed.

Evaluations of rum distillation wastes, pharmaceutical wastes and chicken feed for rearing Tilapia aurea in Puerto Rico

Rum distillation wastes (solubles and yeast), pharmaceutical wastes (spent beer and spent beer plus solids), and a locally manufactured chicken feed were evaluated for their potential use in the culture of Tilapia aurea in Puerto Rico. The experimental products were compared to three types of controls: a commercial fish feed, an inorganic fertilizer, and an unmanaged system. The yield trials were conducted for 120 days in 9.3 m plastic pools. Three replications were made of each treatment. Survival of fish in the various treatments ranged from 80 to 96.7%. The highest mean standing crop at harvest (690 kg ha −1 equivalent) resulted from the fish receiving the commercial fish feed. This was followed by the fish from the spent beer treatment (643 kg ha −1 equivalent), inorganic fertilizer (559 kg ha −1 equivalent), distiller's yeast (454 kg ha −1 equivalent), spent beer plus solids (429 kg ha −1 equivalent), chicken feed (413 kg ha −1 equivalent), distiller's solubles (347 kg ha −1 equivalent), and the unmanaged system (145 kg ha −1 equivalent). The average feed conversion values for the fish fed the commercial fish feed and chicken feed were 1.53 and 2.06, respectively. Dissolved oxygen levels in pools treated with rum distiller's yeast declined from approximately 8.0 to 0.4 p.p.m. following initial application of the product. Dissolved oxygen depletions occurred after each subsequent application. All other systems had waters with dissolved oxygen concentrations generally suitable for fishculture.