Integration and the performance of healthcare networks: do integration strategies enhance efficiency, profitability, and image?

Purpose

This study examines the integration effects on efficiency and financial viability of the top 100 integrated healthcare networks (IHNs) in the United States.

Theory

A contingency- strategic theory is used to identify the relationship of IHNs' performance to their structural and operational characteristics and integration strategies.

Methods

The lists of the top 100 IHNs ranked in two years, 1998 and 1999, by the SMG Marketing Group were merged to create a database for the study. Multiple indicators were used to examine the relationship between IHNs' characteristics and their performance in efficiency and financial viability. A path analytical model was developed and validated by the Mplus statistical program. Factors influencing the top 100 IHNs' images, represented by attaining ranking among the top 100 in two consecutive years, were analysed.

Results and conclusion

No positive associations were found between integration and network performance in efficiency or profits. Longitudinal data are needed to investigate the effect of integration on healthcare networks' financial performance.

Equation of state and Raman frequency of diamond from quantum Monte Carlo simulations

We report variational and diffusion quantum Monte Carlo (VMC and DMC) calculations of the equation of state and Raman frequency of diamond. The pressure derivative of the bulk modulus, which has not been accurately determined experimentally, is calculated to be 3.8 (VMC) and 3.7 (DMC). The values of the Raman frequency calculated at the experimental volume are 1373 cm-1(VMC) and 1359 cm-1 (DMC), in good agreement with the experimental value of 1333 cm-1.

A high-resolution anthropomorphic voxel-based tomographic phantom for proton therapy of the eye

Proton therapy is increasingly used in medical treatments for cancer patients due to the sharp dose conformity offered by the characteristic Bragg peak. Proton beam interactions with the eye will be simulated using the MCNPX Monte Carlo code and available nuclear cross-section data to calculate the dose distribution in the eye gel and surrounding organs. A high-resolution eye model will be employed using a 3D geometrical voxel-based anthropomorphic head phantom obtained from the Visible Human Project (female data). Manual segmentation of the eye, carried out by the Medical Physics group at the University of Surrey resulted in 15 identified structures. This work emphasizes the use of a realistic phantom for accurately predicting dose deposition by protons.

A pilot study of ranolazine in patients with intermittent claudication

AIM

This pilot study provides preliminary information regarding safety and changes in exercise performance during treatment with ranolazine extended-release in patients with reproducible claudication during exercise treadmill testing (ETT).

METHODS

We enrolled 45 patients with documented peripheral arterial disease, reproducible claudication on ETT, and ankle-brachial indices <0.85 at rest that decreased by at least 0.15% or 20% immediately postexercise. Randomized patients received double-blind treatment with either ranolazine 1 000 mg b.i.d. (n=22) or placebo (n=23) for 4 weeks.

RESULTS

Compared with baseline, peak walking time (PWT) increased (mean+/-SEM) by 53+/-34 s with ranolazine (P=0.13) and by 41+/-33 s with placebo (P=0.22). Pain-free walking time during ETT increased by 62+/-18 s with ranolazine (P=0.002) and 36+/-18 s with placebo (P=0.045). Supplemental analyses, excluding patients with baseline exercise duration (16 min and (12 min, showed additional improvement with ranolazine on PWT.

CONCLUSIONS

Ranolazine was well tolerated and these data provide a rationale for proceeding with a definitive trial.

Inhomogeneous backflow transformations in quantum Monte Carlo calculations

An inhomogeneous backflow transformation for many-particle wave functions is presented and applied to electrons in atoms, molecules, and solids. We report variational and diffusion quantum Monte Carlo (VMC and DMC) energies for various systems and study the computational cost of using backflow wave functions. We find that inhomogeneous backflow transformations can provide a substantial increase in the amount of correlation energy retrieved within VMC and DMC calculations. The backflow transformations significantly improve the wave functions and their nodal surfaces.

Quantum Monte Carlo study of the Ne atom and the Ne+ ion

We report all-electron and pseudopotential calculations of the ground-state energies of the neutral Ne atom and the Ne(+) ion using the variational and diffusion quantum Monte Carlo (DMC) methods. We investigate different levels of Slater-Jastrow trial wave function: (i) using Hartree-Fock orbitals, (ii) using orbitals optimized within a Monte Carlo procedure in the presence of a Jastrow factor, and (iii) including backflow correlations in the wave function. Small reductions in the total energy are obtained by optimizing the orbitals, while more significant reductions are obtained by incorporating backflow correlations. We study the finite-time-step and fixed-node biases in the DMC energy and show that there is a strong tendency for these errors to cancel when the first ionization potential (IP) is calculated. DMC gives highly accurate values for the IP of Ne at all the levels of trial wave function that we have considered.

VEGF-A regulates the expression of VEGF-C in human retinal pigment epithelial cells

AIM

To determine the expression and regulation of vascular endothelial growth factor C (VEGF-C), and its receptor VEGFR-3, in human retinal pigment epithelial (RPE) cells and to consider their angiogenic role in choroidal neovascularisation (CNV).

METHOD

The expression of VEGF-C and VEGFR-3 in cultured human RPE was confirmed by immunostaining, PCR, western blotting, and ELISA. Cultured RPE cells were exposed to VEGF-A and glucose and VEGF-C and VEGFR-3 changes in gene expression determined by RT-PCR. Secreted VEGF-C protein in conditioned media from RPE was examined by western blotting and ELISA analysis. The ability of VEGF-C to elicit tube formation in choroidal endothelial cells was assayed by an in vitro Matrigel model.

RESULT

VEGF-A and glucose upregulated VEGF-C mRNA expression and increased the secretion of VEGF-C protein into the culture medium. VEGF-A, but not glucose alone, stimulated VEGFR-3 mRNA expression. VEGF-C acted synergistically with VEGF-A to promote in vitro tube formation by choroidal endothelial cells.

CONCLUSION

VEGF-A has a critical role in the orchestration of VEGF-C expression in RPE cells and the synergistic action of VEGF-C with VEGF-A may play an important part in the aetiology of CNV.

Immunological evaluation of combination therapy with tacrolimus and sirolimus on long-term allograft survival in nonhuman primates

We reported that a 60-day course of combination therapy with tacrolimus and sirolimus induced long-term survival of renal allograft after withdrawal of immunosuppressants in Vervet monkeys. In the present study, the mechanism of drug-induced allograft survival was evaluated via Th1/Th2 cytokines, apoptosis and MLC activity in primates.

MATERIALS AND METHODS

Cytokines were evaluated by ELISA. MLR and CTL assays were performed by incorporation of 72 hours (3)H-TdR and 4 hours (51)Cr release assay.

RESULTS

A 60-day course of tacrolimus with sirolimus resulted in long-term survival of kidney allografts. (67% > 100 days) without intermittent acute rejection. Low sensitivity to MLR was seen in long-term renal allograft survival among monkeys treated with tacrolimus and sirolimus. Increased levels of CD3(+)CD8(+), CD3(+)/CD56(+) NKT cells and CD86(+)CD8(-)CD11(+) dendritic cells were observed. A population of high expression of CD4(+)FasL(+) was detected. In addition, the concentrations of IL-2 and IFN-gamma from long-term allograft surviving monkeys was not significantly increased, rather a late phase dominance of Th2, IL-4, IL-10, and TGF-beta was found correlated with long-term survival of recipients. In conclusion, the mechanism of tacrolimus and sirolimus induced long-term allograft survival in primates relates to up-regulated FasL expression, NKT cells and dendritic cells, with downregulation of MLR sensitivity. It is also associated with late-dominant expression of Th2 cytokines.

Scheme for adding electron–nucleus cusps to Gaussian orbitals

A simple scheme is described for introducing the correct cusps at nuclei into orbitals obtained from Gaussian basis set electronic structure calculations. The scheme is tested with all-electron variational quantum Monte Carlo (VMC) and diffusion quantum Monte Carlo (DMC) methods for the Ne atom, the H2 molecule, and 55 molecules from a standard benchmark set. It greatly reduces the variance of the local energy in all cases and slightly improves the variational energy. This scheme yields a general improvement in the efficiency of all-electron VMC and DMC calculations using Gaussian basis sets.

All-electron quantum Monte Carlo calculations for the noble gas atoms He to Xe

We report all-electron variational and diffusion quantum Monte Carlo (VMC and DMC) calculations for the noble gas atoms He, Ne, Ar, Kr, and Xe. The calculations were performed using Slater-Jastrow wave functions with Hartree-Fock single-particle orbitals. The quality of both the optimized Jastrow factors and the nodal surfaces of the wave functions declines with increasing atomic number Z, but the DMC calculations are tractable and well behaved in all cases. We discuss the scaling of the computational cost of DMC calculations with Z.

Cardioprotective effects of peroxisome proliferator activated receptor gamma activators on acute myocarditis: anti-inflammatory actions associated with nuclear factor kappaB blockade

OBJECTIVE

To test the hypothesis that activation of peroxisome proliferator activated receptor gamma (PPAR-gamma) reduces experimental autoimmune myocarditis (EAM) associated with inhibitor kappaB (IkappaB) alpha induction, blockade of nuclear factor kappaB (NF-kappaB), and inhibition of inflammatory cytokine expression.

METHODS

EAM was induced in Lewis rats by immunisation with porcine cardiac myosin. PPAR-gamma activators 15-deoxy-Delta(12,14)-prostaglandin J2 (15d-PGJ2) and pioglitazone (PIO) were administered to rats with EAM.

RESULTS

Enhanced PPAR-gamma expression was prominently stained in the nuclear and perinuclear regions of infiltrating inflammatory cells. Administration of 15d-PGJ2 and PIO greatly reduced the severity of myocarditis and suppressed myocardial mRNA and protein expression of inflammatory cytokines in rats with EAM. In addition, treatment with PPAR-gamma activators enhanced IkappaB concentrations in the cytoplasmic fractions and nuclear fractions from inflammatory myocardium. Concurrently, NF-kappaB was greatly activated in myocarditis; this activation was blocked in the 15d-PGJ2 treated and PIO treated groups.

CONCLUSIONS

PPAR-gamma may have a role in the pathophysiology of EAM. Because an increase in IkappaB expression and inhibition of translocation of the NF-kappaB subunit p65 to the nucleus in inflammatory cells correlated with the protective effects of PPAR-gamma activators, these results suggest that PPAR-gamma activators act sequentially through PPAR-gamma activation, IkappaB induction, blockade of NF-kappaB activation, and inhibition of inflammatory cytokine expression. These results suggest that PPAR-gamma activators such as 15d-PGJ2 and PIO may have the potential to modulate human inflammatory heart diseases such as myocarditis.

Neutron-fluence-to-dose conversion coefficients in an anthropomorphic phantom

A set of fluence-to-effective-dose conversion coefficients has been calculated for neutrons with energies <20 MeV using a high-resolution anthropomorphic phantom (Zubal model) and the MCNPX code. The calculation used 13 monodirectional monoenergetic neutron beams in the energy range 10(-9) to 20 MeV, under three different source irradiation configurations: anterior-posterior, posterior-anterior and left lateral. Dose calculations were performed for 18 selected organs of the body, for which the International Commission on Radiological Protection and the International Commission on Radiological Units and Measurements have set tissue weighting factors for the determination of the effective dose. Another set of neutron-fluence-to-effective-dose conversion coefficients was also calculated with the proposed modification wR from ICRP Publication 92. From comparison between the dose results calculated and the data reported for the MIRD and VIPMAN models, it can be concluded that, although some discrepancies exist between the Zubal model and the two other models, there is good agreement in the left lateral irradiation geometry.

Selective denervation and resection of cervical muscles in the treatment of spasmodic torticollis: long-term follow-up results in 207 cases

OBJECT

To report the outcome of patients with selective denervation and resection of cervical muscles for spasmodic torticollis.

METHODS

We reviewed 362 cases of surgically treated spasmodic torticollis. 207 patients were followed from 2 years to 29 years.

RESULTS

Total or marked relief of symptoms with preservation of normal of nearly normal movements has been obtained in 87.9%.

CONCLUSION

This procedure may be recommended if one to two years of conservative therapy does not offer satisfactory relief of symptoms.

[Effect of folic acid and supplemented with vitamin A and vitamin E on depressing teratogenesis induced by cyclophosphamide]

The effect of folic acid and the combined effect of folic acid(FA) + vitamin A + vitamin E on the prevention of teratogenesis induced by cyclophosphamide during pregnancy were observed. The results showed that cyclophosphamide resulted a decreased weight and length of the fetuses, an increased rate of neural tube defects and a retardation of ossification centers. The neural tube defects rates in the groups with no any supplementation, supplemented with folic acid alone and supplemented with FA + vitamin A + vitamin E were 87.27%, 42.93% and 30.08% respectively(P < 0.01). The supplementation of FA or the combined supplementation resulted also in greater fetal weight and length, increased ossification of supraoccipital bone (P < 0.01). The study suggested that the combined effect of FA, vitamin A and vitamin E was superior to FA alone.

Short-chain fatty acids induce intestinal epithelial heat shock protein 25 expression in rats and IEC 18 cells

BACKGROUND & AIMS

Because short-chain fatty acids (SCFAs) and heat shock proteins (hsps) confer protection to intestinal epithelia cells (IECs), we studied whether SCFAs modulate IEC hsp expression.

METHODS

Hsp 25, hsp72, and hsc73 protein expression in rat intestinal tissues and IEC-18 cells were determined by Western blot and immunohistochemistry. Cell survival under conditions of oxidant stress (monochloramine) was determined using (51)Cr release in hsp25 cDNA anti-sense and sense-transfected cells expressing minimal and increased hsp25, respectively.

RESULTS

Butyrate induces a time- and concentration-dependent increase in hsp25, but not hsp72 or hsc73, protein expression in rat IEC-18 cells but not 3T3 fibroblasts. Other SCFAs, including the poorly metabolized isobutyate, also induced selective expression of hsp25. Butyrate treatment significantly improved the ability of IEC-18 cells to withstand oxidant (monochloramine) injury. This effect could be blocked in cells in which hsp25 induction by butyrate was blocked by stable hsp25 antisense transfection. Additionally, hsp25-transfected overexpressing IEC-18 cells showed increased resistance to monochloramine. In vivo, increasing dietary fiber increased colonic, but not proximal, ileal hsp25 while having no effect on hsp72 or hsc73 expression.

CONCLUSIONS

SCFAs, the predominant anions of colonic fluid derived from bacterial flora metabolism of luminal carbohydrates, protect IECs against oxidant injury, an effect mediated in part by cell-specific hsp25 induction.

[Poison effect of plant granules on Oncomelania hupensis]

Plant granules (phi 2-3 mm) made of starch, gelatin and medicine plant powder were used to kill Oncomelania hupensis. The results showed that after eating the plant granules, the mortality of the snail was 92.5%-100% within 24 hrs. The poison effect of the plant granules was much better than that of others, e.g., they could kill snails 12-24 h earlier than Niclosamidum (1 x 10(-3) g.L-1). In a field experiment, the snail mortality was up to 61.5% by using plant granules.

Serine phosphorylation of focal adhesion kinase in interphase and mitosis: a possible role in modulating binding to p130(Cas)

Focal adhesion kinase (FAK) is an important regulator of integrin signaling in adherent cells and accordingly its activity is significantly modulated during mitosis when cells detach from the extracellular matrix. During mitosis, FAK becomes heavily phosphorylated on serine residues concomitant with its inactivation and dephosphorylation on tyrosine. Little is known about the regulation of FAK activity by serine phosphorylation. In this report, we characterize two novel sites of serine phosphorylation within the C-terminal domain of FAK. Phosphorylation-specific antibodies directed to these sites and against two previously characterized sites of serine phosphorylation were used to study the regulated phosphorylation of FAK in unsynchronized and mitotic cells. Among the four major phosphorylation sites, designated pS1-pS4, phosphorylation of pS1 (Ser722) is unchanged in unsynchronized and mitotic cells. In contrast, pS3 and pS4 (Ser843 and Ser910) exhibit increased phosphorylation during mitosis. In vitro peptide binding experiments provide evidence that phosphorylation of pS1 (Ser722) may play a role in modulating FAK binding to the SH3 domain of the adapter protein p130(Cas).

[Effect of Nerium indicum on killing Oncomelania hupensis]

A laboratory experiment at 20 +/- 5 degrees C shows that the water extract of fresh Nerium indicum had an obvious effect on killing Oncomelania hupensis. Treated with 0.1% water extract for four days, the mortality of O. hupensis was up to 100%. The effect of different tissues of N. indicum on O. hupensis was in order of stem phloem > leaf > root phloem > flower. The effect of N. indicum on O. hupensis was about ten times higher than that of Pterocarya stenoptera and Rumex japonicus, and was equal to that of 1 x 10(-3) mg.L-1 niclosamidum.

Conservation of heterochromatin protein 1 function

Heterochromatin represents a cytologically visible state of heritable gene repression. In the yeast, Schizosaccharomyces pombe, the swi6 gene encodes a heterochromatin protein 1 (HP1)-like chromodomain protein that localizes to heterochromatin domains, including the centromeres, telomeres, and the donor mating-type loci, and is involved in silencing at these loci. We identify here the functional domains of swi6p and demonstrate that the chromodomain from a mammalian HP1-like protein, M31, can functionally replace that of swi6p, showing that chromodomain function is conserved from yeasts to humans. Site-directed mutagenesis, based on a modeled three-dimensional structure of the swi6p chromodomain, shows that the hydrophobic amino acids which lie in the core of the structure are critical for biological function. Gel filtration, gel overlay experiments, and mass spectroscopy show that HP1 proteins can self-associate, and we suggest that it is as oligomers that HP1 proteins are incorporated into heterochromatin complexes that silence gene activity.

Regulation of c-SRC activity and function by the adapter protein CAS

SRC family kinases play essential roles in a variety of cellular functions, including proliferation, survival, differentiation, and apoptosis. The activities of these kinases are regulated by intramolecular interactions and by heterologous binding partners that modulate the transition between active and inactive structural conformations. p130(CAS) (CAS) binds directly to both the SH2 and SH3 domains of c-SRC and therefore has the potential to structurally alter and activate this kinase. In this report, we demonstrate that overexpression of full-length CAS in COS-1 cells induces c-SRC-dependent tyrosine phosphorylation of multiple endogenous cellular proteins. A carboxy-terminal fragment of CAS (CAS-CT), which contains the c-SRC binding site, was sufficient to induce c-SRC-dependent protein tyrosine kinase activity, as measured by tyrosine phosphorylation of cortactin, paxillin, and, to a lesser extent, focal adhesion kinase. A single amino acid substitution located in the binding site for the SRC SH3 domain of CAS-CT disrupted CAS-CT's interaction with c-SRC and inhibited its ability to induce tyrosine phosphorylation of cortactin and paxillin. Murine C3H10T1/2 fibroblasts that expressed elevated levels of tyrosine phosphorylated CAS and c-SRC-CAS complexes exhibited an enhanced ability to form colonies in soft agar and to proliferate in the absence of serum or growth factors. CAS-CT fully substituted for CAS in mediating growth in soft agar but was less effective in promoting serum-independent growth. These data suggest that CAS plays an important role in regulating specific signaling pathways governing cell growth and/or survival, in part through its ability to interact with and modulate the activity of c-SRC.

Fifth-order raman spectrum of an atomic liquid: simulation and instantaneous-normal-mode calculation

Experimental artifacts and technical difficulties in carrying out theoretical calculations have consistently frustrated attempts to obtain the two-dimensional (5th-order) Raman spectrum of a liquid. We report here a new theoretical development: the first microscopic numerical simulation of the 5th-order Raman signal in a liquid. Comparison with an instantaneous-normal-mode treatment, a fully microscopic model which interprets liquid dynamics as arising from coherent harmonic modes, shows that the 5th-order spectrum reveals profound effects stemming from dynamical anharmonicity.