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Biomedical subjects

G J Young

Publications and source records attributed to G J Young.

At least 37 records · Page 2Linked to original sources
PubMed1992

Organizational and environmental determinants of hospital strategy.

This study focuses on the relationship between the business strategy of acute care hospitals and several organizational and environmental characteristics. Business strategy is assessed using the Miles and Snow (1978) typology. The organizational characteristics examined are size, system membership, type of ownership, and case-mix severity. The environmental characteristics examined are those of the local environment, which includes general economic factors and measures of market structure. General economic factors include family income, unemployment rate, percent of population over 65, and ratio of physicians to general population. The measures of market structure include the Herfindahl index and each hospital's individual market share. The results of our analysis using multiple regression indicate that organizational characteristics are more likely than environmental factors to influence the business strategy of hospitals. Specifically, hospitals that are relatively small or operate independently are less likely than other hospitals to follow a proactive strategic orientation.

Chi-Square Distribution↗
PubMed1992

The process and outcome of hospital care for Medicaid versus privately insured hospital patients.

Some have argued that low Medicaid payment rates compromise the accessibility and quality of medical care for Medicaid beneficiaries. In this study we compare the process and outcome of hospital care for Medicaid versus privately insured hospital patients. We studied 4,033 emergency patients admitted with a principal diagnosis of acute myocardial infarction, to Massachusetts hospitals in 1987. After we statistically adjusted for differences among patients relating to clinical and demographic characteristics and the type of hospital where treatment occurred, we found that the Medicaid patients had longer hospital stays but were less likely to receive three selected coronary procedures. Moreover, after controlling for confounding variables, we found the risk of death for Medicaid patients to be almost twice as high as for privately insured patients.

Angiography↗
PubMed1991

Inequities in hospital care, the Massachusetts experience.

This study examined the relationship between patient insurance status and the process and outcome of hospital care in Massachusetts, a state that has had an uncompensated care pool for paying hospitals since 1986. This study examined data on 4,972 patients admitted to a Massachusetts hospital on an emergency basis in 1987 and diagnosed with acute myocardial infarction. We classified these patients into three groups: having fee-for-service insurance, having prepaid coverage through a health maintenance organization (HMO), or being uninsured at the time of hospital admission. Results showed treatment differences by insurance status and significantly greater mortality rates for uninsured patients than for either fee-for-service or HMO patients. Our findings indicate that in Massachusetts the process and outcome of hospital care do differ by insurance status.

Cardiology Service, Hospital↗
PubMed1986

Cooperation between epithelial cells demonstrated by potassium transfer.

Junction-mediated communication can be measured in fibroblast cultures by determining the ability of mixed cultures of cells sensitive and resistant to ouabain to concentrate K+ in the presence of ouabain. We now report the extension of this assay procedure to cultured epithelial cells. Hamster kidney (HaK) cells maintain their ability to concentrate K+ in ouabain at levels inhibitory to dog kidney (MDCK) cells. When HaK and MDCK cells were cultured together in ouabain-containing medium, the K+ (measured as 86Rb+) in the mixed population was greater than expected if the cells were not interacting. The degree of enhancement, expressed as "index of cooperation," depended on the numbers of cells in the cultures, their opportunity for cell-to-cell contact, and (above a certain permissive level) the concentration of ouabain. As with other cell types, protein synthesis in MDCK cells depends on maintenance of cell K+. Autoradiography of cells incubated with [3H]leucine demonstrated that MDCK cells in ouabain-treated mixed cultures were able to synthesize proteins only when physically adjacent to HaK cells. The transmission of labeled nucleosides among the cells provides independent evidence of the phenomenon of cooperation, probably mediated by gap junctions. This system offers promise for investigation of stimuli modulating junctional communication.

Animals↗
PubMed1985

Nucleoside transport and cytosine arabinoside (araC) metabolism in human T lymphoblasts resistant to araC, thymidine and 6-methylmercaptopurine riboside.

Alteration in cellular nucleoside transport characteristics, deoxynucleoside triphosphate (dNTP) pools and araCTP formation from cytosine arabinoside (araC) were determined for human T lymphoblasts (CCRF-CEM) resistant to araC, thymidine or 6-methylmercaptopurine riboside (6-MMPR). AraC resistance was accompanied by reduced activities of deoxycytidine and thymidine kinases, lowered cellular deoxycytidine triphosphate concentration and markedly reduced formation of araCTP from araC. The ID50 values for araC, araCTP formation and dNTP levels of thymidine-resistant lymphoblasts, which exhibited reduced thymidine kinase activity, and 6-MMPR-resistant cells, with reduced adenosine kinase activity, were similar to the corresponding parameters of wild type lymphoblasts. The nucleoside transport sites density determined by nitrobenzylmercaptopurine riboside binding was comparable for araC-resistant, wild type and thymidine- or 6-MMPR-resistant lymphoblasts.

Adenosine Kinase↗
PubMed1984

S-adenosylhomocysteine hydrolase inactivation and purine toxicity in cultured human T- and B-lymphoblasts.

Accumulation of intracellular deoxyadenosine triphosphate and inactivation of the enzyme S-adenosylhomocysteine hydrolase by deoxyadenosine have been suggested as molecular mechanisms for lymphoid toxicity of inherited or acquired deficiency of adenosine deaminase. The relative roles of these two deoxyadenosine-mediated effects for lymphotoxicity have been explored by employing mutant human T- and B-lymphoblasts deficient in either adenosine kinase, deoxycytidine kinase, or both. At low concentrations (less than 25 mumol/L) of deoxyadenosine or ara-adenine, deoxycytidine kinase deficiency decreases growth sensitivity of human T-lymphoblasts to deoxyadenosine approximately fourfold, and to ara-adenine approximately twofold. Loss of both activities completely eliminates deoxyadenosine phosphorylation and cellular dATP accumulation, and decreases deoxyadenosine growth sensitivity approximately 200-fold and ara-adenine sensitivity approximately 80-fold. The inactivation by deoxyadenosine of intracellular S-adenosylhomocysteine hydrolase activity of human adenosine deaminase-deficient B-lymphoblasts and wild-type or deoxycytidine kinase-deficient T-lymphoblasts is comparable, despite the differing toxicity of this compound for these cell lines. Adenosine kinase deficiency in T-lymphoblasts results in resistance to 2'-deoxyadenosine--but not ara-adenine--associated inactivation of S-adenosylhomocysteine hydrolase, and this compound produces comparable degrees of inactivation of S-adenosylhomocysteine hydrolase in both the wild-type and double mutant cells, despite markedly different growth sensitivity. For B-lymphoblasts, 2'-deoxyadenosine together with adenosine produces comparable growth inhibition of wild-type and adenosine kinase-deficient cells, and this inhibition is more marked than with adenosine alone, but is independent of S-adenosylhomocysteine hydrolase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Kinase↗
PubMed1983

Cleavage in vivo and in culture in the Dasyurid marsupial Antechinus stuartii (macleay).

Cleavage in the brown marsupial mouse, Antechinus stuartii, from the zygote to the unilaminar blastocyst, was observed in vivo and in culture and in sections of embryos. The first three divisions were meridional and passed from the yolk pole to the opposite pole. Deutoplasmolysis, resulting in a distinct yolk mass, occurred during the first two divisions. Prior to the third and fourth divisions, the blastomeres elongated and flattened against the zona pellucida. The fourth division was latitudinal and resulted in two histologically distinct rings of eight blastomeres which were at first rounded and then became flattened against the zona. Further divisions and flattening of the blastomeres resulted in a complete unilaminar blastocyst by the time the blastocyst numbered 22 to 30 cells. Some expansion, causing compression of the zona and mucoid layers, occurred before completion of the blastocyst, but most expansion occurred once the blastocyst was complete. No histological differences could be detected between the blastomeres at this stage. Embryos were successfully cultured from the zygote to the rounded four-cell stage and from the flattened four-cell stage to the completed unilaminar blastocyst of around 32 cells. Total estimated cleavage times were slower in culture than in vivo, but the relative lengths of time for each division were approximately the same.

Animals↗
PubMed1981

Heavy metal concentrations in the Holston River Basin (Tennessee).

Contamination levels of zinc, cadmium, mercury, copper, lead, and manganese of the major streams in the Holston River Basin in Eastern Tennessee are reported and compared with other waterways. Heavy metal levels are sufficiently high in areas of the Basin to affect the health of aquatic life. The levels of cadmium, copper, manganese, lead and zinc were measured in fish samples from each lake and stream in the Basin and compared to those reported for fish throughout the world. The use of fish to monitor the levels of heavy metals is discussed as an alternative to grab samples of water; mercury levels in fish muscle reflected pollution of a stream, whereas grab samples of water did not.

Animals↗
PubMedDate not supplied

Clinical practice guidelines in the nursing home.

Clinical practice guidelines are an important tool for improving quality of care. This study determined whether and how guidelines are being used in nursing homes. We surveyed staff at 36 Department of Veterans Affairs (VA) nursing homes. Employees were asked whether they were familiar with guidelines as well as whether 5 specific guidelines had been read, were available, and had been adopted. Among 1065 respondents (60% of those surveyed), 79% reported familiarity with guidelines. The proportion of staff at a facility reporting adoption was generally less than 50%. Those nursing homes in which a high percentage of the staff reported adoption of one guideline were more likely to have adopted other guidelines. However, staff were not more likely to report adoption of a specific guideline when the nurse manager stated that it was adopted. We conclude that staff at VA nursing homes are familiar with guidelines. Guideline adoption at individual nursing homes, however, is not a systematic process involving the entire staff.

Diffusion of Innovation↗
PubMedDate not supplied

Implementing quality improvement in hospitals: the role of leadership and culture.

Many advocates of quality improvement (QI) suggest that there is a link between an organization's leadership commitment and culture and its ability to implement a QI initiative. This paper reports empirical evidence from a study of QI implementation in Veterans Health Administration (VHA) hospitals that supports this hypothesized linkage. The findings suggest that the extent to which top management becomes directly involved in QI activities determines the degree of QI implementation. Additionally, study findings suggest that a culture emphasizing innovation and teamwork provides an important foundation for implementing a QI initiative. We discuss the implications of these findings for organizational leaders interested in implementing QI.

Analysis of Variance↗