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Biomedical subjects

R P Ellis

Publications and source records attributed to R P Ellis.

At least 37 records · Page 2Linked to original sources
PubMed1996

Hospital response to prospective payment: moral hazard, selection, and practice-style effects.

In response to a change in reimbursement incentives, hospitals may change the intensity of services provided to a given set of patients, change the type (or severity) of patients they see, or change their market share. Each of these three responses, which we define as a moral hazard effect, a selection effect, and a practice-style effect, can influence average resource use in a population. We develop and implement a methodology for disentangling these effects using a panel data set of Medicaid psychiatric discharges in New Hampshire. We also find evidence for the form of quality competition hypothesized by Dranove (1987).

Adolescent↗
PubMed1996

Diagnosis-based risk adjustment for Medicare capitation payments.

Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.

Aged↗
PubMed1996

Bundling post-acute care (PAC) with Medicare DRG payments: an exploration of the distributional and risk consequences.

This exploratory study simulates the distributional and risk consequences of bundling 60 days' worth of post-hospital, post-acute care (PAC) with the inpatient stay, and paying for both on an all-inclusive, single-free basis. Simulations are conducted using 1987-1988 Medicare claims data from five states, focusing on patients discharged in 14 PAC-intensive diagnosis-related groups (DRGs). In this data, we find that hospital-level risk actually would be reduced if post-acute care were bundled with the DRG payments for inpatient stays.

Diagnosis-Related Groups↗
PubMed1995

Prospective characterization of the clinicopathologic and immunologic features of an immunodeficiency syndrome affecting juvenile llamas.

The clinicopathologic and immunologic features of 15 llamas affected with juvenile llama immunodeficiency syndrome (JLIDS) are described. Healthy adult (n = 10) and juvenile (n = 10) llamas served as controls. JLIDS llamas were characterized by wasting, and clinically apparent, repeated infections were frequently observed. The median age at which a health problem was first perceived was 11.6 months. All 15 affected llamas died or were killed, and JLIDS was confirmed at necropsy. The median duration of illness was 3.5 months. Lymphocyte blastogenesis assays showed suppressed responses (particularly to Staphylococcus sp. Protein A) in JLIDS llamas. No evidence of retroviral infection was detected. Mild, normocytic, normochromic, non-regenerative anemia, low serum albumin concentration and low to low-normal globulin concentrations were typically found on initial clinical evaluation. Lymph node biopsies showed areas of paracortical depletion. All llamas affected with JLIDS had low serum IgG concentrations, pre-vaccination titers against Clostridium perfringens C and D toxoids of < or = 1:100, and no titer increase following vaccination.

Animals↗
PubMed1994

Vesicular adenitis syndrome in beef bulls.

Vesicular adenitis syndrome was diagnosed in 69.3% (52/75) of a group of yearling bulls on breeding soundness examination. Association of Haemophilus somnus infection with vesicular adenitis syndrome was confirmed in these bulls by microbial culture of vesicular gland fluid or semen samples and serologic testing.

Animals↗
PubMed1994

Mycobacterium paratuberculosis infection in two llamas.

Mycobacterium paratuberculosis was diagnosed in 2 llamas by bacteriologic culturing and DNA probe testing of fecal and intestinal specimens. Diarrhea and weight loss were observed in both animals. Lesions in the gastrointestinal tracts of the 2 llamas were similar to pathologic changes reported in cattle infected with M paratuberculosis.

Animals↗
PubMed1994

A monoclonal antibody to lateral element proteins in synaptonemal complexes of Lilium longiflorum.

To identify synaptonemal complex (SC) proteins in Lilium longiflorum (lily), monoclonal antibodies were generated using mice immunized with isolated pachytene nuclei. While most of the resulting monoclonal antibodies recognized nucleolar or chromatin proteins, one monoclonal antibody (anti-LE) was found that binds to lateral elements. Anti-LE bound more to lateral elements of SCs digested with DNase than to lateral elements that had not been digested with DNase. The opposite pattern of labeling was observed using monoclonal antibodies to lily chromatin and nucleolar proteins. These results indicate that anti-LE is specifically recognizing lateral element proteins and not chromatin or nucleolar proteins surrounding the lateral elements. On immunoblots, anti-LE binds to three pachytene nuclear proteins (Mr 60000, 66000 and 70000), two tetrad (early microspore) nuclear proteins (Mr 60000 and 70000), and two root tip nuclear proteins (Mr 52000 and 60000). However, anti-LE does not bind to proteins from leaf nuclei. Of these four tissues, leaf is the only one that does not have actively dividing cells. This observation suggests that at least some SC proteins are related to nuclear proteins from mitotically active cells.

Animals↗
PubMed1992

Alternative payment systems for hospital medical staffs.

This paper examines the implications of using a Medical Staff Payment System (MSPS) for reimbursing physicians for services provided to inpatients. Inpatient episodes are defined to include seven days before admission and 30 days postdischarge. Simulations are performed using Medicare Part A and B data from nine states in 1988. DRGs are strong predictors of expenditures on physician services during the inpatient episode, achieving an R2 of .61. Gains and losses for various types of facilities are simulated, and the characteristics of winning and losing hospitals under an MSPS are identified.

Diagnosis-Related Groups↗
PubMed1991

Visualization of Trichoderma reesei Cellobiohydrolase I and Endoglucanase I on Aspen Cellulose by Using Monoclonal Antibody-Colloidal Gold Conjugates.

Monoclonal antibodies (MAbs) specific for cellobiohydrolase I (CBH I) and endoglucanase I (EG I) were conjugated to 10- and 15-nm colloidal gold particles, respectively. The binding of CBH I and EG I was visualized by utilizing the MAb-colloidal gold probes. The visualization procedure involved immobilization of cellulose microfibrils on copper electron microscopy grids, incubation of the cellulose-coated grids with cellulase(s), binding of MAb-colloidal gold conjugates to cellulase(s), and visualization via transmission electron microscopy. CBH I was seen bound to apparent crystalline cellulose as well as apparent amorphous cellulose. EG I was seen bound extensively to apparent amorphous cellulose with minimal binding to crystalline cellulose.

Journal Article↗
PubMed1990

Optimal payment systems for health services.

Demand-side cost sharing and the supply-side reimbursement system provide two separate instruments that can be used to influence the quantity of health services consumed. For risk-averse consumers, optimal payment systems--pairs of insurance and reimbursement plans--are characterized by conflict rather than consensus between patient and provider about the quantity of treatment. A model of conflict resolution based on bargaining theory is used to represent the outcome when the payment system creates divergences between desired demand and desired supply. Using that model, we describe the optimal combination of insurance and reimbursement systems that maximize consumer welfare.

Community Participation↗
PubMed1990

Advances in the control of foot rot in sheep.

All cases of foot rot, whether acute, chronic, benign, or inapparent, must be identified. If the outbreak is severe and production losses warrant, each foot of each animal must be examined thoroughly. Proper handling facilities and equipment, adequate light, and dry working conditions are needed to properly examine each foot. Infected sheep must be separated from the clean flock. Following extensive treatment, these animals must be diagnosed as free from the disease before returning to the clean flock. Animals that do not respond must be culled from the flock. Although copper sulfate and formalin are effective materials for footbathing, zinc sulfate is equally effective and does not irritate the skin, eyes, or lungs as does formalin, or stain the wool as does copper sulfate. A 10% zinc sulfate solution with a nonionic surfactant is an effective footbathing or foot soaking solution. The cure rate is improved by a thorough foot paring and a foot soak of at least 30 minutes. A number of treatment options along with formulations are outlined in the 1988 edition of the Sheep Production Handbook of the Sheep Industries Development Program, Inc, 6911 Yosemite, Englewood, CO 80112.

Animals↗
PubMed1990

Cross-reactive and specific monoclonal antibodies against cellobiohydrolases I and II and endoglucanases I and II of Trichoderma reesei.

Splenocytes derived from mice inoculated with a commercial cellulase preparation or purified cellulases were fused with a stable myeloma cell line (SP2/0). Specific monoclonal antibodies to cellobiohydrolases I and II and endoglucanases I and II were established. In addition to specific monoclonal antibodies, we were also able to establish stable hybridoma cell lines which produced monoclonal antibodies that recognized similar epitopes possessed by two or more of the above cellulases. By obtaining monospecific antibodies for all four individual cellulases, the role and function of the individual cellulases can thus be studied in greater detail.

Animals↗
PubMed1990

Polymerase chain reaction amplification of the constant and variable regions of the Bacteroides nodosus fimbrial gene.

Serogrouping of Bacteroides nodosus is based on antigenic differences in fimbriae of the different New Zealand prototype strains. Because of the time needed to isolate and grow pure cultures of B. nodosus and the difficulty in distinguishing between different serogroups because of cross-agglutination, a new DNA-based diagnostic approach based on the fimbrial gene sequence of B. nodosus was developed. Published nucleotide sequences of the fimbrial genes for serogroups A, G, D, and H showed conservation at the 5' end, coding for the N terminus, and variability at the 3' end, coding for the C terminus. The polymerase chain reaction was used to amplify both the constant and variable regions of the fimbrial genes. Constant-region oligonucleotide primers were used to amplify a 100-base-pair fragment from the constant regions of the fimbrial genes of 10 New Zealand serogroups. Serogroup-specific oligonucleotide primers for serogroups A and H allowed amplification of a 282-base-pair fragment from serogroup A and a 363-base-pair fragment from serogroup H. Thus, amplification of the constant and variable regions of the fimbrial gene allows rapid detection and grouping of B. nodosus.

Amino Acid Sequence↗
PubMed1989

Provider response to Medicare's PPS: reductions in length of stay for psychiatric patients treated in scatter beds.

We used Medicare discharge data for the years 1984 and 1985 to analyze reductions in lengths of stay for psychiatric patients treated in general hospitals that did not have specialized psychiatric units. In response to Medicare's Prospective Payment System (PPS), not-for-profit hospitals experienced declines in lengths of stay averaging between 10% and 20% two years after they went onto PPS, while for-profit hospitals experienced a somewhat greater decline. Lengths of stay fell most rapidly during the months immediately surrounding the date on which a hospital began to be paid under PPS. This response included an anticipatory effect--hospital lengths of stay began shortening just before PPS payments started.

Hospitals, General↗
PubMed1988

An economic evaluation of various treatments for contagious foot rot in sheep, using decision analysis.

Two decision analysis models were constructed to identify the cost-effectiveness of treatment and/or prevention regimens for ovine foot rot through a systematic evaluation approach of 2 consecutive phases. The first model evaluated the cost-effectiveness of examining the sheep for foot lesions and the use of 1 of 32 treatment regimens when lesions were present. The second model evaluated the 6 most cost-effective treatment regimens from the first model with or without a preventive measure (in this case, vaccination) to determine the most cost-effective approach to preventing/treating foot rot in a single year. Three prevalence levels of foot rot were used. In addition, 3 levels of reduced production attributable to foot rot were used. Threshold analysis, a form of sensitivity analysis, was used to evaluate allowable variations in the success rates and cost of treatments/prevention where the outcome of the models remains unchanged. Of the 32 treatment regimens tested in this model, the use of 10% zinc sulfate applied to the feet of sheep with foot rot was the most cost-effective regimen, regardless of the prevalence levels of the disease or its impact on productivity. In the second model, the use of vaccination with paring of the feet, as a preventive measure, followed by a treatment of the sheep that were still infected, was less cost-effective than to treat only the sheep with foot lesions and disregard prevention. This was true regardless of the prevalence levels of the disease or its impact on productivity.

Animals↗