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At least 397 records · Page 22Linked to original sources
PubMed2002

Prediction of estrogen receptor binding for 58,000 chemicals using an integrated system of a tree-based model with structural alerts.

A number of environmental chemicals, by mimicking natural hormones, can disrupt endocrine function in experimental animals, wildlife, and humans. These chemicals, called "endocrine-disrupting chemicals" (EDCs), are such a scientific and public concern that screening and testing 58,000 chemicals for EDC activities is now statutorily mandated. Computational chemistry tools are important to biologists because they identify chemicals most important for in vitro and in vivo studies. Here we used a computational approach with integration of two rejection filters, a tree-based model, and three structural alerts to predict and prioritize estrogen receptor (ER) ligands. The models were developed using data for 232 structurally diverse chemicals (training set) with a 10(6) range of relative binding affinities (RBAs); we then validated the models by predicting ER RBAs for 463 chemicals that had ER activity data (testing set). The integrated model gave a lower false negative rate than any single component for both training and testing sets. When the integrated model was applied to approximately 58,000 potential EDCs, 80% (approximately 46,000 chemicals) were predicted to have negligible potential (log RBA < -4.5, with log RBA = 2.0 for estradiol) to bind ER. The ability to process large numbers of chemicals to predict inactivity for ER binding and to categorically prioritize the remainder provides one biologic measure to prioritize chemicals for entry into more expensive assays (most chemicals have no biologic data of any kind). The general approach for predicting ER binding reported here may be applied to other receptors and/or reversible binding mechanisms involved in endocrine disruption.

Animals↗
PubMed2006

Emotion and pain: a functional cerebral systems integration.

Emotion and pain are psychological constructs that have received extensive attention in neuropsychological research. However, neuropsychological models of emotional processing have made more progress in describing how brain regions interact to process emotion. Theories of emotional processing can describe inter-hemispheric and intra-hemispheric interactions during emotional processing. Due to similarities between emotion and pain, it is thought that emotional models can be applied to pain. The following review examines the neuropsychology of emotion and pain using a functional cerebral systems approach. Specific comparisons are made between pain and anger. Attention is given to differences in cerebral function and physiology that may contribute to the processing of emotion and pain. Suggestions for future research in emotion and pain are given.

Animals↗
PubMed1987

Integrated system brings hospital data together.

Healthcare industry changes during the 1980s--increased competition and alterations in the Medicare payment methodology--place new and more complex demands on a hospital's information systems, which often fall short of meeting those demands. These systems were designed for financial reporting, billing, or providing clinical data, and few of them are capable of linking with other unrelated systems. Today's hospital manager needs timely and simultaneous access to data from a variety of sources within the hospital. All the elements to accomplish this are collected somewhere in the hospital, but finding them and bringing them together is difficult. The key to the efficient management and use of data bases is in understanding the fundamental concept of relational data bases, which is the capability of linking or joining separate data files through a common data element in each file. In this way, data files may be integrated into a "related" data base. Any number of separate files, or tables, may exist within a "relational" data base as long as a series of threads links them. A strategic management information data base includes the information necessary to analyze, understand, and manage the hospital's markets, products, resources, and profitability. The major components of this information system are the case mix and cost accounting, budgeting, and modeling systems. The case mix and cost accounting factors involve managing concrete pieces of data, whereas the budgeting and modeling factors manipulate data to create a scenario. The strategic management information data base is the foundation of a hospital's decision support system, which is rapidly moving into the category of a necessary tool of the hospital manager's trade.

Computer Systems↗
PubMed2004

Robot-assisted 3D-TRUS guided prostate brachytherapy: system integration and validation.

Current transperineal prostate brachytherapy uses transrectal ultrasound (TRUS) guidance and a template at a fixed position to guide needles along parallel trajectories. However, pubic arch interference (PAI) with the implant path obstructs part of the prostate from being targeted by the brachytherapy needles along parallel trajectories. To solve the PAI problem, some investigators have explored other insertion trajectories than parallel, i.e., oblique. However, parallel trajectory constraints in current brachytherapy procedure do not allow oblique insertion. In this paper, we describe a robot-assisted, three-dimensional (3D) TRUS guided approach to solve this problem. Our prototype consists of a commercial robot, and a 3D TRUS imaging system including an ultrasound machine, image acquisition apparatus and 3D TRUS image reconstruction, and display software. In our approach, we use the robot as a movable needle guide, i.e., the robot positions the needle before insertion, but the physician inserts the needle into the patient's prostate. In a later phase of our work, we will include robot insertion. By unifying the robot, ultrasound transducer, and the 3D TRUS image coordinate systems, the position of the template hole can be accurately related to 3D TRUS image coordinate system, allowing accurate and consistent insertion of the needle via the template hole into the targeted position in the prostate. The unification of the various coordinate systems includes two steps, i.e., 3D image calibration and robot calibration. Our testing of the system showed that the needle placement accuracy of the robot system at the "patient's" skin position was 0.15 mm+/-0.06 mm, and the mean needle angulation error was 0.07 degrees. The fiducial localization error (FLE) in localizing the intersections of the nylon strings for image calibration was 0.13 mm, and the FLE in localizing the divots for robot calibration was 0.37 mm. The fiducial registration error for image calibration was 0.12 mm and 0.52 mm for robot calibration. The target registration error for image calibration was 0.23 mm, and 0.68 mm for robot calibration. Evaluation of the complete system showed that needles can be used to target positions in agar phantoms with a mean error of 0.79 mm+/-0.32 mm.

Automation↗
PubMed1990

A review of techniques and results obtained in one laboratory by an integrated system of methods designed for routine clinical flow cytometric DNA analysis.

Establishing flow cytometric DNA analysis as a clinical routine procedure requires adequate and proven guidelines, by which the data can be obtained and interpreted to directly influence management of the individual patient with a specific neoplasm. The present paper is intended as a contribution to such guidelines, of which only fragments are available today. We have previously described a system of methods, designed for routine flow cytometric DNA analysis. In the present status report our experience, based on approximately 18,000 samples (clinical and experimental) is summarised. Sample acquisition with fine-needle aspiration, storage at -80 degrees C, internal standardization by chicken (CRBC) and trout red blood cells (TRBC), staining with propidium iodide (PI), and analysis in the flow cytometer is recapitulated, with emphasis on previously unpublished aspects. The method of statistical analysis which has an integrating role is described in some detail. A lack of linearity between channel number and DNA content was determined experimentally, and the coefficient of variation (CV) was found to decrease with increasing channel number. The corrections in the algorithm of deconvolution made necessary by these findings are fundamental for estimating the end results. The zero point adjustment and procedures for changing from one batch of standards to another are described. A systematic approach to interpretation of DNA histograms is attempted and illustrated by data from clinical specimens of malignant lymphoma, breast cancer, small cell lung cancer, cancer of the oral cavity, and bladder cancer. Some problems are still unsolved and visual inspection is required to determine if the quality of the individual histogram is satisfactory. Inspection of the fluorescence/light scatter dot-plot provides additional information for the recognition of artifacts. The results stress that good quality DNA histograms with as small CVs as possible are important for interpretation of the data. It is essential that statistical methods are employed to extract the key end-point results. These are the number of subpopulations and their relative representation, and for each subpopulation the DNA index (DI) and the fractions of cells in the cell cycle phases. For the DNA data to have any rationally based impact on clinical decision making, it must be demonstrated that they have an independent prognostic value. Strategies for final evaluation are discussed. Multicenter trials on fresh material, to accrue quickly the number of patients necessary for firm conclusions, are suggested.

DNA↗
PubMed1994

State laws: a stumbling block for systems integration?

Health care providers and insurers moving to form networks face a raft of state regulations on the purchase of equipment or the addition of new services, selective contracting, the hiring of physicians, referral practices and licensure. Two of these of regulations, the "any-willing-provider" laws and certificate-of-need laws, are making headlines in some states.

Certificate of Need↗
PubMed1994

Precision maneuvers. A recent survey finds group practices are gearing up for reform and systems integration.

Physician group practices, like other providers, are experiencing the rapid transition to a new health care environment dominated by managed care penetration, at-risk capitation, and reform-related changes. Just how quickly things are changing is revealed by a new nationwide survey, which was conducted by Hospitals & Health Networks, the American Group Practice Association, Alexandria, VA, and Hamilton/KSA, Atlanta.

Attitude of Health Personnel↗
PubMed1999

Methodological issues in performance improvement in integrated systems.

This article presents an overview of processes necessary for effective performance improvement (PI) projects and includes a discussion of methodological issues that affect the quality of PI projects. Issues related to project design, project purpose, selection of a representative population for the project, and issues of sampling are presented. Data collection methods and instruments are analyzed and issues related to connecting the problem, the intervention, and the outcome are described. The final sections address strategies related to data analysis procedures and interpretation.

Data Collection↗
PubMed1997

Mycobacteriophage D29 contains an integration system similar to that of the temperate mycobacteriophage L5.

A mycobacteriophage D29 DNA fragment cloned in pRM64, a shuttle plasmid that transforms Mycobacterium smegmatis, was sequenced. The determined sequence was 2592 nucleotides long and had a mean G+C content of 63.7 mol%, similar to that of mycobacterial DNA. Four ORFs were identified: one with strong homology to dCMP deaminase genes; one homologous to mycobacteriophage L5 gene 36, whose function is unknown; one encoding a possible excisase; and one encoding an integrase. The intergenic region between the putative excisase gene and the integrase gene had a lower than average G+C content and showed the presence of the same attP core sequence as mycobacteriophage L5. Transformation experiments using subclones of pRM64 indicated that the integrase gene and all the intergenic region were essential for stable transformation. A subclone containing the integrase gene and the core attP sequence was able to transform but recombinants were highly unstable. Southern analysis of total DNA from cells transformed with pRM64 and its derivatives showed that all the plasmids were integrated at one specific site of the bacterial chromosome. A recombinant exhibiting a high level of resistance to the selective drug kanamycin had two plasmids integrated at different sites. These results demonstrated that the D29 sequences contained in pRM64 were integrative, indicating that the generally hold view of D29 as a virulent phage must be reviewed.

Amino Acid Sequence↗
PubMed1996

Third generation information systems: integrating costs and outcomes. Tools for professional development and program evaluation.

The authors present specific procedures for obtaining cost per closed case and a case outcome rating for each closed case, computer generated, yielding a cost-outcome report for single cases and aggregated cases. The procedures are illustrated with field data from an alcohol and drug addiction service. Cost per closed case is seen as the new unit cost datum. Combined with case outcome information, the cost-outcome report is seen as a promising new measure of efficiency. The potential of the cost-outcome report as a new basis for professional self-development, increased treatment effectiveness, and program evaluation is discussed.

Budgets↗
PubMed1996

The Community Medical Alliance: an integrated system of care in Greater Boston for people with severe disability and AIDS.

The Community Medical Alliance in Boston has adapted principles of prepaid managed care to redesign service delivery for people with severe physical disability and with late-stage AIDS. Experience to date suggests that the flexibility of capitation can be used to substantially shift care from its usual hospital focus to clinicians in home and community settings, especially nurse practitioners, with a high degree of patient satisfaction and without apparent compromise in quality. Instead of limiting access, managed care can use prepayment to support early interventions, coordination, and the development of services specifically designed to meet the needs of the target population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Hospice and a university integrate systems through a nurse liaison position.

In many ways, acute hospital care and hospice care are two very different health care modalities based on two very different philosophies. Acute hospital care is primarily curative in nature, and of course, hospice is palliative care. This major philosophical difference renders understanding, appreciation, and relinquishing care to each other difficult, and at times impossible. Collaboration between the two is fraught with barriers and, therefore, requires facilitation. The initiation of this hospice nurse liaison program required vision and risk taking as well as understanding and appreciation of the contributions of both acute care and hospice care. The outcomes of patient and staff satisfaction, decreased length of stays, increased appropriate hospice referrals, decreased costs, and increased communication and collaboration between the hospital and hospices validate the worthiness of the program.

Case Management↗
PubMed1999

Non-invasive assessment of autonomic nervous system integrity in able-bodied and spinal cord-injured individuals.

The purpose of this study is to identify features of the Valsalva maneuver (VM) that differentiate between able-bodied (AB, n = 14) and spinal cord-injured individuals with high (T, n = 11) and low (P, n = 10) lesions. The systolic blood pressure (BP) recovery during the VM was used as a measure of sympathetic and vagal activity, whereas from the BP rise in phase IV of the VM baroreflex sensitivity was derived. After a similar initial BP decrease in all groups, BP recovered faster and more completely in AB compared to P and T during the VM. After release of the VM, the BP overshoot was very similar in AB and P, suggesting that the BP overshoot reflects sympathetic activity onto the heart. The baroreflex sensitivity was smaller in P, but not in T, compared to AB. However, 36% of the observations of T had such a low correlation between BP and RR interval that a slope could not be determined, which caused loss of observations, but suggested a low baroreflex sensitivity as well.

Adult↗
PubMed1993

A model system. Integration of services for cancer treatment.

The care of pediatric cancer patients continues to grow in complexity. Paradoxically, treatment regimens grow more intensive, while regulatory pressures mandate more outpatient care. The challenge is to integrate services around episodes of illness and encounters over periods of 1-3 years. The approach of the author's clinic has been to create seamless relationships that place the patient at the center of care and address the major boundaries patients face. The inpatient-outpatient boundary has been effectively breached by an inpatient case manager and the simultaneous temporary rotation of an inpatient nurse to the outpatient area for specialty training. Discharge planning has been improved by sharing a nurse with the clinic's major home health care company, providing a direct clinic-home health liaison for patients. Ongoing formal evaluations have documented the effects of the institution of each part of the program. These surveys have indicated that inpatient staff participating in the outpatient rotation are more satisfied with the continuity of care and the availability of divisional resources. Patient satisfaction was extremely high and pediatric oncology discharge planning was rated significantly higher than other pediatric services. Despite rapid growth of the oncology service since 1985 and the personal intensity of care, length of stay has shortened and the number of staff has not required excessive increases to meet the needs of the new model.

Ambulatory Care↗
PubMed2000

Sharing obstetric care: barriers to integrated systems of care.

OBJECTIVES: To map the provision of shared obstetric care in Victoria, and investigate the views of care providers about the ways in which current practice could be improved. METHOD: All Victorian public hospitals with > or = 300 births per annum and a purposive sample of hospitals with < 300 births per annum were mailed a questionnaire seeking information about current practice. Interviews with key informants (n = 32) were conducted at four case study sites. RESULTS: The response rate to the hospital survey was 98% (42/43). Fourteen different models of shared care were identified. Two-thirds of hospitals with > or = 300 births per annum (16/28) had three or more different models of shared care. Six hospitals (15%) had written guidelines for all models of shared care offered; 13 (32%) had written guidelines covering some models. Practice varied considerably in relation to: exclusion criteria, recommended schedule of visits and use of patient-held records. There was little consensus about the content of visits and responsibility for covering particular aspects of care. Few hospitals (6/42) had written information for women about shared care. Care providers expressed divergent views regarding the question of where ultimate responsibility lies for individual patient care and for the overall management of shared care. CONCLUSIONS: Current funding arrangements provide strong incentives to expand enrollment in shared obstetric care. Expansion of shared care has occurred without the development of formal, consultative and agreed arrangements between providers, or adequate provision for monitoring, evaluation and review. The variety, complexity and fluidity of models of shared care and lack of agreed procedures contribute to difficulties experienced by both providers and women participating in shared care. IMPLICATIONS: Detailed evidence-based agreed guidelines developed in consultation with hospital and community providers, and provision of improved information to women about what to expect in shared care arrangements are urgently required.

Attitude of Health Personnel↗
PubMedDate not supplied

Implementing the Hospital Emergency Incident Command System: an integrated delivery system's experience.

INTRODUCTION: Hospital disaster manuals and response plans often lack formal command structure; instead, they rely on the presence of key individuals who are familiar with hospital operations, or who are in leadership positions during routine, day-to-day operations. Although this structure occasionally may prove to be successful, it is unreliable, as this leadership may be unavailable at the time of the crisis, and may not be sustainable during a prolonged event. The Hospital Emergency Incident Command System (HEICS) provides a command structure that does not rely on specific individuals, is flexible and expandable, and is ubiquitous in the fire service, emergency medical services, military, and police agencies, thus allowing for ease of communication during event management. METHODS: A descriptive report of the implementation of the HEICS throughout a large healthcare network is reviewed. RESULTS AND CONCLUSIONS: Implementation of the HEICS provides a consistent command structure for hospitals that enables consistency and commonality with other hospitals and disaster response entities.

Delivery of Health Care, Integrated↗
PubMed1997

Integrated system for preparation of bone cement and effects on cement quality and environment.

We developed a prepacked mixing system for the preparation of bone cement. The system is based on mixing and collection of bone cement under a vacuum and serves as both the storage and mixing device for the cement components, thereby minimizing the exposure of the operating staff to the monomer and the risk for contamination of the cement during preparation. We evaluated the system using Palacos R and Simplex P. The cement produced was compared with cement obtained from a commercially available mixing system. Temperature evolution during curing, handling characteristics, density, and porosity of the cement obtained were analyzed. The results showed that the experimental system produces cement with physical properties (i.e., setting times and temperature, porosity, and density) equal to or better than those obtained with commercially available systems. Reducing the amount of monomer in the experimental system led to a reduction of the curing temperature without compromising the physical properties of the cements.

Biocompatible Materials↗