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Quantitation and mapping of integrated human papillomavirus on human metaphase chromosomes using a fluorescence microscope imaging system.

Integrated human papillomavirus type 16 (HPV-16) DNA was directly visualized on metaphase chromosomes in the two human cervical carcinoma cell lines SiHa and CaSki by fluorescence in situ hybridization with a biotinylated DNA probe (7.9 kb). The fluorescence intensities of hybridization signals from single copies and dispersed clusters of integrated HPV-16 DNA were quantified using a microscope equipped with a cooled-CCD camera that was interfaced to an image processor and host computer. Hybridization signals were localized on chromosomes using separate, registered images of 4',6-diamidino-2-phenylindole (DAPI) or propidium iodide stained metaphase chromosome spreads. In both SiHa and CaSki spreads, a single fluorescein signal was observed on one or both chromatids of chromosome 13, which was identified by simultaneous hybridization with a biotinylated centromere probe specific for chromosomes 13 and 21. Ratios of the distance from 13pter to the HPV-16 signals to the entire chromosome length were approximately 0.63 +/- 0.05 in both SiHa and CaSki cells, indicating the possibility of a common integration domain on chromosome 13. In SiHa cells, no additional signals were observed on other chromosomes. This observation, taken together with literature reports that SiHa cells contain 1 to 2 copies of the HPV-16 genome in this region of chromosome 13, suggests that each fluorescein signal on chromosome 13 represents one equivalent of the HPV-16 genome. The total integrated fluorescence intensity in isolated CaSki metaphase chromosome spreads was approximately two orders of magnitude greater than that of a single copy of HPV-16 DNA in SiHa cells, indicating an increase in HPV-16 copy number.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Data processing in microbiology: an integrated, simplified system.

A MUMPS based computer system is described for the processing of data in a microbiology laboratory. The system uses visual display units and mnemonic codes for data input. All functions are carried out within the department by the medical, technical, and clerical staff. While the system described is integrated with other user-systems in the hospital, it is readily adaptable, and portable to a stand-alone system.

Laboratories↗

Accessing capital for integrated delivery systems.

As healthcare organizations integrate to better coordinate services and control costs, they often must turn to capital markets for financing. To successfully access capital for system development, however, healthcare executives first must understand how capital markets view the various entities of a healthcare system and must structure financing proposals in keeping with market expectations. Some relatively new financing strategies, such as taxable debt and equity financing, can help healthcare executives acquire the necessary capital for systems development.

Capital Financing↗

Integrated real-time control for a sequencing batch reactor plant and a combined sewer system.

Integrated real-time control (RTC) concepts, which are trying to operate drainage systems and WWTPs depending on the current capacities of both systems, are becoming more and more important. While almost all publications in this field have been concentrating on continuous flow systems, this paper will present a project which has been initiated to realise an integrated RTC strategy for a Sequencing Batch Reactor (SBR) plant in simulation as well as in full-scale. The results of the simulation are that SBR plants can handle high hydraulic loads. The cost-benefit analysis shows that an integrated operation is reasonable concerning environmental and economic aspects. In order to verify the simulation results, full-scale operation has been started in January 2004. The first results seem to confirm the results of the simulation study.

Bioreactors↗

Pharmacy formularies in integrated health systems.

Formulary management implications are described for an Oklahoma integrated health system comprising 14 acute care facilities, numerous owned medical practices, and a fledgling HMO. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations management for the Oklahoma City area has been created. A physician group has been formed that is expected to address system-wide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, including a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information system. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Ambulatory Care↗

The immune system and integrated homeostasis.

The immune system is usually viewed as an effector mechanism reacting to environmental antigenic challenge with defensive responses designed to eliminate 'foreign' substances and return to standby or surveillance mode. However, there is now substantial evidence to suggest that immunity is not effector-biased but is also a sensory organ and forms part of an integrated homeostatic network. Evidence that communication pathways exist between the immune and central nervous systems which support bi-directional information flow, and that the output of the immune system influences other physiological adjustments to environmental change, is discussed in this paper. The proposition that an endocrine-immune gradient determines the homeostatic response to combined microbial and other ambient stressors is established and the potential for management of this gradient is explored.

Animals↗

On-line biosensors for simultaneous determination of glucose, choline, and glutamate integrated with a microseparation system.

An effective microseparation system integrated with ring-disc electrodes and two microfluidic devices was fabricated for in vivo determination using a microdialysis pump. The major interference of ascorbic acid (AA) was excluded by direct oxidation with ascorbate oxidase. Glucose, glutamate, and choline were successfully determined simultaneously through the biosensors modified with a bilayer of osmium-poly(4-vinylpyridine)gel-horseradish peroxidase (Os-gel-HRP)/glucose oxidase (GOD), glutamate oxidase (GlutaOD) or choline oxidase (ChOD). To stabilize the biosensors, 0.2% polyethylenimine (PEI) was mixed with the oxidases. The cathodic currents of glucose, glutamate, and choline biosensors started to increase after the standard solutions were injected into the microseparation system. The on-line biosensors show a wide calibration range (10(-7)-10(-5) mol/L) with a detection limit of 10(-8) mol/L at the working potential of -50 mV. The variations of glucose, glutamate, and choline were determined simultaneously in a free moving rat when we perfused the medial frontal cortex with 100 micro mol/L N-methyl-D-aspartate (NMDA) solution, which is the agonist of the NMDA receptor.

Alcohol Oxidoreductases↗

An integrated information system for the intervention and prevention of AIDS.

The epidemic of acquired immune deficiency syndrome (AIDS) and its causative agent, the human immunodeficiency virus (HIV), are serious and spreading. In response to the epidemic, a variety of intervention and prevention programs have been instituted. In such AIDS intervention and prevention (AIP) activities, the role played by information systems becomes more and more important. The applications of information systems technology in AIP mostly seem to fall within a spectrum of databases, decision support systems and expert systems. This paper describes the implementation of an information system in a regional AIDS intervention and prevention program. In this integrative information system, the database is integrated with both decision support systems and expert systems, and decision support systems are integrated with expert systems. The implementation results of the system present evidence of the usefulness of the system in AIDS intervention and prevention.

Acquired Immunodeficiency Syndrome↗

Integrated health systems: promise and performance.

Today's ¿virtually¿ and vertically integrated health systems increasingly are much better positioned than the multihospital systems of the 1980s to respond to the healthcare challenges of the twenty-first century. The authors argue that the control of the health services ¿value chain¿ will devolve naturally to those market players who have the comparative advantage in coordinating the flows of information, human, and physical resources along the continuum of services required to improve and maintain the health of populations. Available evidence does not render a clear verdict on whether superior performance is generated by the virtual integration of strategic alliances and affiliations or the vertical integration represented by unified single ownership of all system components. While inertia, acute care-based ¿mental models,¿ weak incentives, and insufficiently developed information systems represent important barriers to the creation and sustainability of integrated systems, the authors argue that system evolution is occurring and offers promise of enhanced efficiency and patient benefit. However, the full potential of these systems will only be realized as they accept explicit accountability for meeting the health needs of their local communities. The transition from ¿covered lives¿ to accountability for the community population is crucial.

Community Health Planning↗

Whole systems shared governance: a model for the integrated health system.

The healthcare system is under renovation and renewal. In the process, roles and structures are shifting to support a subscriber-based continuum of care. Alliances and partnerships are emerging as the models of integration for the future. But how do we structure to support these emerging integrated partnerships? As the nurse executive expands the role and assumes increasing responsibility for creating new frameworks for care, a structure that sustains the point-of-care innovations and interdisciplinary relationships must be built. Whole systems models of organization, such as shared governance, are expanding as demand grows for a sustainable structure for horizontal and partnered systems of healthcare delivery. The executive will have to apply these newer frameworks to the delivery of care to provide adequate support for the clinically integrated environment.

California↗

A decision support system for managing forest fire casualties.

Southern Europe is exposed to anthropogenic and natural forest fires. These result in loss of lives, goods and infrastructure, but also deteriorate the natural environment and degrade ecosystems. The early detection and combating of such catastrophes requires the use of a decision support system (DSS) for emergency management. The current literature reports on a series of efforts aimed to deliver DSSs for the management of the forest fires by utilising technologies like remote sensing and geographical information systems (GIS), yet no integrated system exists. This manuscript presents the results of scientific research aiming to the development of a DSS for managing forest fires. The system provides a series of software tools for the assessment of the propagation and combating of forest fires based on Arc/Info, ArcView, Arc Spatial Analyst, Arc Avenue, and Visual C++ technologies. The system integrates GIS technologies under the same data environment and utilises a common user interface to produce an integrated computer system based on semi-automatic satellite image processing (fuel maps), socio-economic risk modelling and probabilistic models that would serve as a useful tool for forest fire prevention, planning and management. Its performance has been demonstrated via real time up-to-date accurate information on the position and evolution of the fire. The system can assist emergency assessment, management and combating of the incident. A site demonstration and validation has been accomplished for the island of Evoia, Greece, an area particularly vulnerable to forest fires due to its ecological characteristics and prevailing wind patterns.

Decision Support Techniques↗

Building patient workflow management systems by integrating medical and organizational knowledge.

Patient management is a distributed activity involving general practitioners, clinicians, analysts, nurses, etc. Thus an integrated Patient Workflow Management System (WfMS), based on a detailed model of both the organizational and medical knowledge, could heavily improve Health Care System's performance in terms of collaborative work and resource utilization. A set of tools was developed to improve 1) acquisition of medical knowledge represented through clinical practice Guideline, and 2) acquisition of organizational knowledge describing the work process.

Computer Simulation↗

Creating physician-driven integrated delivery systems.

Put doctors in control of key strategic and clinical decisions? Make them part owners or give them financial performance incentives? Yes, say many experts, that's the road to success for integrated systems. Read how they're doing it and evaluate your physician integration initiatives on HSL's 10-question self-assessment.

Comprehensive Health Care↗

Routine use of the crystal device integrity testing system in pediatric patients.

Crystal Device Integrity Testing System (CITS), the first commercially available testing system of its type, allows rapid assessment of cochlear implant function by measuring averaged electrode voltages-the scalp-recorded fields generated by electrode currents. We describe our experience performing routine integrity tests on 44 pediatric cochlear implant patients using the CITS. We present our findings focusing on the monopolar and common ground scans to provide a framework from which CITS scans can be evaluated in the future. We also describe selected cases in which abnormal results using the CITS influenced clinical treatment, demonstrating the utility of performing routine integrity tests.

Child↗

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--2001.

The results of a 2001 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of similar surveys conducted in 1997 and 1999. Three hundred and seventy-six MCOs and integrated health systems participated in the telephone survey. The surveyelicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey respondents were asked about 24 specific ambulatory care pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary care teams, automated dispensing systems, integrated electronic medical records, very supportive medical staff, and very supportive senior management. Twenty previously measured functions decreased since 1999. Decreases were greatest in negotiating pharmaceutical contracts (-28%), administering immunizations (-27%), and immunization screening (-24%). Enabling factors supported continued expansion. Two clusters of functions, patient-related and population-related activities, were identified and supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the broadest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of functions, with an emphasis on population-focused functions. Ambulatory care functions of pharmacists have expanded to new areas and have decreased in more traditional areas, perhaps because of the current pharmacist shortage and the increase in the number of prescriptions and patients.

Ambulatory Care↗

'Televaluation' of clinical information systems: an integrative approach to assessing Web-based systems.

The World Wide Web provides an unprecedented opportunity for widespread access to health-care applications by both patients and providers. The development of new methods for assessing the effectiveness and usability of these systems is becoming a critical issue. This paper describes the distance evaluation (i.e. 'televaluation') of emerging Web-based information technologies. In health informatics evaluation, there is a need for application of new ideas and methods from the fields of cognitive science and usability engineering. A framework is presented for conducting evaluations of health-care information technologies that integrates a number of methods, ranging from deployment of on-line questionnaires (and Web-based forms) to remote video-based usability testing of user interactions with clinical information systems. Examples illustrating application of these techniques are presented for the assessment of a patient clinical information system (PatCIS), as well as an evaluation of use of Web-based clinical guidelines. Issues in designing, prototyping and iteratively refining evaluation components are discussed, along with description of a 'virtual' usability laboratory.

Attitude to Computers↗

Failure patterns of four osseointegrated oral implant systems.

The aim of this metanalysis was to investigate possible differences in failure patterns among four different osseointegrated oral implant systems. Only systems with a supposed scientific validation, based on long-term follow-up studies, were selected for this analysis, i.e. the Brånemark system, the Calcitek Integral system, the Interpore IMZ system and the Straumann ITI system. While several prospective reports could be found on the Brånemark system, only a few retrospective investigations concerning the ITI and the IMZ systems were available. No data on the Integral system could be employed. Despite these limitations, a substantial difference in failure patterns among various implant systems was observed. The Brånemark implants showed a higher incidence of early failures, though sharply decreasing over time. On the contrary, IMZ implant characterized by rougher surfaces displayed a lower incidence of early failures, but showed constant or increased failure rates over time. For the ITI implants, for example, a higher prevalence of late failures, attributable to chronic bacterial infection (peri-implantitis), was observed when compared to the Brånemark system. With the exception of the latter implant system, prospective long-term follow-up studies, using similar and well-defined success criteria, are needed for the others to confirm the current preliminary findings.

Journal Article↗

Integrated delivery systems focus on service delivery after capitation efforts stall.

Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.

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