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PubMed2005

Strategic integration of hospitals and physicians.

A striking development in the healthcare market place has been the formation of strategic relationships between hospitals and physicians. Hospital-physician integration appears to be a response to rapidly expanding managed care health insurance. We examine whether integration lead to efficiency gains from transaction cost economies thereby allowing providers to offer managed care insurance plans lower prices or whether integration is really a strategy to improve bargaining power and thereby increase prices. We find that integration has little effect on efficiency, but is associated with an increase in prices, especially when the integrated organization is exclusive and occurs in less competitive markets.

Cost-Benefit Analysis↗
PubMed2002

DNA alkylating agents alleviate silencing of class II transactivator gene expression in L1210 lymphoma cells.

MHC class II (Ia) Ag expression is inversely correlated with tumorigenicity and directly correlated with immunogenicity in clones of the mouse L1210 lymphoma (1 ). Understanding the mechanisms by which class II Ag expression is regulated in L1210 lymphoma may facilitate the development of immunotherapeutic approaches for the treatment of some types of lymphoma and leukemia. This study demonstrates that the variation in MHC class II Ag expression among clones of L1210 lymphoma is due to differences in the expression of the class II transactivator (CIITA). Analysis of stable hybrids suggests that CIITA expression is repressed by a dominant mechanism in class II-negative L1210 clones. DNA-alkylating agents such as ethyl methanesulfonate and the chemotherapeutic drug melphalan activate CIITA and class II expression in class II negative L1210 cells, and this effect appears to be restricted to transformed cell lines derived from the early stages of B cell ontogeny. Transient transfection assays demonstrated that the CIITA type III promoter is active in class II(-) L1210 cells, despite the fact that the endogenous gene is not expressed, which suggests that these cells have all of the transacting factors necessary for CIITA transcription. An inverse correlation between methylation of the CIITA transcriptional regulatory region and CIITA expression was observed among L1210 clones. Furthermore, 5-azacytidine treatment activated CIITA expression in class II-negative L1210 cells. Collectively, our results suggest that 1) CIITA gene expression is repressed in class II(-) L1210 cells by methylation of the CIITA upstream regulatory region, and 2) treatment with DNA-alkylating agents overcomes methylation-based silencing of the CIITA gene in L1210 cells.

5' Untranslated Regions↗
PubMed2005

Members of TALE and WUS subfamilies of homeodomain proteins with potentially important functions in development form dimers within each subfamily in rice.

Transacting factors often form homo- and heterodimers and regulate various targets, the type of regulation depending on the dimeric combination. The WUS and TALE subfamilies are two atypical homeodomains in plants. A homeodomain mediates sequence-specific binding to its target DNA and usually consists of 60 amino acid residues, whereas atypical homeodomains have extra amino acid residues in the well-conserved region. The genes OsWUS and OsPRS, which encode atypical homeodomain proteins from the WUS subfamily, and OsBEL and OSH15, which encode those from the TALE subfamily, were isolated from rice and tested for their interactions by yeast two-hybrid analysis. OsWUS and OsPRS formed homodimers and formed heterodimers with each other but did not form dimers with the TALE family homeodomain proteins OSH15 or OsBEL. Likewise, OSH15 and OsBEL formed homodimers and heterodimers but did not form dimers with the WUS family homeodomain proteins OsWUS and OsPRS. These findings suggest that the combinations of dimers are well correlated with the classification of these proteins on the basis of sequence similarity. RT-PCR analysis revealed that expression of OsWUS and OsPRS was detected in the same organs, namely floral buds, roots, and suspension cells. Therefore, it is possible that the proteins encoded by both of these genes function as homo- and heterodimers in planta. These results suggest that, during the evolution of these subfamilies, various combinations of dimers within proteins encoded by paralogous genes were formed and generated independent regulatory networks that enabled complex patterns of plant development.

Base Sequence↗
PubMed2000

HIPAA brings new requirements, new opportunities.

The passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) brought with it the need for Federal rules to implement the act's simplification and cost-reduction efforts. HHS has published proposed rules related to security for the electronic transmission of health information, privacy of individually identifiable health information, transactions and code sets, and national provider and employer identifiers. Additional proposed rules will be published this year for claims attachments and health plan identifiers. Although HIPAA does not require providers to conduct business electronically, the new standards give providers the opportunity to reduce healthcare administrative costs significantly and undertake electronic commerce efficiently and cost-effectively.

Computer Security↗
PubMed1993

Müllerian inhibiting substance: new perspectives and future directions.

MIS, as a differentiate and antiproliferative agent, is precisely regulated, for example, at the transcriptional level by such transacting factors as SRY, and posttranslationally by testosterone. Processing of MIS most likely requires an as yet unknown in vivo protease which probably serves to control cleavage of MIS and hence its activation at specific sites wherein a localized program of cell death is initiated via a receptor mediated event. Progress has been made in understanding the molecular domains of MIS; current efforts are focused on characterizing the wild type MIS receptor as well as cloning and expressing the MIS receptor. We need now to understand how to target and efficiently activate MIS at its projected site of action. We must focus, after structural analysis of its receptor, on elucidating the MIS initiated intracellular signals which result in localized cell inhibition. Understanding of these mechanisms will permit design of antitumor agents and therapeutic strategies. Similarly, understanding regulation of MIS expression may lead to therapeutic induction of expression in those states where depressed expression is associated with tumorigenesis, sexual ambiguity, or infertility.

Amino Acid Sequence↗
PubMed1996

Characterization of a sex-influenced modifier of gene expression and suppressor of position-effect variegation in Drosophila.

Modifier of white (Mow), a dominant transacting gene, has been identified through a mutagenic screen for second-site loci that alter the level of expression of the white eye color locus. Mow reduces the expression of white in most developmental stages, but enhances its expression in the pupal stage, the time at which the major contribution to the adult phenotype is made. Tests with an Alcohol dehydrogenase promoter-white reporter and a series of white truncation constructs have shown that Mow fails to affect the reporter; cis-regulatory mutations of white also show no response, suggesting a requirement for white regulatory domains for interaction with Mow. A quantitative analysis of steady-state transcript levels reveals that the white mRNA level decreases in the presence of one dose of Mow in larvae and adults, but the reduction is greater in females than males. Two other functionally related genes, brown and scarlet, also exhibit a similar sexually dimorphic alteration in expression, mediated by Mow. In the mid-pupal stage, by contrast, the level of white and brown mRNA is increased by Mow. In addition, Mow acts as a weak suppressor of position effect variegation (PEV). These observations suggest a connection between dosage modulation of gene expression and suppression of position-effect variegation.

Alcohol Dehydrogenase↗
PubMedDate not supplied

Is talking to an automated teller machine natural and fun?

Usability and affective issues of using automatic speech recognition technology to interact with an automated teller machine (ATM) are investigated in two experiments. The first uncovered dialogue patterns of ATM users for the purpose of designing the user interface for a simulated speech ATM system. Applying the Wizard-of-Oz methodology, multiple mapping and word spotting techniques, the speech driven ATM accommodates bilingual users of Bahasa Melayu and English. The second experiment evaluates the usability of a hybrid speech ATM, comparing it with a simulated manual ATM. The aim is to investigate how natural and fun can talking to a speech ATM be for these first-time users. Subjects performed the withdrawal and balance enquiry tasks. The ANOVA was performed on the usability and affective data. The results showed significant differences between systems in the ability to complete the tasks as well as in transaction errors. Performance was measured on the time taken by subjects to complete the task and the number of speech recognition errors that occurred. On the basis of user emotions, it can be said that the hybrid speech system enabled pleasurable interaction. Despite the limitations of speech recognition technology, users are set to talk to the ATM when it becomes available for public use.

Analysis of Variance↗
PubMed1997

Gene expression of albumin and liver-specific nuclear transcription factors in liver of protein-deprived rats.

Protein-energy malnutrition causes hypoalbuminemia. Recent work has suggested that this may be partly due to decreased transcription of the albumin gene. This study examined the role of cis-acting and transacting elements of the albumin gene during protein deprivation. Male 7-wk-old Donryu rats were fed a protein-free diet (0% casein diet) for 10 d or given restricted (pair-fed control) or free access (freely fed control) to a 25% casein diet. Serum albumin concentrations were significantly lower in the protein-deprived rats (29 +/- 1 g/L) than in the pair-fed controls (42 +/- 3 g/L) or the freely fed controls (45 +/- 3 g/L). The albumin mRNA level was also significantly lower in livers of protein-deprived rats (36% of pair-fed control). However, gel mobility shift analysis using liver nuclear extracts did not show any significant difference between the protein-deprived rats and the pair-fed controls in the binding activity to the B and D sites of the albumin promoter. Furthermore, gel mobility shift-Western blot analysis showed no significant difference between the two groups in the protein levels of nuclear transcription factors binding to the D sites. The amounts of mRNA of hepatocyte nuclear factor-1 binding to the B site were not significantly different between these two groups. These results suggest that the proximal promoter region may not play a major role in the down-regulation of the albumin gene during protein deprivation.

Analysis of Variance↗
PubMed1992

[Dimensions of coping with chronic pain--a replication study].

Clinical-psychological research on pain conceptualizes pain as a transactional process. There, important components are pain-experience, pain control (coping with pain) and subjectively felt pain-related stress. The intent of one preceding study (Geissner, 1991) was to describe, analyze, and validate behavioral and cognitive aspects of pain control and emotional and behavioral aspects of pain-related subjective stress. The purpose of the present study is to replicate the factors of pain-processing, gained by exploratory data-analyses. 162 patients with headache, back pain and joint pain answered the revised version of the set of questionnaires used in the former study. Analyses are done by means of confirmatory factor analysis (LISREL 7 by Jöreskog & Sörbom) and with admission of steps to optimize a solution found. 3 Dimensions of more behavioral aspects of pain control are identified: Mental distraction, relaxation and counteractivities. Also, 3 dimensions of cognitive aspects of pain control are found: Cognitive restructuring, planning skills to deal with the pain, and self-assurance of ones own skills. The dimensions of subjectively felt pain-related stress are (1) helplessness/depression, (2) anxiety, and (3) anger. All dimensions prove to be factorially homogenous and structurally distinct. In regard to the solution found in the preceding study, differences are small. Therefore, it can be said, that the results gained formerly are replicable. Findings from correlational and regression-analytic studies further support the validity of the dimensions of pain-processing.

Adaptation, Psychological↗
PubMed1979

Systems issues in psychiatric treatment of adolescents in their community.

The psychiatric treatment of adolescents is analyzed as having, on the one hand, staff and client subsystems interacting continuously and, on the other hand, cross-boundary transactions between the treatment program and two other systems, the neighborhood and the community mental health system of which the program is a part. Through the use of the concepts of boundaries and mirroring, it is possible to explain more clearly how certain dramatic events relate to adolescent psychology and to the treatment tasks.

Adolescent↗
PubMed1995

HIS priorities in developing countries.

Looking for a solution to fulfill the requirements that the new global economical system demands, developing countries face a reality of poor communications infrastructure, a delay in applying information technology to the organizations, and a semi-closed political system avoiding the necessary reforms. HIS technology has been developed more for transactional purposes on mini and mainframe platforms. Administrative modules are the most frequently observed and physicians are now requiring more support for their activities. The second information systems generation will take advantage of PC technology, client-server models and telecommunications to achieve integration. International organizations, academic and industrial, public and private, will play a major role to transfer technology and to develop this area.

Costs and Cost Analysis↗
PubMed1992

Development of conduct problems and peer rejection in preschool children: a social systems analysis.

The development of impulsive-aggressive problem behavior and peer rejection was examined in sixty 4- to 5-year-old boys from low-income family backgrounds. Children's sociometric status and behavioral adjustment were assessed longitudinally at the beginning and end of the preschool year, and related to measures of peer interaction at three different points in time. Boys identified as socially rejected and aggressive in the beginning of the year were highly likely to be identified as such at the end of the year. Early in the preschool year, these children contributed to their own rejection by initiating socially aversive exchanges with peers. Although peers clearly perceived these problems, they did not reciprocate with counteraggression at first. However, as time passed, peers began to actively victimize these children, and most of the aggression on the part of victims became reactive in nature. Thus, the current findings strongly support a transactional model of the development of early peer rejection and conduct problems.

Aggression↗
PubMed2002

A socio-legal and economic analysis of contracting in the NHS internal market using a case study of contracting for district nursing.

The introduction of an internal market in the National Health Service (NHS) in the United Kingdom necessitated the use of contracts between purchasers and providers. Little thought was given to the nature of these contracts by policy makers, who appeared to assume that the contracts could conform to the classical, complete model. This paper uses socio-legal and economic theories of contract (which provide an alternative model of relational contracts, in contrast to classical contracts) to explore how realistic that assumption was. An analysis of the institutional context in which the contracts were made is provided, including a legal analysis of the relevant legislation. Contracting by health authorities and GP fundholders is examined, using the results of a recent case study of contracting for district nursing services carried out in a health authority in Greater London. The results show that classical contracting is an inappropriate model for NHS contracts, but that relational contracting is not an entirely appropriate model either. Contracting was found to have increased the accountability of providers in respect of some financial matters, but not in respect of the quality of district nursing services. There are negative implications for the use of contracting in publicly financed health services--hierarchies may be more efficient (as lower transaction costs can be incurred) and possibly more effective in improving quality of care.

Community Health Nursing↗
PubMed2005

Multivariate prediction of relatives' stress outcome one year after first hospitalization of schizophrenic and depressed patients.

OBJECTIVE: The present study presents the 1-year follow-up findings of the Munich 5-year follow-up study on relatives of first hospitalized patients with schizophrenia or depression. The aim of the study was to determine which factors moderate the impact of the patient's illness on the stress experienced by his key relative in different dimensions. METHOD: Of the relatives who had participated in the baseline assessment, 90% could be reassessed (n = 69) with respect to their objective and subjective burden, well-being, self-rated symptoms and subjective quality of life as well as different personal dispositions and resources. RESULTS: Data demonstrate a considerable level of burden in most of the relatives at 1-year follow-up. Compared to baseline, a significant reduction in objective and subjective burden as well as significant improvements in well-being, self-rated symptoms and subjective quality of life occurred in two-thirds of the relatives, while well-being and self-rated symptoms remained worse when compared to norm values. Although stress reduction was significantly associated with patients' residual symptoms on the bivariate level, no main effects on relatives' stress outcome at 1-year follow-up could be observed under multivariate conditions. In multivariate linear regression models for each stress indicator, different combinations of predictors resulted, explaining up to 75% of the total variance of the stress indicators. The most relevant predictors were relatives'expressed emotion and neuroticism, their generalized negative stress response and life stressors, having significant direct and indirect effects on relatives' stress outcome. Stress reduction was mainly caused by an interaction of relatives' generalized positive stress response and patients' residual symptoms. CONCLUSION: Findings support the transactional character of the stress process in caring for a patient with a severe mental disease. A multidimensional approach is necessary to identify the most important predictors of burden in order to improve family intervention strategies which aim to reduce burden.

Adaptation, Psychological↗
PubMed1997

Transactional patterns of child, mother, and father adjustment in insulin-dependent diabetes mellitus: a prospective study.

Utilized both interview and self-report methods to examine transactional patterns of child, mother, and father adjustment in a sample of children and adolescents with insulin-dependent diabetes mellitus (IDDM). Overall, levels of child and parental adjustment were relatively stable over the 1-year study period. Regression analyses revealed that increases in fathers', but not mothers', distress over time contributed significant incremental variance to poorer subsequent children's adjustment, after controlling for demographic (age, gender, and SES) and disease parameters (illness duration and metabolic control). Decline in fathers' adjustment was a significant predictor of better mothers' adjustment at follow-up; child adjustment was not significantly associated with mothers' adjustment. Variations in both children's and mothers' adjustment made significant, independent contributions to predicting subsequent fathers' adjustment. Findings illustrate the transactional nature of relationships that exist in families of children with IDDM and underscore the importance of family systems or biobehavioral family treatment approaches in the clinical management of children with chronic illnesses.

Adaptation, Psychological↗
PubMed2000

Health insurance reform: standards for electronic transactions. Office of the Secretary, HHS. Final rule.

This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.

Cost-Benefit Analysis↗
PubMed1995

Translational control by influenza virus. Identification of cis-acting sequences and trans-acting factors which may regulate selective viral mRNA translation.

We have shown that sequences contained within the viral mRNA 5'-untranslated region (UTR) played a critical role in directing selective influenza viral mRNA translation. We therefore attempted to identify transacting factors that may regulate viral mRNA translation through interactions with the 5'-UTR and at the same time map the precise sequences to which these factors bind. We can now demonstrate that multiple cellular proteins interact with influenza viral but not cellular 5'-UTRs using gel mobility shift and UV cross-linking analyses. Gel supershift studies revealed that the La autoantigen was one of the cellular proteins that interacted with the viral 5'-UTR. Utilizing mutants of the viral mRNA 5' UTR, we have determined that sequences within the very 5'-conserved region and nucleotides immediately 3' are necessary but not always sufficient for binding certain cellular proteins. Northwestern analysis showed the binding of a distinct subset of cellular proteins to the viral 5'-UTR, but also demonstrated interactions of the viral nonstructural protein NS1. Gel shift analysis with purified recombinant NS1 confirmed the binding of the viral protein to a specific region of the viral 5'-UTRs. A model describing the possible role of these cellular and viral RNA-binding proteins in regulating influenza virus mRNA translation will be discussed.

Base Sequence↗
PubMed1981

A typology of marital interaction for sexually dysfunctional couples.

An empirical typology of marital interactions for couples seeking sexual dysfunction therapy was developed based upon their self-evaluations and interpersonal perceptions on the Taylor-Johnson Temperament Analysis (T-JTA). T-JTA scores of 246 couples on the psychological traits of Expressive-Responsive/Inhibited and Hostility/Tolerance were used to separate four groups of couples defining three distinct types of marital interactions. Groups 1 and 2 represented the Conflict-Centered relationship in which one spouse, wives and husbands respectively, scored high on the trait Hostility. Group 3, the Passive-Constrained relationship was characterized by husbands who scored low on the trait Expressive-Responsive (Inhibited) and Group 4, the Congenial-Affectionate relationship was based upon the profiles of the remaining couples in this sample. Self-perceptions of spouses are described and the transactional dynamics of the couple types discussed in terms of their therapeutic implications.

Adolescent↗