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PubMed1988

Growing pains: twelve lessons from corporate restructuring.

Corporate reorganization is a realignment of resources to enhance competitive strength and can follow one of two lines, vertical or horizontal. Whichever strategy is used, the reason for it remains unchanged: to provide a structural hierarchy through which strategic market niches are acquired and resources are economically deployed throughout the system. Healthcare corporate restructuring, however, is encountering growing pains, some of which were inevitable and others avoidable. When the healthcare organizational landscape is surveyed, 12 lessons can be learned about corporate reorganization: 1. Reorganization should be based on anticipated market and environmental conditions. 2. Form follows function. 3. Interdependence among multiple corporate units must be clearly acknowledged. 4. Reorganization is much more costly and politically charged than it appears at first. Reserved rights must be clearly defined. 6. The purpose and composition of the parent governing board must be distinguished from those of subsidiary boards. 7. Clarification of roles and relationships between the parent and subsidiaries is critical. 8. Unrealistic expectations of success should be confronted through up-front planning, negotiation, and creative problem solving. 9. False assumptions about corporate staffing needs create internal system warfare. 10. Physician support is crucial for success. 11. Hospital-based management skills and understanding may be inadequate for making personnel decisions in subsidiaries other than the hospital. 12. Competitive strategies must be strategically determined and must not be taken gamesmanship.

Economic Competition↗
PubMed2002

IMGT, the international ImMunoGeneTics database: a high-quality information system for comparative immunogenetics and immunology.

IMGT, the international ImMunoGeneTics database (http://imgt.cines.fr), is a high quality integrated information system specializing in Immunoglobulins (IG), T cell Receptors (TR) and Major Histocompatibility Complex (MHC) of human and other vertebrates, created in 1989, by LIGM, at the Université Montpellier II, CNRS, Montpellier, France. IMGT provides a common access to standardized data, which include nucleotide and protein sequences, oligonucleotide primers, gene maps, genetic polymorphisms, specificities, 2D and 3D structures. IMGT includes several databases (IMGT/LIGM-DB, IMGT/HLA-DB, IMGT/3Dstructure-DB), Web resources ('IMGT Marie-Paule page') which comprise IMGT Scientific Chart, IMGT Repertoire, IMGT Bloc-notes, IMGT Education, IMGT Aide-mémoire and IMGT Index, and interactive tools (IMGT/V-QUEST, IMGT/JunctionAnalysis). These expertly annotated data on the genome, proteome, genetics and structure of the IG, TR and MHC are of high value for comparative genome evolution studies of the adaptative immune response.

Animals↗
PubMed1999

Perfusion education in the United States at the turn of the century.

The challenges facing institutions charged with the delivery of health care have also affected the delivery of education in the health sciences. In the 30 years since the establishment of a process for formalized perfusion education, significant changes have shaped how the fundamentals of perfusion sciences are learned. The establishment and maintenance of a profession can only be secured through the creation of standards that guide educational facilities in the delivery of formalized instruction in a discipline. Perfusion education programs continue to meet these standards but are doing so at a time where resources continue to dwindle and quantitative assessment of manpower issues are fuzzy, at best. The peak of perfusion education programs occurred in 1994, and 5 years later only 25 programs were still accredited by the Committee on Accreditation of Allied Health Programs (CAAHEP). In the past decade, only one new education program has sought accreditation from CAAHEP. There were 41% fewer graduates in the United States in 1998 than in 1992, which follows a 6-year trend in declining numbers of individuals entering the field of perfusion. Individual programs are challenged by the reordering of university and community hospital structures, which often results in critical reviews of resource allocation to perfusion programs. The health of the perfusion profession remains deeply tied to the success of perfusion education programs. Likewise, the health of these programs can only be assured by means of continued solicitation of support and guidance from practitioners who serve as stewards of perfusion technology.

Costs and Cost Analysis↗
PubMed2006

AgBase: a functional genomics resource for agriculture.

BACKGROUND: Many agricultural species and their pathogens have sequenced genomes and more are in progress. Agricultural species provide food, fiber, xenotransplant tissues, biopharmaceuticals and biomedical models. Moreover, many agricultural microorganisms are human zoonoses. However, systems biology from functional genomics data is hindered in agricultural species because agricultural genome sequences have relatively poor structural and functional annotation and agricultural research communities are smaller with limited funding compared to many model organism communities. DESCRIPTION: To facilitate systems biology in these traditionally agricultural species we have established "AgBase", a curated, web-accessible, public resource http://www.agbase.msstate.edu for structural and functional annotation of agricultural genomes. The AgBase database includes a suite of computational tools to use GO annotations. We use standardized nomenclature following the Human Genome Organization Gene Nomenclature guidelines and are currently functionally annotating chicken, cow and sheep gene products using the Gene Ontology (GO). The computational tools we have developed accept and batch process data derived from different public databases (with different accession codes), return all existing GO annotations, provide a list of products without GO annotation, identify potential orthologs, model functional genomics data using GO and assist proteomics analysis of ESTs and EST assemblies. Our journal database helps prevent redundant manual GO curation. We encourage and publicly acknowledge GO annotations from researchers and provide a service for researchers interested in GO and analysis of functional genomics data. CONCLUSION: The AgBase database is the first database dedicated to functional genomics and systems biology analysis for agriculturally important species and their pathogens. We use experimental data to improve structural annotation of genomes and to functionally characterize gene products. AgBase is also directly relevant for researchers in fields as diverse as agricultural production, cancer biology, biopharmaceuticals, human health and evolutionary biology. Moreover, the experimental methods and bioinformatics tools we provide are widely applicable to many other species including model organisms.

Agriculture↗
PubMed1996

A new alpha-conotoxin which targets alpha3beta2 nicotinic acetylcholine receptors.

We have isolated a 16-amino acid peptide from the venom of the marine snail Conus magus which potently blocks nicotinic acetylcholine receptors (nAChRs) composed of alpha3beta2 subunits. This peptide, named alpha-conotoxin MII, was identified by electrophysiologically screening venom fractions against cloned nicotinic receptors expressed in Xenopus oocytes. The peptide's structure, which has been confirmed by mass spectrometry and total chemical synthesis, differs significantly from those of all previously isolated alpha-conotoxins. Disulfide bridging, however, is conserved. The toxin blocks the response to acetylcholine in oocytes expressing alpha3beta2 nAChRs with an IC50 of 0.5 nM and is 2-4 orders of magnitude less potent on other nAChR subunit combinations. We have recently reported the isolation and characterization of alpha-conotoxin ImI, which selectively targets homomeric alpha7 neuronal nAChRs. Yet other alpha-conotoxins selectively block the muscle subtype of nAChR. Thus, it is increasingly apparent that alpha-conotoxins represent a significant resource for ligands with which to probe structure-function relationships of various nAChR subtypes.

Acetylcholine↗
PubMed2006

[Provincial ecological footprint of China in the year of 2002].

Based on the calculation of actual yield per unit area in 2002, this paper analyzed the ecological footprint and its composition of each province in China. The results showed that there was a significant difference in the ecological footprint and its composition among different provinces, e. g., cropland changed from 0. 078 hm2 x cap(-1) in Shaanxi to 0.126 hm2 x cap(-1) in Beijing, grazing land changed from 0.020 hm2 x cap(-1) in Jiangxi to 0.372 hm2 x cap(-1) in Xizang, forestland changed from 0.020 hm2 x cap(-1) in Guizhou to 0.209 hm2 x cap(-1) in Beijing, fishery area changed from 0.001 hm2 x cap(-1) in Xizang to 0.011 hm2 x cap(-1) in Shanghai, built-up area changed from 0.013 hm2 x cap(-1) in Guizhou to 0.045 hm2 x cap(-1) in Neimenggu, and fossil energy changed from 0.251 hm2 x cap(-1) in Guangxi to 2.854 hm2 x cap(-1) in Shanxi. The eastern and southern provinces were mostly in a state of ecological deficit, while the western and northern provinces were mostly in a state of ecological remainder. As for the relationships among ecological footprint, economic development and technological progress, great difference existed in different provinces, e. g. , the ecological footprint was about 1 hm2 x cap(-1) in Fujian, Henan, Sichuan, Anhui, Yunnan, Shaanxi and Guizhou, while the GDP per capita changed from 1.35 x 10(4) yuan in Fujian to 0.3 x 10(4) yuan in Guizhou, and the ecological footprint per 1 x 10(4) yuan GDP changed from 0.74 hm2 in Fujian to 3.51 hm2 in Guizhou. Therefore, to resolve the conflicts between the shortage of natural resources and the economic development of China, emphasis should be put on the provinces with big ecological footprint per capita, low GDP per capita, and high ecological footprint per 1 x 10(4) yuan GDP. In these provinces, economic growth mode and industrial structure should be changed, dependence of economy on natural resources should be decreased, use efficiency and economic output of natural resources should be improved, and ecological, resources and economic sustainability should be realized.

China↗
PubMed2006

Improving efficiency of uncertainty analysis in complex integrated assessment models: the case of the RAINS emission module.

Ever since the Regional Acidification Information and Simulation Model (RAINS) has been constructed, the treatment of uncertainty has remained an issue of major interest. In a recent review of the model performed for the Clean Air for Europe (CAFE) programme of the European Commission, a more systematic and structured uncertainty analysis has been recommended. This paper aims at contributing to the scientific debate how this can be achieved. Because of its complex structure on the one hand and limited research resources (time, computational capacities) on the other hand a full-blown uncertainty analysis in RAINS is hardly feasible. Therefore, all types of uncertainty require more efficient ways for uncertainty analysis. With respect to parameter uncertainty, we propose to focus research efforts for uncertainty analysis on key parameters. Among different approaches to select key parameters that have been discussed in the literature screening methods seem to be particularly appropriate for complex, deterministic Integrated Assessment models such as RAINS. Surprisingly, in Integrated Assessment modelling for air pollution problems of screening design have not been taken up so far. As a case study we consider the emission module of RAINS. We show that its structure allows for a straightforward and effective screening procedure.

Air Pollution↗
PubMed2005

Predictors of resourcefulness in African American women.

UNLABELLED: Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. OBJECTIVE: Using Rosenbaum's theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. METHODS: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. RESULTS: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. DISCUSSION: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.

Adaptation, Psychological↗
PubMed1987

[Plans for the training of health personnel: basic considerations for its formulation].

This article presents the problem of "plans for human resources development"--formulated by some countries, but not always utilized. Although the term "development of human resources" has an ample, comprehensive meaning, the authors limit the discussion to the formative phase, leaving the utilization aspects for a future paper. The reasons for preparing such plans are analyzed within the context of the health strategies to reach the goal of HFA/2000, and the article brings up-to-date the meaning and interpretation, within that context, of some commonly used definitions and planning concepts. The authors establish a frame of reference for these plans, examining the influence of different factors in determining the course a plan may follow in its implementation. Included among these factors are: human resources policies; governmental priorities and planning measures; professional practices and how they influence the development and structure of the work force; teaching capacity, and availability of funds and of other resources. The process of formulating a plan comes next, outlining some premises and detailing the different components. The article concludes pointing out that a plan for the development of human resources is not a solution to existing problems, but should rather be used as a guideline. The authors insist as well on the flexibility of objectives and purpose, and the reason for this characteristic. Perhaps the most important conclusion is the warning that a plan for human resources development is not an isolated, independent instrument, but should be considered as an integral part of more comprehensive development plans within the health services infrastructure, and within the political, social and economic framework of a concrete reality.

Health Occupations↗
PubMed2026

Pan-genome-based resequencing of 2,320 accessions reveals structural variations and accelerates breeding advances in cultivated peanut.

The cultivated peanut is a crucial global legume crop that is essential for food security and nutrition, particularly in developing regions. However, its limited genetic variation hampers breeding progress and yield improvement. Here we constructed a graph-based pan-genome for peanut, incorporating 14 genomes that represent all 6 peanut varieties. Using this pan-genome, we genotyped 2,320 accessions, covering 88.03% of ICRISAT and 59.21% of USDA core germplasm, enriching valuable resources for genomic studies and breeding. We cataloged genomic structural variations and investigated the role of homoeologous exchanges in population divergence. Through our pan-genome approach, we overcame the challenges of genotyping posed by homoeologous exchanges and identified key genes associated with flowering and dwarfism in peanut. By integrating superior haplotypes and germplasm resources guided by the pan-genome, we further developed high-yield dwarf lines. This work provides essential genomic resources to accelerate functional gene discovery and modern peanut breeding.

Journal Article↗
PubMedDate not supplied

Direct patient treatment costs in the Allergology Service of a University Hospital.

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Allergy Unit of the University Hospital Virgen de la Arrixaca in Murcia (Spain), the health area in which allergic patients are attended, and the final healthcare products generated. Based on the 2004-2005 budget, variable costing was used to calculate the costs of the healthcare products generated (first visits, subsequent visits, and diverse laboratory tests) by two of the three homogeneous functional groups (HFG), i.e., HFG of the ambulatory service and HFG of complementary tests. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) clinical management and complementary tests should go hand in hand with a view to optimizing resources.

Allergy and Immunology↗
PubMed2003

Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health.

In this paper, we attempt to verify that neighborhood economic structure influences individual health over and above other individual characteristics, and to comparatively evaluate the effects of neighborhood concentrated affluence, concentrated poverty and income inequality in relation to individual health in the USA. We also explore physical environment, health-enhancing services, social hazards (crime) and social resources as mechanisms operating at the neighborhood level that may help to explain the influence of structural economic conditions on health. We use Hierarchical Ordinal Logit Models to examine a rich multi-level data set. Results indicate that affluence exerts significant contextual effects on self-rated health while poverty and income inequality at the neighborhood level are not important structural factors. Moreover, we find that a composite measure of social resources distinguishes itself in both explaining the impact of concentrated affluence and exerting an independent contextual effect on individual health. Physical environment, or the level of physical disorder in the neighborhood, also mediates the effect of affluence on self-rated health, although to a lesser degree than social resources. Our empirical findings suggest that different dimensions of economic structure do not in fact have unique and additive contributions to individual health; the presence of affluent residents is essential to sustain neighborhood social organization which in turn positively affect health.

Adult↗
PubMed2006

Chromatin structure in the genomics era.

The packaging of eukaryotic genomes into chromatin has a large influence on DNA-templated processes, such as transcription. The availability of genome sequences and 'genomics' technologies such as DNA microarrays and high-throughput sequencing had an immediate effect on the study of transcriptional regulation, by enabling researchers to identify the coregulation patterns of thousands of genes. These same resources are now being used successfully to study the structure of chromatin. Here, I review some of these new genomics approaches to understanding chromatin structure in eukaryotes.

Animals↗
PubMed2004

SCOPEC: a database of protein catalytic domains.

MOTIVATION: Domains are the units of protein structure, function and evolution. It is therefore essential to utilize knowledge of domains when studying the evolution of function, or when assigning function to genome sequence data. For this purpose, we have developed a database of catalytic domains, SCOPEC, by combining structural domain information from SCOP, full-length sequence information from Swiss-Prot, and verified functional information from the Enzyme Classification (EC) database. Two major problems need to be overcome to create a database of domain-function relationships; (1) for sequences, EC numbers are typically assigned to whole sequences rather than the functional unit, and (2) The Protein Data Bank (PDB) structures elucidated from a larger multi-domain protein will often have EC annotation although the relevant catalytic domain may lie elsewhere. RESULTS: SCOPEC entries have high quality enzyme assignments; having passed both computational and manual checks. SCOPEC currently contains entries for 75% of all EC annotations in the PDB. Overall, EC number is fairly well conserved within a superfamily, even when the proteins are distantly related. Initial analysis is encouraging; suggesting that there is a 50:50 chance of conserved function in distant homologues first detected by a third iteration PSI-BLAST search. Therefore, we envisage that a knowledge-based approach to function assignment using the domain-EC relationships in SCOPEC will gain a marked improvement over this base line. AVAILABILITY: The SCOPEC database is a valuable resource in the analysis and prediction of protein structure and function. It can be obtained or queried at our website http://www.enzome.com

Catalysis↗
PubMed2002

Molecular genetics and structural genomics of the human protein kinase C gene module.

BACKGROUND: Protein kinase C (PKC) has become a major focus among cell biologists interested in second-messenger signal transduction and much has been learned about differences in the cellular localization and function of its different isotypes. In this study we systematically address the genomic locations and gene structures of the human PKC gene module. RESULTS: We first carried out fine chromosomal mapping of all nine PKC genes by fluorescence in situ hybridization (FISH), using cosmid and BAC probes. The PKC genes are found to be dispersed throughout the genome, and in some positions distinct from those previously reported: PKCalpha is at 17q24, PKCbeta at 16p12, PKCgamma at 19q13.4, PKCdelta at 3p21.2, PKCepsilon at 2p21, PKCzeta at 1p36.3, PKCeta at 14q22-23, PKCtheta; at 10p15 and PKCiota at 3q26. For PKCiota, an additional FISH signal mapped on Xq21.3 revealed a pseudogene (derived by retrotransposition). PKCgamma, zeta, and theta; are found to map to the most distal positions on the chromosomes, potentially implicating telomere position effects in their expression. Using the complete human genome draft sequence and bioinformatics tools, we then carried out a systematic analysis of PKC gene structure, including determination of the occurrence of single-nucleotide polymorphisms corresponding to the PKC loci. CONCLUSION: This resource of genomic information now facilitates investigation of the PKC gene module in structural chromosomal abnormalities and human disease locus mapping studies.

Alternative Splicing↗
PubMed2004

The U.S. National Library of Medicine's Toxicology and Environmental Health Information Program.

For nearly 40 years, the National Library of Medicine's (NLM) Toxicology and Environmental Health Information Program (TEHIP) has been a significant leader in organizing and providing public access to an extensive storehouse of toxicological information through its online databases. With the advent of the Internet, TEHIP has expanded its role to also serve as a pre-eminent portal to toxicological information worldwide. Its primary databases reside within the web-based TOXNET system, and include the scientifically peer-reviewed Hazardous Substances Data Bank (HSDB), the U.S. Environmental Protection Agency's Integrated Risk Information System (IRIS) and Toxics Release Inventory, the National Cancer Institute's Chemical Carcinogenesis Research Information System (CCRIS) and the TOXLINE file of over 3 million bibliographic references. TEHIP's ChemIDplus is an extensive chemical dictionary that extends beyond simple nomenclature to offer displays of molecular structures and links from particular chemicals to other databases containing more information. Specialty files in occupational safety and health, and household products have recently been added to TEHIP's suite of resources. Additional databases in risk assessment, drugs, toxicology education, and global resources, are under development. "Special Topics" pages lead users to structured summaries and links in areas such as arsenic, chemical warfare agents, biological warfare, and West Nile Virus. A database on alternatives to the use of live animals, a three-module toxicology tutor, and a glossary of terms in toxicology are among TEHIP's other information aids, as well an increasing commitment to serving consumers, as witnessed by the animated ToxTown program. Outside the sphere of TEHIP, NLM offers additional databases, such as PubMed, of significant value to toxicology researchers.

Animals↗
PubMed1998

Characterization of the triage process in neonatal intensive care.

OBJECTIVE: Despite intense interest in allocation of resources to neonatal intensive care, no description exists of resource use by the large numbers of newborns admitted for triage, the process of short-term evaluation and management of infants after delivery. This study characterized the triage phase of neonatal care with respect to infant demographics, risk factors for illness, and the course of the hospital admission. We hypothesized that triage infants were responsible for a significant fraction of total intensive care resource utilization, and that patterns of use were predictable. DESIGN: Cross-sectional cost analysis of prospectively collected data. PARTICIPANTS: Data were collected prospectively on 2486 inborn infants admitted to two neonatal intensive care units (NICUs) for <24 hours and subsequently discharged to routine care. Over the 11-month study period, these two hospitals delivered 15 097 live births and admitted a further 1837 infants for nontriage NICU care. INTERVENTIONS: On a 50% random subsample, we calculated severity of illness using the Score for Neonatal Acute Physiology (SNAP) and applied a NICU resource checklist. Daily NICU workload was estimated according to the number and labor intensity of NICU admissions using Medicus and SNAP. Charges were obtained from patient-level item charge records and converted to costs using Medicare ratios of costs to charges. Length of stay (LOS) and costs for triage were correlated with diagnoses, perinatal descriptors, severity of illness, and markers of concurrent NICU workload using stepwise regression. RESULTS: Mean birth weight for triage infants was 3367 g (standard deviation, 600 g) and mean gestational age 39.1 weeks (standard deviation, 1.8 weeks). The predominant reasons for evaluation were exclusion of sepsis (34%), birth complications including meconium aspiration, perinatal depression and trauma (24%), and transitional respiratory distress (23%). Severity illness, as measured by SNAP, was minimal, with 70% having scores of 0, indicating no derangement. Only 6% experienced depressed 5-minute Apgar scores (<7), and 80% required no delivery room resuscitation. The most frequent forms of resource use were antibiotic administration (34%), placement of a peripheral intravenous line (40%), cardiac monitoring (53%) and external warming (26%). Median LOS was 102 minutes, corresponding over the study period to 2% of total NICU hours but 7% of NICU days charged. Median cost was $870, with aggregate costs accounting for a total of 9.5% of total NICU costs. In the multivariate model, LOS was increased by respiratory diagnosis or hypoglycemia, severity of illness, lower gestational age, the need for intravenous placement, daytime shift, hospital, and lower acuity of concurrent NICU admissions (R2 = 0.24). CONCLUSIONS: Neonatal triage is a low-acuity but time-intensive process that contributes significantly to total resource use by newborns because of the large numbers of infants involved. Both LOS and costs are affected not only by infant medical characteristics but also by nonmedical markers of unit structure, which may be amenable to change. This source of resource consumption should be recognized in future assessments of costs associated with neonatal intensive care.

Academic Medical Centers↗
PubMedDate not supplied

Proposal for relative units of value (RUV) for use in allergy examinations.

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand.

Allergy and Immunology↗