Achieving cultural congruence in integrated health systems: lessons from two corporate change initiatives.
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This article considers a hypothetical imaging device with a spinning slat collimator that measures parallel-planar-integral data from an object. This device rotates around the object 180 degrees and stops at N positions uniformly distributed over this 180 degrees. At each stop, the device spins on its own axis 180 degrees and acquires measurements at M positions uniformly distributed over this 180 degrees. For a fixed total imaging time, an optimal distribution of the scanning time among the data measurement locations is searched by a nonlinear programming method: Nelder-Mead's simplex method. The optimal dwell time is approximately proportional to the weighting factor in the backprojector of the reconstruction algorithm. By using an optimal dwell-time profile, the reconstruction signal-to-noise ratio has a gain of 23%-24% for the filtered backprojection algorithm and a gain of 10%-18% for the iterative algorithms, compared with the situation when a constant dwell-time profile is used.
A picture archiving and communication system (PACS) is a system integration of many components, including radiologic image acquisition devices, computers, communication networks, image display workstations, and data base management systems. The author describes three general approaches to implementing a PACS. In the first approach, the department or institution acts as a systems integrator, designing and implementing the PACS. In the second approach, the PACS is planned on the basis of the department's operations and environment and then a manufacturer is contracted to design and build the system. The third approach is to purchase a turnkey system, with some modifications provided by the manufacturer for a specific clinical application. The author provides examples of each approach in the clinical environment and presents the disadvantages and advantages of each.
The IntelliClean System from Sonicare and Crest combines a rechargeable sonic power toothbrush and a novel liquid toothpaste into one integrated system, providing the opportunity to re-dose with toothpaste during the brushing cycle. The purpose of this study was to investigate cleaning effects from in-mouth re-dosing with toothpaste during the brushing cycle vs conventional bolus dosing. This was a randomized, examiner-blind, six-period, crossover clinical study. Eighteen adult subjects used an experimental integrated system employing either a re-dosing regimen (2 doses at the start of brushing with 1 additional in-mouth dose during the last 30 seconds of brushing [2+1]) or a conventional regimen (2 doses at the start of brushing only [2+0]). Gingival crevicular fluid (GCF) was sampled at the final brushing quadrant from a preselected site in the gingival sulcus using filter strips at baseline and at 4, 15, and 120 minutes postbrushing. Mean change from baseline in the concentrations of total facultative anaerobes (TFAs) and gram-negative anaerobes (GNAs) in the GCF at 120 minutes posttreatment were modeled separately using general linear mixed models. Area under the curve of surfactant (sodium dodecyl sulfate [SDS]) in GCF over 2 hours postbrushing was calculated and modeled using an analysis of variance model. All hypotheses were tested 2-sided at the 5% significance level. Relative to the conventional regimen, the re-dosing (2+1) regimen produced a significantly greater reduction in log10 (TFA colony-forming units [CFU]/microL GCF) after brushing, 0.99+/-0.12 vs 0.65+/-0.12 (mean change +/- standard error), and a significantly greater reduction in log10 (GNA CFU/microL GCF) after brushing, 0.75 +/-0.14 vs 0.45 +/- 0.14. The re-dosing regimen led to significantly more SDS in GCF relative to the conventional regimen over the 2-hour time period. Re-dosing of liquid toothpaste during the brushing cycle with the IntelliClean System leads to a significantly increased cleaning effect, as defined by a reduced bacterial count in GCF, and significantly higher levels of surfactant in the GCF up to 2 hours after the brushing event.
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The Friendly Hills HealthCare Network keeps moving forward along the leading edge of systems integration, and making headlines in the process. In 1993, it became the first physician-driven integrated delivery system to have its tax-exempt status approved by the Internal Revenue Service. This year, the La Habra, CA-based network took the health care field by surprise when it struck a deal to sell its assets to Caremark International, a nationwide alternate-site provider with a diverse portfolio of services. The purchase, expected to be finalized by the end of the year, will turn Friendly Hills back into a for-profit entity. Chairman and CEO Albert E. Barnett, N.D., spoke recently with senior editor Terese Hudson about the change.
Effective removing of Joule heat in polymer-based microchip system is an important factor for high efficient separation because of lower heat conductivity of polymers than silica or glass. In this paper, a new kind of polydimethylsiloxane (PDMS) microchip electrophoresis system integrated with a laser-induced fluorescence detector has been successfully constructed on the basis of a commercial heat sink for computer CPU (central processor unit). Experimental results on separation current using high concentration running buffers demonstrated that heat dissipation of PDMS/PDMS microchip system was significantly improved. Furthermore, with this integrated system, theoretical plate number of fluorescein using 100 mM phosphate-buffered saline + 1 mM sodium dodecyl sulfate as running buffer was determined to be 2750 (for 2.5-cm separation channel, corresponding to 110,000/m). This high separation efficiency demonstrated that such heat sink-based polymer microchip system could be effectively applied for high-concentration buffers.
As intracellular gene delivery pathways are highly complex combinations of multiple potentially rate-limiting cellular and molecular processes, approaches to the design of synthetic delivery vectors focusing on any single barrier individually will likely be suboptimal. We offer here an "integrative systems" approach to vector characterization and design, combining quantitative experiment and computational modeling studies of vector uptake and trafficking kinetics. This model is validated using data for delivery of a green fluorescent protein (GFP)-encoding plasmid by means of Lipofectamine, permitting specification of model parameter values. The model is then used to make a priori predictions on the effect of polymer length in polyplex vectors, with additional parameter values determined from previous independent experimental studies of plasmid release. Comparison with data on GFP expression via these polyplex vectors shows that the model successfully predicts an experimentally observed biphasic dependence of expression efficiency on polymer length and quantifies the contributions of competing effects yielding the optimal intermediate polymer length. Finally, we use the model to predict potential effects of incorporating nuclear localization sequences in these kinds of synthetic vectors, and find that the degree of benefit from these will depend on the values of other key system properties including the vector unpackaging rate constant. Thus, we demonstrate the usefulness of a bioengineering, integrative-systems modeling approach to improved vector design and analysis.
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Global Positioning Systems (GPS) are considered suitable to monitor the position and velocity of horses during cross-country competition or in training. Furthermore, simultaneous recording of life data such as heart rate could be useful to assess the horse's condition during exercise. To test the suitability and reliability of a commercially available GPS system with integrated heart rate recording system and with built in GSM for data transmission, the Fidelak Equipilot Type EP-2003-15/G-2.11 (EP-15/G) was evaluated first for reliability of pulse recording from a pulse generator within the physiological range of horses; furthermore distance, velocity and heart rate recordings were carried out on a standard 1000 m field track with five repetitions. Agreement (% deviation from actually measured distance and from stopwatch-distance based velocity calculations) and variability (Coefficient of Variation for distance, velocity, heart rate) were calculated. From the results it was safe to assume that the heart rate sensor recorded horse heart rates at a high degree of accuracy. Overall distances and velocities are in high agreement with actually measured values. However, overall variability expressed in terms of relative variability (C.V.) is smaller for distance recording (C.V. 0.68%) when compared to velocity (C.V. 1.01%). The system tested is suitable and reliable for simultaneously recording of distance, velocity and heart rates for horses during cross country exercise. GPS-based monitoring of movement along with simultaneous recording of physiological data and the possibility to call upon data will not only be of benefit for training horses or for surveillance during competition, it may also be suitable for distant patient monitoring and in behavioural studies as well as in veterinary medicine in general.
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