Integrated delivery systems: Mercy Health Services, Part II. Interview by SueEllen Pinkerton.
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OBJECTIVE: The purpose of this study was to investigate the perceptions of community staff regarding service process and quality, while a public mental health service integrated acute inpatient and continuing care components. METHODS: The study employed a naturalistic successive measures design in which community mental health staff completed a questionnaire on three occasions during the integration process. RESULTS: Staff perceived overall service quality to improve during the integration process with continuity of care being the area subject to greatest improvement. CONCLUSIONS: The integration of acute inpatient and continuing care services resulted in changes to service process and outcome, which were judged by staff to be beneficial, especially with respect to continuity of patient care.
This paper introduces an integrated, objective and biomechanically sound approach for the analysis and evaluation of the functional status of lower extremity amputee-appliance systems. The method is demonstrated here in its application to the unilateral lower extremity amputee-axillary crutches system and the unilateral below-knee amputee-PTB prosthesis system, both of which are commonly encountered in day-to-day rehabilitation practice.
In 2004, the Canadian Adverse Events Study (Baker et al. 2004) determined the incidence rate of adverse events (AE) in Canada to be 7.5%. This translates to approximately 185,000 for the almost 2.5 million annual hospital admissions in Canada. The study noted "close to 70,000 of these AEs were potentially preventable". In March 2005, a "Good Catch" program was implemented in Edmonton's Capital Health Region, one of the largest integrated health regions in Canada, as part of the region's comprehensive system of reporting, analyzing and managing incidents, adverse events and near misses.
Information technologies are rapidly becoming the major process drivers of health care system integration. These integrated information systems will emanate from MCOs and pervade the entire health care system at each level of service delivery. Suggestions for facilitating the integration process and the role of pharmaceutical industry, wholesalers, service providers, and end users are discussed herein.
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Fluorescence Correlation Spectroscopy (FCS) has developed into a routine method to quantitatively study diffusion of molecules and kinetic processes. FCS has recently become popular to complement live cell imaging with biophysical information. The enabling technology has been commercially realised by combining laser scanning microscopes and fluorescence correlation spectrometers in one integrated platform. This article provides an overview of the Zeiss solution of such a combined instrument, the LSM 510 META / ConfoCor 2 system. We focus on the instrumental set up as well as technical advances and improvements in the software that controls FCS data acquisition and evaluation. In addition, we outline the calibration of the instrument and the work flow for data analysis with emphasis on in vivo pharmacological applications.
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Scientific progress in the biological sciences increasingly relies on an integration of behavioral, pharmacological, cellular, and molecular approaches, particularly in translating basic research observations into therapeutic potential. The strength of in vivo model systems lies in the direct assessment of physiological function. However, they only allow indirect evidence for mechanism of action. Frequently, in vitro models provide just the opposite. A combination of both in vitro and in vivo approaches are often essential for establishing the underlying mechanisms of a specific pharmacological effect. In recent times, an endogenous cannabinoid system has been characterized due to the combined efforts of chemists, pharmacologists, molecular and cellular biologists, and biochemists. This endogenous cannabinoid system is providing a basis for systematically addressing the pharmacological controversies surrounding marijuana. The description of this endogenous cannabinoid system and the strategies for establishing the physiological function of this system are the subjects of this article.
Creating an integration-friendly infrastructure is the best way to prepare for current as well as next-generation POC devices. Fortunately, hassle-free system integration is needed throughout healthcare today for reasons beyond the domain of POC devices, so integration progress already made in other areas helps pave the way for POC devices. Healthcare IT professionals, as much or more than any other IT group, have had to deal with the challenges of integrating disparate systems. When considering deployment of POC devices, you will want to make sure they adhere to open industry standards. In this way, these important devices won't add to the problem of disparate systems, but will contribute to the solution. We see XML and Web services as being especially important to the future of healthcare delivery and administration. XML and Web services, along with powerful orchestrators, can provide an ever-richer collection of clinical data to be delivered to, and received from, the POC devices that will become an ever more important addition to the physician armamentarium.
During locomotion, mammals update their position with respect to a fixed point of reference, such as their point of departure, by processing inertial cues, proprioceptive feedback and stored motor commands generated during locomotion. This so-called path integration system (dead reckoning) allows the animal to return to its home, or to a familiar feeding place, even when external cues are absent or novel. However, without the use of external cues, the path integration process leads to rapid accumulation of errors involving both the direction and distance of the goal. Therefore, even nocturnal species such as hamsters and mice rely more on previously learned visual references than on the path integration system when the two types of information are in conflict. Recent studies investigate the extent to which path integration and familiar visual cues cooperate to optimize the navigational performance.
BACKGROUND: The large gap between the number of protein sequences in databases and the number of functionally characterized proteins calls for the development of a fast computational tool for the prediction of subnuclear and subcellular localizations generally applicable to protein sequences. The information on localization may reveal the molecular function of novel proteins, in addition to providing insight on the biological pathways in which they function. The bulk of past work has been focused on protein subcellular localizations. Furthermore, no specific tool has been dedicated to prediction at the subnuclear level, despite its high importance. In order to design a suitable predictive system, the extraction of subtle sequence signals that can discriminate among proteins with different subnuclear localizations is the key. RESULTS: New kernel functions used in a support vector machine (SVM) learning model are introduced for the measurement of sequence similarity. The k-peptide vectors are first mapped by a matrix of high-scored pairs of k-peptides which are measured by BLOSUM62 scores. The kernels, measuring the similarity for sequences, are then defined on the mapped vectors. By combining these new encoding methods, a multi-class classification system for the prediction of protein subnuclear localizations is established for the first time. The performance of the system is evaluated with a set of proteins collected in the Nuclear Protein Database (NPD). The overall accuracy of prediction for 6 localizations is about 50% (vs. random prediction 16.7%) for single localization proteins in the leave-one-out cross-validation; and 65% for an independent set of multi-localization proteins. This integrated system can be accessed at http://array.bioengr.uic.edu/subnuclear.htm. CONCLUSION: The integrated system benefits from the combination of predictions from several SVMs based on selected encoding methods. Finally, the predictive power of the system is expected to improve as more proteins with known subnuclear localizations become available.
We developed a novel microarray system to assess gene expression, DNA methylation, and histone acetylation in parallel, and to dissect the complex hierarchy of epigenetic changes in cancer. An integrated microarray panel consisting of 1507 short CpG island tags located at the 5'-end regions (including the first exons) was used to assess effects of epigenetic treatments on a human epithelial ovarian cancer cell line. Treatment with methylation (5-aza-2'-deoxycytidine) or deacetylation (trichostatin A) inhibitors alone resulted in up-regulation of 1.9 or 1.1% of the genes analyzed; however, the combined treatment resulted in synergistic reactivation of more genes (10.4%; P < 0.001 versus either treatment alone). On the basis of either primary or secondary responses to the treatments, genes were identified as methylation-dependent or -independent. Synergistic reactivation of the methylation-dependent genes by 5-aza-2'-deoxycytidine plus trichostatin A revealed a functional interaction between methylated promoters and deacetylated histones. Increased expression of some methylation-independent genes was associated with enhanced histone acetylation, but up-regulation of most of the genes identified using this technology was because of events downstream of the epigenetic cascade. We demonstrate proof of principle for using the triple microarray system in analyzing the dynamic relationship between transcription factors and promoter targets in cancer genomes.
A field study was performed on 32 male deep drilling workers engaged in hard physical work and 10 male operators with mainly supervisory tasks; both groups working in a shiftwork system including 12 hr shifts. Both the analysis and evaluation of stresses and strains were carried out by means of physiological, psychological and sociological methods. The obtained results show that under the conditions of the given working requirements, existing reproduction conditions, and observed social structure of the populations operating and supervisory activities in a 8 hr shiftwork system including 12 hr shifts are acceptable. In case of hard physical work this shiftwork arrangement can't be agreed to for industrial-medical reasons.