An alternative to "quick-fix" systems integration solutions.
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Calorimetric studies of the effect of superoxide dismutase and/or catalase on the reduction of dioxygen into water by dithionite in oxyhemoglobin have been carried out and the results compared with those in red cell hemolysates. In the absence of the enzymes the stoichiometry (moles dithionite/mole dioxygen) is less than the value of 2:1 which was found previously in red cell hemolysates [Forlani et al., J. Inorg. Biochem. 20, 147-155 (1984)]. In the presence of either superoxide dismutase or catalase alone the stoichiometry increases but is still less than 2:1. In the presence of both enzymes the stoichiometry and the shape of the thermogram is that previously observed for hemolysates, suggesting the presence of a hemoglobin-catalase-superoxide dismutase integrated system. The absence of a calorimetric signal for hydrogen peroxide in the reduction of oxyhemoglobin in the presence of superoxide dismutase suggests a wider biological role of superoxide dismutase than previously thought.
Tyrosine protein kinases (TPKs) play a major role in the transformation of cells. They are currently used as molecular targets for new generations of anticancer compounds. Numerous TPKs have been described from various tissues using either classical molecular biochemical techniques or cloning strategies. As a natural extension of these discoveries, a large number of "specific" inhibitors have been described in the literature. The major problem with these inhibitors is that there is no simple way to compare their specificity and/or selectivity from one report to another. We have set up a simple, straightforward technique to compare the inhibitory potency of 14 classical inhibitors towards six well-described and at least partially purified protein kinases. This technique is based on a new assay, easy to carry out and non-restrictive in terms of the type of protein substrate used. It permits direct comparisons between the results obtained from various sources. Data obtained showed that, when assessed in this integrated system, specificity and selectivity of many "classical" inhibitors are often weak, thus demonstrating that a universal technique such as ours is essential for the molecular screening of new protein kinase inhibitors. Compounds showing specificity for this panel of protein kinases will be more easily targeted to some defined types of oncogene and of transformed cells.
It is often suggested that animals may link landmark memories to a global coordinate system provided by path integration, thereby obtaining a map-like representation of familiar terrain. In an attempt to discover if desert ants form such associations we have performed experiments that test whether desert ants recall a long-term memory of a global path integration vector on arriving at a familiar food site. Ants from three nests were trained along L-shaped routes to a feeder. Each route was entirely within open-topped channels that obscured all natural landmarks. Conspicuous artificial landmarks were attached to the channelling that formed the latter part of the route. The homeward vectors of ants accustomed to the route were tested with the foodward route, either as in training, or with the first leg of the L shortened or extended. These ants were taken from the feeder to a test area and released, whereupon they performed a home vector. If travelling the latter part of a familiar route and arriving at a familiar food site triggers the recall of an accustomed home vector, then the home vector should be the same under both test conditions. We find instead that the home vector tended to reflect the immediately preceding outward journey. In conjunction with earlier work, these experiments led us to conclude in the case of desert ants that landmark memories do not prime the recall of long-term global path integration memories. On the other hand, landmark memories are known to be linked to local path integration vectors that guide ants along a segment of a route. Landmarks thus seem to provide procedural information telling ants what action to perform next but not the positional information that gives an ant its location relative to its nest.
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OBJECTIVES: To describe an integrated, operational platform from which mail- and telephone-based health promotion programs are implemented and to specifically relate this approach to weight management programming in a managed care setting. APPROACH: In-depth description of essential systems structures, including people, computer technology, and decision-support protocols. The roles of support staff, counselors, a librarian, and a manager in delivering a weight management program are described. Information availability using computer technology is a critical component in making this system effective and is presented according to its architectural layout and design. Protocols support counselors and administrative support staff in decision making, and a detailed flowchart presents the layout of this part of the system. This platform is described in the context of a weight management program, and we present baseline characteristics of 1801 participants, their behaviors, self-reported medical conditions, and initial pattern of enrollment in the various treatment options. CONCLUSION: Considering the prevalence and upward trend of overweight and obesity in the United States, a need exists for robust intervention platforms that can systematically support multiple types of programs. Weight management interventions implemented using this platform are scalable to the population level and are sustainable over time despite the limits of defined resources and budgets. The present article describes an innovative approach to reaching a large population with effective programs in an integrated, coordinated, and systematic manner. This comprehensive, robust platform represents an example of how obesity prevention and treatment research may be translated into the applied setting.
Managed care has only recently come to Green Bay, Wis., and healthcare providers are setting up systems designed to capture market share. Bellin's strategy includes creating strong relationships through alliances, integrating services using techniques learned from quality improvement experts and teaching an uncertain public that managed care can improve care and save money.
An original computer monitoring system for preoperative monitoring was developed at the department of anesthesiology and intensive care of the Research Center for Obstetrics and Gynecology of the Russian Academy of Medical Sciences. The system includes a bedside monitor Athena (S&W + Artema, Denmark) and two special monitors ABM-100 (Datex, Finland) and NCCOM (Bomed, USA). The potentialities of the system are discussed; physiological parameters were monitored and estimated in the real time mode. Variants of graphic interface of the system are presented, including an original multisystem integral nomogram. Utilization of the system demonstrated the advantages of objective physiological information recorded by the system, a high informative values of integral estimated parameters in the real time mode. The use of the multisystem integral nomogram helps the anesthesiologist rapidly and unambiguously to interpret the clinical situation and essentially accelerates the decision-making on further treatment strategy. The work with the system does not require any special knowledge and skills, the system is simple and easy in use.
Most organizations planning to implement picture archiving and communications systems (PACS) are aware of the need to integrate the hospital information system (HIS) and radiology information system (RIS) with the PACS, yet few are acutely aware of the challenges associated with this requirement. This report highlights the results of collaborative efforts between Children's Hospital Medical Center-Cincinnati (CHMC) applications specialists with expertise in the HIS and CHMC information system, radiology staff familiar with the enterprise and radiology workflow and data flow requirements; and General Electric integration engineers familiar with the SMS HIS and RIS, and GE PACS. CHMC received Board approval, including full funding of the entire PACS project, in October 1998. An aggressive time frame for installation was established, as CHMC's PACS leadership committed to the selection, design, and implementation of PACS and computed radiography (CR) within 18 to 20 months. CHMC selected GE (Milwaukee, WI) as its PACS vendor in July 1999, and began its implementation in November 1999. We will present the four-stage integration process undertaken at CHMC: (1) planning the integration effort, (2) designing the Interface, (3) building the interface, and (4) testing the Interface.
Morpho-functional equivalents of reaction of the hypophyseal and adrenal elements have been studied in 7 test and 10 control dogs biometrically, histologically, histoenzymatically and electron microscopically under the condition of integration in the cardio-respiratory systems. The condition has been modelled by individually chosen physical loading (running in the treadmill) up to the IV stage of the organism's adaptation according to the author's technique. The integration state is developing instead of the starting desintegration state (the beginning of the work) and is characterized by an economical and effective functioning of the cardio-respiratory system elements. At the integration of the cardio-respiratory apparatus, the hypophysial-adrenal system is activating. The principle of the zonal reaction in the adrenals and that of the selective activity of the adenohypophysis is clearly followed, that is demonstrated in the predominant activation of the bundle zone elements, chromophobic and basophilic adenocytes where certain signs of the secretory excretion predominate. In cells of the glomerular zone the signs of synthetic processes prevail over those of the secretory excretion. In cells of the medullary substance the signs of the preceding forced secretory excretion are clearly seen. A suggestion is made that it is expedient to elaborate training regimes according to the loading determining integration of the organism's cardio-respiratory systems.
To maximize the effectiveness of home care in improving or maintaining the health of Canadians, home-care programs must have clear goals, be founded firmly on evidence of effectiveness, form part of an integrated healthcare system and be grounded in constitutional and political reality. Goals should be client-centred and distinguish between curative, supportive and preventive care. Curative and supportive home care can be cost-effective if substitution for more costly institutional services can be achieved, but the cost-effectiveness of preventive home care and comprehensive care for the elderly has not been clearly demonstrated. Integrated delivery systems are a prerequisite for effective substitution of care at home for institutional care. Federal financing dedicated to a home-care program is unnecessary and is a political and constitutional non-starter. Federal leadership for a national home-care approach would be welcome. Canada Health Act protection for access to medically necessary home care is attractive, but such protection for pharmaceuticals is a higher need. Federal support for research and demonstration of new models of care is valuable.
Healthcare organizations are undergoing tremendous change in an attempt to become more flexible and adaptive. To be successful in any such transformation, organizations must build processes and systems that allow them to move with change and create a culture that allows individuals to thrive amid change. The authors describe how a community teaching hospital has attempted this through its partnership in a vertically integrated delivery system, its reorganization to product line management, its adoption of a shared governance structure, and its commitment to building a culture with strong relationships. Many of these processes and systems are in their infancy, but an examination of the journey will inform other organizations as they respond to change.
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Explore the source record for details and available documents.
Caught in the middle of HMO price wars, integrated delivery systems are tightening their belts and demanding a greater share of what they save from delivering good outcomes more efficiently. Quality isn't endangered yet, leaders agree, but could be unless employers start to incorporate outcomes measures into their choice of health plans.