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A low cost microcomputer system is described that manages PM and test scheduling, provides lists of selected equipment, prints labels, and calculates management data. The files for 2800 devices fit on a standard mini-diskette and are easily updated.
BACKGROUND: Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. OBJECTIVES: The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, in conjunction with process integration, on hospital costs. STUDY DESIGN: We studied a 1995 American Hospital Association (AHA) special survey that has information on 44 different physician-hospital integrative activities and on global capitation contracts held by management service organizations, physician-hospital organizations, and other similar entities. These data were combined with the AHA's Annual Survey of Hospitals, InterStudy HMO data, the area resource file, and state regulation data. Multivariate analysis was used to assess the relationship between capitation and integration and then to examine the influence of these factors and others on hospital costs. We studied 319 urban hospitals with complete data. FINDINGS: Provider capitation was found to promote integration between hospitals and physicians in relation to administrative/practice management, physician financial risk sharing, joint ventures to create new services, computer linkages, and an overall measure of physician-hospital integration. However, anticipated effects of integration and capitation on hospital costs were not evident. CONCLUSIONS: Global capitation is motivating tighter integration between physicians and hospitals in a number of respects. Although capitation is currently having the intermediate effect of encouraging process integration, it is not yet having the ultimate anticipated effect of lowering hospital costs.
OBJECTIVE: To compare the process of care received by Medicaid-enrolled children with asthma served by community health centers (CHCs) and other Medicaid providers. DESIGN: Retrospective cohort study. SETTING: Five provider types serving Massachusetts Medicaid enrollees: three provider groups--CHCs, hospital outpatient departments (OPDs), and solo/group physicians--participating in the statewide Primary Care Clinician Plan; a staff model health maintenance organization (HMO); and fee-for-service (FFS) providers. STUDY POPULATION: Six thousand three hundred twenty-one Medicaid-enrolled children (age 2-18) with asthma assigned to one of the above provider types in 1994. DATA: Person-level files were constructed by linking Medicaid claims, demographic and enrollment files with HMO encounter data. METHODS: Five claims-based process of care measures reflecting aspects of care recommended in national guidelines were developed and used to analyze patterns of care across provider types, controlling for case-mix and other covariates. RESULTS: Children served by CHCs and the HMO had significantly higher asthma visit rates compared with those served by OPDs, solo/group physicians and FFS providers. CHCs emergency department (ED) visit rates for asthma were lower than those of OPDs (P <0.001) and similar to other providers. However, CHC patients averaged more asthma hospitalizations relative to solo/group physicians or the HMO (P <0.0001). In multivariate analyses, children served by CHCs were 2.2 times as likely (95% CI, 1.02-4.91) as those served by solo/group physicians to receive a follow-up visit within 5 days of an asthma ED visit and 4.3 times as likely (95% CI, 1.45-12.68) to receive a follow-up visit within 5 days of hospital discharge. CHC patients with utilization suggestive of persistent asthma were less likely (OR, 0.28; 95% CI, 0.13-0.59) than those served by solo/group physicians to be seen by an asthma specialist. There were no significant differences in measures of asthma pharmacotherapy across providers types. CONCLUSION: These data suggest that CHCs provide more timely follow-up care after an asthma ED visit or hospitalization relative to solo/group physicians, but diminished access to asthma specialists. There were no differences in asthma pharmacology across providers. Relatively low access to asthma specialists among children served by CHCs warrants further investigation.
OBJECTIVE: Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squamous cell carcinoma of the cervix and does PSTCC have true transitional cell differentiation? MATERIALS AND METHODS: Twenty cases of PSTCC were identified from archival files. Clinical data were compiled. Immunoperoxidase stains for uroplakin III, p63 and p16 were performed on available tissue blocks. RESULTS: Patients ranged in age from 27 to 85 years. Twelve patients were FIGO Stage I, 4 were Stage II, and 2 were Stage III. Thirteen patients had clinical follow-up ranging from 5 to 132 months. Three patients subsequently had more extensive disease than initial clinical staging indicated. Nine patients had no tumor progression, three had local recurrence and one had metastatic disease. Eight cases were strongly immunoreactive for p63 and p16 and 14 were negative for uroplakin III. CONCLUSIONS: PSTCC lacks true transitional cell differentiation and probably shares similar clinicopathologic features with conventional cervical squamous cell carcinoma.
The transmembrane-tyrosine-kinase receptor, c-kit, is involved in cell differentiation and has been found to be expressed in normal human cell types and solid tumors. This study was designed to investigate the effects of c-kit expression on: 1) tumor proliferation and apoptosis, and 2) survival in patients with high-grade advanced stage ovarian serous carcinoma (OSC). We identified 118 patients with high-grade advanced stage OSC from our files. Clinical data, including demographics and overall survival, were collected. Immunohistochemical panel consisting of c-kit, ki-67, p53, and bcl-2 was performed. C-kit was categorized as positive if any cytoplasmic or membranous staining pattern was identified. Correlation between c-kit expression and the other markers was performed. Survival analysis was performed using COX proportional hazards regression and Kaplan-Meier test. Of 118 cases, 25 (21.2%) expressed c-kit. Of 93 c-kit-negative tumors, 87.1% had a high proliferation index. High p53 and bcl-2 expression was identified in 96 (81.4%) and 59 (50%) cases respectively. No significant statistical correlation was identified between c-kit and apoptosis markers. Tumors lacking c-kit expression showed a trend toward having high proliferation index, but this did not achieve statistical significance (p = 0.07). Of the seven variables included in the multivariate survival analysis, only c-kit (odds ratio, 2.12; 95% confidence interval, 08-4.17; p = 0.02) and ki-67 (odds ratio, 1.9; 95% confidence interval, 1.1-3.1; p = 0.03) showed an independent statistically significant impact on survival. High-grade advanced stage OSC lacking c-kit expression correlates with poor outcome. Interestingly, cases lacking c-kit expression also showed a trend to have high proliferation index.
Using monoclonal tubulin and actin antibodies, Al-mediated alterations to microtubules (MTs) and actin microfilaments (MFs) were shown to be most prominent in cells of the distal part of the transition zone (DTZ) of an Al-sensitive maize (Zea mays L.) cultivar. An early response to Al (1 h, 90 μM) was the depletion of MTs in cells of the DTZ, specifically in the outermost cortical cell file. However, no prominent changes to the MT cytoskeleton were found in elongating cells treated with Al for 1 h in spite of severe inhibition of root elongation. Al-induced early alterations to actin MFs were less dramatic and consisted of increased actin fluorescence of partially disintegrated MF arrays in cells of the DTZ. These tissue- and development-specific alterations to the cytoskeleton were preceded by and/or coincided with Al-induced depolarization of the plasma membrane and with callose formation, particularly in the outer cortex cells of the DTZ. Longer Al supplies (>6 h) led to progressive enhancements of lesions to the MT cytoskeleton in the epidermis and two to three outer cortex cell files. Our data show that the cytoskeleton in the cells of the DTZ is especially sensitive to Al, consistent with the recently proposed specific Al sensitivity of this unique, apical maize root zone.
A parallel-aware program MPI_FSEARCH has been implemented to perform molecular replacement using an exhaustive six-dimensional search. In particular, the program can be used to deal with diffraction data at very low resolution (d > 10 A) that would normally not be appropriate for other molecular-replacement programs such as AMoRe and CNS. Although an envelope constructed from a PDB (Protein Data Bank) file was tested in the present study, the program can be used to perform low-resolution molecular replacement with an envelope derived from various sources such as electron microscopy or small-angle solution X-ray scattering.
A computer program, VOIDOO, is described which can be employed in the study of cavities such as they occur in macromolecular structures (in particular, in proteins). The program can be used to detect unknown cavities or to delineate known cavities, either of which may be connected to the outside of the molecule or molecular assembly under study. Optionally, output files can be requested that contain a description of the shape of the cavity which can be displayed by the crystallographic modelling program O. Additionally, VOIDOO can be used to calculate the volume of a molecule and to create a file containing data pertaining to the surface of the molecule which can also be displayed using O. Examples of the use of VOIDOO are given for P2 myelin protein, cellular retinol-binding protein and cellobiohydrolase II. Finally, operational definitions to discern different types of cavity are introduced and guidelines for assessing the accuracy and improving the comparability of cavity calculations are given.
The non-covalent combination of residues 1-118 of RNase A with a synthetic 14-residue peptide containing residues 111-124 of the molecule forms a highly active semisynthetic enzyme, RNase 1-118:111-124. With this enzyme, the roles played by the six C-terminal residues in generating the catalytic efficiency and substrate specificity of RNase can be studied using chemically synthesized analogs. The structure of RNase 1-118:111-124 from 43% aqueous ethanol has been determined using molecular-replacement methods and refined to a crystallographic R-factor of 0.166 for all observed reflections in the range 7.0-1.6 A (Protein Data Bank file ISSC). The structure is compared with the 2.0 A structure of RNase A from 43% aqueous 2-methyl-2-propanol and with the 1.8 A structure of the semisynthetic enzyme obtained from crystals grown in concentrated salt solution. The structure of RNase 1-118:111-124 from aqueous ethanol is virtually identical to that of RNase A from aqueous 2-methyl-2-propanol. Half of the crystallographically bound water molecules are not coincident, however. The structure is somewhat less similar to that of RNase 1-118:111-124 from salt solutions, with a major difference being the positioning of active-site residue His119.
Under a contract with the National Cancer Institute, we have developed a research interface to an ultrasound system. This ultrasound research interface (URI) is an optional feature providing several basic capabilities not normally available on a clinical scanner. The URI can store high-quality beamformed radio-frequency data to file for off-line processing. Also, through an integrated user interface, the user is provided additional control over the B-mode receive aperture and color flow ensemble size. A third major capability is the ability to record and playback macro files. In this paper, we describe the URI and illustrate its use on three research examples: elastography, computed tomography, and spatial compounding.
Under a contract with the National Cancer Institute, we have developed a research interface to an ultrasound system. This ultrasound research interface (URI) is an optional feature providing several basic capabilities not normally available on a clinical scanner. The URI can store high-quality beamformed radio-frequency data to file for off-line processing. Also, through an integrated user interface, the user is provided additional control over the B-mode receive aperture and color flow ensemble size. A third major capability is the ability to record and playback macro files. In this paper, we describe the URI and illustrate its use on three research examples: elastography, computed tomography, and spatial compounding.
The purpose of the present study was to determine the rate of substance abuse in the juvenile detention house and to determine the relationship between crime and substance abuse and conduct disorder. Two hundred and thirty cases in the biggest juvenile detention house in Istanbul, Turkey were assessed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. Law files and data of crime were examined. A total of 80 out of 230 juvenile detainees (34.8%) were found to have substance abuse excluding nicotine and alcohol. The substances abused in preferential order were cannabis (72.5%), volatile substances (21.3% bally and 3.7% thinner; 25%) and sedative hypnotic drugs and biperidents (2.5%). The rate of conduct disorder was 46.3% in substance abusers and 25.3% in the others (odds ratio: 2.536). The rate of substance abuse was 48.5% in the juveniles who had committed multiple crimes and 14.1% in the others (odds ratio: 5.735). The study shows that conduct disorder was very high in juvenile detainees. Conduct disorder was higher in substance-abusing than in non-abusing juvenile detainees. Substance-abusing juvenile detainees were found to have a higher detention rate than non-abusing juvenile detainees. There was a close relation between conduct disorder and substance abuse and multiple crimes. In the light of these results, diagnosis and treatment for conduct disorder in juvenile detainees are of great importance.
AIM: To investigate a possible relationship between tibolone therapy and recurrence or mortality in breast cancer survivors. METHODS: In a retrospective study, data from files of 247 patients who had been treated for breast cancer were analyzed. Twenty women were treated with tibolone because of menopausal symptoms (Group 1: mean duration of tibolone use 37.1 months). One hundred and one women who did not take tibolone were selected as the control group (Group 2). All women were followed up in our Department on our standard protocol (mean follow up: 73.4 months in Group 1, 67.4 months in Group 2). Comparison of the survival curves was applied with the Wilcoxon (Gehan) statistic. Cox regression analysis was also applied in order to identify significant coefficients in the survival curve. RESULTS: Recurrence of breast cancer was observed in two (10%) Group 1 women versus 21 (21%) Group 2 women (P = NS). Two Group 1 women died (one from breast cancer recurrence) versus 15 Group 2 women (14 from breast cancer recurrence). CONCLUSIONS: Despite of the inherent limitations of this small retrospective study, it seems that tibolone does not reveal an apparent negative impact on breast cancer outcome when given to breast cancer survivors.
OBJECTIVES: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN: Longitudinal study. SETTING: Five-county Piedmont area of North Carolina. PARTICIPANTS: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. MEASUREMENTS: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. RESULTS: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. CONCLUSION: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.
OBJECTIVE: About 5% of all suicides occur in psychiatric hospitals. The aim of this study was to look for potential characteristics common to patients who committed suicide in psychiatric hospital. METHOD: All patients who committed suicide in University Psychiatric Hospital in Ljubljana, Slovenia, in the period 1984-1993 were included. The suicidal patients (SP) with schizophrenia (SCH) and affective psychoses (AP) were compared to an age-, sex- and diagnosis-matched control group. Data from files and (in control patients) patient interviews were gathered. Multivariate logistic regression analysis was used. RESULTS: A total of 79 patients (34 males and 45 females) committed suicide. The majority of them had SCH (n = 36) and AP (n = 23). The predictors of suicide among patients with AP and SCH were depression and lack of insight and, in addition in patients with SCH, past suicidal behaviour and poor relationships with family members. CONCLUSION: This study provides the clinician with information on risk factors for in-patient suicide.
The human immunodeficiency viruses (HIVs)-acquired immunodeficiency syndrome (AIDS) or HAIDS pandemic originated from lentiviruses of nonhuman primates (thus qualifying as a zoonosis) that moved into humans in Africa. The HAIDS patients eventually die of opportunistic infections, all potentially zoonotic. The HAIDS infection remained parochial, first endemically and then epidemically, until the African urbanization that occurred in each of the countries postindependence. The latter included wars and the massive movement of soldiers (virologically naive) from the American continent to Africa and back. The HAIDS viral ecology coincided with African swine fever (ASF) in the Americas. Haiti became the focal point for both infections. Some infected Haitians also became, together with some infected drug addicts in the United States, a source of contaminated human blood for transfusions and production of plasma derivatives.
BACKGROUND: Glaucoma affects approximately 2% of the population in developed countries and is estimated to affect 67 million people worldwide. The authors investigated the effect of the introduction of new medications on the volume and cost of drugs for glaucoma in two countries, Northern Ireland (NI, population approximately 1.7 million) and the Republic of Ireland (ROI, population approximately 3.9 million) in the 8 years from 1996 to 2003. They also looked at the surgical rates for glaucoma within the same time period for the two countries. METHODS: A retrospective analysis was performed of drug costs, prescribing data, and operation rates for glaucoma in Ireland from January 1996 to December 2003. Information regarding costs and volume were obtained for each type of glaucoma drug and these were then grouped into the glaucoma treatment subsections as found in the British National Formulary. The drug information was obtained from the Central Services Agency in NI and IMS Health in the ROI and included both public and private prescriptions. The information on surgical rates for glaucoma was obtained from the Department of Health and Social Services in NI and the Hospital In-patient Enquiry (HIPE) data national files in the ROI. RESULTS: There was a 30% increase in prescription items for glaucoma in NI and a 59% increase in the ROI from 1996 to 2003. The costs increased more rapidly than the number of items: 227% in the ROI and 78% in NI from January 1996 to December 2003. In the ROI, there was an average 19% year on year increase in costs. In NI, new drugs accounted for 40% of the quantity of prescription items for glaucoma and 63% of the market cost in 2003. In the ROI new drugs accounted for 57% of the quantity and 77% of the market cost for glaucoma in 2003; prostaglandin analogue drugs alone accounted for 53% of the cost. The number of trabeculectomies performed decreased by more than 60% in both countries. CONCLUSION: Volume and cost of glaucoma drugs increased dramatically in both NI and the ROI from 1996 to 2003, probably the result of a combination of changing demographics and a changing approach towards the management of patients with glaucoma and ocular hypertension. In 2003 in the ROI, prostaglandin analogues were the most commonly prescribed class of drug for patients with glaucoma and/or ocular hypertension causing a profound rise in drug expenditure.
OBJECTIVE: To assess the effects of selective cyclo-oxygenase-2 (COX 2) inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of vascular events. DESIGN: Meta-analysis of published and unpublished tabular data from randomised trials, with indirect estimation of the effects of traditional NSAIDs. DATA SOURCES: Medline and Embase (January 1966 to April 2005); Food and Drug Administration records; and data on file from Novartis, Pfizer, and Merck. REVIEW METHODS: Eligible studies were randomised trials that included a comparison of a selective COX 2 inhibitor versus placebo or a selective COX 2 inhibitor versus a traditional NSAID, of at least four weeks' duration, with information on serious vascular events (defined as myocardial infarction, stroke, or vascular death). Individual investigators and manufacturers provided information on the number of patients randomised, numbers of vascular events, and the person time of follow-up for each randomised group. RESULTS: In placebo comparisons, allocation to a selective COX 2 inhibitor was associated with a 42% relative increase in the incidence of serious vascular events (1.2%/year v 0.9%/year; rate ratio 1.42, 95% confidence interval 1.13 to 1.78; P = 0.003), with no significant heterogeneity among the different selective COX 2 inhibitors. This was chiefly attributable to an increased risk of myocardial infarction (0.6%/year v 0.3%/year; 1.86, 1.33 to 2.59; P = 0.0003), with little apparent difference in other vascular outcomes. Among trials of at least one year's duration (mean 2.7 years), the rate ratio for vascular events was 1.45 (1.12 to 1.89; P = 0.005). Overall, the incidence of serious vascular events was similar between a selective COX 2 inhibitor and any traditional NSAID (1.0%/year v 0.9%/year; 1.16, 0.97 to 1.38; P = 0.1). However, statistical heterogeneity (P = 0.001) was found between trials of a selective COX 2 inhibitor versus naproxen (1.57, 1.21 to 2.03) and of a selective COX 2 inhibitor versus non-naproxen NSAIDs (0.88, 0.69 to 1.12). The summary rate ratio for vascular events, compared with placebo, was 0.92 (0.67 to 1.26) for naproxen, 1.51 (0.96 to 2.37) for ibuprofen, and 1.63 (1.12 to 2.37) for diclofenac. CONCLUSIONS: Selective COX 2 inhibitors are associated with a moderate increase in the risk of vascular events, as are high dose regimens of ibuprofen and diclofenac, but high dose naproxen is not associated with such an excess.