Market model addresses hospitals' need for decision support

A Decision Support System should be approached, not as “starting over,” but as a natural extension of the design and development of a hospital's current HIS. Integrated, real-time HISs generate reams of information that, when combined with relevant external data, provide the essential information base for a hospital DDS. The Travenol Market Model is discussed as an example of a DSS specific to hospital needs.     

Developing network adequacy standards for VA Community Care

ObjectivesTo inform how the VA should develop and implement network adequacy standards, we convened an expert panel to discuss Community Care Network (CCN) adequacy and how VA might implement network adequacy standards for community care.Data Sources/Study settingData were generated from expert panel ratings and from an audio‐recorded expert panel meeting conducted in Arlington, Virginia, in October 2017.Study DesignWe used a modified Delphi panel process involving one round of expert panel ratings provided by nine experts in network adequacy standards. Expert panel members received a list of network adequacy standard measures used in commercial and government market and were provided a rating form listing a total of 11 measures and characteristics to rate.Data Collection MethodsItems on the rating form were individually discussed during an expert panel meeting between the nine expert panel members and VA Office of Community Care leaders. Attendees addressed discordant views and generated revised or new standards accordingly. Recorded audio data were transcribed to facilitate thematic analysis regarding opportunities and challenges with implementing network adequacy standards in VA Community Care.Principal FindingsThe five highest ranked standards were network directories for Veterans, regular reporting of network adequacy data to VA, maximum wait time/distance standards, minimum ratio of providers to enrolled population, and qualitative assessments of network adequacy. During the expert panel discussion with VA Community Care leaders, opportunities and challenges implementing network adequacy standards were highlighted.ConclusionsOur expert panel shed light on priorities for network adequacy to be implemented under CCN contracts, such as developing comprehensive provider directories for Veterans to use when selecting community providers. Remaining questions focus on whether the VA could reasonably develop and implement network adequacy standards given current Congressional restraints on VA reimbursement to community providers.     

Role of antibody in the protection of mice from arthritis induced by Mycoplasma pulmonis.

C3H and C57Bl10 mice exhibit a differential susceptibility to arthritis induced by Mycoplasma pulmonis. Resistant C57Bl10 mice consistently demonstrated higher complement-fixing antibody titres than susceptible C3H mice throughout the development of the acute arthritis. A strong correlation was demonstrated between the levels of anti-mycoplasma antibody and resistance to acute arthritis in six strains of mice. To test the hypothesis that the difference of arthritis resistance of C3H and C57Bl10 mice was caused by a different susceptibility of their lymphocytes to mitogenic stimulation by M. pulmonis, we investigated the generation of non-specific immunoglobulin in vivo and in vitro. M. pulmonis acted as a polyclonal mitogen, but stimulated approximately equal responses in lymphocytes of both strains.     

Giant squamous cell carcinoma of the hand: Epithelioma cuniculatum — A case report

We report a case of a giant squamous cell carcinoma of the hand. It demonstrates the natural history of a neglected well differentiated squamous cell tumour in this site. It resembles the epithelioma cuniculatum variant of squamous cell carcinoma, previously described as being peculiar to the foot. Correspondence to: Mr. C. McCormack.     

An investigation into the effects of polishing on surface hardness and corrosion of orthodontic archwires.

The purpose of this study was to investigate the effect of surface roughness on the relative corrosion rates of wires of four alloys-stainless steel, nickel titanium, cobalt chromium, and beta titanium. Batches of wire were divided into two groups. Wires in one group were industrially polished to provide a uniform surface finish; wires in the other group were left for comparison "as received." Wire diameter, hardness, and relative corrosion rates were compared within groups before and after polishing. Comparisons were also made across the four groups of alloys. The samples of as-received wires showed variations in surface finish, with beta titanium having the roughest appearance and cobalt chromium the smoothest. Nickel titanium and stainless steel surfaces were similar. Polishing provided a more uniform finish, but significantly reduced the diameter of the wires. Microhardness testing of wire surfaces of each alloy indicated that no significant work-hardening occurred as a result of polishing. The relative corrosion rates (expressed in terms of corrosion current density) in a 0.9% sodium chloride solution were estimated using the electrochemical technique of polarization resistance. Nickel titanium wires exhibited the greatest corrosion current density in the as-received state. Polishing significantly reduced the corrosion rate of nickel titanium, such that comparison between the four alloys in the polished state revealed no significant difference in their relative corrosion rate/corrosion current density.     

The psychology of facial appearance

Facial attractiveness is now recognized as being important in situations as diverse as education, relationships and employment. An individual's facial appearance is one of their most obvious characteristics and facial disfigurements are judged to be among the least desirable 'handicaps'. A face which deviates from the norm becomes a stigma. This paper looks at the complex area of facial appearance and its importance in the field of dentistry. The relationship between facial attractiveness and varying forms of dental and surgical intervention are discussed, as well as some of the problems which may be encountered during treatment.     

Identifying genes for alcohol and drug sensitivity: recent progress and future directions

New methods for identifying chromosomal regions containing genes that affect murine responses to alcohol and drugs have been used to identify many provisional quantitative trait loci (QTLs) since 1991. By 1998, 24 QTLs had been definitively mapped (P<5x10(-5)) to specific murine chromosomes, which indicates the presence of a relevant gene or genes at each location. The syntenic (homologous) region of the human genome for these genes is often known. For many mapped QTLs, candidate genes with relevant neurobiological function lie within the mapped region. Data that implicate candidate genes for specific responses include studies of knockout animals. Current strategies for gene identification include the use of congenic strains containing QTL regions introduced from another strain. There is increasing emphasis on gene-gene and gene-environment interactions in such studies.     

Tissue factor pathway inhibitor expression in human crescentic glomerulonephritis

BACKGROUND: Tissue factor (TF) pathway inhibitor (TFPI), the major endogenous inhibitor of extrinsic coagulation pathway activation, protects renal function in experimental crescentic glomerulonephritis (GN). Its glomerular expression and relationship to TF expression and fibrin deposition in human crescentic GN have not been reported. METHODS: Glomerular TFPI, TF, and fibrin-related antigen (FRA) expression were correlated in renal biopsies from 11 patients with crescentic GN. Biopsies from 11 patients with thin basement membrane disease and two normal kidneys were used as controls. RESULTS: TFPI was undetectable in control glomeruli but was detectable in interstitial microvessels. In crescentic biopsies, TFPI was detected in cellular crescents and was more prominent in fibrous/fibrocellular crescents, indicating a correlation with the chronicity of crescentic lesions. TFPI appeared to be associated with macrophages but not endothelial or epithelial cells. TFPI was generally undetectable in regions of the glomerular tuft with minimal damage. In contrast, TF and FRA were strongly expressed in regions of minimal injury, as well as in more advanced proliferative and necrotizing lesions. Despite prominent TF expression, FRA was less prominent in fibrous/fibrocellular crescents in which TFPI expression was maximal. CONCLUSIONS: These data suggest that TFPI is strongly expressed in the later stages of crescent formation and is inversely correlated with the presence of FRA in human crescentic GN. This late induction of TFPI may inhibit TF activity and favor reduced fibrin deposition in the chronic stages of crescent formation.