Reconstitution of the not-for-profit hospital: new ethics, new equity

In meeting the challenge of economic competition, the not-for-profit hospital has made two significant responses: corporate reorganization and formation of multihospital systems. However, an additional response is needed to improve access to equity capital. This can be achieved by separating the hospital into a not-for-profit entity that contains nursing care, administration, and support services and a series of economic partnerships with members of its medical staff and other investors for provision of ancillary diagnostic and treatment services. Additionally, it is proposed that the parent holding company add an insurance arm, form a primary care network, and vertically integrate all modalities of care.     

The somatotopic organization of primary afferent terminals in the superficial laminae of the dorsal horn of the rat spinal cord

Transganglionic transport of wheatgerm agglutinin conjugated horse-radish peroxidase (WGA-HRP) was used to reveal the central distribution of terminals of primary afferent fibers from peripheral nerves innervating the hind leg of the rat. In separate experiments the sizes and locations of cutaneous peripheral receptive fields were determined by electrophysiological recording techniques for each of the nerves that had been labeled with WGA-HRP. By using digital image analysis, the sizes and positions of the peripheral receptive fields were correlated with the areas of superficial dorsal horn occupied by terminals of primary afferents from each of these receptive fields. Data were obtained from the posterior cutaneous nerve of the thigh, lateral sural, sural, saphenous, superficial peroneal, and tibial nerves. The subdivisions of the sciatic nerve, the sural, lateral sural, superficial peroneal, and tibial nerves each projected to a separate and distinct region of the superficial dorsal horn and collectively formed a "U"-shaped zone of terminal labeling extending from lumbar spinal segments L2 to the caudal portions of L5. The gap in the "U" extended from L2 to the L3-4 boundary and was occupied by terminals from the saphenous nerve. Collectively, all primary afferents supplying the hindlimb occupied the medial 3/4 of the superficial dorsal horn with terminals from the tibial nerve lying most medially and occupying the largest of all the terminal fields. Afferents from the superficial peroneal lay in a zone between the medially situated tibial zone and the more laterally placed sural zone. Afferents from the posterior cutaneous nerve were located most caudally and laterally. Terminal fields from the posterior cutaneous and saphenous nerves differed from the others in having split representations caused presumably by their proximity to the mid-axial line of the limb. Comparisons between the peripheral and the central representations of each nerve revealed that 1 mm2 of surface area of the superficial dorsal horn serves approximately 600-900 mm2 of hairy skin and roughly 300 mm2 of glabrous skin. The vast majority of terminal labeling observed in the dorsal horn was found in the marginal layer and substantia gelatinosa, suggesting that small diameter afferents have an orderly somatotopic arrangement in which each portion of the skin surface is innervated by afferent fibers that terminate in preferred localities within the dorsal horn.     

Motoneurons of the rat sciatic nerve

The sciatic nerve of the rat is a commonly used model for studies on nerve injury, regeneration, and recovery of function. To interpret the changes that occur in a neuron population subsequent to peripheral nerve injury, and to compare different repair procedures, it is essential to have a complete and accurate understanding of the population's normal cellular constituents and their locations. This study reports on the numbers, sizes, and topographic distributions of the motoneuron populations of individual branches of the rat sciatic nerve (peroneal, tibial, sural, and the medial and lateral gastrocnemius nerves), as determined by retrograde transport of HRP (or WGA-HRP) from cut proximal nerve ends isolated in wax to prevent spread of the tracer substance. Optimal labeling of motoneurons was evident between 42 and 73 h of survival. Reconstructions were made from 40-micron serial sections of spinal segments L6 through L2, usually in the coronal plane. Accurate motoneuron counts were obtained by detailed reconstructions in which an accounting of all "split cell" fragments was made to avoid double cell counts. The sciatic nerve of the albino rat contains a total population of about 2005 +/- 89 motoneurons. The tibial nerve contained 982 +/- 36 cells or 49% of the total. The common peroneal nerve contained 31% or 632 +/- 27 motoneurons. The medial and lateral gastrocnemius nerve branches contained collectively 322 +/- 16 (16%). The sural nerve accounted for only 68 +/- 10 motoneurons (3%). The sciatic motoneurons form a continuous, compact cell column in the dorsolateral quadrant of the ventral horn extending from rostral L6 into the caudal third of L3 over a longitudinal distance of about 6.3 to 7.5 mm. This fusiform column shows its greatest width, 0.5 mm, in mid-L4. Within this compartment motoneurons of each branch of the sciatic occupy spatially distinct subcompartments. Their relative positions are described in detail.     

Age-related loss of bone marrow pre-B- and immature B-lymphocytes in the autoimmune-prone flaky skin mutant mice

Defective B-lymphopoiesis has been associated with development of auto-antibodies and auto-immunity in a number of auto-immune-prone strains of mice. The flaky skin (fsn) mutation results in development of chronic inflammation and auto-immunity. Associated with the development of auto-immunity is the hyperactivation of B-lymphocytes and production of auto-antibodies. We, therefore, undertook a detailed examination of B-lineage precursors in the bone marrow of fsn/fsn mice. We observed a rapid age-related loss of the pre-B and immature B cells. It was also noted that an accumulation of early precursor populations occurs coincident with the loss of Fr.D and Fr.E bone marrow B cell populations indicating a developmental block or accumulation of pro-B cells in 7 and 10 week old fsn/fsn mice. Our data suggests changes in the fsn/fsn bone-marrow microenvironment that results in senescence of B cell development.     

SCL-90-R factor structure in an acute,involuntary, adult psychiatric inpatient sample

The dimensionality of the SCL-90-R was investigated in an acute, involuntarily committed adult psychiatric sample (N = 260) using common principal factor extraction and confirmatory factor analytic procedures. The findings show a large primary factor accounting for 42% of the variance. Confirmatory factor analyses failed to replicate the standardization data. These results are consistent with previous research suggesting a primary global distress factor. They raise questions of the validity of the SCL-90-R clinical profile from acute involuntarily hospitalized psychiatric adults. © 1996 John Wiley & Sons, Inc.     

The prospect of expert system—Based cognitive support as a by-product of image acquisition and reporting

In order for computer-based decision-support tools to find routine use in the everyday practice of clinical radiology, further development of user interface and knowledge content are required. In an ideal interface, the interaction between the radiologist and the computer would be minimized and painlessly integrated into existing work patterns. In this article, we explore some of the ways that pre-existing computer interactions in the processes of image acquisition and reporting can be used to feed case information into an expert system and thereby allow users to acquire advice from it in an automatic fashion. We describe interface models that we have developed in the domains of mammography and obstetric ultrasound, and discuss interface and content-related questions that have arisen from informal evaluations of these systems. In particular, the need for clinical outcome-relevant decision support and training level-appropriate decision support are discussed in detail.     

Sexual and physical abuse histories and psychiatric symptoms among male psychiatric outpatients

Of 125 consecutive male patients at an adult psychiatric outpatient clinic, 48% reported histories of sexual abuse and/or physical abuse. The mean scores on the global severity index of the SCL-90-R at the first visit were significantly higher for those who reported histories of abuse than for those who had no such history. Childhood abuse also was associated with high levels of psychiatric symptoms in these men.     

Expert system-controlled image display

Conventional computer-based medical expert systems deliver advice to physicians as written text. While such advice is useful, it has distinct limitations in a visually oriented discipline such as diagnostic radiology, in which decisions often depend on pattern recognition and appreciation of subtle morphologic features. The authors developed a prototype expert computer system, IMAGE/ICON, which displays groups of images sorted into a series of axes based on different ways in which they may be similar. They may share a common feature, group of features, causes, or clinical setting. IMAGE/ICON may display examples of morphologic variations of a dominant finding or a spectrum of abnormalities seen in an specific disease or group of diseases. The system also assembles a written analysis of key features of a case. Such a tool may be useful as a diagnostic aid or for continuing medical education. It is likely to have particular impact in the form of an intelligent radiologic workstation, as picture archiving and communication systems become available.