Changes in Quality of Health Care Delivery after Vertical Integration

ObjectivesTo fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area.ConclusionsMoving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns.     

Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery

BACKGROUND: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery. METHODS: We prospectively studied 279 morbidly obese patients seeking gastric bypass surgery for vitamin D nutritional status as assessed by serum 25-hydroxyvitamin D level. In addition, serum samples were analyzed for calcium, alkaline phosphatase (AP), intact parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D. RESULTS: Mean patient age was 43 +/- 9 years; 87% of the study patients were women, and 72% were white. Serum calcium and AP levels were normal in 88% and 89% of the patients, respectively. Vitamin D depletion, defined as serum 25-hydroxyvitamin D level 相似文献   

p70 lupus autoantigen binds the enhancer of the T-cell receptor beta-chain gene.

The p70 (Ku) autoantigen has been described as a nonhistone nuclear protein recognized by antibodies from lupus patients. In our studies on the regulation of T-cell receptor (TCR) beta-chain gene expression we have identified the p70 lupus autoantigen as a DNA-binding protein that binds the enhancer of the TCR beta-chain gene. This enhancer is essential for expression of the TCR beta gene. The core TCR beta enhancer contains the E3 motif, which we show here is essential for enhancer activity. The protection of the E3 motif in T cells and the marked reduction in enhancer activity when the E3 motif is mutated underline its physiological importance in regulating beta enhancer activity. The p70 lupus autoantigen gene was identified by screening T-cell lambda gt11 libraries with an E3 probe. The gene encodes a protein which binds the E3 motif in a sequence-specific manner. The identification of a 70-kDa protein as a major E3-binding protein by UV crosslinking is consistent with the conclusion that the p70 lupus autoantigen binds the beta enhancer. Finally, we have shown that T-cell nuclear proteins which bind the E3 motif bear p70 (Ku) lupus autoantigenic determinants. Together these data suggest that the p70 autoantigen binds a critical motif in the beta enhancer and probably regulates TCR beta gene expression.     

Sulphasalazine inhibition of human granulocyte activation by inhibition of second messenger compounds.

The effects of sulphasalazine on the production of second messenger compounds in human granulocytes have been characterised by various stimuli. The increases in cytosolic calcium, inositol trisphosphate, diacylglycerol, and phosphatidic acid (all important mediators of intracellular signal transduction) triggered by stimulation were inhibited by sulphasalazine. The metabolites 5-amino-salicylic acid and sulphapyridine were less potent inhibitors than the mother compound. It is concluded that sulphasalazine inhibits the synthesis of phosphoinositide derived second messenger compounds at the level of phospholipase C or its regulatory guanosine 5'-triphosphate (GTP) binding protein. Inhibition of phosphatidic acid synthesis was either due to the same mechanism, or to interaction with a phospholipase D regulating GTP binding protein.     

Disposition and pharmacokinetics of [14C]finasteride after oral administration in humans.

The disposition of [14C]finasteride, a competitive inhibitor of steroid 5 alpha-reductase, was investigated after oral administration of 38.1 mg (18.4 microCi) of drug in six healthy volunteers. Plasma, urine, and feces were collected for 7 days and assayed for total radioactivity. Concentrations of finasteride and its neutral metabolite, omega-hydroxyfinasteride (monohydroxylated on the t-butyl side chain), in plasma and urine were determined by HPLC assay. Mean excretion of radioactivity equivalents in urine and feces equaled 39.1 +/- 4.7% and 56.8 +/- 5.0% of the dose, respectively. The mean peak plasma concentrations reached for total radioactivity (ng equivalents), finasteride, and omega-hydroxyfinasteride were 596.5 +/- 88.3, 313.8 +/- 99.4, and 73.7 +/- 11.8 ng/ml, respectively, at approximately 2 hr; the mean terminal half-life for drug and metabolite was 5.9 +/- 1.3 and 8.4 +/- 1.7 hr, respectively. Of the 24-hr plasma radioactivity, 40.9% was finasteride, 11.8% was the neutral metabolite, and 26.7% was characterized as an acidic fraction of radioactivity. Binding of [14C]finasteride to plasma protein was extensive (91.3 to 89.8%), with a trend suggesting concentration dependency (range 0.02 to 2 micrograms/ml). Little of the dose was excreted in urine as parent (0.04%) or omega-hydroxyfinasteride (0.4%). Urinary excretion of radioactivity was largely in the form of acidic metabolite(s)--18.4 +/- 1.7% of the dose was eliminated as the omega-monocarboxylic acid metabolite. Finasteride was scarcely excreted unchanged in feces. In humans, finasteride is extensively metabolized through oxidative pathways.(ABSTRACT TRUNCATED AT 250 WORDS)     

Survival and Implantation of Escherichia coli in the Intestinal Tract

Preliminary experiments established that a 0.5-ml inoculum that is introduced directly into the stomach of mice was cleared rapidly into the small intestine. Bicarbonate buffer, but not skim milk, protected such an inoculum from stomach acid until at least 90% of it had entered the small intestine. Passage and survival of various Escherichia coli strains through the mouse gut were tested by introducing a buffered bacterial inoculum directly into the stomach, together with the following two intestinal tracers: Cr(51)Cl(3) and spores of a thermophilic Bacillus sp. Quantitative recovery of excreted bacteria was accomplished by collecting the feces overnight in a refrigerated cage pan. The data show that wild-type E. coli strains and E. coli K-12 are excreted rapidly (98 to 100% within 18 h) in the feces without overall multiplication or death. E. coli varkappa1776 and DP50supF, i.e., strains certified for recombinant DNA experiments underwent rapid death in vivo, such that their excretion in the feces was reduced to approximately 1.1 and 4.7% of the inoculum, respectively. The acidity of the stomach had little bactericidal effect on the E. coli K-12 strain tested, but significantly reduced the survival of more acidsensitive bacteria (Vibrio cholerae) under these conditions. Long-term implantation of E. coli strains into continuous-flow cultures of mouse cecal flora or into conventional mice was difficult to accomplish. In contrast, when the E. coli strain was first inoculated into sterile continuous-flow cultures or into germfree mice, which were subsequently associated with conventional mouse cecal flora, the E. coli strains persisted in a large proportion of the animals at levels resembling E. coli populations in conventional mice. Metabolic adaptation contributed only partially to the success of an E. coli inoculum that was introduced first. A mathematical model is described which explains this phenomenon on the basis of competition for adhesion sites in which an advantage accrues to the bacterium which occupies those sites first. The mathematical model predicts that two or more bacterial strains that compete in the gut for the same limiting nutrient can coexist, if the metabolically less efficient strains have specific adhesion sites available. The specific rate constant of E. coli growth in monoassociated gnotobiotic mice was 2.0 h(-1), whereas the excretion rate in conventional animals was -0.23 h(-1). Consequently, limitation of growth must be regarded as the primary mechanism controlling bacterial populations in the large intestine. The beginnings of a general hypothesis of the ecology of the large intestine are proposed, in which the effects of the competitive metabolic interactions described earlier are modified by the effects of bacterial association with the intestinal wall.     

Sexual dimorphism of the miniature pig submandibular glands

The submandibular salivary glands of 14 Pitman-Moore miniature pigs were examined to determine whether they exhibit sexual dimorphism. Sections of the glands from seven male and seven female animals were stained by several histochemical methods. No morphological sex differences were noted in hematoxylin and eosin-stained sections but differences were found with all of the histochemical methods utilized. Most noticeable was the higher concentration of sialic acid-containing mucosubstances in mucous acini of the female submandibular gland sections when they were stained with either the Alcian blue (pH 2.5), Alcian blue (pH 2.5)-periodic acid-Schiff or periodic acid-phenyl-hydrazine-Schiff methods. Unlike mucous acini, demilunes of the male submandibular gland possessed a higher concentration of sialic acid-containing mucosubstance than did those of the female. The miniature pig, unlike other animal orders studied, possesses sexual dimorphism at three weeks of age, thus differing markedly from other animals in which sexual dimorphism of the salivary glands does not occur until after the onset of puberty.     

Life events and early onset depression: cause or consequence?

BACKGROUND: Adverse life events prior to episodes of depression are assumed to play a causal role. Earlier studies have, however, not adequately controlled for the potential confounding effects of previous depression. METHOD: A two-phase study was nested within a six-wave population based cohort study of 1947 adolescents. Interviews at two assessment phases with the CIS-R and CIDI were used to generate ICD-10 diagnoses of depressive disorder. Life events with longer-term contextual threat were reported for the 6 months before first diagnosis and categorized on the basis of participant appraisal as negative and neutral/positive in effects. Previous depressive and anxiety symptoms were measured 6 months earlier. RESULTS: Pre-existing depressive and anxiety symptoms predicted later events, increasing three-fold the risks for both neutral/positive and negative events in females and increased seven-fold the risk of negative events in males. Life events in turn predicted the onset of depressive disorder independently of previous symptoms. Single negative events held an over five-fold elevated risk and multiple events an almost eight-fold higher risk. Personal threat and loss were associated with disorder in females but not males. CONCLUSIONS: The findings are consistent with a causal role for life events in early episodes of depression. The association also reflects a reciprocal relationship in which earlier symptoms predict later events, perhaps as a result of an individual's attempts to change unfavourable social circumstances.     

Ultrastructure and histochemistry of human anterior lingual salivary glands (glands of blandin and nuhn)

Background: Speciamens of human anterior lingual salivary glans obtained by surgery and by dissection of cadavers were studied ultrastructurally and histochemically. Methods: Specimens were obtained by surgery for ultrastructural study. Other specimens for histochemistry were obtained by dissection of fresh cadavers. Tissues for electron microscopy were fixed and processed by conventional mesns. Formalin-fixed cadaver specimens were subjected to a battery of tests for glycoconjugates. Results: The anterior lingual salivary glands are composed predominantly of mucous tubules (which come in two distinct sizes: large and small), seromucous demilunes, and rare seromucous acini. Regardless of tubule size, mucous cells are typically in appearance and, like mucous cells in other human salivary glands, contain filamentous bodies. Histochemically, the larger tubules contain neutral glycoproteins, low concentrations of sialoglycoproteins, and large amounts of sulfated glycoproteins. The small mucous tubules contain neutral glycoproteins, much sialoglycoprotein, and relatively small amounts of sulfated glycoprotein. The seromucous cells, whether demilunar or acinar, are identical. They contain numerous secretory granules, which show a spectrum of internal patterns from one individual to another. These cells have considerable concentrations of neutral- and sialoglycoproteins and lower concentrations of sulfated gly-coproteins. Countrary to previously published reports, we could find no differences in the ratio of mucous to seromucous cells along the anteriorposterior lingual axis: there was no gradient of seromucous cells in our specimens. The ducts in the anterior lingual salivary glands are not precise counterparts of those in the major salivary glands, since the former have no capsules, hence lack lobulation. Without these familiar structural landmarks, the only duct that can be identified with certainty is the intercalated duct, and then only if it is in continuity with or lies close to a secretory endpiece. Such ducts consist of simple cuboidal epithelium of prosaic appearance. The ductular epithelium gradually thickens and gives rise to what appear to be excretory ducts consisting of columnar cells with few mitochondria. Scattered within the walls of the walls of the larger ducts are patches of typical striated ducts wherein the taller cells display basal striations resulting from highly folded basal plasma membranes and numerous, vertically oriented, virgulate mitochondria. In other atypical regions of the excretory duct, basal cells may have a primary cilium that juts into the intercellular space. Conclusions: There is a high degree of structural variability in human anterior lingual salivary glands. Because of the technical difficulties in collecting pristine saliva from these glands, the precise functions(s) of these organs remains unknown. © 1994 Wiley-Liss, Inc.