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.     

Sliding mode control of time‐varying delay Markov jump with quantized output

This paper investigates the quantized sliding mode control of Markov jump systems with time‐varying delay. A dynamical adjustment law is explored to quantize the system output. By constructing an observer‐based integral sliding surface, a sliding mode controller is designed to take over the dynamical motion of state estimation and ensure the reachability of sliding surface. A new scaling manner is developed to build the bound between the system output and quantized error. With the help of separation strategies for controller synthesis and general transition probabilities and a lower bound theorem for nonlinear integral terms, a new synthesis method to ensure the required stability and meet the required performance is proposed in the form of linear matrix inequalities. The validity of the proposed control method is illustrated by a numerical example.     

Prospective comparative study of intraoperative “Towel clip test” and “Vertical patella test” assessing lateral retinaculum tightness in patients undergoing TKA

BackgroundProper patellar tracking is one of the most important aspect of TKA to ensure good functional outcome. A patellar tracking problem noted intraoperatively serves as a warning sign and should prompt the surgeon to reassess position of each component. Various tests are there to assess lateral retinaculum tightness viz. "No thumb test", "Towel clip test". A new test "Vertical patella test" is described to assess lateral retinaculum tightness. A study was conducted to assess the effectiveness, correlation and validity of two techniques.Materials & MethodsPatients >50 years of age and with diagnosis of Osteoarthritis knee having less than 30 varus and flexion deformity going in for primary TKA were selected with a sample size of 100 knees in a tertiary care centre. Revision cases or patients with flexion contracture more than 30, complex knee surgery; with pre existing patellar tilt were excluded from study.ResultsResults of both tests were found to correlate in 75% of case with sensitivity of 96.65% and specificity of 75.00%. Kappa came out to be 0.634 which shows good agreement of vertical patella test and towel clip test. Result was computed using excel and SPSS and was found to be significant with p value< 0.05. Lateral retinaculum release was done in 8 knees.ConclusionsVertical patella test correlates with towel clip test, is easy to perform and saves time. The limitation of our study was small sample size.     

Vertical profile of Cs in soil

In this paper, a vertical distribution of ¹³⁷Cs in undisturbed soil was investigated experimentally and theoretically. Soil samples were taken from the surroundings of the city of Kragujevac in central Serbia during spring-summer of 2001. The sampling locations were chosen in such a way that the influence of soil characteristics on depth distribution of ¹³⁷Cs in soil could be investigated. Activity of ¹³⁷Cs in soil samples was measured using a HpGe detector and multi-channel analyzer. Based on vertical distribution of ¹³⁷Cs in soil which was measured for each of 10 locations, the diffusion coefficient of ¹³⁷Cs in soil was determined. In the next half-century, ¹³⁷Cs will remain as the source of the exposure. Fifteen years after the Chernobyl accident, and more than 30 years after nuclear probes, the largest activity of ¹³⁷Cs is still within 10 cm of the upper layer of the soil. This result confirms that the penetration of ¹³⁷Cs in soil is a very slow process. Experimental results were compared with two different Green functions and no major differences were found between them. While both functions fit experimental data well in the upper layer of soil, the fitting is not so good in deeper layers. Although the curves obtained by these two functions are very close to each other, there are some differences in the values of parameters acquired by them.     

流行性出血热流产婴儿与胎盘的病理变化及巨噬细胞内抗原定位

妊娠6~ 个月孕妇感染流行性出血热(EHF),临床有典型的EHF的发病过程。第23病日血清学检测孕妇外周血EHF-IgG(卅)、IgM(-),第24病日流产一女婴,抽取脐带血检测EHF-IgG(卅),流产女婴心血检测EHF-IgG(卅),IgM(-)。病理:肾小球上皮细胞肿胀,上皮细胞足突融合、坏死,毛细血管基底膜皱缩,肾小管上皮细胞线粒体肥大,间质内大单核细胞浸润。肺间质细胞增生、水肿、毛细血管基底膜不规则增厚,肺泡壁Ⅱ型细胞增多。肝细胞肿胀,胞浆内查见包涵体样物质,有多核肝巨细胞,地依红染色阴性。胎盘母体面、脐带、肺、肝间质内大单核细胞、中性粒细胞浸润。EHF-MCAb荧光直接法染色、PAP、ABC等免疫组化染色,在巨噬细胞浆内均为阳性反应,从而证实母体感染EHF可以经胎盘感染给胎儿,其传播方式可能是通过巨噬细胞系统。     

Visual spatial attention to stimuli presented on the vertical and horizontal meridian: An ERP study

In the first experiment, 48 subjects carried out a visual spatial attention task. Stimuli were presented at the vertical meridian, either above or below a fixation dot, and the subjects were instructed to attend to one of these stimulus positions and ignore the other position. In three different conditions, the distances between stimulus positions and fixation were 0.5°, 0.9°, and 1.3°. Subjects searched for the presence of prememorized target letters at the attended location: memory load was one or four items in different conditions. The P1/N1 enhancement typically found on the horizontal dimension was not observed on the vertical dimension. Instead, a positive shift of the attended compared with the unattended stimuli was found, which was most prominent at anterior electrodes. This positivity showed effects of the distance manipulation. The N2b-P3a effect of attention and the effect of memory load (search negativity) normally present in this kind of selective search task were also found. Reaction times were faster when attention was directed above fixation than when it was directed below fixation. The event-related potential data suggested that this difference could be attributed to a more efficient neglecting of irrelevant stimuli presented below fixation. In Experiment 2, we examined whether the absence of the P1/N1 enhancement as the result of spatial attention in Experiment 1 could be attributed to (a) the presentation of stimuli along the vertical meridian instead of along the horizontal meridian, (b) the use of midline electrodes instead of lateralized electrodes, and (c) the relatively small spatial separation between the relevant and irrelevant stimuli. Twelve subjects searched for the presence of a single target letter at an attended position in three different conditions. In two of the conditions the letters were presented to the left or right of fixation. The distance between fixation and the stimulus positions was 1.3° in one of these conditions and 3° in the other condition. In the third condition, the stimuli were presented at 3° above or below fixation. In all three conditions effects similar to those in Experiment 1 were observed. In addition, in all three conditions an enhancement of the P1 and N1 components was found at two lateral occipitotemporal electrodes.     

Transmission of HIV-1 infection between trophoblast placental cells and T-cells take place via an LFA-1-mediated cell to cell contact

HIV-1 vertical transmission is thought to mainly take place by virus crossing the placental barrier. However, the mechanism by which HIV-1-infects placental cells remains to be elucidated. We have found that purified cytotrophoblasts as well as trophoblastic cell lines are susceptible to infection by different HIV-1 isolates as detected by DNA-PCR and release of infectious virus, although with very low efficiency. Purified trophoblast or trophoblastic cell lines express low levels of chemokine receptors CCR-5 and CXCR-4 but not CD4 on the cell surface. To test if those molecules were used as receptors for HIV-1 infection, placental cells were pretreated with antibodies to CD4, CC-chemokines, C-X-C chemokines. None of those treatments inhibited HIV-1 infection. In contrast, we have found that HIV-1 infection of placental cells was increased in cocultures of infected T-cell blasts and placental cells. More interestingly, antibodies to beta(2) integrins and to LFA-1 were able to significantly block infection of placental cells. Cell surface expression of ICAM-1, an adhesion molecule involved in attachment of leukocytes to placenta, was upregulated in HIV-1-infected placental cells. Placental cells were able to transfer HIV-1 infection to T-cell blasts. This transmission required cell to cell contact and was also inhibited by anti-LFA-1 antibodies. In summary our results suggest that placental trophoblast could be infected by HIV-1 by a mechanism involving T cell to placental contact. Moreover, placental infection enhanced ICAM-1 expression and leukocyte adherence, an event which was required to transfer HIV-1 infection to T cells. This provides an explanation of the virus passing through the placental barrier during in utero HIV-1 vertical transmission.     

Saccular and utricular inputs to single vestibular neurons in cats

Saccular and utricular organs are essential for postural stability and gaze control. Although saccular and utricular inputs are known to terminate on vestibular neurons, few previous studies have precisely elucidated the origin of these inputs. We investigated the saccular and utricular inputs to single vestibular neurons in whole vestibular nuclei of decerebrated cats. Postsynaptic potentials were recorded from vestibular neurons after electrical stimulation of the saccular and utricular nerves. Ascending and descending axonal projections were examined by stimulating the oculomotor/trochlear nuclei and the cervical segment of the spinal cord, respectively. After each experiment, locations of recorded neurons were identified. The recorded neurons (140) were classified into vestibulo-spinal (79), vestibulo-oculo-spinal (9), and vestibulo-ocular (3) neurons based on antidromic responses; 49 other vestibular neurons were unidentified. The majority of recorded neurons were mainly located in the lateral vestibular nucleus. Most of the otolith-activated vestibular nuclei neurons seemed to participate in vestibulospinal reflexes. Of the total 140 neurons recorded, approximately one third (51) received saccular and utricular inputs (convergent neurons). The properties of these 51 convergent neurons were further investigated. Most (33/51) received excitatory postsynaptic potentials (EPSPs) after saccular and utricular nerve stimulation. These results implied that most of the convergent neurons in this study additively coded mixed information for vertical and horizontal linear acceleration. Based on the latencies of convergent neurons, we found that an early integration process for vertical and horizontal linear acceleration existed at the second-order level.     

The relationship between muscle kinetic parameters and kinematic variables in a complex movement

Summary Kinematic variables of the vertical jump (jumping height, jump phase durations and joint angles) were measured on 39 male physical education students. In addition, kinetic parameters of the hip and knee extensors, and of the plantar flexors (maxima voluntary force and its rate of development) were recorded on the same subjects, in isometric conditions. The results demonstrated significant positive correlations between kinetic parameters of the active muscle groups and jumping height (r=0.217−0.464). The dominant effect on these correlations was due to the knee extensors. Correlations between these parameters and the duration of the jump phases were much weaker. Correlation coefficients between kinetic parameters and limb angles in the lowest body position showed that fast force production in one muscle group was related to a significant decrease in the joint angles of distant body segments. Multiple correlation coefficients between leg extensor parameters and kinematic variables (ranging between 0.256 for the duration of the counter-movement phase and 0.616 for jump height) suggested that kinetic parameters could explain more than a quarter of the variability of this complex human movement. Therefore, the conclusion was drawn that an extended set of measurements of the relevant musculo-skeletal system parameters could predict a considerable amount of the variability of human movement. However, high correlation coefficients between the same kinetic parameters of different muscle groups suggest that not all active muscle groups have to be included in the measurements.