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Standard approaches for determining weights when calculating a composite measure of health care quality from individual quality indicators (QIs) include equal weighting, opportunity-based weights, and judgment-based weights. Benef...
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Standard approaches for determining weights when calculating a composite measure of health care quality from individual quality indicators (QIs) include equal weighting, opportunity-based weights, and judgment-based weights. Benefit-of-the-doubt approaches have not been used in the health services area, though one has been used to calculate composite measures for profiling countries. Underlying these approaches is the assumption that relative performance on a set of indicators is, at least to some extent, a revealed preference by the organizational unit about the relative importance of the indicators. A benefit-of-the-doubt approach recognizes these revealed preferences by assigning higher weights to indicators on which performance is better and lower weights to indicators on which performance is poorer. We consider two benefit-of-the-doubt approaches. The first uses simple linear programming (LP) models; the second uses data envelopment analysis (DEA), the way in which the benefit-of-the-doubt approach has been previously implemented. In both cases, constraints are added to limit weight adjustments to some percentage of policy-determined baseline weights. Using both standard and benefit-of-the-doubt approaches, composite scores are calculated from data on five QIs from 32 Department of Veterans Affairs (VA) nursing homes. We examine the tradeoff between the level of allowable weight adjustment and impact on facility rankings. If weights are constrained to be within 75% of baseline weights, all approaches identify pretty much the same high performing facilities. Weights from benefit-of-the-doubt approaches, because they are able to reflect local preferences and conditions, should be attractive to facilities and, in a collaborative environment, to policy makers.
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The effect of β-iron intermetallics and porosity on the tensile properties in cast Al-Si-Cu and Al-Si-Mg alloys were investigated for this research study, using experimental and industrial 319.2 alloys, and industrial A356.2 allo...
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The effect of β-iron intermetallics and porosity on the tensile properties in cast Al-Si-Cu and Al-Si-Mg alloys were investigated for this research study, using experimental and industrial 319.2 alloys, and industrial A356.2 alloys. The results showed that the alloy ductility and ultimate tensile strength (UTS) were subject to deterioration as a result of an increase in the size of P-iron intermetallics, most noticeable up to P-iron intermetallic lengths of ～100 μm in 319.2 alloys, or ～70 μm in A356.2 alloys. An increase in the size of the porosity was also deleterious to alloy ductility and UTS. Although tensile properties are interpreted by means of UTS vs. log elongation plots in the present study, the properties for all sample conditions were best interpreted by means of log UTS vs. log elongation plots, where the properties increased linearly between conditions of low cooling rate-high Fe and high cooling rate-low Fe. The results are explained in terms of the β-Al_5FeSi platelet size and porosity values obtained.
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In order to create an empirically derived parsimonious typology of physician financial incentives that will be useful for future research, we used data from the nationally representative 2004-2005 Community Tracking Study Physicia...
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In order to create an empirically derived parsimonious typology of physician financial incentives that will be useful for future research, we used data from the nationally representative 2004-2005 Community Tracking Study Physician Survey (N = 6,628). Linear regression analyses informed by economic theory were used to identify the combinations of incentives associated with an overall financial incentive to expand services to individual patients. The approach was validated using two nonparametric methods (CART analysis and data mining techniques) and by examining the relationship between the resulting typology and other measures of physician behavior including hours worked, visit volume, and specialty-adjusted income. Of the 6,628 physicians surveyed, approximately 25% (1,605) reported an overall incentive to increase services and 75% (5,023) reported either neutral incentives or incentives to decrease services. Men, who were approximately 75% of respondents, were slightly more likely to report incentives to increase services (P < 0.05). There were no differences in reported incentives according to specialty. We created two typologies (one with eleven categories and the other with a collapsed set of six categories) based on combinations of variables measuring ownership, base compensation methods, and financial incentives. The percentage with an overall incentive to increase services ranges from 6% for employed physicians compensated via fixed salary to 36.7% for owners in low capitation environments with either individual or practice level productivity incentives. The criterion validity of the typology was established by examining the relationship with adjusted physician income, hours worked, and visit volume, which showed generally consistent relationships in the expected direction. A parsimonious typology consisting of six mutually exclusive groups reasonably captures the continuum of incentives to increase service delivery experienced by physicians.
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The annulus fibrosis electrically insulates the atria and ventricles, allowing the timed sequential beating of these structures that is necessary for efficient heart function. Abnormal development of the annulus fibrosis leads to ...
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The annulus fibrosis electrically insulates the atria and ventricles, allowing the timed sequential beating of these structures that is necessary for efficient heart function. Abnormal development of the annulus fibrosis leads to persistence of accessory electrical pathways from atria to ventricles, providing the anatomical substrate for re-entrant cardiac arrhythmias such as Wolff-Parkinson-White syndrome. To better understand the development of the annulus fibrosis and the etiology of these cardiac arrhythmias, we used Cre-LoxP technology to assess the contribution of epicardium derived cells (EPDCs) to the annulus fibrosis. We found that EPDCs migrated into the region of the forming annulus fibrosis, marked by the protein periostin. These EPDCs also stained positive for procollagen I, suggesting that the EPDCs themselves synthesize proteins of the annulus fibrosis. To further test the hypothesis that EPDCs contribute to cells that synthesize the annulus fibrosis, we purified genetically marked EPDCs from the atrioventricular region and measured gene expression by quantitative PCR. These EPDCs were highly enriched for mRNAs encoding periostin, procollagen I, fibronectin I, vimentin, discoidin domain receptor 2, and tenascin C, markers of fibroblasts and components of the annulus fibrosis. In addition, these EPDCs were highly enriched for Snail, Smad1, Slug, and Twist1, markers for epithelial-to-mesenchymal transition (EMT), and a metalloprotease, Mmp2, that contributes to cellular migration. Our work provides for the first time definitive evidence that epicardium contributes to formation of the mammalian annulus fibrosis through EMT. Abnormalities of this differentiation process may underlie development of some forms of re-entrant atrioventricular tachycardia.
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Laser microsurgery and finite element modeling are used to determine the cell-level mechanics of the amnioserosa-a morphogenetically crucial epithelium on the dorsal surface of fruit fly embryos (Drosophila melanogaster). In the e...
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Laser microsurgery and finite element modeling are used to determine the cell-level mechanics of the amnioserosa-a morphogenetically crucial epithelium on the dorsal surface of fruit fly embryos (Drosophila melanogaster). In the experiments, a tightly focused laser ablates a subcellular hole (1 microm in diameter) that passes clean through the epithelium. The surrounding cells recoil from the wound site with a large range of initial recoil velocities. These depend on the embryo's developmental stage and the subcellular wound site. The initial recoil (up to 0.1 s) is well reproduced by a base finite element model, which assumes a uniform effective viscosity inside the cells, a constant tension along each cell-cell boundary, and a large, potentially anisotropic, far-field stress--one that far exceeds the stress equivalent of the cell-edge tensions. After 0.1 s, the experimental recoils slow dramatically. This observation can be reproduced by adding viscoelastic rods along cell edges or as a fine prestressed mesh parallel to the apical and basal membranes of the cell. The mesh also reproduces a number of double-wounding experiments in which successive holes are drilled in a single cell.
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Triclosan, a very widely used biocide, specifically inhibits fatty acid synthesis by inhibition of enoyl-acyl carrier protein (ACP) reductase. Escherichia coli FabI is the prototypical triclosan-sensitive enoyl-ACP reductase, and ...
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Triclosan, a very widely used biocide, specifically inhibits fatty acid synthesis by inhibition of enoyl-acyl carrier protein (ACP) reductase. Escherichia coli FabI is the prototypical triclosan-sensitive enoyl-ACP reductase, and E. coli is extremely sensitive to the biocide. However, other bacteria are resistant to triclosan, because they encode triclosan-resistant enoyl-ACP reductase isozymes. In contrast, the triclosan resistance of Pseudomonas aeruginosa PAO1 has been attributed to active efflux of the compound (R. Chuanchuen, R. R. Karkhoff-Schweizer, and H. P. Schweizer, Am. J. Infect. Control 31:124-127, 2003). We report that P. aeruginosa contains two enoyl-ACP reductase isozymes, the previously characterized FabI homologue plus a homologue of FabV, a triclosan-resistant enoyl-ACP reductase recently demonstrated in Vibrio cholerae. By deletion of the genes encoding P. aeruginosa FabI and FabV, we demonstrated that FabV confers triclosan resistance on P. aeruginosa. Upon deletion of the fabV gene, the mutant strain became extremely sensitive to triclosan (>2,000-fold more sensitive than the wild-type strain), whereas the mutant strain lacking FabI remained completely resistant to the biocide.
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The objective of this study was to assess the clinical efficacy and safety of concomitant or adjuvant tomozolomide with whole-brain irradiation (WBI) in patients with brain metastases. MEDLINE, EMBASE, Cochrane Library, Chinese Bi...
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The objective of this study was to assess the clinical efficacy and safety of concomitant or adjuvant tomozolomide with whole-brain irradiation (WBI) in patients with brain metastases. MEDLINE, EMBASE, Cochrane Library, Chinese Biomedical Literature Database were searched to identify relevant original published trails, and the references of eligible studies were manually screened. Randomized controlled trails reported in any language, comparing concomitant or adjuvant temozolomide (TMZ) and WBI with WBI alone in patients with brain metastases, were eligible for inclusion. Two investigators independently assessed the quality of included trials and extracted data. The RevMan 5 software was used for statistical analysis. Four trials involving 280 patients were included. The result showed that the group TMZ+WBI was superior to group WBI in partial response, stable disease, progressive disease, and objective response with the pooled risk ratio value and 95% confidence interval, respectively, 1.89 (1.19-3.02), 0.82 (0.45-1.50), 0.29 (0.10-0.78), and 1.72 (1.32-2.24). The incidence of gastrointestinal symptoms and > or =grade 3 myelosuppression presented statistical difference, TMZ+WBI group is higher than WBI group, the pooled risk ratio value and 95% confidence interval were 3.75 (1.04-13.44) and 13 (1.75-96.79), respectively. The currently available evidence showed that the combination of TMZ and WBI may moderately improve the response rate, but accordingly increase the incidence of gastrointestinal symptoms and myelosuppression. Future large-scale, high-quality, placebo-controlled, double-blind trials are needed.
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This study was to explore a potential role of epithelium-derived cytokines in Th17 differentiation. Th17 induction was evaluated by murine CD4(+) T cells treated with different combinations of five inducing cytokines, or condition...
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This study was to explore a potential role of epithelium-derived cytokines in Th17 differentiation. Th17 induction was evaluated by murine CD4(+) T cells treated with different combinations of five inducing cytokines, or conditioned media of human corneal epithelial cells (HCECs) exposed to a variety of stimuli. Th17 differentiation was determined by measuring Th17 associated molecules, IL-17A, IL-17F, IL-22, CCL-20, and STAT3 at mRNA and protein levels, and numbers of IL-17-producing T cells by real-time PCR, and cytokine immunobead and ELISPOT assays, respectively. IL-23 was the strongest inducer for expanding Th17 cells in the presence of TGF-beta1 + IL-6; and IL-1beta was the strongest Th17 amplifier in the presence of TGF-beta1 + IL-6 + IL-23. These inducing cytokines were found to be significantly stimulated in HCECs challenged by hyperosmotic media (450 mOsM), microbial components (polyI:C, flagellin, R837, and other TLR ligands) and TNF-alpha. Interestingly, when incubated with conditioned media of HCECs irritated by polyI:C or TNF-alpha, CD4(+) T cells displayed increased mRNA levels of IL-17A, IL-17F, IL-22, CCL-20, and STAT3, increased IL-17 protein in the supernatant, and increased numbers of IL-17-producing T cells (Th17 cells). These findings demonstrate for the first time that Th17 differentiation can be promoted by cytokines produced by corneal epithelium that are exposed to hyperosmotic, microbial, and inflammatory stimuli.
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OBJECTIVE: The aim of this study was to examine the influence of endogenous cannabinoids on neuroprotection of the spinal cord afforded by limb remote ischemic preconditioning. METHODS: In experiment 1 (RIPC group), 3 cycles of li...
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OBJECTIVE: The aim of this study was to examine the influence of endogenous cannabinoids on neuroprotection of the spinal cord afforded by limb remote ischemic preconditioning. METHODS: In experiment 1 (RIPC group), 3 cycles of limb remote ischemic preconditioning within different episodes (2, 3, or 5 minutes) were induced before spinal cord ischemia in rats (N = 5, n = 8). In experiment 2, animals were pretreated intravenously by the vehicles, cannabinoid 1 (AM251, 1 mg/kg) or cannabinoid 2 (AM630, 1 mg/kg) receptor antagonist 15 minutes before remote ischemic preconditioning, or else they were subjected to a sham operation. Thirty minutes after the pretreatment, spinal cord ischemia was induced (N = 8, n = 8). In experiment 3, the arachidonylethanolamide and 2-arachidonoylglycerol contents in the spinal cord after remote ischemic preconditioning and spinal cord ischemia were detected in rats (N = 2, n = 12). Spinal cord ischemia was induced by 12 minutes of thoracic aorta occlusion in rats. Neurologic function was assessed 24 and 48 hours after reperfusion. Histopathologic examination was performed and the number of normal neurons in anterior spinal cord were counted. RESULTS: In experiment 1, 3 cycles of limb remote ischemic preconditioning (3 minutes of ischemia/3 minutes of reperfusion) induced ischemic tolerance on the spinal cords of the rats. The RIPC group showed a significant reduction in motor deficit index (P < .01) as well as an increase in the number of normal neurons (P < .01). In experiment 2, the cannabinoid 1 receptor antagonist AM251 pretreatment abolished the protective effects of remote preconditioning. In experiment 3, arachidonylethanolamide content in spinal cord was elevated by remote ischemic preconditioning in rats. CONCLUSION: These results indicated that endogenous cannabinoids, through acting on cannabinoid 1 receptors, were involved in the neuroprotective phenomenon on spinal cords of limb remote ischemic preconditioning.
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The hepatoprotective effects of acteoside from O. coerulescens were evaluated in BCG plus LPS-induced immunological liver injury (ILI) in mice. Acteoside (50, 150, or 300 mg/kg) was administered via gavage daily for 12 days. The l...
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The hepatoprotective effects of acteoside from O. coerulescens were evaluated in BCG plus LPS-induced immunological liver injury (ILI) in mice. Acteoside (50, 150, or 300 mg/kg) was administered via gavage daily for 12 days. The liver index (liver weight/body weight), liver homogenate levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), hepatic nitric oxide (NO), malondialdehyde (MDA) content, superoxide dismutase (SOD) activity, production of tumor necrosis factor-gamma (TNF-gamma) and interleukin-2, 4, 10 (IL-2, 4, 10), as well as histopathological changes of the liver were evaluated following the 12-day treatment. Moreover, the modulation influence of acteoside on the expression of B cell lymphoma/leukemia-2 (Bcl-2, hepatocyte apoptosis inhibitor) and Bcl-2 associated X protein (Bax, hepatocyte apoptosis promoter) in the mice liver with immunological hepatic injury was studied also. Acteoside (50, 150, or 300 mg/kg) effectively reduced the BCG/LPS-induced elevated liver index, liver homogenate AST and ALT levels, hepatic NO and MDA contents, restored hepatic SOD activity and reduced the degree of liver injury in ILI mice. The expression of Bax was decreased (vs. BCG + LPS model group), while the expression of Bcl-2 increased (vs. BCG + LPS model group). These results are close to those of DDB (as a reference drug), and suggest that acteoside has a protective and therapeutic effect on ILI mice, which might be associated with its antioxidant properties, immunoregulatory function and regulation of hepatic apoptosis.
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