Differing Strategies to Meet Information‐Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

POLICY POINTS: Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. CONTEXT: The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. METHODS: We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. FINDINGS: Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. CONCLUSIONS: Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation

Quality control in Orange-spotted grouper, Epinephelus coioldes, during ice storage

In this study, changes of TMA and its relation with bacteria count was evaluated in Orange-spotted grouper, Epinephelus coioides during ice storage at 18th day. TMA and bacteria count changes were evaluated at days 0, 3, 6, 9, 12, 15, and 18. TMA increased at days 0, 3 and 6 but changes during these days were not noticeable and it showed no significant differences (P>0.05). By passing time and from day 9 amount of TMA showed increased compared with other days and had significant difference in the value (P<0.05) such I that reached from 0.96 (day 0) to 12.46ms/100g (day 18). The psychrophilic bacteria showed a more monotonous change relative to the mesophilic bacteria and became dominant in ice through time. Logarithm of colonies of the psychrophilic bacteria per gram increased from 1.37 at day 0 to 7.72 at day I 8th. The mesophilic bacteria showed fluctuations in their number such that at day 15th they decreased and at day 18th, increased. The level of TMA showed significant difference between the first days and last days (P<0.05) such that they increased from 2 at day 0 to 4.61 at day 18th. Bacterial count especially *psychrophilic bacteria were increased during storage, whereas mesophilic bacteria decreased at day 15 of storage. TMA showed relationship with psychrophilic bacteria and storage days (P<0.05, R=0.98)

Accumulation of heavy metals in the muscle, liver and gill tissues of Epinephelus coioiedes

We studied concentration of heavy metals Cd, Pb, Cu, Ni in the muscle, liver and gill tissues of Epinephelus coinoiedes caught in autumn 2006 from Hendijan Coastal waters in the Persian Gulf. After biometrical measurements, the muscle, liver and gill tissues of 30 randomly selected fish were separated; metals were extracted from the tissues using chemical digestion method with pure nitric acid and their concentrations were determined by AAS. Mean concentrations (ppm/dry weight) were compared with the international standards such as WHO, UKMAFF and NHMRC. The mean concentration for Cd and Pb in all tissues with the exception of muscle tissue, were found higher than permissible limit. We found a positive linear relationship between accumulation of Ni, Pb and Cu in muscle tissue with total weight and total length factors (P<0.05)

Effects of environmental, living space and climate variability on the utilization of impregnated bed nets in west Cameroon: A community based survey for policy implementation

Background: Despite the fact that Long Lasting Impregnated Mosquito Net (LLIN) represents one of the most effective tools in fighting malaria, its use remains limited. Our study aimed at determining how environmental, household characteristics and climate affect bed net use. Methodology: A cross sectional descriptive and analytic study was carried out from January to April 2014 in Mifi health district. Data collected were collected in households during a face to face interview with standard household questionnaires, entered and analyzed using Epi Info software version 3.5.3. Graphics and tables were obtained using MS Excel and Word. Results: Of the 317 participants interviewed, average age was 33.23 years (SD = 10.80) and female sex predominant (85.2%). Most participants had attended secondary education 53.6% (n= 170), married marital status was most represented (58.1%; n= 185).75.4% (n=239) of households had at least 1 LLIN and average district coverage estimated to 1 LLIN for 3.3 persons. 78% of occupants in households with at least one LLIN had slept under the night before the survey. The presence of a ceiling in a house reduced net usage by 2.5% (p = 0.67) compared to house lacking ceiling. Standing waters around the compound increased net utilization rate to 16.6% (p = 0.03), whereas the presence of a covered well decreased the rate by 1.4% (p = 0.86). The dry season was identified as the period during which 86.8% (n= 239) of respondents sleep less under a net. Heat (57.60% n = 138/239), increased choking (2.5%), reduction in vector breeding sites (39.90%; n = 95) were cited as main reasons. Conclusion: Although classified as zone of continuous transmission, our findings indicate that bed net usage by our study population depends on environmental, household characteristics and climate. There is therefore an urgent need to develop strategic communication and sensitization campaigns coupled to environmental management to help scale up and optimize malaria burden reductio

DABCO as a novel and efficient catalyst for the synthesis of 4(3H)-quinazolinone derivatives

4(3H)-Quinazolinones were synthesized in high to excellent yields through the one-pot condensation of anthranilic acid, trimethyl orthoformate and primary amines in the presence of DABCO under solvent free conditions.KEY WORDS: 4(3H)-Quinazolinone, DABCO (1,4-diazabicyclo[2,2,2]octane), Trimethyl orthoformate, Anthranilic acid Bull. Chem. Soc. Ethiop. 2011, 25(2), 305-308

Student Perception Towards Personal Branding of Political Leaders on Twitter Ahead of Presidential Election 2014

Recent technology developments bring improvement for communication studies. Computer mediated communication (CMC) theory ispotential to rapid messages send using computer with internet connection. Twitter is one of well-known social media, which is used by large number of societies, including our president candidates, e.g. Prabowo Subianto and Aburizal Bakrie. Majority twitter users are teenagers, because teenagers are active society and they use twitter to let themselves know about their upcoming president. Active society had explained in uses and gratification theory. This study aims to identify college student's perception about politician's personal branding on twitter lately before the election on 2014. This research is a descriptive research which used qualitative approach, and equipped with content analysis. This research usednon probability sampling to select the main informants, and also snowball sampling method. Results show that college student's perceptionstowards Prabowo Subianto's twitter were better than their perceptions to Aburizal Bakrie's although Aburizal twitter's management is much betterand friendly. Active and positive responses from college students didn't influenced by politician's personal branding. There are eight concepts in personal branding, known as the eight of law of personal branding. From the eight concepts, Prabowo Subianto known as a well behavior person with high nationalism while Aburizal Bakrie had very well law of visibility in twitter's management

A Safe and Efficient Method to Retrieve Mesenchymal Stem Cells from Three-Dimensional Fibrin Gels

Mesenchymal stem cells (MSCs) display multipotent characteristics that make them ideal for potential therapeutic applications. MSCs are typically cultured as monolayers on tissue culture plastic, but there is increasing evidence suggesting that they may lose their multipotency over time in vitro and eventually cease to retain any resemblance to in vivo resident MSCs. Three-dimensional (3D) culture systems that more closely recapitulate the physiological environment of MSCs and other cell types are increasingly explored for their capacity to support and maintain the cell phenotypes. In much of our own work, we have utilized fibrin, a natural protein-based material that serves as the provisional extracellular matrix during wound healing. Fibrin has proven to be useful in numerous tissue engineering applications and has been used clinically as a hemostatic material. Its rapid self-assembly driven by thrombin-mediated alteration of fibrinogen makes fibrin an attractive 3D substrate, in which cells can adhere, spread, proliferate, and undergo complex morphogenetic programs. However, there is a significant need for simple cost-effective methods to safely retrieve cells encapsulated within fibrin hydrogels to perform additional analyses or use the cells for therapy. Here, we present a safe and efficient protocol for the isolation of MSCs from 3D fibrin gels. The key ingredient of our successful extraction method is nattokinase, a serine protease of the subtilisin family that has a strong fibrinolytic activity. Our data show that MSCs recovered from 3D fibrin gels using nattokinase are not only viable but also retain their proliferative and multilineage potentials. Demonstrated for MSCs, this method can be readily adapted to retrieve any other cell type from 3D fibrin gel constructs for various applications, including expansion, bioassays, and in vivo implantation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140244/1/ten.tec.2013.0051.pd

HISTO-ANATOMICAL AND PRELIMINARY CHROMATOGRAPHIC ANALYSIS ON POLYGALA VULGARIS L. (POLYGALACEAE) SPECIES

The paper highlights the histo-anatomical investigation of root, rhizome, aboveground stem and leaf of Polygala vulgaris L. (Polygalaceae) species, harvested in August 2016, from southern Romania, as well as the preliminary thin-layer chromatographic analysis of the polyphenols content of the aerial parts (Polygalae vulgaris herba). Rutin was identified and quantified starting from the 11 TLC fingerprint bands

The Association Between State-Level Health Information Exchange Laws and Hospital Participation in Community Health Information Organizations

Evidence suggests that health information exchange (HIE) is an effective strategy to improve efficiency and quality of care, as well as reduce costs. A complex patchwork of federal and state legislation has developed over time to encourage HIE activity. Hospitals and health systems have adopted various HIE models to meet the requirements of these statutes and regulations. Given the complexity of HIE laws, it is important to understand how these legal levers influence HIE engagement. We combined data from two unique data sources to examine the association between state-level HIE laws and hospital engagement in community HIEs. Our results identified three legal provisions of state laws (HIE authorization, financial & non-financial incentives, opt-out consent) that increased the likelihood of community HIE engagement. Other provisions decreased the likelihood of engagement. This analysis provides foundational evidence about the utility of HIE laws. More research is needed to determine causal relationships

Stem Cells Derived from Tooth Periodontal Ligament Enhance Functional Angiogenesis by Endothelial Cells

In regenerative medicine approaches involving cell therapy, selection of the appropriate cell type is important in that the cells must directly (differentiation) or indirectly (trophic effects) participate in the regenerative response. Regardless of the mode of action of the cells, angiogenesis underlies the success of these approaches. Stem cells derived from tooth tissues, specifically the periodontal ligament of teeth (periodontal ligament stem cells [PDLSCs]), have recently been identified as a good source of multipotent cells for cell therapies. PDLSCs have demonstrated properties similar to mesenchymal stem cells (MSCs), yet, unlike MSCs, their vascular potential has not been previously demonstrated. Thus, the aim of this study was to determine if PDLSCs could modulate angiogenesis. In comparison to MSCs and stem cells derived from tooth pulp tissues (SHEDs), we first determined if PDLSCs released soluble proangiogenic factors with the capacity to induce vessel formation by endothelial cells (ECs). Next, the ability of PDLSCs to modulate angiogenesis was examined through their cotransplantation with ECs in subcutaneous sites of immunocompromised mice. Finally, the stability of the PDLSC-mediated vasculature was determined through evaluation of the maturity and functionality of the vessels formed following PDLSC transplantation. It was determined that PDLSCs produced appreciable levels of vascular endothelial growth factor and basic fibroblast growth factor-2, and additionally, were able to initiate in vitro angiogenesis of ECs comparable to MSC- and SHED-mediated angiogenesis. In vivo cotransplantation of ECs with PDLSCs significantly (>50% increase) enhanced the number of blood vessels formed relative to transplantation of ECs alone. Finally, vessels formed following PDLSC cotransplantation were more mature and less permeable than those formed after transplantation of EC alone. These data demonstrate for the first time that PDLSCs have vascular potential, which could make them a very attractive cell population for utilization in regenerative cell therapies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140229/1/ten.tea.2013.0512.pd