Management structures of the academic medical center

Academic medical centers perform several important functions of the healthcare system by providing patient care, research, and education. Their responsibility is not only to provide quality care to patients today, but also to train new physicians and researchers to deal with the health problems of tomorrow. At their core, academic medical centers function as both hospitals and universities; often, these are separate entities that each have powers and responsibilities over multiple facilities and medical departments. The university will control research and education, while the hospital or health system controls patient care and operations. However, these two entities are frequently intertwined through affiliation agreements, policies and procedures, and management practices. For example, a Department of Surgery in an academic medical center may function as a department of the medical center for its clinical operations and as a department of the university for its research and training operations. This department is thus responsible to and controlled by two bosses, each with separate goals, values, and methods. Having the practice of medicine and the teaching of medicine so closely aligned can have enormous benefits in terms of the resources that both entities bring to the table, but it can also create problems for management. This essay aims to look at departments of the University of Pittsburgh Medical Center (UPMC) and the University of Pittsburgh School of Medicine to examine operational challenges and benefits to this dual-management approach through an examination of selected projects and tasks that function under the umbrella of the two entities. Statement of Public Health Relevance: While organizational management and structure may not be thought of as core functions of public health, it is nonetheless vital to the performance of the health care system in general. A well-run program or medical center can make life-or-death differences to patients. Likewise, proper financial management and cost-savings measures can decrease costs for each individual patient and increase the pool of resources available to the public at large. Academic Medical Centers (AMCs) are arguably the premier medical institutions in the United States, providing quality care in a not-for-profit setting and also conducting impactful and innovative research that has produced some of the most notable cures and treatments of the modern era. At least some share of these achievements can be credited to effective management. As many AMCs have evolved into full-fledged health care networks with multiple hospitals and even their own health insurance plans, management has become ever more complex. As these institutions have grown, so has the internal and external tension between their distinct academic and clinical operations. As the two sides grow together and apart, proper management becomes essential to link their important functions. On an operational level, this “split” can mean more layers of management and more complex approval processes to get routine tasks done. On a positive note, however, the split can also mean that more resources are generally available as divisions and departments have a larger pool to draw from in terms of funding and administrative support. Management’s capacity to align effectively the complementary missions of the AMC will have considerable effect on the lives and welfare of the general public

Transcriptome of the deep-sea black scabbardfish, Aphanopus carbo (Perciformes: Trichiuridae) : tissue-specific expression patterns and candidate genes associated to depth adaptation

Deep-sea fishes provide a unique opportunity to study the physiology and evolutionary adaptation to extreme environments. We carried out a high throughput sequencing analysis on a 454 GS-FLX titanium plate using unnormalized cDNA libraries from six tissues of A. carbo. Assemblage and annotations were performed by Newbler and InterPro/Pfam analyses, respectively. The assembly of 544,491 high quality reads provided 8,319 contigs, 55.6% of which retrieved blast hits against the NCBI nonredundant database or were annotated with ESTscan. Comparison of functional genes at both the protein sequences and protein stability levels, associated with adaptations to depth, revealed similarities between A. carbo and other bathypelagic fishes. A selection of putative genes was standardized to evaluate the correlation between number of contigs and their normalized expression, as determined by qPCR amplification. The screening of the libraries contributed to the identification of new EST simple-sequence repeats (SSRs) and to the design of primer pairs suitable for population genetic studies as well as for tagging and mapping of genes. The characterization of the deep-sea fish A. carbo first transcriptome is expected to provide abundant resources for genetic, evolutionary, and ecological studies of this species and the basis for further investigation of depth-related adaptation processes in fishes.Publisher PDFPeer reviewe

Infinity war : Trichomonas vaginalis and interactions with host immune response

Trichomonas vaginalis is the pathological agent of human trichomoniasis. The incidence is 156 million cases worldwide. Due to the increasing resistance of isolates to approved drugs and clinical complications that include increased risk in the acquisition and transmission of HIV, cervical and prostate cancer, and adverse out-comes during pregnancy, increasing our understanding of the patho-gen’s interaction with the host immune response is essential. Produc-tion of cytokines and cells of innate immunity: Neutrophils and mac-rophages are the main cells involved in the fight against the parasite, while IL-8, IL-6 and TNF-α are the most produced cytokines in re-sponse to this infection. Clinical complications: T. vaginalis increases the acquisition of HIV, stimulates the invasiveness and growth of prostate cells, and generates an inflammatory environment that may lead to preterm birth. Endosymbiosis: Mycoplasma hominis increased cytotoxicity, growth, and survival rate of the parasite. Purinergic sig-naling: NTPD-ases and ecto-5’-nucleotidase helps in parasite survival by modulating the nucleotides levels in the microenvironment. Anti-bodies: IgG was detected in serum samples of rodents infected with isolates from symptomatic patients as well as patients with symp-toms. However, antibody production does not protect against a rein-fection. Vaccine candidate targets: The transient receptor potential- like channel of T. vaginalis (TvTRPV), cysteine peptidase, and α-actinin are currently cited as candidate targets for vaccine develop-ment. In this context, the understanding of mechanisms involved in the host-T. vaginalis interaction that elicit the immune response may contribute to the development of new targets to combat trichomoni-asis

Sensors integration in additive DMLS metal parts

The fabrication of metal parts by laser-based additive manufacturing (AM) processes is providing many applications in the medical field. The layer-by-layer growth of the component provided by powder micromelting allows, at least in theory, the incorporation of discrete sensors and wires inside the metal material. However, several process-related issues make this operation very challenging. This paper introduces the incorporation of thermal and inertial sensors inside 17-4PH steel specimens fabricated by DMLS (direct metal laser sintering) process (PCT/IB2019/053581, 02/05/2018). In the final configuration, the sensors are totally encased into the continuous metal parts with complete protection against contamination and tampering

No evidence for an intragenomic arms race under paternal genome elimination in <i>Planococcus</i> mealybugs

Genomic conflicts arising during reproduction might play an important role in shaping the striking diversity of reproductive strategies across life. Among these is paternal genome elimination (PGE), a form of haplodiploidy which has independently evolved several times in arthropods. PGE males are diploid but transmit maternally inherited chromosomes only, whereas paternal homologues are excluded from sperm. Mothers thereby effectively monopolize the parentage of sons, at the cost of the father's reproductive success. This creates striking conflict between the sexes that could result in a co-evolutionary arms race between paternal and maternal genomes over gene transmission, yet empirical evidence that such an arms race indeed takes place under PGE is scarce. This study addresses this by testing whether PGE is complete when paternal genotypes are exposed to divergent maternal backgrounds in intraspecific and hybrid crosses of the citrus mealybug, Planococcus citri, and the closely related Planococcus ficus. We determined whether males can transmit genetic information through their sons by tracking inheritance of two traits in a three-generation pedigree: microsatellite markers and sex-specific pheromone preferences. Our results suggest leakages of single paternal chromosomes through males occurring at a low frequency, but we find no evidence for transmission of paternal pheromone preferences from fathers to sons. The absence of differences between hybrid and intraspecific crosses in leakage rate of paternal alleles suggests that a co-evolutionary arms race cannot be demonstrated on this evolutionary timescale, but we conclude that there is scope for intragenomic conflict between parental genomes in mealybugs. Finally, we discuss how these paternal escapes can occur and what these findings may reveal about the evolutionary dynamics of this bizarre genetic system

Microarray gene expression profiling of neural tissues in bovine spastic paresis

Abstract: Background: Bovine Spastic Paresis (BSP) is a neuromuscular disorder which affects both male and female cattle. BSP is characterized by spastic contraction and overextension of the gastrocnemious muscle of one or both limbs and is associated with a scarce increase in body weight. This disease seems to be caused by an autosomal and recessive gene, with incomplete penetration, although no genes clearly involved with its onset have been so far identified. We employed cDNA microarrays to identify metabolic pathways affected by BSP in Romagnola cattle breed. Investigation of those pathways at the genome level can help to understand this disease. Results: Microarray analysis of control and affected individuals resulted in 268 differentially expressed genes. These genes were subjected to KEGG pathway functional clustering analysis, revealing that they are predominantly involved in Cell Communication, Signalling Molecules and Interaction and Signal Transduction, Diseases and Nervous System classes. Significantly enriched KEGG pathway's classes for the differentially expressed genes were calculated; interestingly, all those significantly under-expressed in the affected samples are included in Neurodegenerative Diseases. To identify genome locations possibly harbouring gene(s) involved in the disease, the chromosome distribution of the differentially expressed genes was also investigated. Conclusions: The cDNA microarray we used in this study contains a brain library and, even if carrying an incomplete transcriptome representation, it has proven to be a valuable tool allowing us to add useful and new information to a poorly studied disease. By using this tool, we examined nearly 15000 transcripts and analysed gene pathways affected by the disease. Particularly, our data suggest also a defective glycinergic synaptic transmission in the development of the disease and an alteration of calcium signalling proteins. We provide data to acquire knowledge of a genetic disease for which literature still presents poor results and that could be further and specifically analysed in the next future. Moreover this study, performed in livestock, may also harbour molecular information useful for understanding human diseases

ELECTION TIMING IN CONSENSUAL SYSTEMS. LINKING COALITION BARGAINING AND VALENCE THEORY OF PARTY COMPETITION

The purpose of this thesis is to investigate the determinants of cabinet termination in parliamentary systems. A preliminary study will raise a fundamental question: do voters punish incumbents for calling anticipated elections? The scarce evidence available reached contradictory conclusions. For the first time in the literature I will link cabinet termination with valence theories of party competition, and I will individuate the determinants of this popularity cost. My valece theory will provide a solution to the existing debate, showing that all the findings provided up to now represent specific cases of a more general phenomenon. The core of my thesis is represented by a coalition bargaining model. In each stage of the game, incumbents observe their electoral expectations and choose between negotiating on public policies, forming a new cabinet with the opposition, and calling elections. My game will show a series of improvements: first, it will introduce time and account for its effects on the outcome of the negotiation; second, it will introduce spatial considerations, such as the ideological location of the players and their coalition opportunities; third, it will encompass a theoretical account of the popularity cost of opportunistic election calling. Its fundamental assumptions will then be tested. Its asumptions will be tested using voting intention trends from four European democracies, covering more than fifty years of parliamentary politics. Results will show that variations in the exit option for the governing parties efficiently explain the likelihood of cabinet termination. On consensual democracies, this kind of test had never been conducted before. A corollary research concludes the dissertation: if voting intention data can be used to explain cabinet termination, then the same data can be used to account for ministerial tenure. The dismissal of ministers, or alterations in their prerogatives, can be described as a currency in the power game among coalition partners. Such an hypothesis had never been tested before. Using duration analysis I will show how imbalances in incumbent parties' popularity are associated with more frequent redistributions of power withing the goverment coalition. Even in this case, my empirical models will include time-varying covariates, producing an empirical contribution to the literature