Market and Organizational Factors Associated with Teaching Hospital Participation in Strategic Hospital Alliances

This research investigated market and organizational factors that influence the strategic decisions of teaching hospitals to participate in strategic hospital alliances (SHAs). It described the characteristics of both teaching hospitals and the health care environment in which they operate. This research also examines the association of these factors with the strategic position of teaching hospitals in terms of their dominance in the market or within their organizations. The theoretical model used two concepts from institutional theory--coercive and normative pressures. It was argued that coercive pressures in the market facilitated the decision to participate in SHAs and gain market and Organizational dominant positions. Alternatively, normative organizational pressures were argued to hinder the process of participating in SRAs and gaining market and organizational dominance. An important finding of this research was that high levels of SRA penetration had a negative influence on all three dependent variables , SRA participation, market dominance, and organizational dominance. This finding suggests that as market consolidation advances, teaching hospitals may find it difficult to participate in SRAs or gain positions of dominance. In addition to the SRA penetration measure there were a number of other relationships of interest. SRA participation was related to the percent of large employers in the market and the teaching hospital\u27s net revenue . Market dominance was related to the percent of large group practices and the percent of primary care physicians in the market as well as the profit status of the teaching hospital. Organizational dominance was related to the profit status and the administrative structure of the teaching hospital

Interpolation of Hilbert and Sobolev Spaces: Quantitative Estimates and Counterexamples

This paper provides an overview of interpolation of Banach and Hilbert spaces, with a focus on establishing when equivalence of norms is in fact equality of norms in the key results of the theory. (In brief, our conclusion for the Hilbert space case is that, with the right normalisations, all the key results hold with equality of norms.) In the final section we apply the Hilbert space results to the Sobolev spaces $H^s(\Omega)$ and $\widetilde{H}^s(\Omega)$, for $s\in \mathbb{R}$ and an open $\Omega\subset \mathbb{R}^n$. We exhibit examples in one and two dimensions of sets $\Omega$ for which these scales of Sobolev spaces are not interpolation scales. In the cases when they are interpolation scales (in particular, if $\Omega$ is Lipschitz) we exhibit examples that show that, in general, the interpolation norm does not coincide with the intrinsic Sobolev norm and, in fact, the ratio of these two norms can be arbitrarily large

Concentrating Membrane Proteins Using Asymmetric Traps and AC Electric Fields

Membrane proteins are key components of the plasma membrane and are responsible for control of chemical ionic gradients, metabolite and nutrient transfer, and signal transduction between the interior of cells and the external environment. Of the genes in the human genome, 30% code for membrane proteins (Krogh et al. J. Mol. Biol.2001, 305, 567). Furthermore, many FDA-approved drugs target such proteins (Overington et al. Nat. Rev. Drug Discovery2006, 5, 993). However, the structure-function relationships of these are notably sparse because of difficulties in their purification and handling outside of their membranous environment. Methods that permit the manipulation of membrane components while they are still in the membrane would find widespread application in separation, purification, and eventual structure-function determination of these species (Poo et al. Nature1977, 265, 602). Here we show that asymmetrically patterned supported lipid bilayers in combination with AC electric fields can lead to efficient manipulation of charged components. We demonstrate the concentration and trapping of such components through the use of a “nested trap” and show that this method is capable of yielding an approximately 30-fold increase in the average protein concentration. Upon removal of the field, the material remains trapped for several hours as a result of topographically restricted diffusion. Our results indicate that this method can be used for concentrating and trapping charged membrane components while they are still within their membranous environment. We anticipate that our approach could find widespread application in the manipulation and study of membrane proteins

Independent control of polar and azimuthal anchoring

Monte Carlo simulation, experiment and continuum theory are used to examine the anchoring exhibited by a nematic liquid crystal at a patterned substrate comprising a periodic array of rectangles that, respectively, promote vertical and planar alignment. It is shown that the easy axis and effective anchoring energy promoted by such surfaces can be readily controlled by adjusting the design of the pattern. The calculations reveal rich behavior: for strong anchoring, as exhibited by the simulated system, for rectangle ratios $\geq 2$ the nematic aligns in the direction of the long edge of the rectangles, the azimuthal anchoring coefficient changing with pattern shape. In weak anchoring scenarios, however, including our experimental systems, preferential anchoring is degenerate between the two rectangle diagonals. Bistability between diagonally-aligned and edge-aligned arrangement is predicted for intermediate combinations of anchoring coefficient and system length-scale.Comment: 12 pages, 12 figure

Some Comments on Multigrid Methods for Computing Propagators

I make three conceptual points regarding multigrid methods for computing propagators in lattice gauge theory: 1) The class of operators handled by the algorithm must be stable under coarsening. 2) Problems related by symmetry should have solution methods related by symmetry. 3) It is crucial to distinguish the vector space $V$ from its dual space $V^*$. All the existing algorithms violate one or more of these principles.Comment: 16 pages, LaTeX plus subeqnarray.sty (included at end), NYU-TH-93/07/0

Nematic liquid crystal alignment on chemical patterns

Patterned Self-Assembled Monolayers (SAMs) promoting both homeotropic and planar degenerate alignment of 6CB and 9CB in their nematic phase, were created using microcontact printing of functionalised organothiols on gold films. The effects of a range of different pattern geometries and sizes were investigated, including stripes, circles and checkerboards. EvanescentWave Ellipsometry was used to study the orientation of the liquid crystal (LC) on these patterned surfaces during the isotropic-nematic phase transition. Pretransitional growth of a homeotropic layer was observed on 1 ¹m homeotropic aligning stripes, followed by a homeotropic mono-domain state prior to the bulk phase transition. Accompanying Monte-Carlo simulations of LCs aligned on nano-patterned surfaces were also performed. These simulations also showed the presence of the homeotropic mono-domain state prior to the transition.</p

A scoping review exploring reablement models of training and client assessment for older people in primary health care

Aim:The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice.Background:The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse.Methods:The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors.Results:A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation.Conclusion:This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of ‘ageing in place’ policy

The Icf Syndrome Protein CDCA7 Harbors a Unique DNA Binding Domain That Recognizes a CpG Dyad in the Context of a Non-B DNA

CDCA7, encoding a protein with a carboxyl-terminal cysteine-rich domain (CRD), is mutated in immunodeficiency, centromeric instability, and facial anomalies (ICF) syndrome, a disease related to hypomethylation of juxtacentromeric satellite DNA. How CDCA7 directs DNA methylation to juxtacentromeric regions is unknown. Here, we show that the CDCA7 CRD adopts a unique zinc-binding structure that recognizes a CpG dyad in a non-B DNA formed by two sequence motifs. CDCA7, but not ICF mutants, preferentially binds the non-B DNA with strand-specific CpG hemi-methylation. The unmethylated sequence motif is highly enriched at centromeres of human chromosomes, whereas the methylated motif is distributed throughout the genome. At S phase, CDCA7, but not ICF mutants, is concentrated in constitutive heterochromatin foci, and the formation of such foci can be inhibited by exogenous hemi-methylated non-B DNA bound by the CRD. Binding of the non-B DNA formed in juxtacentromeric regions during DNA replication provides a mechanism by which CDCA7 controls the specificity of DNA methylation

Effect of cadence on locomotor–respiratory coupling during upper-body exercise

Introduction: Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor–respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise. Methods: Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min−1) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter. Results: The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min−1 (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min−1 (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p < 0.05) at higher cadences. During moderate exercise, (Formula presented.) and fC were higher at 90 rev min−1 (p < 0.05) relative to 70 and 50 rev min−1 ((Formula presented.) 1.19 ± 0.25 vs. 1.05 ± 0.21 vs. 0.97 ± 0.24 L min−1; fC 116 ± 11 vs. 101 ± 13 vs. 101 ± 12 b min−1), with concomitantly elevated dyspnoea. There were no discernible cadence-mediated effects on diaphragm EMG. Conclusion: Participants engage in LRC to a greater extent at moderate-high cadences which, in turn, increase respiratory airflow. Cadence rate should be carefully considered when designing aerobic training programmes involving the upper-limbs