Illinois Government Research no. 55 1982: Regulating Hospital Facilities Construction: The Illinois Experience 1975-1979

In the present political climate, reform or elimination of the certificate of need program is a distinct possibility. At the national level, the deregulatory movement has led to attacks on the program by officials in the Reagan administration, who claim it is ineffective in containing capital spending and impedes competition in the industry. In the 1980-81 session of the Illinois General Assembly, legislation was introduced that would have abolished the program. Although unsuccessful, the proposed bill reflects the controversy surrounding the program within the state. As the debate continues, at both the national and state level, it is a good time to examine the experience of the Illinois program. This article does that by analyzing the decisions made by the certificate of need program on hospital proposals from 1975 through 1979 and by examining some evidence of the program's impact. In the first section, we present an overall summary of the program's approval rate in terms of the number and percent of projects approved, withdrawn, denied, and modified; in the next section, we describe the types of projects which the program favors; and in the final section, we discuss some evidence of the program's impact on hospital bed supplies. The complex process by which CON decisions are reached in the state is not addressed in this paper so that we may focus on the results of the process and its possible impacts.published or submitted for publicatio

A new invertebrate member of the p53 gene family is developmentally expressed and responds to polychlorinated biphenyls.

The cell-cycle checkpoint protein p53 both directs terminal differentiation and protects embryos from DNA damage. To study invertebrate p53 during early development, we identified three differentially expressed p53 family members (p53, p97, p120) in the surf clam, Spisula solidissima. In these mollusks, p53 and p97 occur in both embryonic and adult tissue, whereas p120 is exclusively embryonic. We sequenced, cloned, and characterized p120 cDNA. The predicted protein, p120, resembles p53 across all evolutionarily conserved regions and contains a C-terminal extension with a sterile alpha motif (SAM) as in p63 and p73. These vertebrate forms of p53 are required for normal inflammatory, epithelial, and neuronal development. Unlike clam p53 and p97, p120 mRNA and protein levels are temporally expressed in embryos, with mRNA levels decreasing with increasing p120 protein (R(2) = 0.97). Highest surf clam p120 mRNA levels coincide with the onset of neuronal growth. In earlier work we have shown that neuronal development is altered by exposure to polychlorinated biphenyls (PCBs), a neurotoxic environmental contaminant. In this study we show that PCBs differentially affect expression of the three surf clam p53 family members. p120 mRNA and protein are reduced the most and earliest in development, p97 protein shows a smaller and later reduction, and p53 protein levels do not change. For the first time we report that unlike p53 and p97, p120 is specifically embryonic and expressed in a time-dependent manner. Furthermore, p120 responds to PCBs by 48 hr when PCB-induced suppression of the serotonergic nervous system occurs

RNA-seq Analysis Reveals That an ECF σ Factor, AcsS, Regulates Achromobactin Biosynthesis in Pseudomonas syringae pv. syringae B728a

Iron is an essential micronutrient for Pseudomonas syringae pv. syringae strain B728a and many other microorganisms; therefore, B728a has evolved methods of iron acquirement including the use of iron-chelating siderophores. In this study an extracytoplasmic function (ECF) sigma factor, AcsS, encoded within the achromobactin gene cluster is shown to be a major regulator of genes involved in the biosynthesis and secretion of this siderophore. However, production of achromobactin was not completely abrogated in the deletion mutant, implying that other regulators may be involved such as PvdS, the sigma factor that regulates pyoverdine biosynthesis. RNA-seq analysis identified 287 genes that are differentially expressed between the AcsS deletion mutant and the wild type strain. These genes are involved in iron response, secretion, extracellular polysaccharide production, and cell motility. Thus, the transcriptome analysis supports a role for AcsS in the regulation of achromobactin production and the potential activity of both AcsS and achromobactin in the plant-associated lifestyle of strain B728a

Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach

IntroductionEpilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient’s epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient’s needs, and increase the patient’s self-efficacy to achieve those goals.MethodsThe purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M

Expanding the scope of health reform: application in the United States

Since the demise of the Clinton national health plan in the early 1990s, a number of states in the US have continued to pursue health reform. The reforms reflect the on-going debate in the US and throughout the world over market-minimizing versus market-maximizing strategies to improve healthcare systems. This paper describes the limits of this debate and supports a broader view that focuses on how health policy can improve population health. Performance measures and indicators traditionally used to evaluate market minimizing/maximizing strategies for reforming healthcare are redefined for evaluating strategies to improve health. Differences in the two views are illustrated by describing state reforms in the US using the market-minimizing/maximizing framework and evaluating the reforms based on the health-related framework.Health systems and services research Public policy USA

The Lifetime Cost of Bipolar Disorder in the US: An Estimate for New Cases in 1998

Objective: To develop a cost model that estimates the total and per case lifetime cost of bipolar disorder for 1998 incident cases in the US. Study design: Lifetime cost simulation model. Perspective: Societal. Methods: Age- and gender-specific incidence of bipolar disorder in 1998 was estimated by simulation based on existing prevalence data. The course of illness and mental health service cost of 6 clinically defined prognostic groups was estimated based on the research literature and the judgement of panels of experts. Excess cost of general medical care was estimated based on claims data from a large insurer. Indirect cost was projected including excess unemployment and reduced earnings reported in the National Comorbidity Survey. Comorbidity treatment and indirect cost related to alcohol (ethanol) and drug abuse was added based on a National Institute on Drug Abuse study. Results: The present value of the lifetime cost of persons with onset of bipolar disorder in 1998 was estimated at 24 billion US dollars ($US). Average cost per case ranged from$US11 720 for persons with a single manic episode to $US624 785 for persons with nonresponsive/chronic episodes. Conclusion: The model indicates the potential cost savings of preventing a case of bipolar disorder and underscores the importance of achieving a stable outcome in new cases to limit the economic consequences of the disorder.Bipolar disorders, Cost of illness, Pharmacoeconomics