Physician-owned specialized facilities: focused factories or destructive competition?: a systematic review.

Multiple studies have investigated the business case of physician-owned specialized facilities (specialized hospitals and ambulatory surgery centers). However literature lacks integration. Building on the theoretical insights of disruptive innovation, a systematic review was conducted to assess the evidence base of these innovative delivery models. The Institute of Medicine’s quality framework (safe, effective, equitable, efficient, patient-centered and accessible care) was applied in order to evaluate the performance of such facilities. In addition the corresponding impact on full-service general hospitals was assessed. Database searches yielded 6,108 candidate articles of which 47 studies fulfilled the inclusion criteria. Overall the quality of the included studies was satisfactory. Our results show that little evidence exists in support of competitive advantages in favor of specialized facilities. Moreover even if competitive advantages exist, it is equally important to reflect on the corresponding impact on full service-general hospitals. The development of specialized facilities should therefore be monitored carefully

Determination of hawser forces using numerical and physical models for the third set of Panama locks studies

C

Interferon alpha suppresses alphaherpesvirus immediate early protein levels in sensory neurons, leading to the establishment of a latent infection

Alphaherpesviruses are a subfamily of the herpesviruses containing closely related human and animal pathogens, including human herpes simplex virus (HSV-1) and porcine pseudorabies virus (PRV)

Porcine NK cells stimulate proliferation of pseudorabies virus-experienced CD8+ and CD4+ CD8+ T cells

Natural killer (NK) cells belong to the innate immune system and play a central role in the defense against viral infections and cancer development, but also contribute to shaping adaptive immune responses. NK cells are particularly important in the first line defense against herpesviruses, including alphaherpesviruses. In addition to their ability to kill target cells and produce interferon-g, porcine and human NK cell subsets have been reported to display features associated with professional antigen presenting cells (APC), although it is currently unclear whether NK cells may internalize debris of virus-infected cells and whether this APC-like activity of NK cells may stimulate proliferation of antiviral T cells. Here, using the porcine alphaherpesvirus pseudorabies virus (PRV), we show that vaccination of pigs with a live attenuated PRV vaccine strain triggers expression of MHC class II on porcine NK cells, that porcine NK cells can internalize debris from PRV-infected target cells, and that NK cells can stimulate proliferation of CD8(+) and CD4(+) CD8(+) PRV-experienced T cells. These results highlight the potential of targeting these NK cell features in future vaccination strategies

Physical model for the emptying and filling system of the third set of Panama locks

The Panama Canal Authority (ACP) extension plan includes the construction of a third lane with new locks at both sides of the Canal. The design ship is a so-called Post- Panamax 12 000 TEU container carrier. In order to maximize the transit throughput of the new locks, and at the same time, to limit hawser forces under an acceptable maximum threshold, many numerical studies and two physical model studies have been carried out. In a first phase, the filling and emptying (F/E) system of the locks has been preoptimized with numerical models (1D, 2D and 3D models). Then, to complete the design, a study have been carried out on a 1/30 physical scale model at Compagnie Nationale du Rhône Hydraulic Laboratory, Lyon, France, operating as member of the consortium CPP. The F/E system is a “double culverts” sidewall and ports system composed of: a main culvert connected by a central flow divider to two secondary culverts in middle section of the lock chamber; each secondary culvert is equipped with 10 ports which feed the lock on 80% of its length. In order to limit water consumption, each lock includes 3 Water Saving Basins (WSB). The scale model represents two locks chambers, 3 WSB associated with the lower chamber, a fore and a tail bay. The Post-Panamax container ship vessel is also modelled. A special emphasis is put on the hawser forces measurements and in the definition of a threshold value for them as no standard values presently exists for Post-Panamax locks given such operating conditions (use of water saving basins or not, hydraulic heads ranging from 3.5 m to 20 m). The experimental setup and the scenarios of tests are described and an overview of the main results (F/E times, times series of water levels with and without ship in the lock chamber, time series of hydraulic efforts on the ship hull) are given. The results of this physical model are an input for the design-build tender for the construction of the third set of locks, presently in progress