Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

<p>Abstract</p> <p>Background</p> <p>Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system.</p> <p>Methods</p> <p>Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models.</p> <p>Results</p> <p>More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration.</p> <p>Conclusions</p> <p>More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.</p

Systems Biology of the qa Gene Cluster in Neurospora crassa

An ensemble of genetic networks that describe how the model fungal system, Neurospora crassa, utilizes quinic acid (QA) as a sole carbon source has been identified previously. A genetic network for QA metabolism involves the genes, qa-1F and qa-1S, that encode a transcriptional activator and repressor, respectively and structural genes, qa-2, qa-3, qa-4, qa-x, and qa-y. By a series of 4 separate and independent, model-guided, microarray experiments a total of 50 genes are identified as QA-responsive and hypothesized to be under QA-1F control and/or the control of a second QA-responsive transcription factor (NCU03643) both in the fungal binuclear Zn(II)2Cys6 cluster family. QA-1F regulation is not sufficient to explain the quantitative variation in expression profiles of the 50 QA-responsive genes. QA-responsive genes include genes with products in 8 mutually connected metabolic pathways with 7 of them one step removed from the tricarboxylic (TCA) Cycle and with 7 of them one step removed from glycolysis: (1) starch and sucrose metabolism; (2) glycolysis/glucanogenesis; (3) TCA Cycle; (4) butanoate metabolism; (5) pyruvate metabolism; (6) aromatic amino acid and QA metabolism; (7) valine, leucine, and isoleucine degradation; and (8) transport of sugars and amino acids. Gene products both in aromatic amino acid and QA metabolism and transport show an immediate response to shift to QA, while genes with products in the remaining 7 metabolic modules generally show a delayed response to shift to QA. The additional QA-responsive cutinase transcription factor-1β (NCU03643) is found to have a delayed response to shift to QA. The series of microarray experiments are used to expand the previously identified genetic network describing the qa gene cluster to include all 50 QA-responsive genes including the second transcription factor (NCU03643). These studies illustrate new methodologies from systems biology to guide model-driven discoveries about a core metabolic network involving carbon and amino acid metabolism in N. crassa

Intersectionality and Sport: Representing Shoni Schimmel, “Rez ball” and the Native American Imaginary

There is a growing body of scholarship that establishes the necessity of using intersectionality as an important framework for understanding sport and sporting representations. This paper builds upon that scholarship to discuss popular representations of professional basketball player Shoni Schimmel. A member of the WNBA’s Atlanta Dream Schimmel is known for her creative style of play. Raised on the Confederate Tribes of the Umatilla Reservation in Mission, Oregon, “Showtime” Schimmel has proven to be quite a draw with numerous Native Americans traveling long distances to watch her play. Merely describing her popularity, however, fails to address why Schimmel means so much to so many Native Americans. This topic is additionally important to investigate given the gendered spaces of sports, where hegemonic masculinity is frequently uncritically celebrated. In this paper, I draw upon theories of intersectionality to link the assent of “Schimmel phonenoma” to longstanding narratives about the playful, expressive and creative potential of “Rez ball” both in American Indian basketball spaces and literature. These narratives complicate the normative gendered and racialized politics of sports, offering points of resistance to dominant commodified sporting ideals

Women in Sports

Please click the links below to view more information about each presentation. “Ain’t I An Athlete: Black Feminist Fitness in the Age of (Michelle) Obama” Courtney Marshall, University of New Hampshire “Push Back, Move Forward: A Feminist Theory of the Master\u27s Golf” Laura R. Woliver, University of South Carolina - Columbia “Intersectionality and Sport: Representing Shoni Schimmel, “Rez ball” and the Native American Imaginary” Mary G. McDonald, Georgia Institute of Technology - Main Campus “Good Will and Gracie (2007): A Critique of 21st Century Feminist Sports Cinema” Stacy L. Tanner, University of Central Florid