Ownership Difference and Hospital Performance: a Theoretical Perspective

This study looks at the relationship between hospital ownership and hospital performance. Efforts are made to focus on the financial rather than legal attributes of ownership by utilizing and an agency model of firm behaviour. Agency theory is a better of firm performance in hospitals than the property rights paradigm which is often applied. This is especially true where questions of ownership are often mistaken for questions of control. Importantly, the study fail to supports a property rights view of hospital ownership and performance, suggesting instead the importance of influences such as access to capital markets and the agents controlling the firm. These are key ingredients to which hospitals need to respond in today\u27s competitive environment

Fabrication of β-Silicon Carbide Nanowires from Carbon Powder and Silicon Wafer

β-SiCNWs were synthesized by simple carbo-thermal process using silicon wafer and carbon powder only. The obtained β-SiCNWs were short and thick with random distribution over Si wafer surface when rapid heating rate is applied. While β-SiCNWs fabricated under low heating rate are 57.0±3.0 nm in average diameter and few millimeters in length. An ambient Ar gas flow rates were found to be critical in the growth yield of resultant β-SiC nanowires. XRD diffraction patterns and FTIR spectrum reveals the composition structure of theses wires

Meckel's Diverticulum with Small Bowel Obstruction Presenting as Appendicitis in a Pediatric Patient

The authors suggest that the small bowel be assessed in all appendectomy cases for a pathological Meckel's diverticulum

Local structure of In_(0.5)Ga_(0.5)As from joint high-resolution and differential pair distribution function analysis

High resolution total and indium differential atomic pair distribution functions (PDFs) for In_(0.5)Ga_(0.5)As alloys have been obtained by high energy and anomalous x-ray diffraction experiments, respectively. The first peak in the total PDF is resolved as a doublet due to the presence of two distinct bond lengths, In-As and Ga-As. The In differential PDF, which involves only atomic pairs containing In, yields chemical specific information and helps ease the structure data interpretation. Both PDFs have been fit with structure models and the way in that the underlying cubic zinc-blende lattice of In_(0.5)Ga_(0.5)As semiconductor alloy distorts locally to accommodate the distinct In-As and Ga-As bond lengths present has been quantified.Comment: 9 pages, 7 figur

A blockchain-based authentication protocol for cooperative vehicular ad hoc network

The efficiency of cooperative communication protocols to increase the reliability and range of transmission for Vehicular Ad hoc Network (VANET) is proven, but identity verification and communication security are required to be ensured. Though it is difficult to maintain strong network connections between vehicles because of there high mobility, with the help of cooperative communication, it is possible to increase the communication efficiency, minimise delay, packet loss, and Packet Dropping Rate (PDR). However, cooperating with unknown or unauthorized vehicles could result in information theft, privacy leakage, vulnerable to different security attacks, etc. In this paper, a blockchain based secure and privacy preserving authentication protocol is proposed for the Internet of Vehicles (IoV). Blockchain is utilized to store and manage the authentication information in a distributed and decentralized environment and developed on the Ethereum platform that uses a digital signature algorithm to ensure confidentiality, non-repudiation, integrity, and preserving the privacy of the IoVs. For optimized communication, transmitted services are categorized into emergency and optional services. Similarly, to optimize the performance of the authentication process, IoVs are categorized as emergency and general IoVs. The proposed cooperative protocol is validated by numerical analyses which show that the protocol successfully increases the system throughput and decreases PDR and delay. On the other hand, the authentication protocol requires minimum storage as well as generates low computational overhead that is suitable for the IoVs with limited computer resources

Surgical resection of a giant peripheral ossifying fibroma in mouth floor managed with fiberscopic intubation

Tracheal intubation for general anesthesia can sometimes be difficult in patients with a large mass in the mouth floor. Preoperative evaluation of the patient's airway is most important when treating large oral disease

A cohort study on the rate of progression of diabetic chronic kidney disease in different ethnic groups.

OBJECTIVE: To compare the rate of progression of diabetic chronic kidney disease in different ethnic groups. DESIGN: Prospective longitudinal observational study. PARTICIPANTS: All new patients attending a tertiary renal unit in east London with diabetic chronic kidney disease between 2000 and 2007 and followed up till 2009 were included. Patients presenting with acute end-stage kidney failure were excluded. MAIN OUTCOME MEASURES: The primary outcome was annual decline in the estimated glomerular filtration rate (eGFR) in different ethnic groups. Secondary end points were the number of patients developing end-stage kidney failure and total mortality during the study period. RESULTS: 329 patients (age 60±11.9 years, 208 men) were studied comprising 149 south Asian, 105 White and 75 Black patients. Mean follow-up was 6.0±2.3, 5.0±2.7 and 5.6±2.4 years for White, Black and south Asian patients, respectively. South Asian patients were younger and had a higher baseline eGFR, but both systolic and diastolic blood pressures were higher in Black patients (p<0.05). Baseline proteinuria was highest for the south Asian group followed by the White and Black groups. Adjusted linear regression analysis showed that an annual decline in eGFR was not significantly different between the three groups. The numbers of patients developing end-stage kidney failure and total mortality were also not significantly different between the three groups. ACE or angiotensin receptor blockers use, and glycated haemoglobin were similar at baseline and throughout the study period. CONCLUSIONS: We conclude that ethnicity is not an independent factor in the rate of progression renal failure in patients with diabetic chronic kidney disease

Comparison of ultrasonographically measured fetal interventricular septal thickness between diabetic and healthy mother

Background: During pregnancy, metabolic changes occur in response to increased nutrient needs of the fetus and mother, including progressive insulin resistance that can lead to gestational diabetes mellitus (GDM). GDM can result in fetal complications. This study aimed to compare fetal interventricular septal thickness, measured by ultrasound, between diabetic and healthy mothers. Methods: This cross-sectional study was conducted at the department of radiology and imaging, BIRDEM, Dhaka, Bangladesh. A total of 334 subjects were enrolled in this study as per inclusion criteria. The study duration was 2 years; from July 2012 to June 2014. All study subjects were divided into 3 groups named group A, group B, and group C. 167 non-diabetic, 84 controlled diabetics, and 83 uncontrolled diabetic mothers were considered as group A, group B, and group C respectively. Data were analyzed by SPSS computed program. Results: In this study, 47.9% of subjects in group A were ≤25 years old, while 52.4% of group B and 53.0% of group C were in the 26-30 age range. The mean age was 25.9±3 years in group A, 25.5±2.9 years in group B, and 25.2+3.3 years in group C, with no statistically significant difference between the three groups (p&gt;0.05). The mean gestational age was similar across the three groups, with no statistically significant difference (p&gt;0.05). However, the mean fetal interventricular septal thickness was significantly different between the groups, with group A and B having similar thicknesses, while group C had a significantly larger thickness (p&lt;0.05). The difference in fetal interventricular septal thickness was also statistically significant between the three groups at 32 weeks of gestational age (p&lt;0.05). Conclusions: In this study, the fetal interventricular septal thickness was significantly higher in uncontrolled diabetic mothers followed by controlled diabetic and non-diabetic and almost alike between non-diabetic and controlled diabetic mothers. The study also revealed that M-mode ultra-sonogram measurement of interventricular septal thickness can be included in routine scanning during the third trimester

Synthetic matrix enhances transplanted satellite cell engraftment in dystrophic and aged skeletal muscle with comorbid trauma

Muscle satellite cells (MuSCs) play a central role in muscle regeneration, but their quantity and function decline with comorbidity of trauma, aging, and muscle diseases. Although transplantation of MuSCs in traumatically injured muscle in the comorbid context of aging or pathology is a strategy to boost muscle regeneration, an effective cell delivery strategy in these contexts has not been developed. We engineered a synthetic hydrogel-based matrix with optimal mechanical, cell-adhesive, and protease-degradable properties that promotes MuSC survival, proliferation, and differentiation. Furthermore, we establish a biomaterial-mediated cell delivery strategy for treating muscle trauma, where intramuscular injections may not be applicable. Delivery of MuSCs in the engineered matrix significantly improved in vivo cell survival, proliferation, and engraftment in nonirradiated and immunocompetent muscles of aged and dystrophic mice compared to collagen gels and cell-only controls. This platform may be suitable for treating craniofacial and limb muscle trauma, as well as postoperative wounds of elderly and dystrophic patients.Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the NIH under award numbers R21AR072287 (to Y.C.J.) and R01AR062368 (to A.J.G.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This work was also funded by the Parker H. Petit Institute for Bioengineering and Bioscience Seed Grant Program (to A.J.G. and Y.C.J.)