Physician Clinical Alignment and Integration: A Community Academic Hospital Approach

An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today\u27s efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital\u27s approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians\u27 employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform

Nicotine-induced brain metabolism associated with anger provocation

Cortico-limbic brain activity associated with anger may be susceptible to nicotine and, thus, may contribute to smoking initiation and nicotine addiction. The purpose of the study was to identify the brain regions that are most reactive to nicotine and show the greatest association with anger task performance. Twenty adult nonsmokers (9 women, 11 men) participated in two laboratory sessions to assess brain metabolism with fluoro deoxy-glucose Positron Emission Topography (FDG-PET) in response to nicotine and placebo patches during an anger provocation task. Outcome variables for the anger provocation task were reaction time, intensity and length of retaliation. Reaction time was associated with nicotine-induced changes in the left thalamus. Length of retaliation was associated with a functionally linked set of cortical and subcortical structures such as right frontal lobe, right anterior cingulate (BA 24), right uncus, left parietal lobe, left BA 11, left cingulate, left BA 25, left amygdala, left BA 30, left BA 38 and BA 9. These findings reveal the underlying brain circuitry targeted by nicotine during anger provocation

Partnering for Change: collaborating to transform occupational therapy services that support inclusive education

The United Nations champions inclusive education as a moral obligation, requiring equitable learning environments that meet all individuals’ diverse learning needs and abilities, including children and youth. Yet the practice of inclusive education is variable and implementation challenges persist. A participatory action research framework was used to develop a solution, Partnering for Change (P4C), which is a tiered service delivery model that bridges health and education by re-envisioning occupational therapy services and transforming the role of the occupational therapist from a service provider for individual children to a collaborative partner supporting the whole school community. This perspective article will describe the P4C model and its evolution, and will outline how it has been implemented in Canadian and international contexts to facilitate children’s inclusion and participation in educational settings

Variant recurrence confirms the existence of a FBXO31-related spastic-dystonic cerebral palsy syndrome

The role of genetics in the causation of cerebral palsy has become the focus of many studies aiming to unravel the heterogeneous etiology behind this frequent neurodevelopmental disorder. A recent paper reported two unrelated children with a clinical diagnosis of cerebral palsy, who carried the same de novo c.1000G \u3e A (p.Asp334Asn) variant in FBXO31, encoding a widely studied tumor suppressor not previously implicated in monogenic disease. We now identified a third individual with the recurrent FBXO31 de novo missense variant, featuring a spastic-dystonic phenotype. Our data confirm a link between variant FBXO31 and an autosomal dominant neurodevelopmental disorder characterized by prominent motor dysfunction

The Ursinus Weekly, October 5, 1972

Jerrold Schecter speaks on China: Mao in control • Ursinus administration appoints twelve new faculty members for coming year • Voting deadline nears; Have you registered? • News editors hope for expansion and diversity • Editorial: A falling star? • Focus: Andrea Turner • Ursinus receives a big fat government grant • Coordinating the freshmen, or Thank God for the relay races • Tired of classes? • Harriers upset by DelVal; Win streak ends • Soccer team impressive in Villanova victory • New coach takes over • Gridders drop first two to F&M, Lebanon Valley • Sports buffs\u27 corner • Sports scoreboardhttps://digitalcommons.ursinus.edu/weekly/1086/thumbnail.jp

Identifying children who are struggling in school

Abstract : Introduction : School-age children with motor coordination challenges typically require formal referral for occupational therapy services and often experience lengthy wait times for one-to-one intervention. In a new service delivery model called Partnering for Change, therapists work collaboratively with educators in classrooms to observe, identify, and support children. This study describes children identified through a traditional referral process and compares them with children identified by occupational therapists through classroom observation and dynamic performance analysis. Methods : Participants included 246 children enrolled in a 2-year evaluative study of the Partnering for Change service delivery. Parents completed a demographic questionnaire, the Developmental Coordination Disorder Questionnaire, and the Strengths and Difficulties Questionnaire. Children’s educators completed the Strengths and Difficulties Questionnaire and the School Function Assessment. Children completed the Movement Assessment Battery for Children. Results : Children identified were significantly younger and more likely to be girls than those referred under the traditional model. Using observation and dynamic performance analysis, occupational therapists identified children who had equally marked difficulties as those who came from the waitlist. In the Partnering for Change model, waitlists for service were eliminated for all children. Conclusions : Occupational therapists can identify children who are experiencing significant challenges participating at school without the need for standardized assessment, formal referrals, and waitlists

Triggering Collapse of the Presolar Dense Cloud Core and Injecting Short-Lived Radioisotopes with a Shock Wave. I. Varied Shock Speeds

The discovery of decay products of a short-lived radioisotope (SLRI) in the Allende meteorite led to the hypothesis that a supernova shock wave transported freshly synthesized SLRI to the presolar dense cloud core, triggered its self-gravitational collapse, and injected the SLRI into the core. Previous multidimensional numerical calculations of the shock-cloud collision process showed that this hypothesis is plausible when the shock wave and dense cloud core are assumed to remain isothermal at ~10 K, but not when compressional heating to ~1000 K is assumed. Our two-dimensional models (Boss et al. 2008) with the FLASH2.5 adaptive mesh refinement (AMR) hydrodynamics code have shown that a 20 km/sec shock front can simultaneously trigger collapse of a 1 solar mass core and inject shock wave material, provided that cooling by molecular species such as H2O, CO, and H2 is included. Here we present the results for similar calculations with shock speeds ranging from 1 km/sec to 100 km/sec. We find that shock speeds in the range from 5 km/sec to 70 km/sec are able to trigger the collapse of a 2.2 solar mass cloud while simultaneously injecting shock wave material: lower speed shocks do not achieve injection, while higher speed shocks do not trigger sustained collapse. The calculations continue to support the shock-wave trigger hypothesis for the formation of the solar system, though the injection efficiencies in the present models are lower than desired.Comment: 39 pages, 14 figures. in press, Ap

GGPS1-associated muscular dystrophy with and without hearing loss

Ultra-rare biallelic pathogenic variants in geranylgeranyl diphosphate synthase 1 (GGPS1) have recently been associated with muscular dystrophy/hearing loss/ovarian insufficiency syndrome. Here, we describe 11 affected individuals from four unpublished families with ultra-rare missense variants in GGPS1 and provide follow-up details from a previously reported family. Our cohort replicated most of the previously described clinical features of GGPS1 deficiency; however, hearing loss was present in only 46% of the individuals. This report consolidates the disease-causing role of biallelic variants in GGPS1 and demonstrates that hearing loss and ovarian insufficiency might be a variable feature of the GGPS1-associated muscular dystrophy