Non-Profit Hospital Service Plans

Hospital service plans fulfill a vital social need. In view of the continuing support and apparently expanding activities of the plans, it is well to understand their legal nature. At the present time problems are arising that could not have been foreseen 25 years ago. The favorable treatment which hospital service plans have received under the law should be continued so long as the plans continue realistically to meet these problems as they have in the past

Command and Control in the Information Age: A Case Study of a Representative Air Power Command and Control Node

As operations command structures change, it is important to be able to explore and understand their fundamental nature; researchers should unearth the gestalt nature of the operational node. The organizational structure and the infrastructure can significantly affect overall command and control (C2) performance. Thus, it is necessary to develop understanding of effectiveness of the technical network and the people using the system as a whole. The purpose of this research is to conduct an analysis of a representative Air Power Operational C2 node, create and use a repeatable method, and present the results as a case study to elicit fundamental understanding. I posit that there is a recognizable (and discoverable) relationship between the social (human) network and technical supporting network. Examining the system under change can result in an understanding of this relationship. In this work, I enhanced an existing simulation tool to investigate the effects of organizational structure on task effectiveness. The primary research question examined is how a representative AOC system changes varying noise and system fragmentation when operating in two different organizational constructs. Network-Enabled Capability (as the term is used in NATO), Network Centric Operations, or Edge Organizations, is a core C2 transformation predicated upon a set of network-centric tenets. These tenets form the intellectual foundation for ongoing transformations. The secondary research question is to determine if these tenets are unbound, and what elucidation results if they are not. This research produces four significant contributions to Operational Command and Control and Engineering Management disciplines. First, I combined social networking theory and information theory into a single lens for evaluation. By using this new concept, I will be able to accomplish a quantitative evaluation by something other than mission treads, field exercise, historical evaluation, or actual combat. Second, I used both information theory and social networking concepts in a non-traditional setting. Third, I hope this research will start the process required to gain the knowledge to achieve some sort of future C2 structure. Fourth, this research suggests directions for future research to enhance understanding of core Operational Command and Control concepts

A Longitudinal Study Involving The Utilization Of A Team-Oriented Structure And An Enterprise Resource Planning Framework In A Medium-Sized Organization

The paper provides an analysis of a custom manufacturer facing issues of growth, productivity concerns, changes in technology, competitive threats, financial management, marketing development, and internal human resource responsibilities, and the response to these issues.  The paper traces the changes that took place in this medium-sized organization over a fifteen-year period in order to improve the culture of the company.  The implementation of a team oriented structure utilizing an external change agent, and the reorganization of employee responsibilities in a major restructuring effort are discussed.  A new enterprise resource planning system (ERP) was implemented to operate and coordinate the company.  The authors analyze in detail the evolution that has taken place in the company over the last four years.  The major benefits and learnings of the change are presented

Organizational Efficacy of Small and Medium-Sized Suppliers: The Role of Information Quality and Continuous Quality Improvement

The role of information quality and continuous quality improvement was analyzed in regards to the organizational efficacy of small and medium-sized suppliers. It was anticipated that both variables would have positive relationships with organizational efficacy. Results supported these hypotheses and demonstrate the importance of firms controlling the flow of quality information and emphasizing continuous quality improvement in order to strengthen organizational efficacy. Given the significant impact of efficacy on individual and group performance and the relationships confirmed as part of the current study, future research is called for such that we might better understand the qualities that characterize the successful supply chain relationships for SMEs

Estradiol inhibition of catecholamine elicited eating in the female rat

Two experiments test the hypothesis that estradiol suppresses food intake by inhibiting [beta] dopamine hydroxylase in the anterior diencephalon where norepinephrine sensitive neurons activate feeding behavior. In the first experiment, dopamine or norepinephrine was injected intracerebrally in female rats during estrous and diestrous phases of the estrous cycle. Dopamine injections in the anterior diencephalon of rats elicited eating (pppp<0.05) only in the absence of circulating estradiol while the increases following norepinephrine were independent of estradiol treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33851/1/0000110.pd

The contact method: A simple technique for electrical self-stimulation without external leads

Electrical currents to reward areas of the brain were administered without the use of external leads by utilizing a method conceptually similar to that of the electronic drinkometer. A wire brush connected to the intracranial electrode protudes above the rat's head. By lifting its head the rat can make contact between the brush and a stimulation plate mounted horizontally overhead. The stimulation circuit is completed through the contact of the rat's feet with a grounded metal floor. Current thresholds and stimulation rates obtained by this method were identical to those obtained by the conventional method of stimulation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33792/1/0000047.pd

Glucocorticoid anorexia in rats

The effects of two mineralocorticoids, two glucocorticoids and a compound possessing both activities on ad lib food intake, water intake and salt intake were investigated. Dose response curves for d-aldosterone, DOCA, 9 alpha fluorocortisone, corticosterone and dexamethasone were obtained following subcutaneous injections in different groups of rats. Results support the conclusion of a clear separation between the mineralocorticoids and glucocorticoids in terms of their effects on salt intake and food intake respectively. In general (but with some notable exceptions) glucocorticoid activity was associated with anorexia while mineralocorticoid activity was associated with enhanced salt appetite, and the two effects appeared entirely independent of each other. Single doses of dexamethasone and 9 alpha flurocortisone significantly reduced (pp<0.001) increased salt intakes for 1 or more post injection days. The glucocorticoid data are discussed in terms of a possible modification of arterial-venous glucose utilization differences affecting hypothalamic sites or the possible activation of glucose sensitive hepatic cells.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22437/1/0000888.pd

Hyaluronan Synthase Elevation in Metastatic Prostate Carcinoma Cells Correlates with Hyaluronan Surface Retention, a Prerequisite for Rapid Adhesion to Bone Marrow Endothelial Cells

Bone marrow is the primary site of metastasis in patients with advanced stage prostate cancer. Prostate carcinoma cells metastasizing to bone must initially adhere to endothelial cells in the bone marrow sinusoids. In this report, we have modeled that interaction in vitro using two bone marrow endothelial cell (BMEC) lines and four prostate adenocarcinoma cell lines to investigate the adhesion mechanism. Highly metastatic PC3 and PC3M-LN4 cells were found to adhere rapidly and specifically (70-90%) to BMEC-1 and trHBMEC bone marrow endothelial cells, but not to human umbilical vein endothelial cells (15-25%). Specific adhesion to BMEC-1 and trHBMEC was dependent upon the presence of a hyaluronan (HA) pericellular matrix assembled on the prostate carcinoma cells. DU145 and LNCaP cells were only weakly adherent and retained no cell surface HA. Maximal BMEC adhesion and RA encapsulation were associated with high levels of HA synthesis by the prostate carcinoma cells. Up-regulation of HA synthase isoforms Has2 and Has3 relative to levels expressed by normal prostate corresponded to elevated HA synthesis and avid BMEC adhesion. These results support a model in which tumor cells with up-regulated HA synthase expression assemble a cell surface hyaluronan matrix that promotes adhesion to bone marrow endothelial cells. This interaction could contribute to preferential bone metastasis by prostate carcinoma cells

Dealing with abstraction: Case study generalisation as a method for eliciting design patterns

Developing a pattern language is a non-trivial problem. A critical requirement is a method to support pattern writers with abstraction, so as they can produce generalised patterns. In this paper, we address this issue by developing a structured process of generalisation. It is important that this process is initiated through engaging participants in identifying initial patterns, i.e. directly dealing with the 'cold-start' problem. We have found that short case study descriptions provide a productive 'way into' the process for participants. We reflect on a 1-year interdisciplinary pan-European research project involving the development of almost 30 cases and over 150 patterns. We provide example cases, detailing the process by which their associated patterns emerged. This was based on a foundation for generalisation from cases with common attributes. We discuss the merits of this approach and its implications for pattern development

Comparison of perinatal outcomes for all modes of second stage delivery in obstetric theatres : a retrospective observational study

Objective To compare rates of vaginal delivery and adverse outcomes of instrumental delivery trials in obstetric theatre compared to primary emergency full dilatation Caesarean section Design Retrospective cohort study Setting University teaching hospital Population Women with singleton, non-anomalous, pregnancy undergoing instrumental delivery trial in obstetric theatre Methods Data was collected from consecutive cases during 2014 until 2018 using clinical records. Multivariate regression analysis was used comparing groups per first delivery attempt. Main Outcome Measures Primary outcome was completion of vaginal delivery between all methods of instrumental delivery. Secondary outcome was a composite of immediate perinatal adverse outcomes for instrumental delivery modes and primary full dilatation Caesarean section. Results From 971 deliveries analysed: ventouse delivery was significantly less likely to achieve vaginal delivery compared to Keilland’s forceps delivery (OR 0.42, 95%CI 0.22-0.79). Once confounding factors were adjusted for, adverse outcome rates were less frequent in the Keilland’s forceps group compared with primary full dilatation Caesarean section (OR 0.37, 95% CI: 0.16-0.81), however the receiver operating characteristic curve produced from this model demonstrated low predictive value (AUC 0.64). Conclusions Attempting instrumental delivery in delivery suite theatre, as an alternative to primary emergency full dilatation Caesarean section, is both reasonable and safe. Ventouse delivery in this situation may be associated with a higher chance of failure than other modes of instrumental delivery, thus making appropriate choice of delivery method of paramount importance according to each clinical situation. Funding None Keywords Caesarean section, Keilland’s forceps, ventouse, trial of instrumental deliver