Större myndigheter, billigare hälsovårdstjänster? : En empirisk analys av ekonomiska följderna av integrering av primärvård och specialvård under samma organisation

Under 2000 talet har Finlands regering försökt genomföra en reform av social- och hälsovårdstjänsterna för att motverka följderna av stigande hälsovårdskostnader och en åldrande befolkning. Syftet med reformen har varit att hindra en okontrollerad ökning av hälsovårdskostnader och att säkra lika tjänster för hela Finlands befolkning. År 2021 godkändes social- och hälsovårdsreformen i Finland och från och med år 2023 är välfärdsområden ansvariga för ordnandet av social- och hälsovårdstjänsterna. Medan reformförsök har gjorts i Finland, har det bildats ett antal samkommuner där primärvård, specialvård och sociala tjänster integrerats under en och samma organisation. De motsvarar på så vis delvis det som man försökt åstadkomma med reformen. Syftet med denna studie är att undersöka ifall medlemskommunerna i dessa samkommuner lyckats erbjuda specialvård och/eller primärvård mera kostnadseffektivt än övriga kommuner. Majoriteten av dessa samkommuner inledde sin verksamhet år 2017, men enstaka har inlett sin verksamhet åren 2007, 2010 och 2019. Som teoretiskt ramverk utnyttjas teori som används när kommunsammanslagningar undersöks. De två huvudpunkterna för och emot kommunsammanslagningar, är större organisationers stordriftsfördelar, mot mindre organisationers möjligheter att bättre anpassa sina tjänster till befolkning. I analysen utnyttjas paneldata från åren 2006–2020. Medlemskommunerna i de ovannämnda samkommunerna bildar behandlingsgruppen, medan övriga kommuner bildar kontrollgruppen. Analysmetoden är tudelad. Först görs en klassisk difference-in-differences analys, där samkommunerna som bildades 2007, 2010 och 2019 utesluts från analysen, och behandlingstidpunkten 2017 används för att granska behandlingseffekten i majoriteten av samkommunerna. Efter detta används all data för mer robusta resultat, i en regressionsmodell med tvåvägsfixa effekter och behandlingstidpunkterna 2007, 2010, 2017 och 2019. Resultaten tyder på att behandlingseffekten på kommunernas invånarmässiga specialvårdsnettodriftskostnader är mellan -4,8 och -2,8 procent. Motsvarande effekt för primärvården är mellan -7,1 och -5,6 procent. De statistisk signifikanta resultaten stämmer överens med teori om stordriftsfördelar inom hälsovårdstjänster. I tidigare empiri om ämnet har motstridiga resultat framförts, och resultaten i dessa studie är delvis i linje med tidigare resultat. Specialvårdens resultat tål test för intern validitet, medan primärvårdens modell tål endast en del av testen och resultaten är därmed mer tveksamma trots estimatets större storlek. Trots osäkerheten av resultatens validitet, pekar alla resultat mot kostnadsbesparingar istället för – ökningar, vilket är ett positivt tecken med tanke på hälsovårdsreformen i Finland. Ifall välfärdsområdena i Finland lyckas nå liknande effektiveringar som samkommunerna i denna studie, skulle det innebära stora besparingar för den offentliga ekonomin

Synthesis and Biological Evaluation of Phenanthrenes as Cytotoxic Agents with Pharmacophore Modeling and ChemGPS-NP Prediction as Topo II Inhibitors

In a structure-activity relationship (SAR) study, 3-methoxy-1,4-phenanthrenequinones, calanquinone A (6a), denbinobin (6b), 5-OAc-calanquinone A (7a) and 5-OAc-denbinobin (7b), have significantly promising cytotoxicity against various human cancer cell lines (IC50 0.08–1.66 µg/mL). Moreover, we also established a superior pharmacophore model for cytotoxicity (r = 0.931) containing three hydrogen bond acceptors (HBA1, HBA2 and HBA3) and one hydrophobic feature (HYD) against MCF-7 breast cancer cell line. The pharmacophore model indicates that HBA3 is an essential feature for the oxygen atom of 5-OH in 6a–b and for the carbonyl group of 5-OCOCH3 in 7a–b, important for their cytotoxic properties. The SAR for moderately active 5a–b (5-OCH3), and highly active 6a–b and 7a–b, are also elaborated in a spatial aspect model. Further rational design and synthesis of new cytotoxic phenanthrene analogs can be implemented via this model. Additionally, employing a ChemGPS-NP based model for cytotoxicity mode of action (MOA) provides support for a preliminary classification of compounds 6a–b as topoisomerase II inhibitors

Genomic Predictors of Outcome in Prostate Cancer

CONTEXT: Given the highly variable behavior and clinical course of prostate cancer (PCa) and the multiple available treatment options, a personalized approach to oncologic risk stratification is important. Novel genetic approaches offer additional information to improve clinical decision making. OBJECTIVE: To review the use of genomic biomarkers in the prognostication of PCa outcome and prediction of therapeutic response. EVIDENCE ACQUISITION: Systematic literature review focused on human clinical studies reporting outcome measures with external validation. The literature search included all Medline, Embase, and Scopus articles from inception through July 2014. EVIDENCE SYNTHESIS: An improved understanding of the genetic basis of prostate carcinogenesis has produced an increasing number of potential prognostic and predictive tools, such as transmembrane protease, serine2:v-ets avian erythroblastosis virus E26 oncogene homolog (TMPRSS2:ERG) gene fusion status, loss of the phosphatase and tensin homolog (PTEN) gene, and gene expression signatures utilizing messenger RNA from tumor tissue. Several commercially available gene panels with external validation are now available, although most have yet to be widely used. The most studied commercially available gene panels, Prolaris, Oncotype DX Genomic Prostate Score, and Decipher, may be used to estimate disease outcome in addition to clinical parameters or clinical nomograms. ConfirmMDx is an epigenetic test used to predict the results of repeat prostate biopsy after an initial negative biopsy. Additional future strategies include using genetic information from circulating tumor cells in the peripheral blood to guide treatment decisions at the initial diagnosis and at subsequent decision points. CONCLUSIONS: Major advances have been made in our understanding of PCa biology in recent years. Our field is currently exploring the early stages of a personalized approach to augment traditional clinical decision making using commercially available genomic tools. A more comprehensive appreciation of value, limitations, and cost is important. PATIENT SUMMARY: We summarized current advances in genomic testing in prostate cancer with a special focus on the estimation of disease outcome. Several commercial tests are currently available, but further understanding is needed to appreciate the potential benefits and limitations of these novel tests

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Search for dark matter produced in association with a hadronically decaying vector boson in pp collisions at sqrt (s) = 13 TeV with the ATLAS detector

A search is presented for dark matter produced in association with a hadronically decaying W or Z boson using 3.2 fb−1 of pp collisions at View the MathML sources=13 TeV recorded by the ATLAS detector at the Large Hadron Collider. Events with a hadronic jet compatible with a W or Z boson and with large missing transverse momentum are analysed. The data are consistent with the Standard Model predictions and are interpreted in terms of both an effective field theory and a simplified model containing dark matter

A search for tt̄ resonances using lepton-plus-jets events in proton-proton collisions at √s = 8 TeV with the ATLAS detector

A search for new particles that decay into top quark pairs is reported. The search is performed with the ATLAS experiment at the LHC using an integrated luminosity of 20.3 fb−¹ of proton-proton collision data collected at a centre-of-mass energy of √s=8 TeV. The lepton-plus-jets final state is used, where the top pair decays to W+bW−b̄, with one W boson decaying leptonically and the other hadronically. The invariant mass spectrum of top quark pairs is examined for local excesses or deficits that are inconsistent with the Standard Model predictions. No evidence for a top quark pair resonance is found, and 95% confidence-level limits on the production rate are determined for massive states in benchmark models. The upper limits on the cross-section times branching ratio of a narrow Z′ boson decaying to top pairs range from 4.2 pb to 0.03 pb for resonance masses from 0.4 TeV to 3.0 TeV. A narrow leptophobic topcolour Z′ boson with mass below 1.8 TeV is excluded. Upper limits are set on the cross-section times branching ratio for a broad colour-octet resonance with Γ/m = 15% decaying to tt̄. These range from 4.8 pb to 0.03 pb for masses from 0.4 TeV to 3.0 TeV. A Kaluza-Klein excitation of the gluon in a Randall-Sundrum model is excluded for masses below 2.2 TeV

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis