Evaluating the impact of vertical integration on health system peformance

Vertical integration is grounded in economic theory as a corporate strategy for reducing cost and enhancing efficiency. There were three purposes for this dissertation. The first was to describe and understand vertical integration theory. The review of the economic theory established vertical integration as a corporate cost reduction strategy in response to environmental, structural and performance dimensions of the market. The second purpose was to examine vertical integration in the context of the health care industry, which has greater complexity, higher instability, and more unstable demand than other industries, although many of the same dimensions of the market supported a vertical integration strategy. Evidence on the performance of health systems after integration revealed mixed results. Because the market continues to be turbulent, hybrid non-owned integration in the form of alliances have increased to over 40% of urban hospitals. The third purpose of the study was to examine the application of vertical integration in health care and evaluate the effects. The case studied was an alliance formed between a community hospital and a tertiary medical center to facilitate vertical integration of oncology services while maintaining effectiveness and preserving access. The economic benefits for 1934 patients were evaluated in the delivery system before and after integration with a more detailed economic analysis of breast, lung, colon/rectal, and non-malignant cases. A regression analysis confirmed the relationship between the independent variables of age, sex, location of services, race, stage of disease, and diagnosis, and the dependent variable, cost. The results of the basic regression model, as well as the regression with first-order interaction terms, were statistically significant. The study shows that vertical integration at an intermediate health care system level has economic benefits. If the pre-integration oncology group had been treated in the post-integration model, the expected cost savings from integration would be 31.5%. Quality indicators used were access to health care services and research treatment protocols, and access was preserved in the integrated model. Using survival as a direct quality outcome measure, the survival of lung cancer patients was statistically the same before and after integration. ^

The Export Insurance System and Export Supply of Britain

This paper examines whether or not the export insurance subsidy provided by the British government has promoted Britain.s export supply. Unlike previous studies on the effectiveness of export subsidy in export supply, the current study examines the stationarity nature of the concerned variables. The unit root tests show that all concerned variables are integrated of order one. According to Johansen cointegration test, the concerned variables are not cointegrated. The empirical evidences using the first differenced data show that the export subsidy in terms of provision of export insurances by the government is not statistically significant in increasing export supply.

Has implementation of integrated mental health services in primary care programs positively impacted health outcomes among the mentally ill in developing countries?

Objective. The World Health Organization (WHO) estimates that nearly 450 million people suffer from a mental disorder in the world. Developing countries do not have the health system structure in place to support the demand of mental health services. This study will conduct a review of mental health integration in primary care research that is carried out in low-income countries identified as such from the World Bank economic analysis. The research follows the standard of care that WHO has labeled appropriate in treatment of mental health populations. Methods. This study will use the WHO 10 principles of mental health integration into primary care as the global health standard of care for mental health. Low-income countries that used these principles in their national programs will be analyzed for effectiveness of mental health integration in primary care. Results. This study showed that mental health service integration in primary care did have an effect on health outcomes of low-income countries. However, information did not lead to significant quantitative results that determined how positive the effect was. Conclusion. More ethnographic research is needed in low-income countries to truly assess how effective the program is in integrating with the health system currently in place.^ ^

DEVELOPMENT AND APPLICATION OF SHORT-TERM MUTAGENICITY AND CYTOTOXICITY BIOASSAYS FOR INTEGRATED HEALTH ASSESSMENT STUDIES OF COAL FLY ASH EMISSIONS

Two respirable coal fly ash samples ((LESSTHEQ) 3(mu)m), one from a pressurized fluidized-bed combustion miniplant and one from a conventional combustion power plant, were investigated for physical properties, chemical composition and biological activity. Electron microscopy illustrated irregularity in fluidized-bed combustion fly ash and sphericity in conventional combustion fly ash. Elemental analysis of these samples showed differences in trace elements. Both fly ash samples were toxic in rabbit alveolar macrophage and Chinese hamster ovary cell systems in vitro. The macrophages were more sensitive to toxicity of fly ash than the ovary cells. For measuring the cytotoxicity of fly ash, the most sensitive parameters were adenosine triphosphate in the alveolar macrophage system and viability index in the hamster ovary system. Intact fluidized-bed combustion fly-ash particles showed mutagenicity only in strains TA98 and TA1538 without metabolic activation in the Ames Salmonella assay. No mutagenicity was detected in bioassay of conventional combustion fly ash particles. Solvent extraction yielded more mass from fluidized-bed combustion fly ash than from conventional combustion fly ash. The extracts of fluidized-bed combustion fly ash showed higher mutagenic activity than conventional combustion fly ash. These samples contained direct-acting, frameshift mutagens.^ Fly ash samples collected from the same fluidized-bed source by cyclones, a fabric filter, and a electrostatic precipitator at various temperatures were compared for particle size, toxicity, and mutagenicity. Results demonstrated that the biological activity of coal fly ash were affected by the collection site, device, and temperature.^ Coal fly ash vapor-coated with 1-nitropyrene was developed as a model system to study the bioavailability and recovery of nitroaromatic compounds in fly ash. The effects of vapor deposition on toxicity and mutagenicity of fly ash were examined. The nitropyrene coating did not significantly alter the ash's cytotoxicity. Nitropyrene was bioavailable in the biological media, and a significant percentage was not recovered after the coated fly ash was cultured with alveolar macrophages. 1-Nitropyrene loss increased as the number of macrophages was increased, suggesting that the macrophages are capable of metabolizing or binding 1-nitropyrene present in coal fly ash. ^

Ichthyoplankton density and zooplankton biomass in the Benguela upwelling system during MSM17/3 in January and February 2011

Ichthyoplankton density (fish eggs and larvae) and bulk zooplankton biomass in January/February 2011 were determined for 38 stations in the northern Benguela upwelling system, based on oblique Multinet hauls during the FS Maria S. Merian MSM17/3 cruise. A HYDROBIOS Multinet, type Midi (0.25 m**2 mouth area) was equipped with five nets of 500 µm-mesh size, temperature and oxygen probes, and an inner and outer flow meter to monitor the net's trajectory (for volume filtered calculations) as well as net clogging. The Multinet was handled over the side, towed horizontally at 2 knots. Winch speed when fearing was 0.5 or 0.3 m/s, heaving velocity 0.2 - 0.3 m/s. The Multinet was towed obliquely at 38 stations sampling the upper 200 m of the water column, which were divided into five different depth strata after inspection of temperature and oxygen concentration depth profiles. Ichthyoplankton densities and zooplankton biomass were calculated for each depth stratum (=single net) from total abundance and the volume of water filtered [individuals per m**3 and g wet weight per m**3, respectively]. In addition, densities and biomass were integrated over the area for each station [individuals per m**2], as sum of calculations for each net: Sum ([individuals per m**3]*Delta (depth bot[m]-depth top [m]).

Ichthyoplankton density and zooplankton biomass in the Benguela upwelling system during MSM19/1b in October 2011

Ichthyoplankton density (fish eggs and larvae) and bulk zooplankton biomass in October 2011 were determined for 22 stations in the northern Benguela upwelling system, based on oblique Multinet hauls during the FS Maria S. Merian MSM19/1b cruise. A HYDROBIOS Multinet, type Midi (0.25 m**2 mouth area) was equipped with five nets of 500 µm-mesh size, temperature and oxygen probes, and an inner and outer flow meter to monitor the net's trajectory (for volume filtered calculations) as well as net clogging. The Multinet was handled over the side, towed horizontally at 2 knots. Winch speed when fearing was 0.5 or 0.3 m/s, heaving velocity 0.2 - 0.3 m/s. The Multinet was towed obliquely at 22 stations sampling the upper 200 m of the water column, which were divided into five different depth strata after inspection of temperature and oxygen concentration depth profiles. Ichthyoplankton densities and zooplankton biomass were calculated for each depth stratum (=single net) from total abundance and the volume of water filtered [individuals per m**3 and g wet weight per m**3, respectively]. In addition, densities and biomass were integrated over the area for each station [individuals per m**2], as sum of calculations for each net: Sum ([individuals per m**3]*Delta (depth bot[m]-depth top [m]).

Data collection of depth and time integrated Calanus finmarchicus abundances, averaged temperatures, and integrated Chlorophyll concentration in the North Atlantic Ocean

Here we present a new, pan-North-Atlantic compilation of data on key mesozooplankton species, including the most important copepod, Calanus finmarchicus. Distributional data of eight representative zooplankton taxa, from recent (2000-2009) Continuous Plankton Recorder data, are presented, along with basin-scale data of the phytoplankton colour index. Then we present a compilation of data on C. finmarchicus, including observations of abundance, demography, egg production and female size, with accompanying data on temperature and chlorophyll. . This is a contribution by Canadian, European and US scientists and their institutions.

(Table 2) Integrated concentration, production and dissolution of silica in the water column of the southern Pacific

An intense diatom bloom developed within a strong meridional silicic acid gradient across the Antarctic Polar Front at 61°S, 170°W following stratification of the water column in late October/early November 1997. The region of high diatom biomass and the silicic acid gradient propogated southward across the Seasonal Ice Zone through time, with the maximum diatom biomass tracking the center of the silicic acid gradient. High diatom biomass and high rates of silica production persisted within the silicic acid gradient until the end of January 1998 (ca. 70 d) driving the gradient over 500 km to the south of its original position at the Polar Front. The bloom consumed 30 to >40 µM Si(OH)4 in the euphotic zone between about 60 and 66°S leaving near surface concentrations <2.5 µM and occasionally <1.0 µM in its wake. Integrated biogenic silica concentrations within the bloom averaged 410 mmol Si/m**2 (range 162-793 mmol Si/m**2). Average integrated silica production on two consecutive cruises in December 1997 and January 1998 that sampled the bloom while it was well developed were 27.5±6.9 and 22.6±20 mmol Si/m**2/d, respectively. Those levels of siliceous biomass and silica production are similar in magnitude to those reported for ice-edge diatom blooms in the Ross Sea, Antarctica, which is considered to be among the most productive regions in the Southern Ocean. Net silica production (production minus dissolution) in surface waters during the bloom was 16-21 mmol Si/m**2/d, which is sufficient for diatom growth to be the cause of the southward displacement of the silicic acid gradient. A strong seasonal change in silica dissolution : silica production rate ratios was observed. Integrated silica dissolution rates in the upper 100-150 m during the low biomass period before stratification averaged 64% of integrated production. During the bloom integrated dissolution rates averaged only 23% of integrated silica production, making 77% of the opal produced available for export to depth. The bloom ended in late January apparently due to a mixing event. Dissolution : production rate ratios increased to an average of 0.67 during that period indicating a return to a predominantly regenerative system. Our observations indicate that high diatom biomass and high silica production rates previously observed in the marginal seas around Antarctica also occur in the deep ocean near the Polar Front. The bloom we observed propagated across the latitudinal band overlying the sedimentary opal belt which encircles most of Antarctica implying a role for such blooms in the formation of those sediments. Comparison of our surface silica production rates with new estimates of opal accumulation rates in the abyssal sediments of the Southern Ocean, which have been corrected for sediment focusing, indicate a burial efficiency of <=4.6% for biogenic silica. That efficiency is considerably lower than previous estimates for the Southern Ocean.