Performance under capitation: the true cost of infrastructure

Administrative costs are a major item of concern for capitated provider groups, who must maintain a sophisticated infrastructure to allow them to manage and deliver clinical care to their patients under a fixed budget. The cost of this infrastructure is under steady upward pressure, as HMOs delegate more activities to providers and step up their reporting requirements. Our experience in establishing an infrastructure for a provider network is reported, and indicates substantial costs for both start-up and ongoing operations, which are highly volume dependent. A powerful case exists in favor of centralizing and pooling administrative infrastructure across related provider groups.     

A twin and family study of the association between immune system dysfunction and dyslexia using blood serum immunoassay and survey data

We conducted a study of the association between developmental reading disability (DRD) and immune disorders (ID) using both survey and immunoassay data in two separate samples of families. One sample was made up of twins and their parents and was ascertained through a population-based sampling scheme. The other sample was a set of extended pedigrees selected for apparent autosomal dominant transmission of DRD. We failed to find an association between DRD and ID in either sample, regardless of the method used to assess immune system function. Even though our twin sample provided evidence that both DRD and immune conditions were significantly heritable, there was no evidence for a genetic correlation between ID and DRD nor was there any clear indication that a special subgroup of individuals may be comorbid for these conditions because of genetic reasons. How these negative findings can be reconciled with the developmental hypothesis of Geschwind, Behan, Galaburda, and colleagues, and how they may relate to the gene locus influencing DRD that has been recently located in the HLA region of the short arm of chromosome 6 is discussed.     

Potential antitumor agents. 19. Multiply substituted 4'-(9-acridinylamino)methanesulfonanilides

A series of 42 multiply substituted 4'-(9-acridinylamino)methanesulfonanilides has been prepared and evaluated in the L1210 system. In addition to biologic activity changes resulting from altered agent lipophilic-hydrophilic balance variants containing both acridine 4-CH3 and 3-NH2, NHCOCH3 or NO2 substituents have reduced activity. Variants 3,6-disubstituted, using functions of differing electronic character, have depressed activity, suggesting that there is limited site bulk tolerance. Asymmetric 3,5-disubstitution should then be the preferred pattern; the 3-ND-5CH-3'-OCH variant is the most dose potent (optimum dose qd 1-5, 1.25 mg/kg/day) of the high activity agents of this series so far prepared.     

Functional longevity of intraperioneal drains: an experimental evaluation

Various types of drains were inserted into the peritoneal cavity of twenty-eight dogs. After one to seven days, all drains failed to show the presence of 200 cc of colored fluid injected intraperitoneally. On autopsy, all tubes were surrounded and occluded by omentum.     

Molecular structure and driving force to metastable states: Janus faces in polymer crystallization

This paper is a retrospective of a past dedicated to research on polymers and a situation sketch of the present and the near future. (Co)polymers discussed are mainly based on ethylene. (Cross‐)fractionation techniques combined with state‐of‐the‐art characterization techniques, like quantitative differential scanning calorimetry, are powerful tools for the study of the links between two main topics: molecular structure and crystallization/melting. These form the two ‘Janus faces’ polymers can show, namely Face 1: the molecular structure resulting from polymerization with the keyword ‘nature’; and Face 2: the driving force of crystallization towards a metastable state, with the keyword ‘nurture’. After all, to meet demands for properties of products, in principle one starts with a given molecular architecture, after which dedicated processing, including application of temperature–time ramps, has to do the job. With new instrumentation, especially fast scanning (chip) calorimetry, for the first time in history the driving force towards crystallization into one of the possible metastable states – via Face 2 – can be controlled, of course within certain limits given by Face 1. This promising outlook of combining the faces to a useful symbiosis of Janus will be a challenge for those working in the science of crystallization of polymers. © 2018 Society of Chemical Industry