Clinical and economic impact of implementing a comprehensive diabetes management program in managed care

Diabetes mellitus places a significant burden on the U.S. healthcare system. Because of the potential to reduce diabetic complications and costs through intensive management, diabetes has become a primary target for disease management programs. We performed a retrospective analysis of short-term baseline and follow-up clinical, economic, and member and provider satisfaction data from approximately 7,000 people with diabetes being treated through seven managed care plans using Diabetes Treatment Centers of America's Diabetes NetCare, (Nashville, TN), a comprehensive diabetes management program. Our analysis indicates that Diabetes NetCare achieved gross economic adjusted savings of $50 per diabetic member per month (12.3%), with gross unadjusted savings of $44 (10.9%) per diabetic member per month. Hospital admissions per 1,000 diabetic member years decreased by 18%, and bed days fell by 21%. Patients with diabetes were more likely to get HbAlc tests, foot exams, eye exams, and cholesterol screenings while enrolled in the program. These data suggest that implementation of a comprehensive healthcare management program for people with diabetes can lead to substantial improvements in costs and clinical outcomes in the short-term. It is expected that improvements will increase over time, with continuing improvements in health status and a reduction in the number of future diabetic complications.     

Generic Representation of Solid-Object Geometry for Genetic Search

Abstract: This paper examines the first stage of using genetic algorithms in design—how to encode designs as chromosomes. Generic representations capable of describing the geometry of any solid object to eliminate the unnecessary duplication of work at this stage are explored. A suitable low-parameter, spatial-partitioning representation is then proposed, using partitions consisting of six-sided polyhedra intersected by planes. Finally, the coding of the representation is examined, with the conclusion that allelic coding with control genes and user-definable, fixed-value alleles would provide the most flexible system.     

Chronic renal failure and its management and nephrolithiasis

Chronic renal failure (CRF) is the most common form of renal disease in dogs and cats. Although CRF occurs in dogs and cats of all ages, it is commonly considered a disease of older animals, and the incidence increases with age. This article presents guide-lines for the diagnosis and conservative management of chronic renal failure in dogs and cats. Nephrolithiasis is uncommon in dogs and cats, accounting for less than 3% of all urinary calculi. The mineral composition of the renolith is important in formulation of therapeutic and preventive management strategies. This article briefly reviews the epidemiology, diagnosis, and management of nephrolithiasis in the dog and cat.     

Mechanisms of resistance in a human cell line exposed to sequential topoisomerase poisoning

Camptothecins are a new class of anticancer drugs that target DNA topoisomerase I; current efforts are directed toward elucidating optimal combinations of these drugs with other antineoplastic agents. A rationale for the use of sequential therapy involving the combination of camptothecins with topoisomerase II-targeting drugs, such as etoposide, has arisen from observations of increased topoisomerase II protein levels in cell lines resistant to camptothecin. In an effort to understand potential mechanisms of resistance to this strategy, we developed a U-937 cell subline, denoted RERC, that is capable of surviving exposure to sequential topoisomerase poisoning. The RERC cells are 200-fold resistant to camptothecin, 8-fold resistant to etoposide, and 10-fold hypersensitive to cisplatin compared to the parental U-937 cells. Biochemical analyses indicate that the resistant phenotype involves alterations in both topoisomerase I and topoisomerase IIalpha. Topoisomerase I catalytic activity in the resistant cells is similar to that of the parental line but is resistant to camptothecin. Moreover, the resistant cells express a single mRNA species of topoisomerase I that codes for a mutation in codon 533. In addition, topoisomerase IIalpha protein levels are decreased 10-fold in the resistant line, coincident with a two-fold decrease in the expression of topoisomerase IIalpha mRNA. Collectively, these results indicate that resistance to sequential topoisomerase poisoning may involve a reduction in total cellular topoisomerase activity.     

Models of visual word recognition: Sampling the state of the art.

A classification of models of visual word recognition is presented that facilitates formal comparisons between models of different formats. In light of the theoretical contributions to this special section, sets of criteria for the evaluation of models and strategies for model construction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of attention in face encoding.

Ss studied faces in a full- or a divided-attention condition and then received a recognition test that included old faces, new faces constructed by combining facial features from previously studied faces ("conjunction faces"), and partly or completely new faces. Full- but not divided attention Ss responded "old" more often to old than to conjunction faces; all Ss responded "old" to these faces more often than to partially or completely new faces. Thus it is less attentionally demanding to encode facial features than it is to encode their interrelations. Dividing attention had identical effects on an incidental and an intentional learning group. Exp 3 demonstrated that dividing attention primarily affected explicit recollection rather than stimulus familiarity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

XIV. Yeast sequencing reports. Sequence of MKT1, needed for propagation of M2 satellite dsRNA of the L-A virus of Saccharomyces cerevisiae

MKT1 is required for m aintenance of K₂ above 30°C in strains with the L-A-HN variant of the L-A double-stranded RNA virus of Saccharomyces cerevisiae. We report that MKT1 encodes a 92 979 Da protein with serine-rich regions and the retroviral protease signature, DTG, but with no substantial homology to proteins presently in the databases. This sequence is available from GenBank under Accession Number U09129.     

Effect of furosemide and intravenous normal saline fluid load upon the renal resistive index in nonobstructed kidneys in children

Recent literature has shown that relative to baseline the renal resistive index remains unchanged in nonobstructed kidneys and increases in obstructed kidneys after administration of furosemide. To our knowledge the effect upon the renal resistive index of furosemide administered in conjunction with intravenous normal saline fluid load has not been reported. We evaluated the renal resistive index in 13 nonobstructed kidneys in 8 children 6 to 18 years old before and after furosemide and intravenous normal saline fluid load. The mean resistive index decreased from baseline (mean decrease was 0.06 +/- 0.06 standard deviation), with the observation of a resistive index decrease significant to p < 0.005). It appears likely that the combination of an intravenous normal saline fluid load and furosemide caused the resistive index decrease, since a decrease was not observed with furosemide alone; however, these results cannot exclude the possibility that the resistive index decrease was due to the intravenous normal saline fluid load alone. Nonetheless, these data are important since they may provide the foundation for the development of a pharmacologically challenged Doppler sonographic examination using furosemide and intravenous normal saline fluid load to evaluate better potentially obstructed kidneys.     

A dual read-out model of word context effects in letter perception: Further investigations of the word superiority effect.

A dual read-out model of context effects in letter perception is described that predicts forced-choice accuracy in the Reicher paradigm and its relation to word reportability. It is hypothesized that a correct choice to a letter in a word context is made when either the correct letter representation or a word representation containing the correct letter in the correct position reaches a response threshold (a criterion level of activation). This hypothesis was implemented using the basic architecture of the interactive activation model (J. L. McClelland & D. E. Rumelhart, 1981) in its semistochastic variant (A. M. Jacobs & J. Grainger, 1992). The model successfully captures the data of J. C. Johnston (1978), otherwise thought to be critically damaging for this type of model, and accurately predicts performance in a series of new experiments using the Reicher paradigm. (PsycINFO Database Record (c) 2010 APA, all rights reserved)