湖南省地市级三级综合医院运行效率及变动研究

目的 分析湖南省13家地市级三级综合医院的运行效率及变动状况,为医院提高效率和生产率提供决策依据。方法 收集湖南省13家地市级三级综合医院2013—2014年的投入产出指标,选取适宜指标构建DEA效率评价模型,利用BC²模型和超效率模型计算样本医院各年度运行效率及排序,再利用Malmquist指数分析跨期效率变动情况。结果 2013年4家样本医院技术效率有效,9家无效,4家处于规模报酬固定阶段,1家处于规模报酬递增阶段,8家处于规模报酬递减阶段;2014年5家样本医院技术效率有效,8家无效,6家处于规模报酬固定阶段,7家处于规模报酬递减阶段。2013—2014年12家样本医院生产率有所改善,仅1家有所下降。结论 样本医院规模效率普遍高于技术效率,不同医院的纯技术效率存在较大差异,由外延式规模发展转为内涵式精益发展是地市级公立医院的必然选择。     

基于效率的医院规模经济实证分析

目的 了解医院是否存在规模经济及适宜床位规模大小。方法 利用浙江省500张床及以上综合性医院数据,用主、客观结合的方式和效率回归调整模型筛选评价指标,用数据包络分析方法和Tobit回归模型进行实证分析。结果 所有决策单元的总体效率和纯技术效率、规模效率平均得分均大于0.93;36%的单元为总体有效,65%的单元为纯技术有效,43%的单元为规模有效;43%的单元处于规模报酬不变区间,42%的单元处于报酬递增区间,15%的单元处于报酬递减区间;全要素生产率平均呈下降;效率的影响因素主要有床位、药品收入比重、设备数量、医院等级、诊次床位比、业务收支比、每床卫技数、每床固定资产、所在地区千人医生数和经济水平等。结论 多数医院存在规模经济。医院床位数在800～1 300张较为合适。提高医院经营效率可采取以下措施：合理控制床位;控制药品收入比重,注重医疗技术的提高;提高管理水平,控制固定资产过度投入;提高地区卫生资源水平和经济发展水平。     

物流云平台在大型综合性医院耗材管理中的应用研究

?????? 目的 确定大型综合性医院消耗品物流云平台的建设方案,提升医院耗材管理的质量和效率,降低医院管理成本。方法 采用定性研究中的深度个案访谈与小组焦点访谈相结合的研究方法。结果 明确物流云平台的定义,确定建设的必要性、功能定位和应用范围。结论 物流云平台的建设在大型综合性医院耗材管理中具有创新意义,根据功能定位的开发具有一定的复杂性,需进行4阶段15期的分期建设,同时需注重系统安全、数据同步联动以及培训推广等开发难点。     

基于数据包络分析的三级医院适宜规模研究

目的 研究三级医院床位和人员的适宜规模,控制医院过度发展和资源浪费。方法 以北京市三级医院为研究样本,确定投入-产出指标,利用DEAP（2.1）软件,分析1991—2011年北京市三级医院规模报酬状态,找出规模报酬拐点,从而确定三级医院适宜规模。结果 2011年,41所医院中,有39家医院处于DEA有效状态,2家医院处于DEA非有效状态;时间序列纵向分析中,有18家医院出现规模报酬拐点。北京市三级综合医院的适宜规模的严格控制标准为：床位606张,95%CI：(425,786),在职职工1 219人,95%CI：(797,1 641);较宽松的控制标准为：床位1 058张,95%CI：(831,1 284),在职职工2 236人,95%CI：(1 716,2 757)。结论 研究得到了三级公立医院的规模控制标准,要严格控制公立医院的规模和特大型医院的数量,注重提高医院的运行效率,缩短平均住院日。     

基于DEA模型的广西41家县级公立医院效率研究

目的 评价广西县级公立医院运行效率,为推进医改提供参考依据。方法 采用DEA对41家县级公立医院进行效率评价。结果 总体有效医院15家（36.59%）,41家医院的总体效率、纯技术效率、规模效率平均值分别为 0.899、0.953和0.944,纯技术效率不高的医院16家（39.02%）,规模报酬递减的医院17家（41.46%）,规模报酬递增的医院7家（17.07%）;实际开放床位数、职工总数、总支出、固定资产投入冗余,门急诊人次数、出院人数、业务收入产出不足。结论 注重投入与产出研究,合理控制医院发展规模,提高资源利用效率,加强医院运营管理。     

基于Malmquist指数的我国省际医院生产效率分析

目的 分析我国医院效率的动态变化及来源。方法 利用马奎斯特指数及分解。结果 2010—2014年间我国医院的马奎斯特指数呈上升趋势。结论 目前我国医院的全要素生产率改善主要来自纯技术效率的变化,说明我国医院逐步从以前粗放式发展阶段迈向精耕细作的新阶段,规模效率大于1,表明组建医药集团经营的可行性。     

广东省县级公立医院改革试点医院效率分析

目的 评价县级公立医院综合改革试点医院服务体系运营效率。方法 以广东省第一批县级公立医院综合改革试点医院为研究对象,运用DEA-Malmquist指数法分析其全要素生产率及其分解因素的变化趋势。结果 2012—2015年广东第一批县级公立医院改革试点医院全要素生产率平均下降1.6%,技术进步下降2.4%,技术效率增长0.8%。纯技术效率和规模效率年平均增长率分别为0.5%和0.2%;跨年度全要素生产率由0.951上,升到1.004。结论 广东省县级公立医院全要素生产率有待提高,需补足技术短板,从而提高整体运营效率。     

湖北省县级公立医院综合改革试点医院运行效率评价

目的 评价湖北省县级公立医院综合改革试点医院运行效率,为后续改革提供相应政策建议。方法 运用数据包络方法,分别使用CCR、BCC模型测量2014年湖北省73家县级公立医院运行效率。结果 总体有效的医院有15家（20.5%）,平均总体效率值是0.814;技术有效的医院有33家（45.2%）,规模有效的医院15家（20.5%）;规模报酬递增的有4家（5.5%）,规模报酬递减的有54家（74.0%）。结论 湖北省县级公立医院总体效率有待提高,特别是需进一步控制医院规模,从而提高整体运行效率。     

武汉市医院效率动态变化的Malmquist指数分析

目的 了解武汉市医院2006—2008年3年间运行效率变化的情况,找出引起其效率变化的原因,有针对性地采取措施,以提高医院的整体效率。方法 通过Malmquist指数法分析了武汉市23家医院3年间的全要素生产率、技术效率、技术变化等方面的变化趋势。结果 23家医院全要素生产率普遍下降主要是由于技术退步所致,医院的纯技术效率和规模效率趋于稳定,发挥的促进作用较小。结论 医院不但需要提高管理水平、引进先进的管理模式、控制合适的规模以保证技术效率的提高;更应引进人才,加强技术培训与进修,鼓励医务人员在诊疗技术、诊疗过程上有所创新,以此来提高医疗技术水平,进而提升医院的运行效率。

     

基于Malmquist指数的北京二级中医医院运行效率研究

目的 分析北京市13家二级中医医院总体运行效率及中医服务提供运行效率现状,探索其影响因素并为医院决策提供建议。方法 采用描述性统计分析方法描述各项指标的基本情况,采用数据包络分析Malmquist指数模型分析运行效率及变化趋势。结果 2012—2013年10家医院总体全要素生产率上升,6家医院中医服务全要素生产率上升;2013—2014年8家医院总体全要素生产率上升,4家医院中医服务全要素生产率上升。结论 近3年二级中医医院中医服务效率略低于总体运行效率,二级中医医院中医服务技术进步缓慢,效率降低为全要素生产率降低的主要原因。

     

Characterization of the 90 kDa heat shock protein (HSP90)-associated ATP/GTPase

The 90 kDa heat shock protein (HSP90) is an ATP-binding molecular chaperone with an associated ATPase activity having nucleoplasmin and HSP70-binding homology domains and containing Ca-binding EF-hands and a nuclear localization signal. Here we characterize the HSP90-associated ATPase and show that it is (i) a P-type ATPase inhibited by molybdate and vanadate, (ii) able to hydrolyze methylfluorescein phosphate with a 5–6-fold higher affinity, (iii) a 3-times better GTPase than ATPase in the presence of calcium and (iv) HSP27 and F-actin, but not HSP10 can “convert” the HSP90-associated ATPase activity to HSP90 autokinase activity. The HSP90-associated ATP/GTPase may participate in the regulation of complex formation of HSP90 with other proteins, such as F-actin, tubulin and heat shock proteins.     

Regulation of cellular signals by G-proteins

Extracellular signals are transduced across the cell by the cell surface receptors, with the aid of G-proteins, which act at a critical point of signal transduction and cellular regulation. Structurally, G-proteins are heterotrimeric consisting α, β and γ subunits but in functionally active state they dissociate into α subunit coupled to GTP and as βγ dimer. G-proteins can be broadly divided into two classes based on their sensitivity to pertussis toxin and cholera toxin. Existence of various forms of each of the subunit allows molecular diversity in the subunit species of G-proteins. These subunits interact with a wide range of receptors and effectors, facilitated by post translational modification of their subunits. Different types of G-proteins mediate several signalling events in different parts of the body. This review summarizes the features of (i) structural and functional heterogenity among different subunits of G-proteins, (ii) interaction of G-proteins and their subunits with effectors with specific cases of G-protein mediated signalling in olfaction, phototransduction in the retina, ras andras related transduction and (iii) disease conditions associated with malfunctioning of G-proteins.     

A study on distribution of natural radionuclide polonium-210 in a pond ecosystem

This paper presents the results of an investigation on the distribution of²¹⁰Po in Mutharasanallur pond ecosystem. It has been demonstrated that²¹⁰Po is non-uniformly distributed within the ecosystem. The results of the study show a dissolved²¹⁰Po concentration in pond water of 1 4mBq 1₋₁. The sediment samplso recorded a²¹⁰Po activity of 59 9 Bq kg₋₁. The aquatic organisms showed differential accumulation of the radionuclide with enhanced bioaccumulation in soft tissues and muscle. The²¹⁰Po activity in the biota fell within the range of 1·2–53 3 Bq kg₋₁ (wet wt). The bivalve mussel,Lamellidens marginalis was identified to accumulate higher concentration of²¹⁰Poin soft tissues, suggesting that these organisms could serve as a bio-monitor of²¹⁰Po radionuclide in a freshwater system. The concentration factors of²¹⁰Po for the biotic components ranged from ∼10²–∼10⁴. Analyses of the results indicate that prawn and fish represent an important source of supply of²¹⁰Po to humans via dietary intake. Results of²¹⁰Po activity in the abiotic and biotic components of the pond ecosystem were higher when compared with those of Cauvery river system, the primary water source of the pond.     

Missing self by heterogeneous natural killer cells

Some murine (YAC, P815 and SP20) and human (Molt4, Raji and HR7) tumour cell lines were (i) treated with IFN-γ for inducing enhanced expression of MHC class I antigen, or (ii) given a brief treatment with citrate buffer (pH 3.0), which resulted in denaturation of class I MHC antigens on these tumour cells. IFL-γ or acid treated tumour cells were used as unlabelled competing targets in cold target inhibition assays. The results indicated that the competing ability of acid-treated tumour cells remained unaltered, whereas IFN-γ treated tumour cells competed with significantly less efficiency. These results have been evaluated in light of the current view of NK cell development and the expression of inhibitory receptors for MHC class I molecules (IRMs), on NK cells. A modified view on NK cell heterogeneity based upon IRM expression has been proposed which reconciles several apparently discordant observations about the activity and role of NK cells. Two classes of NK cells have been proposed. Type I NK ceils have target recognition receptors which do not recognize autologous normal cells, lack IRMs, and may participate in first line of defence against transformed cells in vivo. Type II NK cells have target recognition receptors for autologous normal cells and express at least one self-reactive IRM in order to prevent auto-killing. Type II NK cells participate in killing those transformed cells which down-regulate their MHC class I expression in order to escape cytotoxic T-cell surveillance. It is also postulated that mechanism of inverse correlation of target cell MHC class I expression levels and their susceptibility to NK cells, involves interference model of missing self hypothesis for type I NK cells and inhibitory signal model of missing self hypothesis for type II NE cells. Finally, it is proposed that acid treatment of tumour cells enhances their lysis susceptibility by making them additionally susceptible to type II NK cells, rather than enhancing their killing by type I NK cells. This proposition would explain the lack of effect of acid treatment on the competing ability of tumour cells, when target cells are only lysed by type I NE cells.     

Source and target enzyme signature in serine protease inhibitor active site sequences

Amino acid sequences of proteinaceous proteinase inhibitors have been extensively analysed for deriving information regarding the molecular evolution and functional relationship of these proteins. These sequences have been grouped into several well defined families. It was found that the phylogeny constructed with the sequences corresponding to the exposed loop responsible for inhibition has several branches that resemble those obtained from comparisons using the entire sequence. The major branches of the unrooted tree corresponded to the families to which the inhibitors belonged. Further branching is related to the enzyme specificity of the inhibitor. Examination of the active site loop sequences of trypsin inhibitors revealed that here are strong preferences for specific amino acids at different positions of the loop. These preferences are inhibitor class specific. Inhibitors active against more than one enzyme occur within a class and confirm to class specific sequence in their loops. Hence, only a few positions in the loop seem to determine the specificity. The ability to inhibit the same enzyme by inhibitors that belong to different classes appears to be a result of convergent evolution.     

Conformation of the C-terminal pentapeptide—the ‘message sequence’—of tachykinins as determined by consensus dynamic

The tachykinins are a family of gastrointestinal peptides comprising eight members: substance P, neurokinin A, neurokinin B, eledoisin, physalemin, uperolein, kassinin and phyllomedusin. Consensus dynamics was carried out on an ensemble of seven tachykinins to determine the binding conformation of the common C-terminal fragment: Phe-X-Gly-Leu-Met-NH ₂ ,the ’message sequence’ of tachykinins. Three binding modes for the C-terminal pentapeptide were determined. The first binding conformation is folded due to an intramolecular H-bond between the NH of the variable residue (X) and CO of Met. Other features include γ-bends at both the variable amino acid (X) and at Gly. The global minimum of the simulation has this conformation for the C-terminal pentapeptide. The other two binding modes have slightly higher energies. The second is chiefly characterized by a β-turn around the segment X-Gly-Leu-Met, with additional β-bends at the variable amino acid (X) and Met. The final binding conformation is composed of β-bends around the variable amino acid (X) and Leu, and a ’pseudo’ γ-bend at the terminal Met. This paper was presented at the MBU Silver Jubilee Symposium on Structural Biology and 24th Annual Meeting of the Indian Biophysical Society held at Indian Institute of Science, Bangalore, Dec. 9–12, 1996.     

Substances interfering with phosphatidyl inositol signalling pathway affect ultradian rhythm ofDesmodium motorium

The ultradian rhythm of the lateral leaflets ofDesmodium motorium}(Houtt.) Merril. was recorded with a picture analysis method using a video camera and a computer. The periods are in the minute range and depend strongly on temperature. The phosphatidyl inositol signal chain might be involved in the ultradian rhythm of the lateral leaflet movement of Desmodium motorium:Myoinositol shortens the period length and reduces the known period lengthening effect of lithium ions. Neomycin, which inhibits the hydrolysis of phosphatidylinositol-4,5 -biphosphate to inositol-4-phosphate and diacylglycerin, lengthens the period of the rhythm at low concentrations (0.2 mM). Higher concentrations shorten the period, perhaps by activating G protein. Mastoparan, which activates G protein, shortens period likewise. The G protein agonists fluorid ion and ethanol are toxic for the lateral leaflets and could therefore not be used to test the involvement of G protein. The intracellular Ca ²⁺ antagonist 3,4,5-trinietlioxybeiizoic acid 8-(diethylamino)octylester lengthens the period of the rhythm. This indicates, that release of Cas ²⁺ from intracellular stores is important for the lateral leaflet movement rhythm.     

Flowcytometric assessment of intracellular interferon -γ production in human CD4 + ve T-cells on mycobacterial antigen stimulation

Interferon-(IFN-γ) has been considered to be a critical protective immunomodulatory component against Mycobacterium tuberculosis (M. tb.) infection. In this study T-cell proliferation and IFN-γ production upon stimulation with M. tb. were assessed in patients of pulmonary tuberculosis and healthy contacts. The studies were based on lymphocyte transformation test and detection of intracellular IFN-γ production by CD4 + ve T-cells by flowcytometry. Patients showed lower levels of proliferation, the stimulation index being in the range of 2.17 1.1 (mean + SD) compared to the contacts (SI = 4 59±1.6) (P < 0.01). The kinetics of intracellular induction of IFN-γ on M. tb. stimulation showed a proportional increase in the CD4 + ve T-cell population. The increase was maximal between 96–120 h of culture. In healthy contacts the number of IFN-γ expressing CD + ve T-cells increased to 2.5 to 41 × 10⁴ cells/ml in M. tb. stimulated cultures compared to control cultures (0.1 – 15 × 10⁴). In contrast patients showed no/marginal increase in CD4 + ve T-cell population expressing intracellular IFN-γ Thus the lack of induction of IFN in CD4 + ve T-cells in patients could be a critical shortcoming in their ability to combat tubercle bacilli infection.     

Mammotrope heterogeneity in the pituitary gland of European ferret,Mustela putorius furo: An immunoelectron-microscopic study

Employing the superimposition technique of electron-microscopic immunocytochemistry ultrastructural heterogeneity of the mammotropes in the pituitary gland of the European ferret,Mustela putorius furo,was studied. On the basis of the size of their secretory granules, the mammotropes were classified into three subtypes, type-I, type-II and type-Ill, which may correspond to different developmental or physiological states of a single cell type. Simultaneous study of mammotropes and somatotropes in several pairs of serial semithin sections demonstrated the occasional occurrence of bihormonal somatomammotropes /mammosomatotropes which may represent a transitional stage of the progenitor stem-somatotrope during its differentiation into mammotrope; alternatively it may be a functional intermediate during the cross-transformation of somatotrope into mammotrope or vice versa.     

Within- and among-population variation in oviposition preference for urea-supplemented food inDrosophila melanogaster

Oviposition preference for ureasupplemented food was assayed by simultaneous choice trials on five pairs of closely related laboratory populations of Drosophila melanogaster.Each pair of populations had been derived from a separate ancestral population about 85 generations prior to this study. One population in each pair had been subjected to selection for larval tolerance to the toxic effects of urea; the other population served as a control. Considerable variation in oviposition preference was seen both within and among populations, with four of the ten populations showing a significant mean preference for ureasupplemented food. The degree of specificity shown by individual females was surprisingly high, leading to a bimodal distribution of oviposition preference in some populations. Overall, selection for larval tolerance to urea did not significantly affect oviposition preference. However, the data indicated that pairwise comparisons between randomly selected populations from the two larval selection regimes would lead to a range of possible outcomes, suggesting, in several cases, that selection for larval urea tolerance had led to significant differentiation of adult oviposition preference for urea in one or the other direction. The results, therefore, highlight the importance of population level replication and caution against the practice, common in ecological studies, of assaying oviposition preference in two populations that utilize different hosts in nature, and then drawing broad evolutionary inferences from the results.