DGA Partners

We appreciate the responses[1][1],[2][2] to our article published in CMAJ entitled, “Health Canada needs to act on laboratory-developed diagnostics.”[3][3] Michele D’Elia from Roche Diagnostics offered an update, indicating that the company’s noninvasive prenatal test was approved by Health

Parathyroid (PT) lesions can be difficult to recognize in thyroid fine needle aspirations (FNAs), and when not identified correctly, PT cells may be mistaken for potentially abnormal thyroid cells. We therefore studied the utility of combining cytology, immunohistochemistry, and a molecular classifier to identify PT cells in thyroid FNAs. Thyroid FNAs were received in CytoLyt, and were evaluated initially using The Bethesda System for Reporting Thyroid Cytology (TBSRTC). The PT molecular classifier was performed along with the Afirma Gene Expression Classifier (GEC) on samples with indeterminate cytology. Immunohistochemistry (IHC) for PT was performed on all samples using Cellient cell block sections. Clinical and ultrasound information was collected, when available. PT tissue was identified in 60 thyroid FNAs. Forty-seven (47) samples had cytologic features that were suggestive of PT cells, and were subsequently confirmed with IHC. Thirteen (13) samples were not recognized as PT, and were considered to be either Bethesda III or IV indeterminate thyroid nodules; a PT gene expression signature was subsequently detected by the GEC. These samples were also confirmed as PT by IHC. Clinical and ultrasound features were suggestive of a PT lesion in only a third of cases. Cytologic features, coupled with IHC, can identify intrathyroidal PT cells in the majority of CytoLyt samples. However, a significant minority (22%) of these FNAs may be misclassified as indeterminate by TBSRTC criteria, and molecular detection of the PT tissue can be helpful to potentially avoid an additional biopsy or diagnostic surgery. Diagn. Cytopathol. 2017;45:526-532. © 2017 Wiley Periodicals, Inc.

Hospital leaders who are contemplating participation in a bundled payment initiative should first assess current circumstances to determine the extent of the opportunity for their organizations. Those who have decided conditions are favorable for such an initiative should next perform a financial assessment that includes modeling direct contract results, assessing the financial impact of reduced utilization and of improved clinical care and operations, and evaluating the net financial impact. Hospital executives also should understand the competitive and strategic benefits that bundled payment offers.

ABSTRACTObjective: To evaluate by survey the comfort upon instillation of timolol hemihydrate compared to timolol maleate with potassium sorbate.Design: A prospective, multicenter, observational, non-interventional study.Participants: One hundred and three patients of open-angle glaucoma or ocular hypertension who were ≥21 years old and were currently prescribed timolol hemihydrate (once or twice daily) or timolol maleate with potassium sorbate once daily as monotherapy or as a part of two-drug therapy.Materials and methods: Study was performed at seven clinical sites in the United States. Patients were surveyed on comfort upon instillation of timolol hemihydrate compared to timolol maleate with potassium sorbate.Results: A difference between timolol hemihydrate and timolol maleate with potassium sorbate for questions 1 (burning/stinging on instillation, p < 0.001) and 4 (tearing on instillation, p = 0.024) was noted. There were no differences between treatment groups for any other question (p > 0.05).Conclusion: This survey suggests that timolol hemihydrate is associated with less stinging/burning and tearing than timolol maleate with potassium sorbate.How to cite this article: Stewart WC, Oehler JC, Choplin NT, Markoff JI, Moster MR, Ichhpujani P, Nelson LA. A Comfort Survey of Timolol Hemihydrate 0.5% Solution Once or Twice Daily vs Timolol Maleate in Sorbate. J Current Glau Prac 2013;7(1):11-16.

For many stand-alone hospitals, a merger, partnership, or affiliation may be the only option to access scale and remain viable in the nation's emerging new healthcare delivery system. These organizations can consider many options for affiliation, including traditional options such as affiliation with regional academic medical centers, a merger or takeover to become the corporate member of a large system, and acquisition by a for-profit system. Emerging options include mergers for scale and access to capital, private-equity transactions, and arrangements involving insurance vertical integration.

Implementing an effective clinical integration program requires deliberate investment of time and resources in five key areas: Physician leadership, Physician-led care management, Quality monitoring, Patient information and data sharing, Payer engagement.

Thousands of large diameter drilled shaft foundations are constructed every year to support electric transmission line steel structures. The design of these relatively short, laterally loaded shafts is quite often controlled by performance criteria, i.e. top of shaft deflection and rotation. Traditional design considers possible impacts to overhead conductor and structure performance. Yet, little research has been done to determine how these criteria relate to foundation performance. A study of historic full scale drilled shaft load test results shows a strong relationship between top of shaft rotation and normalized top of shaft deflection (deflection divided by shaft diameter). Test data indicate that lateral loads cannot be maintained without rapid progression to geotechnical failure when top of shaft rotation exceeds about 1 degree. Shaft movement less than this threshold most often exhibits linearly elastic load-deflection and load-rotation behavior, while more plastic movement is generally observed above this level. Evaluating top of shaft rotation/deflection and below ground line deflection results from full scale tests shows short, large diameter reinforced concrete shafts are most accurately modeled assuming rigid body motion with uniform flexure stiffness of the shaft. The paper presents a simplified state-of-practice approach for establishing appropriate performance criteria in relation to drilled shaft diameter.

This paper presents a hydraulic analysis of a fluid coupling which is designed to operate either in a forward or reverse mode when a set of turning vanes are respectively withdrawn or inserted into the flow between the driving and driven rotors. The flow path is subdivided into a set of streamtubes and an iterative method is used to adjust the cross-sectional areas of these streamtubes in order to satisfy radial equilibrium. Though the analysis requires the estimation of a number of loss coefficients, it predicts coupling performance data which are in good agreement with that measured in NAVSSES tests of a large reversible coupling intended for use in a ship drive train.