Vertical Integration, Competition, and Financial Exchanges: Is There Grain in the Silo?

SUMMARY Important elements in the curriculum at the Faculty of Health Sciences in Linköping are vertical integration, i.e. integration between the clinical and basic science sections of the curriculum, and horizontal integration between different subject areas. Integration throughout the whole curriculum is time-consuming for both teachers and students and hard work is required for planning, organization and execution. The aim was to assess the importance of vertical and horizontal integration in an undergraduate medical curriculum, according to opinions among students and teachers. In a questionnaire 102 faculty teachers and 106 students were asked about the importance of 14 different components of the undergraduate medical curriculum including vertical and horizontal integration. They were asked to assign between one and six points to each component (6 points = extremely important for the quality of the curriculum; 1 point = unimportant). Students as well as teachers appreciated highly both forms of integration. Students scored horizontal integration slightly but significantly higher than the teachers (median 6 vs 5 points; p=0.009, Mann-Whitney U-test), whereas teachers scored vertical integration higher than students (6 vs 5; p=0.019, Mann-Whitney U-test). Both students and teachers considered horizontal and vertical integration to be highly important components of the undergraduate medical programme. We believe both kinds of integration support problem-based learning and stimulate deep and lifelong learning and suggest that integration should always be considered deeply when a new curriculum is planned for undergraduate medical education.

In the domain of manufacturing, the pursuit of process optimization has undergone a notable transition towards a data-driven approach. However, it must be noted that the quantity of available data is often inadequate for generating precise predictions regarding the outcomes of manufacturing processes. Consequently, this paper presents an empirical investigation of how horizontal and vertical data integration, as part of a proposed conceptual optimization workflow, influence the predictive readiness of multi-stage regression models intended for downstream surrogate-based optimization in manufacturing. While data integration has been widely discussed as a means to overcome limited data availability, quantitative evidence on its effects within multi-stage regression settings remains scarce. To address this gap, a case study based on a publicly available multi-stage continuous-manufacturing dataset is conducted to quantify the impact of varying degrees of horizontal integration across similar machines and vertical integration across consecutive process stages. The results show that (i) horizontal data integration can improve model robustness to data drift by expanding the attribute value range, (ii) vertical integration of cross-stage process data has the potential to enhance prediction accuracy compared to siloed modeling, and (iii) more general models trained on heterogeneous environments do not necessarily yield better performance for environment-specific prediction tasks. Full physical validation of the proposed optimization workflow and real-world deployment are outside scope due to dataset limitations. The findings provide practical and scientific insights on when and how data integration supports data-driven manufacturing optimization.

PurposeDesign, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.Design/methodology/approachThis case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.FindingsOn the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.Originality/valueThis case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.

Vertical vs. horizontal integration: Game analysis for the rare earth industrial integration in China

Reducing the manufacturing and marketing time of products by means of integrated simulation-based design and development of the material, product, and the associated manufacturing processes is the need of the hour for industry. This requires the design of materials to targeted performance goals through bottom-up and top-down modeling and simulation practices that enables handshakes between modelers and designers along the entire product realization process. Manufacturing a product involves a host of unit operations and the final properties of the manufactured product depends on the processing steps carried out at each of these unit operations. In order to effectively couple the material processing-structure-property-performance spaces, there needs to be an interplay of the systems-based design of materials with enhancement of models of various unit operations through multiscale modeling methodologies and integration of these models at different length scales (vertical integration). This ensures the flow of information from one unit operation to another thereby establishing the integration of manufacturing processes (horizontal integration). Together these types of integration will support the decision-based design of the manufacturing process chain so as to realize the end product. In this paper, we present a goal-oriented, inverse decision-based design method to achieve the vertical and horizontal integration of models for the hot rolling and cooling stages of the steel manufacturing process chain for the production of a rod with defined properties. The primary mathematical construct used for the method presented is the compromise Decision Support Problem (cDSP) supported by the proposed Concept Exploration Framework (CEF) to generate satisficing solutions under uncertainty. The efficacy of the method is illustrated by exploring the design space for the microstructure after cooling that satisfies the requirements identified by the end mechanical properties of the product. The design decisions made are then communicated in an inverse manner to carry out the design exploration of the cooling stage to identify the design set points for cooling that satisfies the new target microstructure requirements identified. Specific requirements such as managing the banded microstructure to minimize distortion in forged gear blanks are considered in the problem. The proposed method is generic and we plan to extend the work by carrying out the integrated decision-based design exploration of rolling and reheating stages that precede to realize the end product.

The problem of interdisciplinary educational integration reflects the realities of the modern world. Rapidly changing technologies set new requirements for the training of specialists capable of innovation. The study of the vertical and horizontal interdisciplinary integration resources for the disciplines of the humanities and management cycle is the purpose of this work. The structure of the article includes a theoretical and methodological analysis and an empirical part, represented by two stages of research (for socio-humanitarian and management disciplines). The article presents the results of modern views on the problem of interdisciplinary integration in higher education. The results of the theoretical analysis showed a mismatch between the depth of the theoretical study of the problem and the success of their practical implementation in the conditions of modern higher professional education. The complexity of the implementation is due to the changed psychological and socio-psychological characteristics of Generation Z students. Based on the theoretical analysis, a typology of interdisciplinary competencies was proposed. The aim of the empirical part of the study was to study the resources of vertical and horizontal integration at a technical university. Based on the empirical research, the possibilities of vertical and horizontal integration of the disciplines of the socio-humanitarian and management cycle were identified. An integrative matrix is presented. A promising direction for this topic is the development of an integrative module “Management workshop”.

BackgroundStudies on multiple modalities of omics data such as transcriptomics, genomics and proteomics are growing in popularity, since they allow us to investigate complex mechanisms across molecular layers. It is widely recognized that integrative omics analysis holds the promise to unlock novel and actionable biological insights into health and disease. Integration of multi-omics data remains challenging, however, and requires combination of several software tools and extensive technical expertise to account for the properties of heterogeneous data.ResultsThis paper presents the miodin R package, which provides a streamlined workflow-based syntax for multi-omics data analysis. The package allows users to perform analysis of omics data either across experiments on the same samples (vertical integration), or across studies on the same variables (horizontal integration). Workflows have been designed to promote transparent data analysis and reduce the technical expertise required to perform low-level data import and processing.ConclusionsThe miodin package is implemented in R and is freely available for use and extension under the GPL-3 license. Package source, reference documentation and user manual are available at https://gitlab.com/algoromics/miodin.

PurposeThe purpose of this paper is to extend the knowledge of the use of performance measurement systems (PMS) in situations where the benefits of both vertical and horizontal integration strategies are sought simultaneously.Design/methodology/approachThis is a single case study, the purpose of which is to build a contextual theory.FindingsThe main results highlight three competing and partly contradictory tendencies in the development and use of PMS in organizational integration. In addition, the authors have identified features of PMS that may benefit or hinder integration. Grounded on empirical findings the paper presents a more complete theoretical framework of PMS for integration.Research limitations/implicationsThe propositions of the framework need to be tested in different contexts with case and field studies or a large sample of data using statistical techniques to improve external validity. The causal relationships explored in this study may be further developed using longitudinal studies.Practical implicationsIn acquisition situations there exists the need for vertical integration to control the growing complexity but at the same time for horizontal control to advance customer-centred production. Performance measurement is the key issue to examine the execution and results of such integrations.Originality/valueCase study findings are used to develop a more comprehensive theory of PMS design and use in situations where both vertical and horizontal integration are sought. Contrary to current understandings, the central statement of this study is that horizontal organization is not an alternative to vertical organizational structure but they can be effectively coupled.

With its remarkable growth, the cable TV industry has witnessed increasing business integration continuously. This study categorizes technology-based operators into 3 groups on the basis of business integration—vertically integrated, horizontally integrated, and isolated system operators-and estimates the efficiency of each group. In addition, metafrontier analysis is employed to compare the efficiencies of the groups. The results suggest that vertically and horizontally integrated system operators can improve technical efficiency by accomplishing economies of scope and scale, respectively.

The sectoral structural model of adjacent markets of the wine industry is considered. System imbalance was detected at all levels of vertical integration. It is proved that the regulatory influence on the development of viticulture and winemaking should be focused on the conditions and behavior of the industry and directly or indirectly affect the efficiency of their business processes. It is important to consider integration processes that reflect the levels and the nature of the interaction of market mechanisms of self-regulation and regulatory influences on the part of the state. The main tendencies and problems of development of domestic viticulture and winemaking are highlighted. Trends in winemaking are the reduction of the vineyard area, the imbalance in the varietal composition of the vineyards, which significantly reduces the production potential of domestic winemaking and reflects on the quality and competitiveness of domestic winemaking products. The promotion of winemaking products in the domestic market is slow. Attempts to enter the domestic wine on the foreign market are more spontaneous than a meaningful planned character. The solution of these problems lies within two interconnected areas: on the one hand, the improvement of product quality by the introduction of innovative technologies under continuous scientific support, and, on the other hand, the adaptation of the scientific and experimental process to the needs of a market economy by the transition to an innovative development model. The importance of formation of the market of wine-making products, its balancing with the market of viticulture with the use of marketing tools for managing the effective development of enterprises of the wine-making industry is proved. The essence and possible directions of implementation of the integrated marketing management as the latest holistic conception for activation of innovative development of winemaking enterprises of Ukraine are substantiated. Integrated marketing management (implementation of planned, regulated, coordinated impact on the consumer) is the basis for balancing demand-supply, regulation of export-import activity, innovation development of the industry. Such an approach enables to reconcile long-term industrial goals of development, to determine the current tasks, to make informed management decisions. The concept of holistic marketing focuses on ensuring a balance of interests of all market participants, increasing the competitiveness of the food sector of the economy, developing its resource and investment opportunities, and also provides the necessary feedback to consumers in the regional food market. Taking into account the vertically integrated interaction of adjacent markets in the field of viticulture and winemaking, the holistic concept should include blocks, according to the levels of marketing management, taking into account both horizontal and vertical (raw) integration: international, macromarketing (state / regional), mesomarketing (sectoral - integration of adjacent markets), micro-marketing.

With the competitive environment accelerating in healthcare industry, the hospital network system is considered as one of the strategies for clinical and managerial efficiency. This study was intended to offer a theoretical view on the hospital network system and to analyze the current network status of hospitals in Korea. Specifically, network types were classified based on the criteria modified from previous studies, and were used to describe and compare the scope and intensity of associated activities. The questionnaire survey was conducted with 237 hospitals during the period of December 27 2005 to January 25 2006. Above 90% of tertiary and secondary care hospitals were under the network system, while only 20% of primary care clinics were affiliated. In general, the scope and intensity of network activities was limited. Vertical and/or clinical integration was more common than horizontal and/or managerial integration. Three most frequent types of hospital network systems were clinical-vertical integration (Type A), clinical/managerial-vertical integration(Type B), and clinical/managerial-horizontal /vertical integration (Type C). Such network types differentiated significantly different features of affiliated hospitals and network systems. The affiliation duration to the network system was the only significant factor influencing on the network type. The strategic approach to the network system was emphasized for hospitals to increase the potential advantage of hospital network systems.

A methodology is outlined for the evaluation of horizontal and vertical integration in socialist agriculture in Eastern Europe and the Soviet Union in terms of a comparison between the volume of production attained after the integration process was carried out and that which would have been attained without further integration. The procedure proposed is based on exponential smoothing forecasting to which adjustments are made for changes in factor inputs via a micro-economic production function. A practical application for Bulgaria is reported. The results of the exponential smoothing plus production function analysis accord with those obtained by traditional evaluation procedures.

Community hospitals may be able to increase revenue by diversifying into non-inpatient service lines. A model predicting this kind of diversification has not been developed. Data from community hospitals in Wisconsin was analyzed to explain diversification into non-inpatient service lines. Principal components analysis was applied to the services offered to identify factors. The derived factor scores were analyzed using multiple linear regression. Two distinct noninpatient identities were identified: a vertically integrated acute hospital and a hospital diversified into community-based services. Regression analysis revealed that horizontal integration was related to vertical integration into non-inpatient service lines. Community hospitals belonging to alliances and systems had lower vertical integration scores.

This study aims to get a deeper explanation of vertical integration in the broiler industry in Indonesia. The data used is secondary data on case decisions number 02 / KPPU-I / 2016. KomisiPengawasPersaingan Usaha (KPPU) Republik Indonesia has issued a decision about the alleged violation of article 11 of Act Number 5 of 1999 related to the regulation of broiler production in Indonesia. The data obtained were analyzed by descriptive method. The results obtained are (1) there are 20 large companies that are directly related to the broiler trade industry, (2) broiler industry products are DOC, feed, vitamins and drugs, raw materials for poultry feed and carcasses, (3) the business category in the broiler trade industry is integrated business, semi-integration business and non-integrated businesses. Integration business consists of vertical integration and horizontal integration. Vertical integration is a business that has a series of production processes from upstream to downstream. Semi-integration business is a business that only has more than one production line but does not control the business from upstream to downstream. Non-integration business is a business that only has one production process. Integration business has a dominant market share and can influence the price maker. It was suggested that the Government monitor more closely the large companies that carry out integration so as not to collude and form a monopoly market.

In its traditional form, medical education begins with learning basic science disciplines, with subsequent transition to clinical training. The basic sciences are taught as a series of separate academic courses, with no coordination applied at the inter-disciplinary level. During past decades, the integrated curriculum has become increasingly popular as a novel instructional strategy that promotes contextual learning in medical practice. The curriculum breaks down the barriers between basic and clinical sciences (vertical integration), interconnects teaching of various basic science disciplines (horizontal integration) and facilitates the acquisition of critical thinking, problem-solving and team-working skills through collaborative learning. The vertical integration is encouraged with training in clinical and communication skills starting in the first semester, teaching basic sciences at the interface with medical problems and involving clinicians in giving lectures on applied anatomy and clinical physiology. In order to facilitate the horizontal integration, basic science disciplines are taught concurrently within interdisciplinary units aligned around the body organ systems. This contributes to a better understanding of complex interrelations between structure and function and stimulates wider insights into mechanisms of the disease. The integrated curriculum supports conceptual learning rather than simple memorisation of fragmented factual knowledge. As such, it relieves the information overload imposed on students due to a rapid growth of medical knowledge in the contemporary world. With the integrated curriculum, the main emphasis is placed on problem-oriented learning guided by an experienced tutor in a small group of students. In this setting, a realistic medical case is used as a trigger for discussion aimed at linking basic science concepts with the clinical problem. Through collaborative problem-solving, students develop a clinical reasoning and team-working skills. Overall, problem-based learning puts forward a student-centred approach in a sense that students themselves are primarily responsible for identifying relevant learning objectives and self-guided acquisition of medical knowledge. This raises their motivation in learning basic sciences and markedly improves the perception of learning environment. In summary, the integrated curriculum offers a number of benefits to medical students and appears to provide an effective instrument in developing professional competencies required in clinical work.