Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program ("IN" group) were compared to members who were not yet enrolled ("OUT" group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1-12 months, 13-24 months, and 25-36 months.Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

The effect of Zhangfei on the unfolded protein response and growth of cells derived from canine and human osteosarcomas

The objective of this study was to determine whether the protein Zhangfei could suppress the unfolded protein response (UPR) and growth of osteosarcoma cells. Dog (D-17) and a human (Saos-2) osteosarcoma cells were infected with adenovirus vectors expressing either Zhangfei or the control protein beta- galactosidase. We monitored cell growth as well as levels of UPR gene transcripts and proteins. We found that Zhangfei suppressed the growth of both D-17 and Saos-2 cells. Zhangfei-expressing D-17 cells displayed large vacuoles containing culture medium and expressed phosphatidylserine on their external surface suggesting that Zhangfei induced macropinocytosis and apoptosis in these cells. While Zhangfei inhibited the growth of both D-17 and Saos-2 cells, it inhibited thapsigargin-induced UPR, as detected by a decrease in transcripts for UPR genes, and HERP and GRP78 proteins, only in D-17 cells, suggesting that the ability of Zhangfei to suppress the UPR and tumour cells growth may not be linked.

Personality and criminal profile of adolescent sexual offenders, general offenders in comparison to nonoffenders

16 adolescent male sex offenders and 13 general offenders were compared with 13 nonoffenders on psychometric tests to investigate differences in their general intelligence, personality, and criminal attitudes. There were no significant differences in general intelligence amongst the groups. Examination of personality scores and criminal attitudes showed that the sex offenders were more socially isolated, more assaultive, and more resentful than the general offenders. Present results, if replicated with larger samples, suggest treatment of adolescent sex offenders in a manner similar to that used in the treatment of adult sex offenders.

Computed tomography after skull base resection

We have obtained serial CT scans in the evaluation and follow-up of 80 patients with lesions of the skull base. CT scanning has been useful for assessment of recurrence in this group of patients, many of whom underwent complex ablative and reconstructive procedures.

Spontaneous extracranial pneumatocele associated with mastoid hyperpneumatization

Spontaneous extracranial pneumatoceles unassociated with trauma are rare. We report a case of spontaneous extracranial mastoid pneumatocele associated with exuberant pneumatization of the calvarium and mastoid. The patient presented with a compressible bulge over the base of the zygoma and superior to the pinna. Surgical exploration demonstrated a large air sac in continuity with nontraumatic bony defects of the tympanosquamous and tympanomastoid sutures.

Ultrastructure of the granule cells in the small intestine of the rainbow trout (Salmo gairdneri) before and after stratum granulosum formation

The ultrastructure of the small intestinal granule cells (GC) of the rainbow trout (Salmo gairdneri) was studied in fry and fingerlings before the cells organized to form the stratum granulosum (SG) and in 12-month-old juveniles which possess a well-developed SG several cell diameters in thickness. The GC of juvenile trout exhibit a striking reduction in nucleolar numbers and in the quantity of rough endoplasmic reticulum relative to the GC of younger fish, but contain even greater numbers of large, electron-dense cytoplasmic granules. The final stages of cellular maturation therefore take place in the GC after their organization to form a layer, and the cells appear to lose their capacity to synthesize protein(s) for the cytoplasmic granules. Since the latter structures are, nevertheless, maintained in large numbers in mature GC, it is suggested that they function intact within the cell. No precursor to the granulated form of the GC was identified in the intestine, a result which suggests that the earliest developmental stages of the GC locate within another organ.

The development of the stratum granulosum of the small intestine of the rainbow trout (Salmo gairdneri)

The ontogeny of the stratum granulosum within the small intestine of the rainbow trout (Salmo gairdneri) was related to the chronological age of the animal. The component granule cells were first seen many weeks after the development of the collagenous stratum compactum. It is therefore concluded that the granule cells do not perform a critical role in stratum compactum formation. In addition, it is proposed that the stratum granulosum develops because of resistance of the stratum compactum to cellular penetration.

Positive and negative contrast myelography in spinal trauma

The myelograms of 60 acutely injured patients were reviewed. Positive contrast material (Pantopaque) was preferred in cervical and thoracic trauma manifesting bony deformity, in cervical trauma without bony deformity (in the prone position), in delineating the thoracic spinal cord in the frontal projection, and in lumbar spinal injuries. Negative contrast material (air) was preferred in cervical trauma without bony deformity, to delineate the thoracic spinal cord in the lateral projection and in chronic trauma to demonstrate cord atrophy. An experimental, water-soluble positive contrast material (Amipaque) may show the spinal cord advantageously in both the anteroposterior and lateral projections and may be more extensively used. A protocol has been devised, based on the analysis of the myelographic findings.

Experimental cerebral infarction in the monkey. Radiographic evaluation of steroid therapy

Cerebral ischemia and infarction have been produced in the Rhesus monkey using an autologous clot embolization technique. Preliminary findings suggest that cerebral arteriography may be used to study experimental cerebral infarction and ischemia, and the resulting cerebral edema and also that cerebral arteriography may be used as a tool for the evaluation of various types of therapy now used clinically in the treatment of these entities. The present experimental study in the monkey suggests that whereas steroid therapy initiated immediately following the onset of cerebral ischemia reduces morbidity and hastens clinical recovery, pretreatment with steroids in these same cases of cerebral ischemia may be hazardous and may increase the risk of cerebral infarction.