Total Functional Score Research Articles

Observations on the Medicare Value-Based Ranking of Hospitals During Fiscal Years 2015 and 2016.

Medicare's Value-Based Purchasing Program (VBPP) compensates hospitals based on value of care provided. VBPP's total performance score (TPS) components data were evaluated by hospital groups: physician-owned surgical hospitals (POSH), Kaiser Hospitals, University HealthSystem Consortium Hospitals, Pioneer Accountable Care Organization Hospitals, US News and World Report Honor Roll Hospitals, and other hospitals. Multilevel random coefficient models estimated mean and significance of TPS differences from fiscal year (FY) 2015 and FY 2016, by hospital type. Overall mean TPS for 2985 hospitals decreased from 41.65 to 40.25. POSH and Kaiser Hospitals had significantly higher TPS in FY 2015 and FY 2016. POSH Patient Experience Domain scores exceeded all other Patient Experience Domain scores. The Efficiency Domain scores of Kaiser greatly exceeded the scores of all groups. Results suggest that POSH and Kaiser Hospitals provide significantly greater value of care with consistency from year to year when compared with other groups studied.

Italian version and normative data of Addenbrooke's Cognitive Examination III.

A total of 574 healthy Italian participants (mean age 68.70 ± 9.65; mean education 9.15 ± 4.04) were recruited from the community and included in the study. Linear regression analysis was performed to evaluate the effects of age, gender, and education on the ACE-III total performance score. Age and education exerted a significant effect on total and subscale ACE-III scores, whereas gender was on attention/orientation, language, and visuospatial subscale scores. From the derived linear equation, correction grids to adjust raw scores and equivalent scores (ESs) with cut-off values were provided. The present study provided normative data, correction grids, and ESs for ACE-III in an Italian population.

The Impact of Hospitalists on Value-Based Purchasing Program Scores

As part of the provisions of the 2010 Affordable Care Act, the Centers for Medicare & Medicaid Services adjusts payments made to hospitals through its Hospital Value-Based Purchasing (HVBP) program. In light of the increasing aim to improve efficiency, healthcare organizations are exploring innovative strategies for care delivery, including the use of hospitalists. Supporters of the hospitalist model suggest use of these specialists offers several advantages over the traditional model of physician care in the inpatient setting, including improved coordination, reduced costs, and improved quality indicator scores. This study explores the effect of hospitalists on hospitals' scores in the four domains of the fiscal year 2016 HVBP program: clinical process of care, patient experience of care (PEOC), outcome, and efficiency. Data from the 2015 HVBP database, the 2015 Medicare Final Rule Standardizing File, and the 2015 American Hospital Association database were used for the analysis. The study used multivariate regression analysis in Stata 12. Results from this study suggest that hospitals employing a higher percentage of hospitalists see related improvement in their overall total performance score. In light of improvements within the PEOC, outcome, and efficiency scores, it would appear that hospitalists are primarily providing linking services, which helps provide better coordination of care that is otherwise lacking in more traditionally fragmented approaches to care.

Providing Culturally Competent Acute Care Physical Therapy for a Complex Medical Patient of Amish Heritage

Background and Purpose: Health care providers, including physical therapists, should identify and incorporate sociocultural, educational, and environmental factors in their clinical decisions for patients of various cultural backgrounds—specifically Amish heritage as illustrated in this case report. The purpose of this case report is to describe how cultural beliefs affected acute care physical therapy (PT) and discharge planning for an older adult of Amish heritage. Case Description: The patient was a 65-year-old woman of Amish heritage 2 days post thoracic aortic aneurysm dissection surgery with an unexpected subsequent stroke. Due to their Amish beliefs, the patient and the family declined the physical therapist's initial postacute care discharge recommendation to an off-site skilled nursing facility. Significant discussion with multiple family members throughout the entire therapy process emphasized continued skilled services in accord with Amish cultural beliefs to promote safe reintegration into the Amish community. PT interventions primarily focused on culturally sensitive patient and family education and functional mobility to encourage safe patient resumption of activities of daily living and role in society. Outcomes: By the end of 2 weeks of PT (1 initial examination and 8 intervention sessions), the patient demonstrated improvements in all aspects of functional mobility and total Functional Independence Measure scores (21/126 to 86/126). On postoperative day 14, the patient transitioned to an on-site inpatient rehabilitation facility. After completing only 4 days in the inpatient rehabilitation facility, the family firmly advocated that the patient be discharged home with assistance from the family and Amish community. Discussion: Physical therapists may be unfamiliar with patients of Amish heritage due to the infrequency of PT services used by these individuals. This case report demonstrates a physical therapist's sensitivity to and acceptance of the Amish cultural beliefs, which ensured appropriate clinical decisions and positive patient- and family-centered outcomes. Engaging the patient's family in dialogue about realistic discharge options early in the acute care stay allowed the family time to understand the complexity of the patient's diagnoses and challenges of the health care environment as well as align decisions with their cultural beliefs.

The relation between gain in cognition during rehabilitation on functional outcome among hip fracture adult patients with and without pre- hip fracture dementia

The purpose of the present study was focused on the relationship between change in cognition and the functional outcome during rehabilitation in demented and non-demented adult hip fracture patients. We studied seventy consecutive adult patients with hip fracture admitted to our rehabilitation wards. Functional outcome was assessed by the Functional Independence Measure (FIM). The gain in cognition during the rehabilitation process was measured by the difference in Mini Mental State Examination scores at admission and discharge. Data was analyzed by t-test, chi square-test and linear regression. Patients without dementia presented and discharged from the rehabilitation ward with statistically significant higher total, motor, and gain functional independence measure scores compared to patients with dementia. In a multiple regression analyses, gain in Mini Mental State scores examination were not independently associated with higher total and motor functional independence measure scores at discharge (beta = 0.086, p = 0.194; beta = 0.077, p = 0.309, respectively). Our findings suggest that there is no association between functional outcome and cognitive gain at the end of the rehabilitation process among adult hip fracture patients with and without dementia. However hip fracture adult patients with dementia should not be deprived of a post-acute rehabilitation.

Model Evaluasi Penerapan Good Farming Practice pada Peternakan Domba Di PT Tawakal Farm Bogor

This research was aimed to evaluate Good Farming Practice (GFP) of sheep fattening at PT TF. The breed of sheep that are fattened in this farm are thin tailed and thick tailed. The aspects that evaluated were equipments aspect, production process, environmental conservation, and surveillance. The data were corrected by observation method and interview company leaders. Data were analyzed using descriptive analysis method with weighting based on importance aspect to GFP. The total GFP performance score were 81.90% indicated that the application of GFP PT TF was sufficiently good. The point of view from the aspect of production facilities and processes, PT TF has applied good GFP with the weighted value of each aspects were 82.13% and 85.25%, respectively.

Quality of Nurses' Performance Regarding Parenteral Nutrition at Neonatal Intensive Care Units

Background: Nurses play a crucial role at neonatal intensive care, as they are responsible for administering parenteral nutrition to critically ill neonates. Aim of the study was to assess quality of nurses' performance regarding parenteral nutrition at neonatal intensive care units. Settings: The study was conducted at neonatal. Intensive care units at Benha city in Benha University Hospital, Teaching Hospital and Specialized Pediatric Hospital. Design: A descriptive research design was utilized in the current study. Sample: A convenient sample of 70 nurses was participated in the current study. The tools of data collection were; a structured interviewing questionnaire and an observational checklist. Results: The present study revealed that more than three quarters of studied nurses had unsatisfactory level of total knowledge scores and more than two thirds of the studied nurses had incompetent in their total performance scores also, there was a statically significant relation between of the studied nurses' total knowledge scores and their personal data, there was a statically significant relation between of the studied nurses' total performance scores and their personal data. Conclusion: The present study revealed that there was statically significant relation between of the studied nurses' total knowledge and their personal data; there was statically significant relation between of the studied nurses' total performance scores and their personal data. Recommendation Developing training: programs recommended for the nurses working at regarding parenteral nutrition are neonatal intensive care units to improve their knowledge and performance.

Enhancing Creativity and Change of Nursing Management Staff and Its Influencing on Their Performance at Benha University Hospital

Currently, organizations work in very competitive and uncertain dynamic environment, which requires organizations to be flexible, to acquire and adapt new knowledge, new technologies and new processes to introduce new products, services, cut costs, act faster than competitors and remain competitive. Purpose of the study: Enhance creativity and change of nursing management staff and it's influencing on their performance at Benha University Hospital. Design: A quasi-experimental design was utilized. The subjects were 98 head nurses, their assistants. Instruments for data collection: four instruments were used: (1) Knowledge Questionnaire Sheet, (2) Nursing Management Staff Observation Checklist (3) Nursing Management Staff Attitude toward Creativity and Change at work Questionnaire. (4) Creativity Questionnaire. The result showed that, There was improvement in the level of knowledge, performance, attitude toward creativity, change and level of creativity throughout post and follow up from the preprogram, There was significant positive statistical correlation between total knowledge scores with total performance scores and attitude toward creativity of the studied nursing management staff at preprogram and follow up phase of the study, there was positive statistical significant correlation between attitude toward change with performance and attitude toward creativity of the studied nursing management staff at post program and follow up program. The study concluded that, Enhance creativity and change of nursing management staff and it's influencing on their performance at Benha University Hospital. The study recommended the following: Hospital administration should provide program about enhancing creativity and change for nursing management staff, Replication of the study on a larger probability sample is highly recommended to achieve generalization of results.

The difference in synovitis (synovial membrane) and angiogenesis between young obese, young lean and old lean people with primary knee osteoarthritis

Purpose: OA is a complex disorder with multiple risk factors including obesity. The excess weight and lipids inherent in obesity have been implicated in the development of OA through mechanical and metabolic effects and low-grade inflammation. Furthermore, synovitis and inflammation have gained an enhanced significance in research as a cause of OA. The aim of this laboratory research: 1: To determine the relationship between BMI and synovial vascularity and inflammation among different age groups with advanced OA. 2: To examine the effect of increased lipid stores as indicated by the fat cell size on the vascularity and inflammation. 3: To assess the difference in synovitis among young obese, young lean and old lean people with advanced OA. Methods: A total of 17 patients (matched for gender, the advanced stage of OA requiring total knee arthroplasty, Kellgren-Lawrence score, comorbidities, ASA grade, medications and functional outcome score) were recruited into three groups based on age (young <60, old >70) and BMI (lean <30, obese >30). Group-1: young-obese (N=6) with age and BMI mean (SD) 53.3 (2.33) and 38.53 (1.16) respectively. Group-2: young-lean (N=5) with age and BMI 55.60(4.5) and 27.01(1.59) respectively. Group-3: old-lean (N=6) with age and BMI 75.33 (3.2) and 25.64 (2.5) respectively. Synovial tissues obtained during surgery were examined using H&E staining and Immunohistochemistry (IHC) on 5μm sections. The monoclonal antibodies included vWF and CD34 for angiogenesis, CD68 for macrophage, CD3 for T-lymphocytes, CD20 for B-lymphocytes and vimentin for fibroblast (all Dako Ltd.). Visualization employed DAB. Quantitative assessment of each marker used image J software. Each slide was divided into synovial and fat sectors based on the content. The software measured each marker in the synovial and fat sectors separately and combined. Further analysis followed regrouping patients into two groups based on fat cell diameter, measured as small (< 68 μm) and large (>68 μm) fat cells. The IHC markers were reanalyzed based on the fat cell size. Additional manual counts, vessel diameter and distance to the synovial surface, were undertaken on vessels in the synovial and fat sectors. A synovitis score was determined using the H&E stained sections (Krenn et al., 2006). Results: Using the initial grouping, overall vascularity did not show any significant differences (p=0.468); vimentin positivity was significantly reduced in the old lean group (p=0.006), and inflammatory markers showed a trend of increasing with increase BMI. Regrouping patients based on fat cell size revealed multiple significant differences. Macrophages, T cells, B cells and fibroblasts positivity was significantly higher in the presence of big fat cells (p= 0.035, 0.016, 0.046, 0.014 respectively). The vascular density was significantly higher in the fatty sections with big fat cells (p= 0.028). Inflammatory markers showed positive correlation with BMI and negative correlation with age. An increasing trend of vascular density, the distance to the synovial surface and vascular wall thickness was observed in the young obese group. There was no clear difference between the groups in relation to synovitis but majority of patients showed mild grade synovitis. Conclusions: The synovium of the obese patients showed more inflammatory response but the vascularity was not significantly different. Increased fat cell size attracted significantly more inflammatory cells. Moreover, vascular hyperplasia, which was noticed mainly in the obese people, could be an indication of atherosclerosis in the synovial vessels. Low grade synovitis is common in primary knee OA. This image showed H&E stain of the synovium of an obese person. The vessels has increased wall thickness very close to the intimal surface.

Evaluation of Stem Cell Therapies in a Bilateral Patellar Tendon Injury Model in Rats.

Regenerative medicine provides novel alternatives to conditions that challenge traditional treatments. The prevalence and morbidity of tendinopathy across species, combined with the limited healing properties of this tissue, have prompted the search for cellular therapies and propelled the development of experimental models to study their efficacy. Umbilical cord matrix-derived mesenchymal stem cells (UCM-MSC) are appealing candidates because they are abundant, easy to collect, circumvent the ethical concerns and risk of teratoma formation, yet resemble primitive embryonic stem cells more closely than adult tissue-derived MSCs. Significant interest has focused on chitosan as a strategy to enhance the properties of MSCs through spheroid formation. This paper details techniques to isolate UCM-MSCs, prepare spheroids on chitosan film, and analyze the effect of spheroid formation on surface marker expression. Consequently, creation of a bilateral patellar tendon injury model in rats is described for in vivo implantation of UCM-MSC spheroids formed on chitosan film. No complication was observed in the study with respect to morbidity, stress rising effects, or tissue infection. The total functional score of the operated rats at 7 days was lower than that of normal rats, but returned to normal within 28 days after surgery. Histological scores of tissue-healing confirmed the presence of a clot in treated defects evaluated at 7 days, absence of foreign body reaction, and progressing healing at 28 days. This bilateral patella tendon defect model controls inter-individual variation via creation of an internal control in each rat, was associated with acceptable morbidity, and allowed detection of differences between untreated tendons and treatments.

Evaluation of Stem Cell Therapies in a Bilateral Patellar Tendon Injury Model in Rats

Regenerative medicine provides novel alternatives to conditions that challenge traditional treatments. The prevalence and morbidity of tendinopathy across species, combined with the limited healing properties of this tissue, have prompted the search for cellular therapies and propelled the development of experimental models to study their efficacy. Umbilical cord matrix-derived mesenchymal stem cells (UCM-MSC) are appealing candidates because they are abundant, easy to collect, circumvent the ethical concerns and risk of teratoma formation, yet resemble primitive embryonic stem cells more closely than adult tissue-derived MSCs. Significant interest has focused on chitosan as a strategy to enhance the properties of MSCs through spheroid formation. This paper details techniques to isolate UCM-MSCs, prepare spheroids on chitosan film, and analyze the effect of spheroid formation on surface marker expression. Consequently, creation of a bilateral patellar tendon injury model in rats is described for in vivo implantation of UCM-MSC spheroids formed on chitosan film. No complication was observed in the study with respect to morbidity, stress rising effects, or tissue infection. The total functional score of the operated rats at 7 days was lower than that of normal rats, but returned to normal within 28 days after surgery. Histological scores of tissue-healing confirmed the presence of a clot in treated defects evaluated at 7 days, absence of foreign body reaction, and progressing healing at 28 days. This bilateral patella tendon defect model controls inter-individual variation via creation of an internal control in each rat, was associated with acceptable morbidity, and allowed detection of differences between untreated tendons and treatments.

Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity.

(1) To determine baseline quality of life (QOL) among children with obesity and newly diagnosed moderate-severe sleep-disordered breathing (SDB) and to compare it to the reported QOL of children with obesity or SDB alone and healthy children. (2) To evaluate QOL change after 1 year. A prospective multicenter cohort study was conducted in children (8-16 years) with obesity, prescribed positive airway pressure (PAP) therapy for moderate-severe SDB. Outcomes included parent-proxy and self-report total and subscale scores on the PedsQL questionnaire (baseline and 1-year). Total PedsQL scores were indicative of impaired QOL in 69% of cases based on parent-report and in 62% on self-report. Parents reported significantly lower QOL in our cohort than that reported in other studies for children with obesity or SDB alone or healthy children, on total PedsQL score and on social and psychosocial subscales. PedsQL total scores for participants were significantly higher (mean difference 7.3 ± 15.3, P = .03) than those reported by parents. Parents reported significant improvements in total PedsQL (mean change 7.29 ± 13.73, P = .04) and social functioning (mean change 17.65 ± 24.69, P = .04) scores after 1 year. No significant differences were found by children's self-report or by PAP adherence. QOL of children with obesity and SDB is lower than in children with obesity or SDB alone or healthy children. One year later, children reported no significant changes in QOL; parents reported significant improvements in total PedsQL and social functioning scores. PAP adherence did not significantly affect QOL change in this population. A commentary on this article appears in this issue on page 307.

Cerebrospinal fluid neurogranin and TREM2 in Huntington\u2019s disease

Biomarkers of Huntington’s disease (HD) in cerebrospinal fluid (CSF) could be of value in elucidating the biology of this genetic neurodegenerative disease, as well as in the development of novel therapeutics. Deranged synaptic and immune function have been reported in HD, and concentrations of the synaptic protein neurogranin and the microglial protein TREM2 are increased in other neurodegenerative diseases. We therefore used ELISAs to quantify neurogranin and TREM2 in CSF samples from HD mutation carriers and controls. CSF neurogranin concentration was not significantly altered in HD compared to controls, nor was it significantly associated with disease burden score, total functional capacity or motor score. An apparent increase in CSF TREM2 in manifest HD was determined to be due to increasing TREM2 with age. After age adjustment, there was no significant alteration of TREM2 in either HD group, nor any association with motor, functional or cognitive score, or brain volume quantified by MRI. Both analyses were well-powered, and sample size calculations indicated that several thousand samples per group would be needed to prove that disease-associated alterations do in fact exist. We conclude that neither neurogranin nor TREM2 is a useful biofluid biomarker for disease processes in Huntington’s disease.

Do current quality measures truly reflect the quality of dialysis?

The US End Stage Renal Disease (ESRD) Program, which came into existence in 1973, was initially envisioned to provide needed financial coverage for about 50 000 patients through Medicare. Over the past 45 years the evolution of the ESRD program has been quite different, and it now serves over one half million dialysis and transplant patients. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 Section 153(c) requires the Centers for Medicare and Medicaid Services (CMS) to develop and implement quality measures for dialysis patients as part of the ESRD Quality Incentive Program (QIP) beginning in payment year (PY) 2012. The annual ESRD Prospective Payment System (PPS) rulemaking process allows CMS to create ESRD QIP rules that specify the measures, scoring methods, and payment reduction ranges applicable to the respective PY. CMS assesses each facility's performance and calculates a score for each measure, according to the method detailed for that PY. Scores for each measure are combined to create the Total Performance Score (TPS) for each facility. If a facility's TPS does not meet or exceed the performance standards established during the earlier comparison period, the facility will incur a payment reduction of up to 2% for the entire PY. The QIP program has evolved over the several years since its inception. There have been deletions and additions of various measures. CMS uses additional measures in its Dialysis Facility Compare (DFC) website which is available to the public and forms the basis of the 5-star rating system for dialysis facilities. The evidence underlying inclusion many of these measures in the QIP and DFC remains an area of debate. In this review, we discuss the evolution of these measures and their appropriateness. We recommend that some of the current QIP and DFC measures should not be used for public reporting and/or payment as unintended consequences may occur. Nonetheless, all the current QIP and DFC measures and others are suitable for internal quality review.

Sequential two stage release for genu valgum correction in total knee replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Valgus deformity presents a major challenge in total knee replacement, especially in moderate or severe cases. Many surgical techniques have been described to balance&lt;sup&gt; &lt;/sup&gt;the soft tissues in correction of a severe valgus deformity&lt;sup&gt; &lt;/sup&gt;during total knee replacement. The structures most commonlyreleased in a valgus knee include the posterolateralaspect of the capsule, iliotibial band (IT band), the lateral collateral ligament (LCL), the popliteustendon, and the lateral head of the gastrocnemius muscle.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;thirty two patients undergoing unilateral total knee replacement were followed for the evaluation of study. There were 22 female (68%) and 10 males (32%) with an age of 62.7±6.9 years (range 50-75) with valgus deformity of 18.59˚±8.32˚ (range 10-40˚). Preoperative diagnosis was rheumatoid arthritis in 23 patients (72%) and osteoarthritis in 9 patients (28%). Posterior stabilizing cemented implants were used&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Based on total knee score we achieved 21 (63.64%) excellent, 10 (31.82%) good and 1 (4%) fair results. With the total functional score we had 16 (50%) excellent, 15 (45.45%) good and 1 (4%) fair results. In patients with only step1 release (17 patients) we achieved 84% (15 pts) excellent, 8% (1 pt) good, 8% (1 pt) fair with knee score; and 67% (11pts) excellent, 33% (6pts) good with functional score. In step 2 release group (15 pt) we achieved 10% (1 pt) excellent, 90% (14 pts) good with knee score; and 10% (1pt) excellent, 80% (13 pts) good and 10% (1 pt) fair with functional score. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Good to excellent results can be achieved with two step sequential lateral release of posterolateral capsule and IT band pie-crusting which has direct correlation with severity of valgus deformity. The safety, simplicity, and high success rate of the two step sequential lateral release of posterolateral capsule and pie-crusting of IT band justify its routine use to correct every valgus deformity in total knee replacement.&lt;/span&gt;&lt;/p&gt;

Alterations of the default mode network and cognitive impairments in patients with chronic obstructive pulmonary disease.

Background and objectivesCognitive impairment is a common extrapulmonary comorbidity in COPD patients. The default mode network (DMN) plays a critical role in maintaining the normal activities of humans, and its function can be evaluated by resting state functional magnetic resonance imaging. The aim of this study was to investigate the correlations between cognition and function changes of the DMN in COPD patients.MethodsOne hundred and thirteen eligible participants including 30 control subjects and 83 COPD patients matched for demographic characteristics were recruited. All participants performed cognitive function tests and underwent resting state functional magnetic resonance imaging.ResultsThe total cognitive function scores of COPD patients were significantly different from those of control subjects (P<0.05) and worsened with the degree of airflow obstruction. The activated brain regions in the DMN of COPD patients were less than those of normal controls. Six activated brain regions in the DMN were found to develop significantly different functional connectivity (FC) values among the subjects. Meanwhile, the FC values of the left posterior cingulate cortex and left hippocampus correlated well with cognitive functions and pulmonary function.ConclusionCOPD patients have cognitive impairments that correlate well with disease severity. FC changes in activated brain regions in the DMN may predict cognitive impairment, and the left posterior cingulate cortex and left hippocampus may be important brain regions related to cognitive impairment in COPD patients.

Performance of ICU Nurses in Providing Respiratory Care.

Background:Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care.Materials and Methods:The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation.Results:According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73).Conclusions:Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.

Pengukuran Kinerja Supply Chain Dengan Pendekatan Supply Chain Operation References (SCOR)

PT. Brodo Ganesha Indonesia is a national company engaged in manufacturing with the production of leather shoes. The company has many stakeholders and it is difficult to manage its supply chain, thereby affecting the effectiveness and efficiency of the company's supply chains. The research was conducted to measure the performance of supply chain by using Supply Chain Operation References (SCOR) approach. The initial hierarchy model of performance measurement is tailored to the company's condition to measure its supply chain performance, while the normalization of Snorm De Boer serves to equalize the value of the matrix used as the measurement indicator. The level of importance of performance attributes is measured by weighting with subjective questionnaires. Value of performance attribute obtained reliability 19,74, responsiveness 16,91, agility 11,00; and asset management 12.26. The total performance score of 59.90. This value indicates that the performance of the supply chain is in an average position.

Effects of Focal vs Total Cryotherapy and Minimum Tumor Temperature on Patient-reported Quality of Life Compared With Active Surveillance in Patients With Prostate Cancer

To investigate the effects of focal (hemiablation) or total cryotherapy and minimum tumor temperature on patient-reported quality of life (QoL) in patients with prostate cancer. An Institutional Review Board-approved database was reviewed for patients who underwent cryotherapy or active surveillance (AS). QoL questionnaire responses were collected and scores were analyzed for differences between focal and total cryotherapy and between very cold (<-76°C) and moderate-cold (≥-76°C) minimum tumor temperatures. A total of 197 patients responded to a total of 547 questionnaires. Focal and total cryotherapy patients had initially lower sexual function scores relative to AS (year 1 mean difference focal: -31.7, P <.001; total: -48.1, P <.001). Focal cryotherapy was associated with a more rapid improvement in sexual function. Both focal and total cryotherapy sexual function scores were not statistically significantly different from the AS cohort by postprocedural year 4. Very cold and moderate-cold temperatures led to initially lower sexual function scores relative to AS (year 1 very cold: -38.1, P <.001; moderate-cold: -30.7, P <.001). Moderate-cold temperature scores improved more rapidly than those of very cold temperature. Neither very cold nor moderate-cold temperatures had a statistically significant difference in sexual function scores relative to AS by postprocedural year 4. Urinary function and bowel habits were not significantly different between focal and total cryotherapy and between very cold and moderate-cold temperature groups. Focal cryotherapy and moderate-cold (≥-76°C) temperature were associated with favorable sexual function relative to total cryotherapy and very cold temperature, respectively. No significant differences in urinary function or bowel habits were observed between groups.

Enhancer transcription reveals subtype-specific gene expression programs controlling breast cancer pathogenesis.

Noncoding transcription is a defining feature of active enhancers, linking transcription factor (TF) binding to the molecular mechanisms controlling gene expression. To determine the relationship between enhancer activity and biological outcomes in breast cancers, we profiled the transcriptomes (using GRO-seq and RNA-seq) and epigenomes (using ChIP-seq) of 11 different human breast cancer cell lines representing five major molecular subtypes of breast cancer, as well as two immortalized (“normal”) human breast cell lines. In addition, we developed a robust and unbiased computational pipeline that simultaneously identifies putative subtype-specific enhancers and their cognate TFs by integrating the magnitude of enhancer transcription, TF mRNA expression levels, TF motif P-values, and enrichment of H3K4me1 and H3K27ac. When applied across the 13 different cell lines noted above, the Total Functional Score of Enhancer Elements (TFSEE) identified key breast cancer subtype-specific TFs that act at transcribed enhancers to dictate gene expression patterns determining growth outcomes, including Forkhead TFs, FOSL1, and PLAG1. FOSL1, a Fos family TF, (1) is highly enriched at the enhancers of triple negative breast cancer (TNBC) cells, (2) acts as a key regulator of the proliferation and viability of TNBC cells, but not Luminal A cells, and (3) is associated with a poor prognosis in TNBC breast cancer patients. Taken together, our results validate our enhancer identification pipeline and reveal that enhancers transcribed in breast cancer cells direct critical gene regulatory networks that promote pathogenesis.