Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

INTRODUCTION: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. OBJECTIVES: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. METHODS: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. RESULTS: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. CONCLUSIONS: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.

A critical look at the Portuguese public-private partnerships in healthcare.

The pre-conceived idea that contracts in a public-private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector.

Information and redundancy in the burial folding code of globular proteins within a wide range of shapes and sizes.

Recent ab initio folding simulations for a limited number of small proteins have corroborated a previous suggestion that atomic burial information obtainable from sequence could be sufficient for tertiary structure determination when combined to sequence-independent geometrical constraints. Here, we use simulations parameterized by native burials to investigate the required amount of information in a diverse set of globular proteins comprising different structural classes and a wide size range. Burial information is provided by a potential term pushing each atom towards one among a small number L of equiprobable concentric layers. An upper bound for the required information is provided by the minimal number of layers L(min) still compatible with correct folding behavior. We obtain L(min) between 3 and 5 for seven small to medium proteins with 50 ≤ Nr ≤ 110 residues while for a larger protein with Nr = 141 we find that L ≥ 6 is required to maintain native stability. We additionally estimate the usable redundancy for a given L ≥ L(min) from the burial entropy associated to the largest folding-compatible fraction of "superfluous" atoms, for which the burial term can be turned off or target layers can be chosen randomly. The estimated redundancy for small proteins with L = 4 is close to 0.8. Our results are consistent with the above-average quality of burial predictions used in previous simulations and indicate that the fraction of approachable proteins could increase significantly with even a mild, plausible, improvement on sequence-dependent burial prediction or on sequence-independent constraints that augment the detectable redundancy during simulations.

Information-theoretic analysis and prediction of protein atomic burials: on the search for an informational intermediate between sequence and structure.

MOTIVATION: It has been recently suggested that atomic burials, as expressed by molecular central distances, contain sufficient information to determine the tertiary structure of small globular proteins. A possible approach to structural determination from sequence could therefore involve a sequence-to-burial intermediate prediction step whose accuracy, however, is theoretically limited by the mutual information between these two variables. We use a non-redundant set of globular protein structures to estimate the mutual information between local amino acid sequence and atomic burials. Discretizing central distances of or atoms in equiprobable burial levels, we estimate relevant mutual information measures that are compared with actual predictions obtained from a Naive Bayesian Classifier (NBC) and a Hidden Markov Model (HMM). RESULTS: Mutual information density for 20 amino acids and two or three burial levels were estimated to be roughly 15% of the unconditional burial entropy density. Lower estimates for the mutual information between local amino acid sequence and burial of a single residue indicated an increase in mutual information with the number of burial levels up to at least five or six levels. Prediction schemes were found to efficiently extract the available burial information from local sequence. Lower estimates for the mutual information involving single burials are consistently approached by predictions from the NBC and actually surpassed by predictions from the HMM. Near-optimal prediction for the HMM is indicated by the agreement between its density of prediction information and the corresponding density of mutual information between input and output representations. AVAILABILITY: The dataset of protein structures and the prediction implementations are available at http://www.btc.unb.br/ (in 'Software').

Constrained Layer Assignment for the Protein Burial Folding Code Accounting for Chain Connectivity.

The connection between protein sequences and tertiary structures has intrigued investigators for decades. A plausible hypothesis for the coding scheme postulates that atomic burial information obtainable from the sequence could be sufficient for structural determination when combined to sequence-independent constraints. Accordingly, folding simulations using native burial information expressed by atomic central distances, discretized into a small number L of equiprobable burial layers, have indeed been successful in reaching and distinguishing the native structure of several globular proteins. Attempted predictions of layers from sequence, however, turned out to be insufficiently accurate for most proteins. Here we explore the possibility that a nonuniform assignment of layers, which is intended to account for constraints imposed by chain connectivity, might provide a more efficient burial encoding of tertiary structures. We consider the condition that adjacent Cα-atoms along the sequence cannot occupy nonadjacent layers, in which case the information required to specify sequences of burials would be smaller. It is shown that appropriate folding behavior can still be observed in this explicitly more constrained scenario with a structure-dependent assignment intended to produce the thinnest possible layers still compatible with the imposed burial constraint. This thinnest assignment turns out to be sufficiently restrictive for the observed examples and provides appropriately thinner layers or, equivalently, a larger number of layers, for examples previously observed to indeed require more restrictive constraints when compared to counterparts of similar size, as well as the appropriate increase in number of layers for larger proteins. Implications for the general understanding of the protein folding code are discussed.

Conceptions of Hegemonic Masculinity as a Mediator of Sexism Directed at Women / Concepções de Masculinidade Hegemônica como Mediadora do Sexismo Direcionado às Mulheres

ABSTRACT This article analyses the relationship between masculine identity and ambivalent sexism, considering concepts of masculinity and culture of honour as mediating variables in this relationship. For this purpose, two studies were carried out with male participants from two regions of Brazil, Midwest (119 participants) and Northeast (117 participants). The results indicated that the concepts of masculinity are mediators of the relationship between masculine identity and ambivalent sexism. In contrast, the culture of honour did not remain significant in the mediation model. We conclude that the conception of masculinity based on hegemonic precepts of gender restates masculine superiority in detriment to the feminine, naturalizes sexism and violent behaviour for maintenance of masculine identity.

RESUMO Este artigo analisa a relação entre identidade masculina e sexismo ambivalente, tomando as concepções de masculinidade e a cultura da honra como variáveis mediadoras dessa relação. Para alcançar este objetivo, foram realizados dois estudos com participantes homens de duas regiões do país, Centro-oeste (119 participantes) e Nordeste (117 participantes). Os resultados indicaram que as concepções de masculinidade são mediadoras da relação entre identidade masculina e o sexismo ambivalente. Em contraste, a cultura da honra não se manteve significativa no modelo da mediação. Conclui-se que a concepção de uma masculinidade, baseada em preceitos hegemônicos de gênero, reafirma a superioridade masculina em detrimento à feminina, e naturaliza práticas de sexismo e comportamentos violentos em defesa da manutenção da identidade masculina.

Psicologia da era virtual: atitudes de estudantes adolescentes frente ao Orkut / Psychology of virtual age: adolescent students' attitudes toward Orkut

O presente estudo consistiu em conhecer quais as principais vantagens e desvantagens da participação dos jovens no site de relacionamento social Orkut, propor uma escala para medir atitudes frente ao Orkut e conhecer a relação destas atitudes com variáveis sócio-demográficas. Isso pode interessar à psicologia social, da mídia ou psicologia da internet. Para a realização deste propósito levou-se a cabo uma pesquisa com 444 estudantes (m = 17 anos, dp = 2,52), da cidade de Aracaju (SE). Foi utilizado um procedimento-padrão para coleta de dados através de um questionário composto por questões sobre vantagens e desvantagens do Orkut, atitudes gerais frente ao Orkut e questões sócio-demográficas. Os resultados principais mostram que a principal vantagem da participação do Orkut é "fazer amigos" e a principal desvantagem reportada foi a "falta de privacidade". A análise psicométrica demonstrou que as atitudes frente ao site podem ser aferidas de modo válido, preciso e breve, independente de sexo, série e classe socioeconômica

The purpose of the present study consisted on knowing the main advantages anddisadvantages of the participation of youngsters on the Orkut social network website andthen to propose a scale to measure the attitudes towards this site, as well as to understandthe relations of these attitudes to social demographics variables. These findings will be ofinterest to social psychologists, media psychologists or internet psychologists. To attainthese objectives, a research with 444 (m = 17 years old, dp = 2,52) high school studentsfrom the city of Aracaju was conducted. A standard procedure to obtain the data was utilized,with a questionnaire composed of questions concerning the advantages and disadvantagesof the Orkut, general attitudes towards the site and social demographics questions. Theresults show that the main advantage of orkut affiliation is "friendship" and the maindisadvantage reported was "lack of privacy". The psychometric analysis indicated that theattitudes towards the site could be measured in a valid, precise and brief way, independentlyof gender, grade level and socio economic status