Milk-fat globule epidermal growth factor 8 (MFGE8) is expressed at the embryo- and fetal-maternal interface in equine pregnancy.

Milk-fat globule epidermal growth factor (EGF) 8 protein (MFGE8), also known as lactadherin, promotes cell adhesion in an Arg-Gly-Asp (RGD)-dependent modus via integrins. In the present study, the expression of MFGE8 was examined in equine endometrium during oestrus and at Days 12 and 16 after ovulation in pregnant and non-pregnant mares and in mares during the 5th month of gestation. Results demonstrated that MFGE8 is expressed at the embryo- and fetal-maternal interface in equine pregnancy. In non-pregnant endometrium its expression was upregulated by oestrogen, a finding that was confirmed using endometrial explant culture. MFGE8 was expressed at similar levels by conceptuses collected 13 and 14 days after ovulation and by allantochorion sampled during the 5th month of gestation. Pericytes of endometrial blood vessels displayed strong MFGE8 expression upon in situ hybridisation. During the 5th month of gestation, the fetal side of the allantochorionic villi in particular displayed pronounced staining upon in situ hybridisation, confirming that MFGE8 expression is not restricted to early pregnancy but persists and is present at the fetal-maternal interface. Potential roles of MFGE8 in equine pregnancy include mediating cell-cell adhesion, promotion of angiogenesis and placental transfer of fatty acids.

Is the Medicare SELECT program a stepping-stone to managed care?

Under the Omnibus Budget Reconciliation Act of 1990, Medicare SELECT programs and standardized Medigap policies were made available to senior citizens. Medigap policies offer coverage to supplement Medicare benefits, and the SELECT program offers a PPO-like product that offers reduced premiums if the beneficiaries agree to enroll in a preferred network. HCFA's recent evaluation of the SELECT program indicated a variable success rate in enrollment and cost-effectiveness. Providers will need to develop a strategic position concerning their participation in the Medicare SELECT program, which should include knowledge of SELECT program incentives, economics of the SELECT contract, and Medicare market position. In addition, providers should assess whether the SELECT program is consistent with strategies to transition Medicare populations into managed care.

Managing the transition to capitation.

Although most experts believe that capitation and financial risk-sharing among providers will become key components of the U.S. healthcare system, providers may not feel the full effect of this shift for several years. In the interim, providers must operate under an activity-based payment system that rewards them for the volume of patients seen, while preparing for the transition to a fixed, per-capita payment system that will reward them for the efficiency with which services are provided. Preparation for the move to capitation will involve implementation of the systems necessary to negotiate managed care contracts, enhance quality and efficiency, and take responsibility for the health of a defined population.

Ambulatory care groupings: when, how, and the impact on managed care.

This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.

Capital management balances charitable, financial goals.

Effective capital management allows not-for-profit healthcare organizations to make investment decisions that fulfill their missions and meet financial goals. The process involves identifying components of the hospital's value and creating policies aimed at maximizing it; determining the hospital's ability to produce financial capital; and developing a process for allocating this financial capability among the components of value. Once this is completed, hospitals should determine criteria that balance charitable and financial goals, enabling them to pursue sound investments.

Comparative healing of mesenteric and antimesenteric incisions in the bovine jejunum.

Paired incisions (n = 6 pairs) were made in the jejunum of each of 8 Holstein cows. Pairs consisted of 2-cm transverse incisions, 35 cm apart, at the antimesenteric region and at the mesenteric region. Bursting-wall tension was used to test mechanical strength, and cellular and vascular events of healing were evaluated using histologic examination and microangiography. Healing was evaluated at postoperative hour (POH) 48 in 4 of the cows (group 1) and at POH 96 in the remaining 4 (group 2). Evidence of leakage of intestinal contents was not found in any of the cows. At POH 48 and 96, bursting-wall tension was significantly (P less than 0.001) greater in the intestinal segments with antimesenteric incisions than in those segments with mesenteric incisions. Disruption of normal vasculature was seen at mesenteric and antimesenteric sites; ingrowth of vessels, reformation of vascular plexuses, and development of collateral circulation were observed at POH 96. Granulation tissue was observed at POH 96 at the antimesenteric and mesenteric sites, and early stages of mucosal reepithelialization were seen in several sections at POH 48. Better apposition of tissue layers was seen in antimesenteric incisions, but mucosal eversion was evident in several mesenteric incisions. Some sections examined from cows at POH 96 had complete bridging of mucosa, submucosa, and muscularis layers at the antimesenteric location. Inflammatory cells were observed along the incision and at the mucosal and serosal surfaces in many of the sections. Deposition of new collagen was not appreciable in any section at POH 48 or 96.

Determining the feasibility of a heart transplant program.

The careful information gathering by the task force provided a foundation for informed decision making. Furthermore, the participation of the affected constituencies in the planning process helped in building a consensus in support of the new program. The group felt confident that the relevant risks and potential benefits had been identified in the feasibility assessment. Finally, the financial forecasts provided quantified benchmarks to use in measuring the performance of the program on ongoing basis.

Arterial and venous supply to the bovine jejunum and proximal part of the ileum.

The blood vasculature of the bovine jejunum and proximal part of the ileum was studied in 20 mature dairy cows at slaughter. The cranial mesenteric artery and vein supplied the jejunum and ileum, and their major branches were present in all specimens and supplied similar regions of the intestinal tract. Proximal branches of the cranial mesenteric artery were pancreatic arteries, caudal pancreaticoduodenal artery, middle colic artery, and ileocolic artery. A large collateral branch arose from the proximal segment of the cranial mesenteric artery, anastomosing with the continuation of the cranial mesenteric artery distally along the jejunum. Jejunal arteries arose from the continuation of the cranial mesenteric artery, forming a series of anastomosing arches. Straight vessels arising from these arches did not branch or anastomose before entering the serosal layer of the intestine. The proximal part of the ileum was supplied by branches from the continuation of the cranial mesenteric artery; these branches anastomosed with the mesenteric ileal (ilei mesenterialis) artery, a branch of the ileocolic artery. The venous supply paralleled the arterial supply in all specimens.