A disciplined approach to capital: today's healthcare imperative.

BJC HealthCare's experience exemplifies several basic principles of a finance-based approach to capital. Organizations that adopt this approach look to improve processes first, remove costs second, and spend capital last. Multiyear planning is required to quantitatively identify the profitability and liquidity requirements of strategic initiatives and address essential funding and financing issues.

Reconciling low- and high-salt solution behavior of sulfobetaine polyzwitterions.

We investigate the water-solubility upon salt additions, of homogeneous families of sulfobetaine-based polyzwitterions. These polymers bear both positive ammonium, and negative sulfonate charges on each monomer and as a result present an upper critical solution temperature (UCST) in the 0-100 degrees C temperature range. Two chemistries are investigated, with either a carboxylate-carrying function (SPE) or an amido-carrying one (SPP). In agreement with the literature published on pSPEs, we find that an addition of simple salts improves the water-solubility of pSPEs, as well as that of pSPPs, yet only once a threshold concentration of added salt has been reached in the solution. We verify using scaling arguments that the onset of solubility promotion, corresponds exactly to the complete screening of the attraction between positive and negative charges inside a polyzwitterionic coil. On the contrary, for salt concentrations smaller than the threshold concentration, we observe that an addition of salt can be adverse to the solubility of polyzwitterions, depending on the degree of polymerization, the type of salt, and the type of zwitterionic motive. Thanks to zeta-potential measurements and systematic variations of these three parameters, we demonstrate, in agreement with theoretical prediction, that this molecular weight-dependent enhanced solubility at small salt concentrations is due to charge asymmetry resulting from partial hydrolysis, combined with specific interactions between salts and zwitterion constituents, evidencing the complexity of the solution behavior of these macromolecules. We thereby reconcile the different behaviors in the domains of low- and high-salinity.

Evidence for the extrapulmonary localization of inhaled nitric oxide.

Inhaled nitric oxide (NO) has emerged as a promising pulmonary vasodilator to treat pulmonary hypertension associated with heart disease and ventilation/perfusion mismatching. However, the pharmacokinetics of inhaled NO still remains obscure and its cardiopulmonary selectivity appears to be increasingly under debate. In the present study measured NO content and levels of cyclic guanosine 3',5'monophosphate (cGMP), a mediator of NO-induced vasodilation, in a variety of organs from rats subjected to NO inhalation. Electron spin resonance spectroscopy associated to a spin trapping technique using N-methyl D-glucamine dithiocarbamate (FeMGD) was used to directly quantify NO levels in the lung, kidney, liver, aorta, and heart from anesthetized Wistar rats subjected to various doses (0, 20, 50, 100, or 200 ppm) and various times (0, 30, 45, or 75 minutes) of inhaled NO. Inhaled NO at a dose of 100 and 200 ppm significantly increased the NO-FeMGD complex in all organs studied. An increase of cGMP was detected in the lung and the aorta after inhaled NO for 45 minutes at the dose of 50 ppm. No changes in NO levels and its metabolites were shown between 30 and 75 minutes of inhaled NO. The results show that inhaled NO at a dose of 100 ppm or more increases NO levels in other organs beside the lung, strongly suggesting that inhaled NO would be more than a pulmonary vasodilator and its selectivity remains to be reconsidered when used for therapeutic purposes.