Activity-based costing via an information system: an application created for a breast imaging center.

Activity-based costing (ABC) is a process that enables the estimation of the cost of producing a product or service. More accurate than traditional charge-based approaches, it emphasizes analysis of processes, and more specific identification of both direct and indirect costs. This accuracy is essential in today's healthcare environment, in which managed care organizations necessitate responsible and accountable costing. However, to be successfully utilized, it requires time, effort, expertise, and support. Data collection can be tedious and expensive. By integrating ABC with information management (IM) and systems (IS), organizations can take advantage of the process orientation of both, extend and improve ABC, and decrease resource utilization for ABC projects. In our case study, we have examined the process of a multidisciplinary breast center. We have mapped the constituent activities and established cost drivers. This information has been structured and included in our information system database for subsequent analysis.

T-cell malignancies in Brazil. Clinico-pathological and molecular studies of HTLV-I-positive and -negative cases.

T-cell malignancies in Brazil have a high seroprevalence rate of HTLV-I antibodies. We have analyzed the disease features in 188 Brazilian patients with a T-cell disorder. These included 40 with T-lymphoblastic leukaemia or lymphoma (T-ALL/T-LbLy) and 148 with mature T-cell diseases: 5 T-prolymphocytic leukaemia, 53 adult T-cell leukaemia/lymphoma (ATLL), 54 cutaneous T-cell lymphomas, 29 pleomorphic T-cell lymphomas and 7 large granular lymphocyte leukaemia. The diagnosis was based on clinical, morphological and immunological features and HTLV-I serology. ATLL in Brazil has the same diseases features as in other endemic regions, the only apparent differences being: age, Brazilian patients being younger than Japanese, and ethnic grouping, one third of Brazilians being white Caucasians of European descent. We applied a scoring system based on the presence or absence of typical features associated with ATLL; hypercalcaemia, cell morphology, immunophenotype, histopathology and HTLV-I status, to see whether it may help in diagnosing cases of ATLL. All had high scores, whereas all other T-cell diseases scored low. Only 5 ATLL cases were HTLV-I-negative by serology, but they had otherwise typical features of ATLL, and their cells did not have HTLV-I proviral sequences by DNA analysis. Such cases suggest that ATLL may develop in a minority of individuals living in regions where it is endemic, without evidence of HTLV-I infection, and that other factors may contribute to the pathogenesis of the disease.

Relationship of reinforcement by student clinicians and peers to accuracy of imitated grammatical constructions during language training.

Percentages of correctly imitated grammatical constructions were examined within a framework of reinforcement theory. Four small treatment groups, each of 4 language-delayed children, were repeatedly observed interacting with different student-clinicians. The Therapy Reinforcement Schedule was used to obtain frequency counts of verbal and non-verbal reinforcements so that within each language group the students could be objectively divided into those who frequently and infrequently were reinforcing, and the children into those for whom peer-reinforcement was high or low. The resulting 4 groups were compared for proportions of accurately imitated constructions with a repeated-measures analysis of variance design (student-clinicians' reinforcement x peers' reinforcement x trials). Correctly scored imitations increased significantly over trials. In addition, children interacting with frequently reinforcing students received higher imitation scores than those with infrequently rewarding ones. Significant main effects of reinforcement by the peer group were not observed, although a reliable interaction of student-clinicians' reinforcement x peers' reinforcement was present. Regression analyses indicated the importance of certain types of reinforcements in predicting accuracy of imitation.