ABSTRACT
Emerging evidence suggests that new cells, including neurons, can be generated within the adult hypothalamus, suggesting the existence of a local neural stem/progenitor cell niche. Here, we identify α-tanycytes as key components of a hypothalamic niche in the adult mouse. Long-term lineage tracing in vivo using a GLAST::CreER(T2) conditional driver indicates that α-tanycytes are self-renewing cells that constitutively give rise to new tanycytes, astrocytes and sparse numbers of neurons. In vitro studies demonstrate that α-tanycytes, but not ß-tanycytes or parenchymal cells, are neurospherogenic. Distinct subpopulations of α-tanycytes exist, amongst which only GFAP-positive dorsal α2-tanycytes possess stem-like neurospherogenic activity. Fgf-10 and Fgf-18 are expressed specifically within ventral tanycyte subpopulations; α-tanycytes require fibroblast growth factor signalling to maintain their proliferation ex vivo and elevated fibroblast growth factor levels lead to enhanced proliferation of α-tanycytes in vivo. Our results suggest that α-tanycytes form the critical component of a hypothalamic stem cell niche, and that local fibroblast growth factor signalling governs their proliferation.
Subject(s)
Aging/metabolism , Ependymoglial Cells/metabolism , Fibroblast Growth Factor 10/metabolism , Fibroblast Growth Factors/metabolism , Hypothalamus/cytology , Neural Stem Cells/metabolism , Third Ventricle/cytology , Animals , Cell Proliferation/drug effects , Ependymoglial Cells/cytology , Ependymoglial Cells/drug effects , Epidermal Growth Factor/pharmacology , Excitatory Amino Acid Transporter 1/metabolism , Glial Fibrillary Acidic Protein/metabolism , Immunohistochemistry , Integrases/metabolism , Mice , Mice, Inbred C57BL , Neural Stem Cells/cytology , Neural Stem Cells/drug effects , Neuroglia/cytology , Neuroglia/drug effects , Neuroglia/metabolism , Signal Transduction/drug effects , Spheroids, Cellular/cytology , Spheroids, Cellular/drug effects , Spheroids, Cellular/metabolismABSTRACT
The importance of modern information systems to manage healthcare delivery at the macro level--particularly through purchasing--is increasingly being recognised. There is also increasing investment in electronic patient record systems to aid care delivery. Both are intended to benefit the individual, yet neither gives full consideration to the human aspects and values--largely because of the under development of appropriate terms and structures. It is important to identify and structure the human facets as the determinants and principal components of healthcare delivery systems, to improve the information structure of these components, and then to use them as the building blocks of macro-management systems, so as to fuel the whole dynamic with one set of person-based values.
Subject(s)
Delivery of Health Care , Hospital Information Systems , Management Information Systems , Delivery of Health Care/economics , Delivery of Health Care/organization & administration , Health Resources , Health Services Accessibility , Health Services Needs and Demand , Hospital Administration , Hospital-Patient Relations , Humans , Information Management , Investments , Medical Records Systems, Computerized , Models, Theoretical , Organizational Objectives , Organizational Policy , Purchasing, Hospital , Social ValuesABSTRACT
Traditionally there is considerable tension between the objectives of clinicians and managers--each claiming an ethical grounding, one to optimize care to the individual and the other to optimize the use of health resources for the client population. Hitherto, there has been a latent challenge in finding empirically supported common ground. However, the development of integrated electronic records, particularly for patients receiving preventive, rehabilitative, or long-term care, has provided a common medium. A successful major development in the United Kingdom is described.
Subject(s)
Ethics, Medical , Medical Records Systems, Computerized , Delivery of Health Care , United KingdomABSTRACT
The continuous challenge within all health services--to use finite resources to the best advantage of patient care--is resulting in the need to ensure that the delivery of care most effectively meets the health needs of the population. Three models of identifying health need are outlined. The development of an integrated real time electronic patent record information system providing comprehensive health needs data is described. It enables the planning of the effective delivery of care to meet the needs of the population and, subsequently, to monitor the effectiveness of care provided; this is seen as an essential step in achieving patient focused care within a community setting.
Subject(s)
Health Services Needs and Demand , Medical Records Systems, Computerized , Community Health Services , United KingdomABSTRACT
Traditionally, telematics initiatives have mainly been used to link patients with specific conditions to monitoring services located in acute hospitals. However, latest application of telematics to the networking of integrated electronic records for ambulatory or community care has great potential to measure and assure the quality of health care delivery to a large sector of the population in a structured and comprehensive way. This paper categorizes the major quality opportunities of a pioneering initiative now achieving operational status.
