The effect of normative social forces on managed care organizations: implications for strategic management.

Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and encouraging and rewarding care providers for being friendly and personable. An MCO should work to inform the public of the organization's efforts to provide high-quality, low-cost medical care in a friendly, convenient manner.

The impact of social norms and economic requirements on the strategic marketing of managed care organizations.

The trend in managed care is toward an increased emphasis on cost containment mechanisms. However, many people have begun to argue that cost controls are being implemented at the expense of the provision of appropriate care. By focusing on the impact of societal values on the performance of MCOs, it is argued that MCOs need to focus their marketing efforts on championing cost-cutting efforts in areas that do not impact the quality of care provided, while at the same time, implementing a marketing campaign aimed at promoting their conformity to prevailing social norms.

Somatic embryogenesis from immature inflorescences of oil palm.

Immature inflorescences of oil palm (Elaeis guineensis) var. Pisifera were inoculated onto modified MS medium containing 0.3% (w/v) activated charcoal and 475 µM 2,4-D. After 2-3 months of culture, a hard yellow callus proliferated at the base of the shoot-like structures. The high incidence of phenolic oxidation required the use of increased levels of activated charcoal (0.5% w/v) and 2,4-D (500 µM). Development of floral structures from inflorescence expiants was frequently observed during the culture period. After 81 weeks of culture, an embryogenic tissue characterized by compact consistency and pearly white color was observed in tissues derived from very young inflorescences. This compact embryogenic tissue differentiated into normal somatic embryos when transferred onto regeneration medium containing NAA (15 µM) and ABA (2 µM). Normal plantlets were recovered from these somatic embryos after 8 weeks on regeneration medium.

Selection and physiology of cell cultures of Douglas-fir grown under conditions of water stress.

Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) cell cultures sampled 3, 6, or 9 days after subculture in nutrient medium were able to survive subsequent subculture in a medium containing 15% polyethylene glycol (PEG) (M(r) 6000-8000) (-1.21 MPa), whereas cell sampled 12 or 16 days after subculture in nutrient medium became senescent when transferred to a medium containing 15% PEG. Cells sampled after subculture for 3, 6, or 9 days in nutrient medium had lower fresh weight/dry weight ratios, lower osmotic potentials, smaller cell diameters, and higher turgor pressures than cells sampled after 12 or 16 days subculture in nutrient medium. Cells surviving subculture to a medium containing 15% PEG did not increase in dry weight for 5 weeks even though the medium was exchanged every 7 days. After 5 weeks, however, dry weight growth resumed and reached 75% of the level attained by control cells grown on PEG-free medium. Long-term growth on a medium containing 15% PEG (PEG-selected cells) could only be sustained if the medium was supplemented with 30 mM glutamine. The PEG-selected cells grew in small clusters, were isodiametric, and had chlorophyll contents 50% higher than unselected cells. The PEG-selected cells also showed lowered cellular osmotic potentials, presumably due to osmoregulation. Turgor pressures of PEG-selected cells were greater than or equal to those of unselected cells.

The influence of glutamine on growth and viability of cell suspension cultures of Douglas-fir after exposure to polyethylene glycol.

The response of cell cultures of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) to osmotic stress was studied by measuring cell growth and viability after exposure to polyethylene glycol (PEG) (M(r) 6000-8000). Growth of cells inoculated in a medium containing 10% PEG was slightly inhibited, whereas growth in a medium containing 15% PEG was severely inhibited. Cells grown for 6 days in nutrient medium and then subcultured in a medium containing 15% PEG to induce water stress showed high viabilities, whereas cells grown for longer than 6 days before exposure to PEG showed decreased viabilities after subculture. Cells grown in medium containing 30 mM glutamine were significantly more resistant to PEG-induced water stress, as measured by viability, than cells grown in medium without glutamine.

Cell wall formation in zoospores of Allomyces arbuscula. III. Carbohydrate composition of cell walls during development from meiospores to hyphae.

Carbohydrate composition was determined in isolated cell walls of meiospores of Allomyces arbuscula after incubation for 15 min (encysted meiospores: cysts), 150 min (germlings: cysts + rhizoids) and 24 h (cysts + rhizoids + hyphae). The principal constituent in all cell wall samples is chitin, accounting for about 75% of the recovered carbohydrates. In addition, cell walls of all stages examined contain polysaccharides which release galactose, glucose, mannose, arabinose, xylose, fucose, and rhamnose on acid hydrolysis. While different developmental stages show minor quantitative changes in chitin, the ratio of galactose to glucose decreases sharply during differentiation of ungerminated cysts into germlings with rhizoids and hyphae. The increase in glucose is accompanied by a decrease in the amount of xylose and/or fucose and of galactose.

Cell wall formation in zoospores of Allomyces arbuscula. II. Development of surface structure of encysted haploid zoospores, rhizoids, and hyphae.

Development of haploid meiospores of Allomyces arbuscula into germling cells with rhizoids and hyphae was followed during incubation in complete growth medium. The surface structure of encysted meiospores, rhizoids and hyphae before and after extraction of amorphous materials with ethanolic KOH was studied by means of carbon-platinum replicas. After 2--3 min incubation in complete medium 10% of the meiospores were surrounded by a cell wall containing microfibrils embedded in a matrix. Structure of cell walls of encysted meiospores, rhizoids, and hyphae differ from one another by the location of amorphous materials and by the arrangement of chitin microfibrils.

Location of glycoproteins that contain glucosamine in plant tissues.

When radioactive d-glucosamine is provided to Acer pseudoplatanus cells in liquid culture in order to label those glycoproteins that contain amino sugars, it is incorporated predominantly into a crude cell wall fraction. This observation was confirmed histologically by preparing autoradiographs of thin tissue sections from plasmolyzed cells. Highly purified cell wall material from unlabeled cells has also been shown to contain small amounts of glucosamine. Similarly, about one-half of the amino sugar recovered from cultured cells of Nicotiana tabacum is present in their cell walls. In corn roots, however, the labeled glycoproteins that are formed after glucosamine incorporation are predominantly cytoplasmic and not deposited outside the protoplast.

The localized incorporation of (3)H-L-fucose into cell-wall polysaccharides of the cap and epidermis of corn roots : Autoradiographic and biosynthetic studies.

When (3)H-L-fucose is provided to corn roots, a large proportion of the radioactivity is recovered in the polysaccharides extracted from the cell wall. Hydrolysis of this material yields (3)H-L-fucose as the sole radioactive product. Two metabolites, identified tentatively as L-fucose-1-phosphate and a nucleoside diphosphate derivative of L-fucose have been isolated from the ethanol soluble fractions of the roots and are possibly precursors of the polysaccharide. Autoradiographs of tissue sections indicate that the synthesis of polysaccharides containing L-fucose is confined largely to the root-cap and epidermis. The outer epidermal wall and root-cap slime are particularly radioactive and, therefore, likely to be relatively rich in fucose. By contrast the cell walls from more deeply lying tissues incorporate negligible amounts of the sugar.