Expanding Internet access for health care consumers.

Sophisticated health care consumers are beginning to use the Internet to educate themselves about their own health and manage their own care. As health care stakeholders (providers, payers, employers) feel pressure from consumers to implement Internet-related strategies, stakeholders must realize that obtaining Internet access is a challenge for many consumers. Stakeholders who expand consumer Internet access will, however, have a competitive advantage. This article outlines how stakeholders can expand consumer Internet access.

The component alignment model: a new approach to health care information technology strategic planning.

The evolving health care environment demands that health care organizations fully utilize information technologies (ITs). The effective deployment of IT requires the development and implementation of a comprehensive IT strategic plan. A number of approaches to health care IT strategic planning exist, but they are outdated or incomplete. The component alignment model (CAM) introduced here recognizes the complexity of today's health care environment, emphasizing continuous assessment and realignment of seven basic components: external environment, emerging ITs, organizational infrastructure, mission, IT infrastructure, business strategy, and IT strategy. The article provides a framework by which health care organizations can develop an effective IT strategic planning process.

A mouse model of transplacental cocaine exposure. Clinical implications for exposed infants and children.

To characterize the effects of cocaine on developing brain we have developed a mouse model of gestational cocaine exposure. We studied pregnant dams injected twice daily with cocaine HCl at 40, 20, or 10 mg/kg/day sc from embryonic days (E)8 to E17 (COC 40, COC20, and COC10, respectively), vehicle-injected dams allowed access to food ad libitum (SAL) or pair-fed with the COC 40 dams (SPF 40), animals pretreated with the short-acting alpha-adrenergic antagonist phentolamine prior to each cocaine injection (P COC 40), and animals administered phentolamine prior to saline (PHENT). COC 40, P COC 40, and SPF 40 dams demonstrated the lowest percentage weight gain during gestation. The surrogate-fostered offspring of COC 40, P COC 40, and SPF 40 dams demonstrated transient brain and body growth retardation on postnatal days (P)1 and P9 when compared to pups born to SAL dams. We conducted behavioral tests which allowed us to dissociate the indirect effect of cocaine-induced malnutrition from a direct effect of prenatal cocaine administration in altering postnatal behavior. Pups from all groups were tested for first-order Pavlovian conditioning on P9 or P12 or for the ability to ignore redundant information in a blocking paradigm on P50. Unlike the SPF 40, PHENT, and SAL controls, COC 40 and P COC 40 mice were unable to acquire an aversion to an odor previously paired with shock on P9, a learning deficit that resolved by P12. However, on P50, COC 40 mice and, to a lesser extent, P COC 40 and SPF 40 mice demonstrated a persistent behavioral deficit in our blocking paradigm, which may reflect alterations in selective attention. We discuss how these findings in our rodent model have developmental implications for human infants exposed to cocaine in utero.

Transplacental cocaine exposure. 2: Effects of cocaine dose and gestational timing.

We have utilized a mouse model of transplacental cocaine exposure to investigate the effects of cocaine dose and gestational timing in altering brain and body growth and postnatal behavior in exposed offspring. Pregnant dams were injected with cocaine HCl at 40 mg/kg/day (COC 40) or 20 mg/kg/day (COC 20), or 10 mg/kg/day (COC 10) SC from embryonic day (E) 8 to E17, or cocaine HCl at 40 mg/kg/day SC from E8 to E13 (COC Early) or from E13 to E17 (COC Late) divided in two daily doses. COC 40 and COC Late dams, as well as dams in nutritionally paired control groups (injected with saline vehicle and pair-fed with the COC dams: SPF 40, SPF 20, SPF 10), demonstrated less weight gain than SAL controls (injected with saline vehicle and allowed access to food ad lib). The surrogate fostered offspring of COC 40 and SPF 40 dams demonstrated brain and body growth retardation [on postnatal day (P) 1 and P9] when compared to pups born to SAL dams. Offspring of COC Late, SPF 20, and SPF 10 dams demonstrated brain and body growth retardation on P1 when compared to pups born to SAL dams. Pups from all groups were tested for first-order Pavlovian conditioning on P9, or for the ability to ignore redundant information in a blocking paradigm on P50. Only COC 40 mice (i.e., offspring born to COC 40 dams) were unable to acquire an aversion to an odor previously paired with shock on P9. When compared with SAL controls, COC 40 mice (and to a less significant extent SPF 40 mice) demonstrated a persistent behavioral deficit in the blocking paradigm on P50, which may reflect alterations in selective attention. Correlation analyses indicated that the dose and gestational timing of transplacental cocaine exposure, and varying degrees of malnutrition, had effects on blocking performance, with greater prenatal cocaine exposure and increased prenatal malnutrition resulting in more significant behavioral impairments. A path regression analysis demonstrated independent and significant effects of prenatal cocaine as well as prenatal malnutrition in contributing to impaired performance in the blocking paradigm. As suggested by the clinical literature, our preclinical data support a model whereby the dose and duration of prenatal cocaine exposure have direct effects on offspring brain and body growth and on behavioral performance.

Transplacental cocaine exposure. 1: A rodent model.

To characterize the transplacental effects of cocaine on the developing brain, we have developed a mouse model of gestational cocaine exposure. Pharmacokinetic analysis revealed that cocaine and its metabolites (BE, BNE, and NC) were found in fetal brain and plasma at 30 and 120 min following SC administration to embryonic day (E) 17 pregnant Swiss Webster mice. Pregnant dams injected twice daily with cocaine HCl at 20 mg/kg SC from gestational day E8 to E17 (COC) demonstrated less food intake and lower percentage weight gain than vehicle-injected dams allowed access to food ad lib (SAL). A nutritionally paired control group of dams injected with saline vehicle and pair-fed with the COC dams (SPF) demonstrated the lowest percentage weight gain of all three groups. The surrogate fostered offspring of COC and SPF dams demonstrated persistent growth retardation [on postnatal days (P) 1, P9, and P50] and transient brain growth retardation (on P1 and P9) when compared to pups born to SAL dams. We conducted behavioral tests that allowed us to dissociate the indirect effect of cocaine-induced malnutrition from a direct effect of prenatal cocaine administration in altering postnatal behavior. Pups from all three groups were tested for first-order Pavlovian conditioning on P9 or P12, or for the ability to ignore redundant information in a blocking paradigm on P50 or P100. Unlike the SPF and SAL controls, COC mice (i.e., mice born to COC dams) were unable to acquire an aversion to an odor previously paired with shock on P9. This learning deficit was transient because on P12, COC mice trained on the same conditioning task displayed an aversion to the odor that was indistinguishable from the SPF and SAL controls. P50 and P100 COC mice (and to a lesser extent, SPF mice) demonstrated a persistent behavioral deficit in the blocking paradigm, which may reflect alterations in selective attention. We discuss how these findings in our rodent model have developmental implications for human infants exposed to cocaine in utero.

Transplacental cocaine exposure. 3: Mechanisms underlying altered brain development.

In a mouse model of transplacental cocaine exposure we have demonstrated alterations in brain structure and function of offspring including disturbances of brain growth, disruption of neocortical cytoarchitecture, and transient as well as persistent behavioral deficits. One mechanism by which cocaine may alter fetal brain development is through cocaine-induced alpha-adrenergic-mediated (uterine) arterial vasoconstriction. In this study pregnant Swiss Webster (SW) mice were injected with cocaine HCl (20 or 40 mg/kg, SC) without any changes evident in mean arterial blood pressure (MAP) measurements. These physiology results suggest that in our mouse model, cocaine's transplacental effects on the fetus are not due to cocaine-induced maternal vasoconstriction, nor concomitant hypoperfusion of the fetus. In a separate series of experiments, pregnant SW dams were administered cocaine HCl at 40 mg/kg/day (COC 40), 20 mg/kg/day (COC 20), or 10 mg/kg/day (COC 10) [SC, divided in two daily doses, from embryonic day (E) 8 to E17 inclusive]. Additional groups of cocaine-treated dams were administered phentolamine (5 mg/kg, SC), a short-acting alpha-adrenergic antagonist, 15 min prior to each cocaine dose (Phent COC 40, Phent COC 20, Phent COC 10). Animals born to Phent COC 40 dams demonstrated transient postnatal brain growth retardation and behavioral deficits in first-order conditioning of P9 mice comparable to mice born to COC 40 dams, which received the same regimen of cocaine injections without phentolamine pretreatment. Like COC 40 offspring, Phent COC 40 offspring also demonstrated a persistent deficit in the blocking paradigm. The behavioral and growth findings confirm and extend the physiology data, and imply that in our rodent model, alpha-adrenergic mechanisms (including maternal vasoconstriction) are unlikely to mediate these toxic effects of transplacental cocaine exposure on developing brain.

The evolution of 'bricolage'.

The past ten years of developmental genetics have revealed that most of our genes are shared by other species throughout the animal kingdom. Consequently, animal diversity might largely rely on the differential use of the same components, either at the individual level through divergent functional recruitment, or at a more integrated level, through their participation in various genetic networks. Here, we argue that this inevitably leads to an increase in the interdependency between functions that, in turn, influences the degree to which novel variations can be tolerated. In this 'transitionist' scheme, evolution is neither inherently gradualist nor punctuated but, instead, progresses from one extreme to the other, together with the increased complexity of organisms.

Fiduciary responsibilities in nonprofit health care conversions.

Conversions of nonprofit hospitals to for-profit status have been controversial because of concerns that community interests are not represented in the deals. As a result, several states have either passed or are considering conversion legislation. However, dramatic variability among states in approaching conversions remains, including the extent of attorney general intervention. Federal or state legislation could standardize rules for nonprofit conversions, but such comprehensive legislation is unlikely. Instead, this article argues that CEOs and trustees of nonprofit organizations undergoing conversions must honor their fiduciary duties to ensure that a conversion represents community interests.

Canalization: a molecular genetic perspective.

The phenomenon of canalization--the genetic capacity to buffer developmental pathways against mutational or environmental perturbations--was first characterized in the late 1930s and early 1940s. Despite enormous subsequent progress in understanding the nature of the genetic material and the molecular basis of gene expression, there have been few attempts to interpret the classical work on canalization in molecular genetic terms. Some recent findings, however, bear on one form of canalization, 'genetic canalization', the stabilization of development against mutational effects. These data indicate that co-expressed paralogous genes can function as mutual 'back-up' elements in developmental processes. Paralogues, however, are far from the only basis of canalization: other genetic sources can be readily envisaged and some of these are described here. The evolutionary questions about genetic canalization and the mechanistic questions about developmental instability that still need to be addressed are also briefly discussed.

Postnatal pup brain dopamine depletion inhibits maternal behavior.

The interactions between dams and their pups and among siblings were investigated in litters with (a) all pups depleted of striatal dopamine by 6-hydroxydopamine (6-OHDA on PND3), (b) all pups treated with vehicle, or (c) half of the pups depleted of dopamine and the other half treated with vehicle. On PND10, two sets of four pups from each litter were videotaped in a novel environment with the dam:pup and maternal behaviors were later scored by blind observers. We observed a 70% decrease in striatal dopamine in 6-OHDA-treated pups but found no effect of treatment on pup weight gain. Dams with some or all DA-depleted pups (a) were slower to retrieve a pup and establish a nest, (b) retrieved pups less frequently, and (c) spent less time huddling with pups than dams with only vehicle-treated pups. When compared with DA-depleted pups in homogeneous litters, DA-depleted pups in mixed litters were less hyperactive and spent more time huddling with other pups than in isolation. These results suggest that DA-depleted pups receive compromised maternal care but can benefit from interactions with normal siblings.