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Office of the National Coordinator.

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology's impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.

Background: Shifts in the supply of and demand for emergency department (ED) resources make the efficient allocation of ED resources increasingly important. Forecasting is a vital activity that guides decision-making in many areas of economic, industrial, and scientific planning, but has gained little traction in the health care industry. There are few studies that explore the use of forecasting methods to predict patient volumes in the ED.

A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0-682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24.6/1000 person-years, with a higher incidence among males and individuals aged 45-64 years. The most common site of infection was the lower extremity (39.9%). The majority of patients were seen in an outpatient setting (73.8%), and most (82.0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.

Chronic stress increased susceptibility to UV-induced squamous cell carcinoma in this mouse model by suppressing type 1 cytokines and protective T cells and increasing regulatory/suppressor T cell numbers.

Inflammatory breast carcinoma (IBC) is a particularly lethal form of breast cancer characterized by exaggerated lymphovascular invasion, which is a phenotype recapitulated in our human xenograft MARY-X. MARY-X generated spheroids in vitro that resemble the embryonal blastocyst. Because of the resemblance of the spheroids to the embryonal blastocyst and their resistance to traditional chemotherapy/radiotherapy, we hypothesized that the spheroids expressed a stem cell-like phenotype. MARY-X spheroids expressed embryonal stem cell markers including stellar, rex-1, nestin, H19, and potent transcriptional factors, oct-4, nanog, and sox-2, which are associated with stem cell self-renewal and developmental potential. Most importantly, MARY-X spheroids expressed a cancer stem cell profile characterized by CD44 Inflammatory breast cancer (IBC) is an aggressive form of human breast cancer characterized by florid lymphovascular invasion (LVI) and early metastasis.1,2 LVI is considered an important rate-limiting step in the metastatic process and is characterized by the formation of tumor emboli within lymphovascular channels.3,4 These emboli are relatively resistant to radiotherapy and chemotherapy because the tight aggregates of tumor cells exert autocrine and paracrine cytoprotective effects from these therapies by unknown mechanisms. 5,6 These emboli are also efficient at escaping local organ confinement with subsequent distant implantation. They therefore exhibit a strong penchant for both distant metastasis as well as local recurrence and confound attempts at both local as well as systemic control. The tumor emboli bear a strong resemblance to the human embryonal blastocyst, a structure also efficient at escaping local organ confinement with subsequent distant implantation. The IBC phenotype has been successfully recapitulated in a human xenograft model of IBC termed MARY-X.3-7 This model exhibits florid LVI in vivo, which generates tight aggregates of tumor cells (spheroids) in vitro. These spheroids also bear a strong resemblance to the blastocyst. Because the blastocyst is the source of human embryonal stem cells (ESs), cells capable of self renewal, proliferation and differentiation along multiple lineages and because tumor stem cells have been implicated in the properties of local recurrence, distant metastasis, and drug resistance that human cancers exhibit, we hypothesized that the tumor lymphovascular emboli of MARY-X and its derived spheroids might, in fact, express a stem cell-like phenotype reflected by both stem cell markers and stem cell biology. In addition we could test this hypothesis in human cases of IBC and, if confirmed, might explain some of the aggressive behavior of IBC.

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