bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Patterns of Movements in Institutionalized Elderly With Dementia During 12 Consecutive Days of Observation in Seoul, Korea
Authors: Makimoto Kiyoko , Eun Ah Lee  , Kang Younhee , Yamakawa Miyae , Ashida Nobuyuki , Kyung Rim Shin
Published: January 2008

Background: The availability of increasingly sophisticated technology has meant that ambulation can be measured with precision over an extended period. Methods: An integrated circuit tag-monitoring system was set up to measure the distance moved in a dementia care unit in Korea in 2006. Various indicators were developed to measure temporal patterns of ambulation over time, such as the median distance moved per hour and the percentage of hours moved. Results: 12 consecutive days of movement data were available for 8 subjects. The mean age of the subjects was 76 ± 5.3 years. The median distance walked per day ranged from 206 to 976 m, and the percentage of hours with movement ranged from 28% to 81%. The changes in the activity level during daytime, evening, and nighttime also differed among the 8 subjects. Discussion: The indicators developed appeared to differentiate temporal patterns of movement in demented persons.
Monocyte migration to inflamed skin and lymph nodes is differentially controlled by L-selectin and PSGL-1
Authors: León Beatriz , Ardavín Carlos
Published: January 2008

Monocyte recruitment and differentiation into dendritic cells or macrophages play a critical role in defense mechanisms against pathogens and in inflammatory and autoimmune diseases. Important contributions have been made on the molecular events controlling neutrophil and lymphocyte extravasation under steady state or inflammation. However, the molecules involved in monocyte rolling during their migration to antigen capture areas and lymphoid organs during infection remain undefined. Here we have analyzed the homing molecules controlling mouse monocyte rolling in an experimental model of Leishmania major infection. Monocyte migration through inflamed dermal venules was dependent on interactions of PSGL-1 with P- and E-selectins, and of L-selectin with PNAd, whereas migration through lymph node high endothelial venules relied essentially on L-selectin–PNAd interactions. These results might have important implications regarding the induction of immune responses against pathogens and future immunotherapeutic protocols of inflammatory and autoimmune diseases, based on selective inhibition of monocyte migration to specific inflammatory foci.
Potentiation of antileukemic therapies by the dual PI3K/PDK-1 inhibitor, BAG956: effects on BCR-ABL– and mutant FLT3-expressing cells
Authors: Weisberg Ellen , Banerji Lolita , Wright Renee D. , Barrett Rosemary , Ray Arghya , Moreno Daisy , Catley Laurence , Jiang Jingrui , Hall-Meyers Elizabeth , Sauveur-Michel Maira , Stone Richard , Galinsky Ilene , Fox Edward , Kung Andrew L. , Griffin James D.
Published: January 2008

Mediators of PI3K/AKT signaling have been implicated in chronic myeloid leukemia (CML) and acute myeloid leukemia (AML). Studies have shown that inhibitors of PI3K/AKT signaling, such as wortmannin and LY294002, are able to inhibit CML and AML cell proliferation and synergize with targeted tyrosine kinase inhi-bitors. We investigated the ability of BAG956, a dual PI3K/PDK-1 inhibitor, to be used in combination with inhibitors of BCR-ABL and mutant FLT3, as well as with the mTOR inhibitor, rapamycin, and the rapamycin derivative, RAD001. BAG956 was shown to block AKT phosphorylation induced by BCR-ABL–, and induce apoptosis of BCR-ABL–expressing cell lines and patient bone marrow cells at concentrations that also inhibit PI3K signaling. Enhancement of the inhibitory effects of the tyrosine kinase inhibitors, imatinib and nilotinib, by BAG956 was demonstrated against BCR-ABL expressing cells both in vitro and in vivo. We have also shown that BAG956 is effective against mutant FLT3-expressing cell lines and AML patient bone marrow cells. Enhancement of the inhibitory effects of the tyrosine kinase inhibitor, PKC412, by BAG956 was demonstrated against mutant FLT3-expressing cells. Finally, BAG956 and rapamycin/RAD001 were shown to combine in a nonantagonistic fashion against BCR-ABL– and mutant FLT3-expressing cells both in vitro and in vivo.
Biomarker reproducibility in exhaled breath condensate collected with different condensers
Authors: Rosias P. P. , Robroeks C. M. , Kester A. , den Hartog G. J. , Wodzig W. K. , Rijkers G. T. , Zimmermann L. J. , van Schayck C. P. , Jöbsis Q. , Dompeling E.
Published: January 2008

Optimal collection and analysis of exhaled breath condensate (EBC) are prerequisites for standardisation and reproducibility of assessments. The present study aimed to assess reproducibility of EBC volume, hydrogen peroxide (H2O2), 8-isoprostane and cytokine measurements using different condensers, including a newly developed glass condenser.

At four points in time, 30 healthy subjects performed sequential EBC collections randomly using the following four condensers: glass, silicone, EcoScreen® (Erich Jaeger GmbH, Hoechberg, Germany) and an optimised glass condenser. In small EBC samples, H2O2was measured by spectrophotometer, 8-isoprostane by enzyme immunoassay, and cytokines by multiplexed xMAP® technology (Luminex Corporation, Austin, TX, USA).

The optimised glass condenser yielded significantly more EBC volume (median 2,025 µL, interquartile range 1,600–2,525). The reproducibility of EBC volume, yielded by the new glass condenser, was comparable with EcoScreen® (19–20 coefficients of variation (CV)%), but was significantly better compared with silicone and glass (29–37 CV%). The new condenser was associated with significantly more detections of H2O2, 8-isoprostane, interleukin-2, -4, -5 and -13, and tumour necrosis factor-α. Isoprostane concentrations were significantly higher using the new condenser, whereas H2O2and cytokine concentrations were not. Reproducibility of biomarkers was equally variable for all condenser types.

In conclusion, significantly more exhaled breath condensate volume and biomarker detections were found using the optimised glass condenser, including higher 8-isoprostane levels. However, biomarker reproducibility in exhaled breath condensate in healthy adults was not influenced by the type of condenser.
Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure
Authors: Lin S-M. , Lin T-Y. , Chou C-L. , Chen H-C. , Liu C-Y. , Wang C-H. , Lin H-C. , Yu C-T. , Lee K-Y. , Kuo H-P.
Published: January 2008

Stent implantation has been reported to facilitate liberation from mechanical ventilation in patients with respiratory failure due to central airway disease. The present retrospective cohort study sought to evaluate the risk and benefit of stent implantationviabronchoscopy without fluoroscopic guidance in mechanically ventilated patients.

From July 2001 to September 2006, 26 patients with acute respiratory failure were recruited. A bronchoscope was inserted through a mouth guard into the space between the tracheal wall and the endotracheal tube. A guide wire was insertedviathe flexible bronchoscope to the lesion site. The bronchoscope was reintroduced through the endotracheal tube. Under bronchoscopic visualisation, the delivery catheter was advanced over the guide wire to deploy the stent.

These procedures were successfully performed in 26 patients, with 22 stents placed in the trachea and seven in the main bronchus. Of the 26 patients, 14 (53.8%) became ventilator independent during their stay in the intensive care unit. Severe pneumonia was the most common cause, in seven (58.3%) out of 12 patients, for continued ventilator dependence after stenting. Granulation tissue formation was found in seven patients during the follow-up period.

It is concluded that metallic stents can be safely implanted without fluoroscopic guidance in patients with respiratory failure, to facilitate ventilator independence.
Impact of a controlled heated breathing tube humidifier on sleep quality during CPAP therapy in a cool sleeping environment
Authors: Nilius G. , Domanski U. , Franke K-J. , Ruhle K-H.
Published: January 2008

There are conflicting data on the effect of adding a heated humidifier to nasal continuous positive airway pressure (CPAP) therapy for patients with obstructive sleep apnoea syndrome (OSAS). The effects of heated humidification on sleep quality and treatment side-effects for patients who prefer a cold bedroom environment have not been studied.

A randomised, controlled crossover trial involving 19 patients with a first-ever diagnosis of OSAS measured the effect of conventional heated humidification added to CPAP compared with a controlled heated breathing tube humidifier (ThermoSmart®; Fisher and Paykel Healthcare, Auckland, New Zealand) on sleep quality.

During the night in the sleep laboratory at a mean room temperature of 14°C, less condensation formed with the controlled heated breathing tube humidifier (1.9 mLversus35.3 mL) in the delivery system. In addition, the total sleep time, time spent in sleep stages 3 and 4, and rapid eye movement sleep phases were significantly longer and the overall side-effect score was lower than with conventional heated humidification.

Patients on nasal continuous positive airway pressure desiring a cool bedroom temperature could benefit from controlled heated breathing tube humidification technology (with inputs from ambient temperature, set pressure and flow).
The Effect of State Regulations on the Quality and Sale of Insurance Policies to Medicare Beneficiaries
Authors: McCall Nelda , Rice Thomas , Hall Arden
Published: January 2008

This paper examines the effects of state regulations on the quality of insurance policies sold to Medicare beneficiaries and on the amount of sales abuse reported in the sale of such policies. State regulations regarding such policies relate to policy content and format, minimum rates of return, sale of these policies related to disclosure requirements, consumer information activities, and penalties for agent and company abuse. This paper examines the impact of specific regulations on the ratio of the expected policy benefits per premium dollars and on the number and kind of abusive sales practices reported by purchasers and nonpurchasers in agent and mail sales. The study finds that loss ratio floors, minimum benefit standards, and the development by states of consumer information guides for prospective policyholders have a positive impact on the quality of the policies purchased. In addition, the study finds that the amount of abuse reported is less when insurance companies routinely issue press releases concerning agent or company misrepresentation and when consumer guides are developed and available from the state.
Using Home Equity to Finance Long-Term Care
Authors: Jacobs Bruce , Weissert William
Published: January 2008

A majority of elderly Americans have the bulk of their assets tied up in the houses they own. Reverse mortgages could tap this home equity, providing loan disbursements without requiring older homeowners to make monthly payments on principal and interest. In this paper we analyze the potential of using home equity to finance long-term care of the elderly, including payments for home care and for long-term care insurance. We first estimate each homeowner's risk of need for care (and risk of institutionalization) and then calculate the degree to which home equity could be used to cover the costs of home care (or of insurance premiums). Special emphasis is placed on those in the highest risk group and on those with the lowest incomes, who often turn out to be the same people.
Private Insurance for Medicaid Recipients: The Texas Experience
Authors: Feldman Penny H. , Gerteis Margaret
Published: January 2008

Shifting financial risk from the public to the private sector is an increasingly attractive option to policymakers seeking to constrain Medicaid costs. This paper discusses the potential advantages and disadvantages of private insurance arrangements for Medicaid recipients and examines the Texas Purchased Health Services Program, the oldest and largest private insurance program for Medicaid recipients in the U.S. Our analysis of the Texas program suggests that while the political benefits are real, the administrative costs are substantial and the fiscal benefits uncertain. While overall benefits may outweigh costs in Texas, differing political and fiscal circumstances may alter the balance in other states considering private insurance arrangements.
A Threat or a Promise: Acquisition of Teaching Hospitals by Investor-Owned Chains
Authors: Feder Judith , Hadley Jack
Published: January 2008

In the early 1980s, acquisition of a small number of teaching hospitals by investor-owned chains raised the spectre of a for-profit takeover of teaching institutions. Drawing on experience to date, as well as interviews with affected parties, this article assesses the likely scope of such acquisitions and their impact on the education, research, and indigent care that teaching hospitals provide. Our assessment concludes that relatively few teaching hospitals are likely to satisfy the financial criteria chains apply to acquisitions; that hospitals with modest rather than extensive commitments to education and research are most likely to satisfy these criteria; and that terms of sale typically enhance, rather than undermine, these institutions' resources for research, education, and, to a lesser extent, indigent care, at least in the short run. In the long run, continuation of these activities is more likely to be a function of third-party payment policies than of proprietary versus nonprofit hospital ownership.
Suicide and Civil Commitment
Authors: Siegel Karolynn , Tuckel Peter
Published: January 2008

The contemporary approach to suicide prevention relies primarily on involuntary commitment of the suicidal individual. While there is generally widespread acceptance of the principle of society's right, even its moral obligation, to intervene to prevent a suicide, there is much less agreement concerning the conditions under which such an action should proceed. Most of the debate centers on the widely applied commitment criteria of mental illness and dangerousness to self and others. Questions have also been raised regarding the efficacy of commitment as a preventive measure. In this paper, these controversies are placed in a broader historical context. We examine empirical evidence concerning prevailing commitment criteria and the prophylactic value of involuntary hospitalization, and discuss the appropriateness of our current approach to civil commitment in light of existing data.
Nonprofit and for-Profit Medical Care: Shifting Roles and Implications for Health Policy
Authors: Schlesinger Mark , Marmor Theodore R. , Smithey Richard
Published: January 2008

The contemporary expansion of investor-owned health care facilities has stimulated much controversy but little response from policymakers. We believe this results from the apparently ambiguous relationship between ownership and socially valued outcomes. In our assessment, this ambiguity occurs largely because the effects of ownership are mediated in complex ways by characteristics of the services being delivered and the training of health care providers. Reviewing both the history and current performance of nonprofit and for-profit health care facilities, we identify some of the more important of these mediating factors. Taking these into account, there is a consistent influence of ownership on the delivery of health services. On the basis of this analysis, we discuss appropriate policy responses to the future growth of investor-owned health care organizations.
An End to a Consensus on Health Care in the Federal Republic of Germany?
Authors: Altenstetter Christa
Published: January 2008

Over the past fifteen years the national government in the Federal Republic of Germany has animated the political debate about rising health care expenditures. However, it has only provided health policy leadership by shifting the burden of financing health and medical care to others. This paper presents three cases that illustrate the political and institutional constraints inherent in the German policy process that limit the proposal and implementation of appropriate policy solutions to rising health care costs. Cost controls have been inhibited because of the near-universal entitlement of national health insurance, the access all social groups have to advanced medical care, and policies targeted at providers rather than users of health services. The paper also underscores the past and future importance of regional policy coalitions in shaping national health policy.
HMO Promotion and the Privatization of Health Care in Chile
Authors: Scarpaci Joseph L.
Published: January 2008

Since 1973 the Chilean junta has privatized sectors of the national economy. This paper analyzes the country's policy process of promoting private medical programs through HMO-like plans (ISAPREs, or Institutes of Provisional Health). These plans have captured less than half of their originally anticipated market share. It is argued that the future performance of ISAPREs will be undermined by their limited maternal benefits, their targeting to a small upper-income group which cannot sustain many private medical programs, and competition with less expensive yet equally competent public medical programs. The paper briefly compares privatization in Chile with the experiences of other countries, and specifically contrasts the restructuring of health services under military rule in Chile with those of Argentina and Uruguay. The paper concludes that the Chilean experience with HMOs epitomizes the perils of planning health care during short-term periods of economic prosperity as well as failing to consult medical care providers and consumers.
Tax Policy as Social Policy: Cafeteria Plans, 1978–1985
Authors: Fox Daniel M. , Schaffer Daniel C.
Published: January 2008

Since the passage of Section 125 of the Internal Revenue Code in 1978, cafeteria plans have offered employees a choice of tax-free fringe benefits. Although these plans have been popular with employers and employees, Treasury Department officials and many tax lawyers soon came to regard Section 125 as a mistake. The Treasury has tried to reclaim through regulation the revenue and the fundamental principles of tax law it had asked Congress to give away in 1978. This paper is a history of Section 125 that emphasizes its relationship to health policy. On the basis of interviews and printed primary sources, the paper argues that Treasury officials made a less than rigorous assessment of the impact of cafeteria plans because they were preoccupied with a larger agenda of making tax-free benefits more equitable. Moreover, they saw no reason to collaborate with the health policy community to plan this agenda; they saw themselves as implementing a social policy already in the Internal Revenue Code.
Small Area Analysis: A Review and Analysis of the North American Literature
Authors: Paul-Shaheen Pamela , Clark Jane Deane , Williams Daniel
Published: January 2008

Variations in health service use rates by geographic area have long interested researchers and policymakers. Typically, investigators comparing population-based health care utilization rates among geographic areas have demonstrated substantial variations in use among seemingly similar communities. One method of investigation is “small area analysis.” Numerous areas in North America have been studied extensively using this technique. This research has attempted to document the amount of variation found in health care use rates among areas; determine whether or not there is a pattern to such use in high- versus low-use areas; and identify the variables that are associated with the variation and explain a portion of the variation. Beyond this, many researchers have attempted to ascertain whether such variables are associated with characteristics of the population, whether they reflect differences in access and need, or whether a substantial portion of the variation is associated with differences in the medical care system itself. This review discusses the methods used to define the areas, the dependent variables that have been studied and the patterns found within them, the independent variables that have been tested, the statistical methods and analysis procedures used, the results of each study, and the policy recommendations emanating from the research. More importantly, based on what has been learned, the paper provides researchers in small area analysis with a set of recommendations for both analyzing and reporting results. These recommendations are designed to facilitate the development of a common research methodology, increase the comparability across studies, and enhance the use of this technique in the health policy formulation process.
The Empire Strikes Back: More Lessons for Health Care Consumers
Authors: Checkoway Barry
Published: January 2008

A previous article in this journal analyzed the efforts of health care consumers to organize around the Health Systems Agency in east central Illinois. This article continues the account by describing how local providers organized in response to these initiatives, elected their own slate to the local HSA board, and caused consumers to reconsider their participation in health planning. Among the conclusions drawn is that health planning operates in an imbalanced political arena in which providers can mobilize powerful resources to defeat consumer action.
Antitrust Law and Collective Physician Negotiations with Third Parties: The Relative Value Guide Object Lesson
Authors: Pfizenmayer Rickard F.
Published: January 2008

This article examines the role of collective physician participation in the third-party reimbursement system. It critiques the Havighurst-Kissam analysis of the antitrust implications of professionally-developed relative value guides and using lessons derived from the only litigated case on relative value guides, argues that collective physician input into third-party reimbursement plans can be made in a manner which is consistent with the antitrust laws and cost-containment policy objectives. In particular, collective “negotiations” by organized physicians with third parties, unaccompanied by fee agreements among physicians or by actual or threatened physician boycotts, are found to be procompetitive and hence permissible under the rule of reason.
A Critical Overview of U.s. Acupuncture Regulation
Authors: McRae Ginger
Published: January 2008

The ancient Oriental art and science of acupuncture, known in the U.S. for a decade, still is practiced here only to a limited extent and does not seem likely to spread. The primary reason, this article hypothesizes, is the stifling effect of acupuncture regulation, which typically prohibits trained nonphysician acupuncturists, mostly Orientals, from performing the therapy. Although all states permit licensed physicians to practice acupuncture with little or no training, few physicians have shown any interest in learning acupuncture and adding it to their practice. The result is that acupuncture services are scarce or unavailable in most states, and the public's newly recognized right to acupuncture treatment is therefore burdened or effectively denied.

Current statutory and medical board regulation of acupuncture is described and evaluated from the standpoint of whether it encourages the practice of acupuncture by persons trained in the therapy. The article finds that both physician-limitation and supervised-practice regulations inhibit or eliminate acupuncture services, while acupuncture licensing laws foster availability of the therapy. The article recommends that states establish autonomous boards of acupuncture to license practitioners, and concludes that a coordinated national effort by acupuncturists and their lay and medical supporters will be necessary to achieve wide-spread adoption of licensing laws.
Strategies for Building Representative Hsas: The Impact of Legal Structure
Authors: Chesney James D.
Published: January 2008

The goal of having local health planning agencies represent their communities is considered. A basic premise is that the legal structure of an agency is related to how well a community is represented. This premise is tested, and two strategies are presented for building HSAs which will include strong representation of traditionally under-represented or under-served groups: (1) increasing competition for governing-body membership by requiring all planning agency governing bodies to be small (30 members or less); and (2) increasing the organizational simplicity of the HSA.
Competition in the Health Sector: A Historical Perspective
Authors: Lippincott Ronald C. , Begun James W.
Published: January 2008

Viewed from a historical (and a theoretical) perspective, current “pro-competition” policy proposals are unbalanced in their emphasis on promoting “free market” behavior by consumers rather than by suppliers in the health services market. A comprehensive competition policy would require removal of supply-side restraints on health providers.

Based on evidence about the evolution of restraints on physicians, dentists, and optometrists in one state, this article speculates on the political feasibility of removing supply-side restraints and thereby implementing a true “competition policy.” Historically, the political environment and the alignment of interest groups have favored the promulgation of stringent restraints on health services providers. While the political environment is more receptive to challenges to those restraints today, there is little evidence that such challenges will succeed at either the state or federal level.
Origins of the “Third Psychiatric Revolution”: The Community Mental Health Centers Act of 1963
Authors: Rochefort David A.
Published: January 2008

In recent decades the community mental health movement has achieved a dramatic reduction in the census of state and county mental hospitals in the United States, and hundreds of federally-funded community mental health centers have been established nationwide. At the same time, national controversy has arisen in response to what in places has seemed the haphazard process of implementing “deinstitutionalization” and the fate of many chronically mentally ill persons who are without needed social services and psychological care. Despite the widespread attention that this contemporary program has received, theoretical analysis of the complex social, scientific, intellectual, and political origins of America's community mental health policy remains deficient. This article examines the background and development of the Community Mental Health Centers Act of 1963, tracing how an important shift in national policy toward the mentally ill grew out of changing perceptions—among policymakers, professional groups, and the general citizenry in the post-World War II era—of the nature of the problem of mental illness.
Evaluating Health Planning: Empirical Evidence on HSA Regulation of Prepaid Group Practices
Authors: Brandon William P. , Lee Emma K.
Published: January 2008

The regulation of HMOs by health planning agencies serves as a “tracer” to aid in evaluating HSAs, and as a source of empirical evidence for the heretofore largely theoretical health policy debate between market reformers and regulators. Two complementary studies (the authors' 1979 survey investigating the hospitalization policies of prepaid group practices, and AMPI's study of all HMO applications submitted to HSAs from 1975 through mid-1978) provide information about the extent of HMO applications to planning agencies, the rate of rejections, the burden of the planning process on HMOs, and the possibility that negative perceptions of regulation may have led HMOs to refrain from activities requiring planning approval. Both studies reveal that health planning review was detrimental to 20 to 30 percent of HMOs. Thus data collected during the period of extensive HSA regulation of HMOs seem to justify the current policy that gives HSAs only very limited authority over HMOs.
Citizen Participation on Regulatory Boards
Authors: Chesney James D.
Published: January 2008

This article examines the relationship between regulatory board function and citizen participation. The research indicates that public members generally prefer advisory boards, while provider members prefer quasi-judicial bodies. Implications of these findings for structuring citizen participation in the regulatory process are examined.
The Determinants of Health Policy, a Case Study: Regulating Safety and Health at the Workplace in Sweden
Authors: Navarro Vicente
Published: January 2008

This article analyzes and criticizes the “technocratic” view of occupational health and safety policies, which sees the values of the personnel in “post-industrial” regulatory agencies as the most important determinant of those policies. It takes an alternate position, which explains occupational health and safety policies as primarily resulting from the different degrees of political power of the two major classes (capital and labor), and from the set of influences exerted on the regulatory agencies by the instruments (e.g., parties, unions, trade organizations) of those classes. It shows how an analysis of the historical evolution of those classes in Sweden and their conflict in both civil and political societies explains Swedish occupational health and safety policies better than a mere analysis of the regulators' views. And it concludes that the occupational health and safety policies in Sweden are not identical to those in the U.S.—as the “technocratic” theorists assume—but rather offer more protection to the workers than U.S. policies do. This situation is a result of labor having more power in Sweden than it has in the U.S. The different class formations and class behavior in the two societies are compared, and the implications of this comparison for occupational health and safety policies are discussed.
Crabs in a Bucket: The Politics of Health Care Reform in California
Authors: Bergthold Linda
Published: January 2008

In 1982 the state of California adopted a package of legislation collectively known as “the Medi-Cal reform.” This article examines the background of this reform, the process through which it was adopted by the state legislature, and its effects on the various interests involved. In particular, the article focuses on the alteration of power relationships occasioned by the emergence of business interests as an active force in the formulation of health policy.
Poor People and Poor Hospitals: Implications for Public Policy
Authors: Feder Judith , Hadley Jack , Mullner Ross
Published: January 2008

In 1980, while most hospitals were in reasonably good financial health, hospitals heavily involved in serving the poor ran a considerable risk of financial trouble. Fewer than 9 percent of the nation's hospitals accounted for 40 percent of the nation's total care to the poor. These hospitals, almost half of which were in the 100 largest cities, not only devoted more of their care to the poor than other hospitals, they also served substantially smaller proportions of privately-insured patients. The result was that one-third of these hospitals—by themselves accounting for over 15 percent of all care to the poor—ran deficits in 1980. Using data from a 1980 survey of nonfederal, nonprofit hospitals, this paper examines the fiscal situation of hospitals heavily involved in serving the poor. The analysis shows that it is insufficient revenues, not inefficiency or underuse, that creates these hospitals' financial problems. The article concludes with an assessment of several policies that could be adopted to alleviate this financial pressure and sustain care to the poor.
The Right to Refuse Treatment and the Movement for Mental Health Reform
Authors: Brown Phil
Published: January 2008

The right to refuse treatment is the most controversial of the rights of mental patients, and usually polarizes the movement for mental health reform between providers of care and external activist reformers. A broad alliance supported earlier struggles for recognition of patients' rights, but most professionals oppose recognizing this most extreme right of treatment refusal. Professional opposition to treatment refusal is not based on a wide extent of actual refusal; rather it derives from a defense against challenges to professional and institutional autonomy, an opposition to legal interference, and a belief that the community as well as the patient must be protected. These three reasons for opposition are examined by reviewing studies of attitudes toward patients' rights, knowledge about patients' rights, and implementation of patients' rights. Finally, the implications of these studies for future directions in the movement for patients' rights are examined.
Implementing Regulatory Reform: The Saga of Michigan's Debedding Experiment
Authors: Carpenter Eugenia S. , Paul-Shaheen Pamela
Published: January 2008

This paper traces the implementation of Michigan's program for hospital bed reduction through four phases in the critical first 30 months following enactment: standard-setting, plan development, plan approval, and legislative oversight. Procedural complexity and goal conflict complicated implementation from the start: what began as a simple proposal to close unneeded beds soon became enmeshed in efforts to address longstanding issues of equity in access to care. A combination of administrative, political, and economic factors peculiar to Michigan, as well as the more generic problems incurred in applying a regulatory approach to containing medical care costs, contributed to the difficulties encountered in implementing bed reduction. Long-range prospects for the program depend upon whether the modest results it is likely to achieve are deemed to be worth the costs incurred in administering it.
“Rationing” And American Health Policy
Authors: Baily Mary Ann
Published: January 2008

This article describes an attempt to persuade the members of a presidential commission on ethics in medicine to open a public dialogue on the rationing of medical care. The need for limits on the health care individuals receive, and the reasons why the existing delivery system fails to set such limits in an ethically acceptable manner, were outlined. It was argued that although the term “rationing” is appropriate to describe the process of setting equitable limits, the word generates so much controversy that it is avoided; this very avoidance is an obstacle to the development of sound policy. As an ethics commission, it was argued, the Commission was in a unique position to educate the public about the need for limits, and to defuse some of the controversy surrounding the word rationing. The Commissioners were not persuaded. They accepted the case for limits, in substance, but refused to use the word rationing in their report.
The contribution of Islet1-expressing splanchnic mesoderm cells to distinct branchiomeric muscles reveals significant heterogeneity in head muscle development
Authors: Nathan Elisha , Monovich Amir , Tirosh-Finkel Libbat , Harrelson Zachary , Rousso Tal , Rinon Ariel , Harel Itamar , Evans Sylvia M. , Tzahor Eldad
Published: January 2008

During embryogenesis, paraxial mesoderm cells contribute skeletal muscle progenitors, whereas cardiac progenitors originate in the lateral splanchnic mesoderm (SpM). Here we focus on a subset of the SpM that contributes to the anterior or secondary heart field (AHF/SHF), and lies adjacent to the cranial paraxial mesoderm (CPM), the precursors for the head musculature. Molecular analyses in chick embryos delineated the boundaries between the CPM,undifferentiated SpM progenitors of the AHF/SHF, and differentiating cardiac cells. We then revealed the regionalization of branchial arch mesoderm: CPM cells contribute to the proximal region of the myogenic core, which gives rise to the mandibular adductor muscle. SpM cells contribute to the myogenic cells in the distal region of the branchial arch that later form the intermandibular muscle. Gene expression analyses of these branchiomeric muscles in chick uncovered a distinct molecular signature for both CPM- and SpM-derived muscles. Islet1 (Isl1) is expressed in the SpM/AHF and branchial arch in both chick and mouse embryos. Lineage studies using Isl1-Cre mice revealed the significant contribution of Isl1+ cells to ventral/distal branchiomeric (stylohyoid, mylohyoid and digastric) and laryngeal muscles. By contrast, the Isl1 lineage contributes to mastication muscles (masseter,pterygoid and temporalis) to a lesser extent, with virtually no contribution to intrinsic and extrinsic tongue muscles or extraocular muscles. In addition,in vivo activation of the Wnt/β-catenin pathway in chick embryos resulted in marked inhibition of Isl1, whereas inhibition of this pathway increased Isl1 expression. Our findings demonstrate, for the first time, the contribution of Isl1+ SpM cells to a subset of branchiomeric skeletal muscles.
Role of epithelial cell fibroblast growth factor receptor substrate 2α in prostate development, regeneration and tumorigenesis
Authors: Zhang Yongyou , Zhang Jue , Lin Yongshun , Lan Yongsheng , Lin Chunhong , Xuan Jim W. , Shen Michael M. , McKeehan Wallace L. , Greenberg Norman M. , Wang Fen
Published: January 2008

The fibroblast growth factor (FGF) regulates a broad spectrum of biological activities by activation of transmembrane FGF receptor (FGFR) tyrosine kinases and their coupled intracellular signaling pathways. FGF receptor substrate 2α (FRS2α) is an FGFR interactive adaptor protein that links multiple signaling pathways to the activated FGFR kinase. We previously showed that FGFR2 in the prostate epithelium is important for branching morphogenesis and for the acquisition of the androgen responsiveness. Here we show in mice that FRS2α is uniformly expressed in the epithelial cells of developing prostates, whereas it is expressed only in basal cells of the mature prostate epithelium. However, expression of FRS2α was apparent in luminal epithelial cells of regenerating prostates and prostate tumors. To investigate FRS2α function in the prostate, the Frs2α alleles were ablated specifically in the prostatic epithelial precursor cells during prostate development. Similar to the ablation of Fgfr2, ablation of Frs2α disrupted MAP kinase activation, impaired prostatic ductal branching morphogenesis and compromised cell proliferation. Unlike the Fgfr2 ablation, disrupting Frs2α had no effect on the response of the prostate to androgens. More importantly, ablation of Frs2α inhibited prostatic tumorigenesis induced by oncogenic viral proteins. The results suggest that FRS2α-mediated signals in prostate epithelial cells promote branching morphogenesis and proliferation,and that aberrant activation of FRS2-linked pathways might promote tumorigenesis. Thus, the prostate-specific Frs2αcn mice provide a useful animal model for scrutinizing the molecular mechanisms underlying prostatic development and tumorigenesis.
Shaping the endoplasmic reticulum into the nuclear envelope
Authors: Anderson Daniel J. , Hetzer Martin W.
Published: January 2008

The nuclear envelope (NE), a double membrane enclosing the nucleus of eukaryotic cells, controls the flow of information between the nucleoplasm and the cytoplasm and provides a scaffold for the organization of chromatin and the cytoskeleton. In dividing metazoan cells, the NE breaks down at the onset of mitosis and then reforms around segregated chromosomes to generate the daughter nuclei. Recent data from intact cells and cell-free nuclear assembly systems suggest that the endoplasmic reticulum (ER) is the source of membrane for NE assembly. At the end of mitosis, ER membrane tubules are targeted to chromatin via tubule ends and reorganized into flat nuclear membrane sheets by specific DNA-binding membrane proteins. In contrast to previous models, which proposed vesicle fusion to be the principal mechanism of NE formation, these new studies suggest that the nuclear membrane forms by the chromatin-mediated reshaping of the ER.
Paxillin-dependent stimulation of microtubule catastrophes at focal adhesion sites
Authors: Efimov Andrey , Schiefermeier Natalia , Grigoriev Ilya , Brown Michael C. , Turner Christopher E. , Small J. Victor , Kaverina Irina
Published: January 2008

An organized microtubule array is essential for the polarized motility of fibroblasts. Dynamic microtubules closely interact with focal adhesion sites in migrating cells. Here, we examined the effect of focal adhesions on microtubule dynamics. We observed that the probability of microtubule catastrophes (transitions from growth to shrinkage) was seven times higher at focal adhesions than elsewhere. Analysis of the dependence between the microtubule growth rate and catastrophe probability throughout the cytoplasm revealed that a nonspecific (mechanical or spatial) factor provided a minor contribution to the catastrophe induction by decreasing microtubule growth rate at adhesions. Strikingly, at the same growth rate, the probability of catastrophes was significantly higher at adhesions than elsewhere, indicative of a site-specific biochemical trigger. The observed catastrophe induction occurred at adhesion domains containing the scaffolding protein paxillin that has been shown previously to interact with tubulin. Furthermore, replacement of full-length paxillin at adhesion sites by microinjected paxillin LIM2-LIM3 domains suppressed microtubule catastrophes exclusively at adhesions. We suggest that paxillin influences microtubule dynamics at focal adhesions by serving as a scaffold for a putative catastrophe factor and/or regulating its exposure to microtubules.
Rac-dependent cyclin D1 gene expression regulated by cadherin- and integrin-mediated adhesion
Authors: Fournier Alaina K. , Campbell Latoya E. , Castagnino Paola , Liu Wendy F. , Chung Betty M. , Weaver Valerie M. , Chen Christopher S. , Assoian Richard K.
Published: January 2008

Integrin-mediated adhesion to substratum is required for cyclin D1 induction in mesenchymal cells, but we show here that the induction of cyclin D1 persists despite blockade of ECM-integrin signaling in MCF10A mammary epithelial cells. E-cadherin-mediated cell-cell adhesion also supports cyclin D1 induction in these cells, and the combined inhibition of both E-cadherin and integrin adhesion is required to prevent the expression of cyclin D1 mRNA and protein. Our previous studies described a pro-proliferative effect of E-cadherin in MCF10A cells, mediated by Rac, and we now show that Rac is required for cyclin D1 mRNA induction by both E-cadherin and integrin engagement. The levels of p21Cip1 and p27Kip1, Cdk inhibitors that are also targets of integrin signaling, are not affected by E-cadherin-mediated cell-cell adhesion. Finally, we show that the increased expression of cyclin D1 mRNA associated with E-cadherin-dependent cell-cell adhesion is causally linked to an increased entry into S phase. Our results identify Rac signaling to cyclin D1 as a crucial pro-proliferative effect of E-cadherin-mediated cell-cell adhesion.
Photoinduced Electron-Transfer and Electron-Mediating Processes of Fullerenes and Phenothiazine Oligomers in a Polar Solvent
Authors: Islam D-M Shafiqul , Sasaki Yoshiko , Kawauchi Hidehito , Kozaki Masatoshi , Araki Yasuyuki , Ito Osamu , Okada Keiji
Published: January 2008

Photoinduced electron transfer between fullerenes (C60 and C70) and three phenothiazine oligomers ((PTZ)ns; n=1, 2, and 3) was studied by using a transient absorption method in the visible and near-IR regions. Electron transfer took place from (PTZ)ns to the triplet states of fullerenes (3C60∗ and 3C70∗), giving the radical anions of fullerenes (C60•− and C70•−) and the radical cations of (PTZ)ns, which exhibited strong absorptions in visible and near-IR region for n=2 and 3. From these absorptions, positions of the radical cation in (PTZ)2•+ and (PTZ)3•+ generated by electron donation were also determined. Rate constants and quantum efficiencies of the electron transfer were found to be quite high, because of the strong electron-donating abilities of (PTZ)ns; the order of the rates of electron transfer to 3C60∗ and 3C70∗ is (PTZ)1 > (PTZ)2 = (PTZ)3, which corresponds to the decreasing order of their oxidation potentials. Upon addition of hexylviologen dication (HV2+), an electron-mediating process occurred from C60•− to HV2+, yielding the viologen radical cation (HV•+). In the presence of a sacrificial donor, HV•+ persisted for a long time.
Ab Initio MO-MD Simulation Based on the Fragment MO Method. A Case of (−)-Epicatechin Gallate with STO-3G Basis Set
Authors: Tamura Katsuhiro , Watanabe Toshio , Ishimoto Takayoshi , Nagashima Umpei
Published: January 2008

We performed ab initio MO-MD simulation based on the fragment MO (FMO) method using the (−)-epicatechin gallate in order to examine the efficiency of fragmentation pattern in comparison with conventional MO-MD. We clearly demonstrated that the FMO-MD simulation gave sufficient results concerning the trajectory of the total energy and the geometry difference.
Electronic Properties in a Five-Coordinate Azido Complex of Nonplanar Iron(III) Porphyrin: Revisiting to Quantum Mechanical Spin Admixing
Authors: Neya Saburo , Takahashi Akihiro , Ode Hirotaka , Hoshino Tyuji , Ikezaki Akira , Ohgo Yoshiki , Takahashi Masashi , Furutani Yuji , Lórenz-Fonfría Víctor A , Kandori Hideki , Hiramatsu Hirotsugu , Kitagawa Teizo , Teraoka Junji , Funasaki Noriaki , Nakamura Mikio
Published: January 2008

The iron(III) azido complex of 5,10,15,20-tetraisopropylporphyrin was characterized with NMR, EPR, Mössbauer, and magnetic susceptibility. These physical methods indicate mixing of the high (S=5⁄2) and intermediate (S=3⁄2) spin-states of the iron atom. The results were interpreted in terms of the core contraction after nonplanar deformation of porphyrin ring by the bulky isopropyl substituents. In the IR spectrum of this complex, there are two signals at 2062 and 2048 cm−1 due to the antisymmetric vibration of the coordinated azido ligand. The split IR bands demonstrate that the two spin isomers are present, and that the S=5⁄2 and 3/2 transition occurs sufficiently slow on the IR timescale. This is in remarkable contrast with the homogeneous spin-mixing model proposed for the S=5⁄2 and 3/2 system. The present observations further suggests that the three S=5⁄2, 3/2, and 1/2 states in iron(III) porphyrin commonly mix through thermal spin equilibrium.
Copper-Catalyzed Intermolecular Generation of Ammonium Ylides with Subsequent [2,3]Sigmatropic Rearrangement. Efficient Synthesis of Bifunctional Homoallylamines
Authors: Honda Kiyoshi , Shibuya Hiromasa , Yasui Hiroto , Hoshino Yujiro , Inoue Seiichi
Published: January 2008

The [2,3]sigmatropic rearrangement of allylic ammonium ylides generated by the reaction of N,N-dimethyl-1-alkyl-2-methylallylamines derived from terpene alcohols with diazo compounds in the presence of copper catalysts gave trisubstituted E-olefins in one-pot. In addition, a cyano substituent at the 2-position of N,N-dimethylallylamine increased the occurrence of the catalytic [2,3]sigmatropic rearrangement to give the corresponding bifunctional homoallylamines.
Discotic Liquid Crystals: Synthesis and Characterization of Radial Polyalkynylbenzene Derivatives
Authors: Varshney Sanjay Kumar , Takezoe Hideo , Rao Doddamane Sreenivasamurthy Shankar
Published: January 2008

New radial polyalkynylbenzene derivatives, which consist of 4-phenylacetylene unit connected with a central phenyl or phenoxy or tolyl linking moiety, are presented. The mesomorphic properties of these compounds in their pure form and as donor–accepter (D–A) complexes with 2,4,7-trinitrofluoren-9-one (TNF) were investigated with polarizing optical microscopy (POM), differential scanning calorimetry (DSC), and X-ray diffraction (XRD) studies. The hexaalkynylbenzene derivatives in a pure form had a columnar mesophase texture, and pentaalkynylphenyl and pentaalkynyltoluene derivatives remained in a highly viscous liquid state even at room temperature, whereas D–A complexes showed a the columnar hexagonal (Colh) mesophase. The unexpected mesophase behavior of these radial polyalkynylbenzene derivatives comes from the molecular architecture arising from the branched aliphatic chain.