bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrophobic treatment of natural fibers and their composites—A review
Authors: Ali Azam , Shaker Khubab , Nawab Yasir , Jabbar Madeha , Hussain Tanveer , Militky Jiri , Baheti Vijay
Published: June 2016

There is a growing interest in the development of natural fiber-reinforced composites, most likely due to their wide availability, low cost, environment friendliness, and sustainability. The market size for natural fiber-reinforced composites is projected to reach $5.83 billion by 2019, with a compound annual growth rate of 12.3%. The composite materials reinforced with wood, cotton, jute, flax or other natural fibers fall under this category. Meanwhile, some major factors limiting the large scale production of natural fiber composites include the tendency of natural fiber to absorb water, degradation by microorganisms and sunlight and ultimately low strength and service life. This paper has focused to review the different natural fiber treatments used to reduce the moisture absorption and fiber degradation. The effect of these treatments on the mechanical properties of these composites has also been summarized.
Design parameters for electrospun biodegradable vascular grafts
Authors: Yalcin Enis Ipek , Gok Sadikoglu Telem
Published: June 2016

The inadequacies of the currently used small diameter, non-biodegradable synthetic grafts prompt researchers to focus on the design parameters of vascular grafts. Since the purpose is to mimic the native vessel as far as possible, the design parameters are mainly determined by the layout of cell types and proteins in the layers of the vessels and the nano and micro structure of their environments. In consequence of this, the complex structure of native vessels has become a broad source of inspiration for researchers. Electrospun fibrous scaffolds with their well accepted advantages are promising candidates and researchers are able to work with various materials with differing forms, structures, dimensions, and surface modifications according to their requirements. On the other hand, both synthetic biodegradable polymers and natural proteins are the key materials that enable researchers to take one step closer to achieving the goal of creating an autologous vessel at some time after implantation. When the priority and significance of the need for small diameter vascular grafts is considered, the research field to improve vascular grafts is worthy of note. In this regard, the objective of this review is to discuss comparatively the current studies on the design parameters of electrospun vascular grafts, defined as fiber orientation, fiber diameter, pore size and porosity, wall thickness, and material selection, based on the structure of native blood vessels, the requirements of vascular grafts and electrospinning technology, and the advantages of electrospun vascular grafts, to give an outlook for further studies.
Interrater Reliability and Concurrent Validity of a New Rating Scale to Assess the Performance of Everyday Life Tasks in Dementia
Authors: de Werd Maartje M. E. , Hoelzenbein Angela C. , Boelen Daniëlle H. E. , Rikkert Marcel G. M. Olde , Hüell Michael , Kessels Roy P. C. , Voigt-Radloff Sebastian
Published: June 2016

Errorless learning (EL) is an instructional procedure involving error reduction during learning. Errorless learning is mostly examined by counting correctly executed task steps or by rating them using a Task Performance Scale (TPS). Here, we explore the validity and reliability of a new assessment procedure, the core elements method (CEM), which rates essential building blocks of activities rather than individual steps. Task performance was assessed in 35 patients with Alzheimer’s dementia recruited from the Relearning methods on Daily Living task performance of persons with Dementia (REDALI-DEM) study using TPS and CEM independently. Results showed excellent interrater reliabilities for both measure methods (CEM: intraclass coefficient [ICC] = .85; TPS: ICC = .97). Also, both methods showed a high agreement (CEM: mean of measurement difference [MD] = −3.44, standard deviation [SD] = 14.72; TPS: MD = −0.41, SD = 7.89) and correlated highly (>.75). Based on these results, TPS and CEM are both valid for assessing task performance. However, since TPS is more complicated and time consuming, CEM may be the preferred method for future research projects.
Large eddy simulation of the flameless oxidation in the IFRF furnace with varying inlet conditions
Authors: Kamali Reza , Mousavi Seyed M , Binesh Ali R , Abolfazli-Esfahani Javad
Published: June 2016

In the present study, large eddy simulation methodology is applied to investigate the 3D non-premixed flameless oxidation in the IFRF furnace. In order to serve this purpose, to model the combustion and radiation, the partially stirred reactor and finite volume discrete ordinate model are used, respectively.Moreover, the detailed mechanism of GRI-2.11 is undertaken to represent chemistry reactions. The present simulations agree qualitatively well with published experimental data. Finally, the present study focusses on the assessment of the effects of variations in the fuel vertical injection by adding an inert gas as well as the fuel temperature on combustion behavior. The results revealed that important changes occur in the characteristics of the flameless oxidation process.
Application of maximum entropy principle for estimation of droplet-size distribution using internal flow analysis of a swirl injector
Authors: Hosseinalipour Seyed Mostafa , Karimaei Hadiseh , Movahednejad Ehsan , Ommi Fathollah
Published: June 2016

The maximum entropy principle is one of the first methods, which have been used to predict droplet size and velocity distributions of liquid sprays. Due to some drawbacks in this model, the predicted results do not match well with the experimental data. This paper presents a different approach for improving the maximum entropy principle model. It is suggested to improve the available energy source in the maximum entropy principle model equation by numerical solution of flow inside the injector based on the computational fluid dynamics technique. This will enhance the calculation accuracy of the turbulent kinetic energy of the output spray. Application of this procedure enhances the model predictions. The liquid sheet properties resulted from the analysis are also applied for calculation of the momentum source in the maximum entropy principle model. The proposed model is applied to predict the droplet size distribution of a hollow-cone spray formed by a swirl injector. The results show a better agreement with the available experimental data than the results of prior models.
A cultural and contextual analysis of health concepts and needs of women in a rural district of Nepal
Authors: Yang Youngran , Bekemeier Betty , Choi Jongsan
Published: June 2016

Introduction:

Globally, individuals and groups have different notions of health promotion influenced by their social and cultural contexts. Effective primary health care and healthy public policy depend on a clear understanding of people’s perceptions of health and their health needs. Women in the Far Western Region (FWR) of Nepal live in one of the most remote and rural areas in that country, and their general health status is one of the worst in that country. In this study we explored the socio-cultural health concepts and needs of women in a district of Nepal’s FWR.

Methods:

Qualitative research methods and a culture-centred approach guided the study, with 30 women from the district of Dadeldhura in the FWR participating in in-depth interviews. Data were analysed through qualitative content analysis.

Results:

The women’s concepts of health included ‘absence of disease’, ‘no tension’, ‘peace in the family’ and ‘being able to work’. The participants felt good health required good food, wealth, education and employment for their children, and a healthy community (free of drug or alcohol addiction). ‘Money is everything’ also emerged as a main theme, linking the concept of wealth to good health. To improve health, respondents recommended that the government provide financial support for education and employment and a focus on listening to and caring for the country’s rural poor.

Conclusions:

Overall, participants’ perceived health as not just about themselves but their families and communities. Socially as well as culturally determined gender roles influenced the health concepts and needs of the women. This study’s findings can be used to guide public health leaders in priority-setting and in determining strategies for women’s health promotion in rural districts of Nepal and other similar cultures.
Remission-induction therapies for early rheumatoid arthritis: evidence to date and clinical implications
Authors: Espinoza Francisco , Fabre Sylvie , Pers Yves-Marie
Published: June 2016

Recent guidelines on rheumatoid arthritis (RA) point to the importance of achieving remission as soon as possible during the course of the disease. The appropriate use of antirheumatic drugs is critical, particularly in early RA patients, before 24 weeks, since this is a ‘window of opportunity’ for treatment to modify disease progression. A treat-to-target strategy added to an aggressive therapeutic approach increases the chance of early remission, particularly in early RA patients. We conducted an overview of current therapeutic strategies leading to remission in early RA patients. We also provide interesting predictive factors that can guide the RA management strategy with regard to disease-modifying treatment and/or drug-free remission.
Promoting Hand Hygiene With a Lighting Prompt
Authors: Diegel-Vacek Lauren , Ryan Catherine
Published: June 2016

Objectives:

The objective of this pilot study was to assess an automatic sink light design intervention as a prompt for clinician hand hygiene (as defined by World Health Organization [WHO]).

Background:

Healthcare-associated infections (HAIs) are still leading causes of morbidity and mortality and contribute to burdens on our healthcare system. Hand hygiene has been related to reducing the rate of HAIs and positively impacting both patient and hospital outcomes.

Methods:

This pilot study was a prospective, longitudinal observational study of a convenience sample of healthcare clinicians. In one inpatient room, clinicians were exposed to a hand hygiene reminder that consisted of a light turning on over the sink as they entered. A control room (the adjacent inpatient room) did not have the intervention.

Results:

A total of 88 clinician encounters were monitored during the study. On the first observation day at the initial activation of the signal light system, the percentage of clinicians performing hand hygiene upon entering a room was only 7% in the control room and 23% in the intervention room. During the second observation (Day 14), those percentages were 16% in the control room and 30% in the intervention room. During the third observation (Day 21), those percentages were 23% in the control room and 23% in the intervention room.

Conclusions:

The healthcare system frequently relies on expensive technology to improve healthcare delivery, but implementation of low-cost, low-technology methods such as this light may be effective in prompting hand hygiene.
Groin Injuries (Athletic Pubalgia) and Return to Play
Authors: Elattar Osama , Choi Ho-Rim , Dills Vickie D. , Busconi Brian
Published: June 2016

Context:

Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition.

Evidence Acquisition:

PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results and Conclusion:

Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases.
Vanishing pineal mass in a young patient without therapy: Case report and review of the literature
Authors: Patriarca Lucia , D’Orazio Federico , Di Cesare Ernesto , Splendiani Alessandra
Published: June 2016

Spontaneous regression is defined as the decrease in size or disappearance of a primary tumour or metastatic disease without therapeutic intervention. Computed tomography and magnetic resonance imaging (MRI) of the brain was performed in a 14-year-old girl experiencing sudden-onset headaches. First diagnostic exams revealed a mass in the pineal region that disappeared at three-month MRI control. Three-year follow-up MRI studies were performed. No therapy was administered, but the pineal lesion had disappeared at three-year follow-up.
Disrupted white matter integrity is associated with cognitive deficits in patients with amnestic mild cognitive impairment: An atlas-based study
Authors: Liu Duan , Wang Zan , Shu Hao , Zhang Zhijun
Published: June 2016

Objective:

This study investigated white matter integrity in patients with amnestic mild cognitive impairment by diffusion tensor imaging.

Methods:

A total of 83 patients with amnestic mild cognitive impairment and 85 elderly healthy controls underwent neuropsychological testing and a diffusion tensor imaging scan. Whole-brain white matter data were parcellated into 50 regions based on the anatomical ICBM-DTI-81 atlas, and regional diffusion metrics consisting of fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity were calculated for each region. Diffusion tensor imaging indices were compared between groups, and it was determined that between-group differences were significantly correlated with neurocognitive performance.

Results:

Relative to the healthy controls group, the amnestic mild cognitive impairment group exhibited poorer cognitive performance in all neuropsychological tests except the complex figure test ( p = 0.083) and showed decreased mean fractional anisotropy in the fornix, increased mean diffusivity in the fornix and bilateral uncinate fasciculus, elevated axial diffusivity in the fornix and genu of corpus callosum, and elevated radial diffusivity in the fornix and bilateral uncinate fasciculus ( p < 0.05). Behaviorally, integrity of the bilateral uncinate fasciculus was correlated positively with episodic memory function, while left uncinate fasciculus integrity was positively associated with language function in the amnestic mild cognitive impairment group ( p < 0.05).

Conclusion:

White matter abnormalities in neural pathways associated with memory were correlated with neurocognitive deficiencies in amnestic mild cognitive impairment. Given that amnestic mild cognitive impairment is putatively a prodromal syndrome for Alzheimer’s disease, this study furthers our understanding of the white matter changes associated with Alzheimer’s disease pathogenesis in the predementia stage.
Chronic intestinal pseudo-obstruction associated with enteric ganglionitis in a Persian cat
Authors: Mortier Jeremy , Elissalt Estelle , Palierne Sophie , Semin Marie Odile , Delverdier Maxence , Diquélou Armelle
Published: June 2016

Case summary A 7-year-old neutered male Persian cat was presented for acute vomiting and inappetence. Physical examination revealed severe abdominal distension. Radiographs demonstrated pneumoperitoneum, megaoesophagus and generalised gaseous distension of the digestive tract. Exploratory coeliotomy was performed, revealing markedly distended and thickened small and large intestines with no observable peristalsis. No intestinal perforation was present. Bacteriological and cytological analysis of abdominal fluid revealed a septic peritonitis involving Pasteurella multocida. Full-thickness intestinal biopsies demonstrated lymphocytic ganglioneuritis localised to the enteric nervous system, in association with glandular atrophy and muscular layer hypertrophy. Amoxicillin-clavulanate and analgesics were given. The cat’s general condition gradually improved after the addition of pyridostigmine bromide (0.5 mg/kg q12h PO), initiated 3 days postsurgery. Vomiting resolved and did not recur. Follow-up radiographs at 15 days, and 1 and 6 months showed persistent intestinal ileus, milder than on the pretreatment radiographs. Thirty months after presentation the cat is still alive, without clinical signs, and receives 1 mg/kg q12h pyridostigmine.

Relevance and novel information To our knowledge, this is the first case of ganglioneuritis of the myenteric plexus described in cats, as well as the first one successfully treated with pyridostigmine. Chronic intestinal pseudo-obstruction is a very rare condition in cats but should be included in the differential diagnosis of generalised gastrointestinal ileus.
Accuracy of the Yamax CW-701 Pedometer for measuring steps in controlled and free-living conditions
Authors: Coffman Maren J , Reeve Charlie L , Butler Shannon , Keeling Maiya , Talbot Laura A
Published: June 2016

Objective

The Yamax Digi-Walker CW-701 (Yamax CW-701) is a low-cost pedometer that includes a 7-day memory, a 2-week cumulative memory, and automatically resets to zero at midnight. To date, the accuracy of the Yamax CW-701 has not been determined. The purpose of this study was to assess the accuracy of steps recorded by the Yamax CW-701 pedometer compared with actual steps and two other devices.

Methods

The study was conducted in a campus-based lab and in free-living settings with 22 students, faculty, and staff at a mid-sized university in the Southeastern US. While wearing a Yamax CW-701, Yamax Digi-Walker SW-200, and an ActiGraph GTX3 accelerometer, participants engaged in activities at variable speeds and conditions. To assess accuracy of each device, steps recorded were compared with actual step counts. Statistical tests included paired sample t-tests, percent accuracy, intraclass correlation coefficient, and Bland–Altman plots.

Results

The Yamax CW-701 demonstrated reliability and concurrent validity during walking at a fast pace and walking on a track, and in free-living conditions. Decreased accuracy was noted walking at a slow pace.

Conclusions

These findings are consistent with prior research. With most pedometers and accelerometers, adequate force and intensity must be present for a step to register. The Yamax CW-701 is accurate in recording steps taken while walking at a fast pace and in free-living settings.
Full activation of mouse platelets requires ADP secretion regulated by SERCA3 ATPase–dependent calcium stores
Authors: Elaïb Ziane , Adam Frédéric , Berrou Eliane , Bordet Jean-Claude , Prévost Nicolas , Bobe Régis , Bryckaert Marijke , Rosa Jean-Philippe
Published: June 2016

Key Points

Defect in thrombus formation, platelet aggregation, and ADP secretion induced by ablation or inhibition of SERCA3−/−.
Surface IgM expression and function are associated with clinical behavior, genetic abnormalities, and DNA methylation in CLL
Authors: D’Avola Annalisa , Drennan Samantha , Tracy Ian , Henderson Isla , Chiecchio Laura , Larrayoz Marta , Rose-Zerilli Matthew , Strefford Jonathan , Plass Christoph , Johnson Peter W. , Steele Andrew J. , Packham Graham , Stevenson Freda K. , Oakes Christopher C. , Forconi Francesco
Published: June 2016

Key Points

High sIgM level is a potential key factor associated with poorer clinical outcome in CLL. Genetic and epigenetic features influence sIgM levels and function in CLL.
Transcriptome sequencing reveals a profile that corresponds to genomic variants in Waldenström macroglobulinemia
Authors: Hunter Zachary R. , Xu Lian , Yang Guang , Tsakmaklis Nicholas , Vos Josephine M. , Liu Xia , Chen Jie , Manning Robert J. , Chen Jiaji G. , Brodsky Philip , Patterson Christopher J. , Gustine Joshua , Dubeau Toni , Castillo Jorge J. , Anderson Kenneth C. , Munshi Nikhil M. , Treon Steven P.
Published: June 2016

Key Points

Transcription profiles associated with mutated MYD88, CXCR4, ARID1A, abnormal cytogenetics including 6q−, and familial WM are described. Mutated CXCR4 profiles show impaired expression of the tumor suppressor response induced by MYD88L265P and also G-protein/MAPK inhibitors.
Cost Savings from Home and Community-Based Services: Arizona’s Capitated Medicaid Long-Term Care Program
Authors: Weissert William G. , Lesnick Timothy , Musliner Melissa , Foley Kathleen A.
Published: June 2016

The Arizona Long-Term Care System is the first capitated, long-term care Medicaid program in the nation to operate statewide. It promotes an extensive home and community-based services program intended to lower long-term care costs by substituting home care for institutional care. Because the program is statewide, finding a suitable control group to evaluate it was a serious problem. A substitute strategy was chosen that compares actual costs incurred to an estimate of what costs would have been in the absence of home and community-based (HCB) services.

To estimate the likelihood of institutionalizing clients in the absence of HCB services, coefficients for institutionalization risk factors were estimated in a logistic regression model developed using national data. These were applied to characteristics of Arizona clients. The model assigned approximately 75 percent of the program’s clients to a category with traits that were determined to resemble nursing home residents’ traits. A similar methodology was used to estimate lengths of nursing home stays. Lengths of stay by the program’s nursing home patients were regressed on their characteristics using an event history analysis model. Coefficients for these characteristics from the regression analysis were then applied to HCB services clients to estimate how long their nursing home stays would have lasted, had they been institutionalized. These estimated nursing home stays were generally shorter than these same patients’ observed home and community stays.

Risk of institutionalization was then multiplied by estimated length of stay and by monthly nursing home costs to estimate what costs would have been without the HCB services option. The expected costs were compared to actual costs to judge cost savings. Home and community-based services appeared to save substantial amounts on costs of nursing home care. Estimates of savings were very robust and did not appear to be declining as the program matured. Savings probably came from several sources: the assessment teams that judged client eligibility were employed by a state agency and thus were independent from the program contractors; clients were required to be in need of at least a three-month nursing home stay; a cap was placed on the number of HCB services clients contractors were allowed to serve each month; the capitated payment methodology forced managed care contractors to hold down average HCB services costs or lose money; and the HCB services and nursing home costs were blended in the capitated rate, so that plans that failed to place clients in HCB services would lose money by using more nursing home days than their monthly capitated rate allowed.
When Do Health Care Decisions Discriminate against Persons with Disabilities?
Authors: Mehlman Maxwell J. , Durchslag Melvyn R. , Neuhauser Duncan
Published: June 2016

Recent interpretations of laws prohibiting discrimination against persons with disabilities indicate that these laws will play a greater role in health care decision making than previously anticipated. This article employs lessons from other areas of antidiscrimination law to examine these developments and to provide a framework for making health care decisions that are consistent with these new legal interpretations. This article addresses decisions in individual cases, treatment policies adopted by health care providers, and coverage programs of third-party payers, both public and private.
Interactions between Mental Health and Law Enforcement Systems: Problems and Prospects for Cooperation
Authors: Wolff Nancy
Published: June 2016

This article examines the challenges posed by system specialization, as illustrated by the difficulties of coordinating the roles of the mental health and law enforcement agencies working with people with severe mental illness. Dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient. This could increase the incidence of disorderly or violent behavior, which foments the myth that the seriously mentally ill are inherently dangerous. Despite the evident need to manage these issues, conventional methods of coordinating services have failed. This article concludes by developing a contracting model that creates more appropriate incentives for the two systems and bridges the gap between them.
Exceptionalism as the Rule? U.s. Health Policy Innovation and Cross-National Learning
Authors: Brown Lawrence D.
Published: June 2016

American health care reformers, who often look to other nations for models of desirable health systems, are often surprised nowadays by cross-national infatuation with health policy innovations minted in the United States. American innovations appeal to policy makers abroad as they struggle with cost pressures, distinguish knowledge about how health systems work, and deal with changing images of what constitutes good public policy. These strategems are adapted, not adopted; however, the premises and practices with which other nations follow American directions differ deeply from those in the United States. Ironically, even cross-national experiments may end up offering instructive policy “rules” to the exceptionalist United States.
Addressing Racial Inequities in Health Care: Civil Rights Monitoring and Report Cards
Authors: Smith David Barton
Published: June 2016

Large racial inequities in health care use continue to be reported, raising concerns about discrimination. Historically, the health system, with its professionally dominated, autonomous, voluntary organizational structure, has presented special challenges to civil rights efforts. De jure racial segregation in the United States gave way to a period of aggressive litigation and enforcement from 1954 until 1968 and then to the current period of relative inactivity. A combination of factors—declining federal resources and organizational capacity to address more subtle forms of discriminatory practices in health care settings, increasingly restrictive interpretations by the courts, and the lack of any systematic mechanisms for the statistical monitoring of providers—offers little assurance that discrimination does not continue to play a role in accounting for discrepancies in use. The current rapid transformation of health care into integrated delivery systems driven by risk-based financing presents both new opportunities and new threats. Adequate regulation, markets, and management for such systems impose new requirements for comparative systematic statistical assessment of performance. My conclusion illustrates ways that current “report card” approaches to monitoring performance of such systems could be used to monitor, correct, and build trust in equitable treatment.
A Cross-National Comparison of Orphan Drug Policies: Implications for the U.s. Orphan Drug Act
Authors: Thamer Mae , Brennan Niall , Semansky Rafael
Published: June 2016

Six countries—Canada, France, Japan, Sweden, the United Kingdom, and the United States—were studied to compare public policies affecting the development and marketing of pharmaceuticals for rare diseases (i.e., orphan drugs). Information was obtained from a variety of published and unpublished sources, including interviews with public policy and pharmaceutical experts in each country. This article presents different approaches to encouraging the development of orphan drugs while ensuring access by regulating their prices. Additionally, the article describes access to orphan drugs as promoted by special coverage for population subgroups, disease categories, and/or specific drugs. Not all efforts to increase access to orphan pharmaceuticals have been the result of government action, as illustrated by the proliferation of for-profit organizations that specialize in orphan drugs. The many policy options from other countries identified in this study are especially relevant, given increasing calls for reform of the U.S. Orphan Drug Act.
Variation in State Spending for Long-Term Care: Factors Associated with More Balanced Systems
Authors: Kane Robert L. , Kane Rosalie A. , Ladd Richard C. , Veazie Wendy Nielsen
Published: June 2016

Pressures to turn over responsibility for long-term care to the states will exacerbate the already sizable difference in such efforts. This article describes the nature of the interstate variation in the types and amounts of long-term care provided under Medicaid. The average Medicaid long-term care expenditure on persons sixty-five years and older varies from $2,720 in New York to $380 in Arizona. Likewise, payments for home and community-based services (HCBS) vary from $1,180 in New York to $29 in Mississippi. Only a modest portion (28 percent) of the variance in total long-term care expenditures appears to be related to differences in population characteristics, and even less (7 percent) appears to be related to differences in HCBS expenditures. When supply factors (e.g., nursing home beds) are added, the explained variance increases to 52 percent and 17 percent, respectively. Medicare replaces some—but not most—of the difference in Medicaid home and community-based services payments.
Does Removing Certificate-of-Need Regulations Lead to a Surge in Health Care Spending?
Authors: Conover Christopher J. , Sloan Frank A.
Published: June 2016

This study assesses the impact of certificate-of-need (CON) regulation for hospitals on various measures of health spending per capita, hospital supply, diffusion of technology, and hospital industry organization. Using a time series cross-sectional methodology, we estimate the net impact of CON policies on costs, supply, technology diffusion, and industry organization, controlling for area characteristics, the presence of other forms of regulation, such as hospital rate-setting, and competition. Mature CON programs are associated with a modest (5 percent) long-term reduction in acute care spending per capita, but not with a significant reduction in total per capita spending. There is no evidence of a surge in acquisition of facilities or in costs following removal of CON regulations. Mature CON programs also result in a slight (2 percent) reduction in bed supply but higher costs per day and per admission, along with higher hospital profits. CON regulations generally have no detectable effect on diffusion of various hospital-based technologies. It is doubtful that CON regulations have had much effect on quality of care, positive or negative. Such regulations may have improved access, but there is little empirical evidence to document this.
Forecasting American Health Care: How We Got Here and Where We Might Be Going
Authors: Marmor Theodore R.
Published: June 2016

This article is a form of thinking about the future properly regarded as conditional forecasting. It begins by reminding readers of the enormous changes in American medicine since World War II. The second part revisits critically an earlier effort at conditional forecasting for 1995 that Paul Starr and I published in the early 1980s. Besides reviewing the prescience of our forecasts, the second part outlines the earlier trends in progress we identified and the four combinations of political and economic settings we explored. On that basis, the final part takes up the challenge of anticipating sensibly some possible medical futures in the America of the early twenty-first century, a task which excludes simple extrapolation.
The Medicare Reforms of 1997: Headlines You Didn’t Read
Authors: Etheredge Lynn
Published: June 2016

The 1997 Medicare reforms were among the most important social and health policy legislation of the past three decades. The legislation was notable in reestablishing a viable health policy process; in disproving predictions that government-run insurance would restrict consumer freedoms more than employer-based health insurance; and in ratifying market-oriented approaches as a national health paradigm. Most important, the legislation achieved a historic philosophical compromise between advocates of govenment health insurance and advocates of private health insurance. The political agreements came at the expense of greater regulatory capture of the Medicare program by health provider and health plan interests and at the expense of deficient consumer protections.
Managed Care: Rationing without Justice, but Not Unjustly
Authors: Buchanan Allen
Published: June 2016

Three ethical criticisms of managed care are often voiced: (1) by “skimming the cream” of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians’ fulfillment of their fiduciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived. The first rests on the false assumption that the health care system includes a workable division of responsibility regarding access that assigns obligations concerning access to managed care organizations. The second and third criticisms wrongly assume that we in the United States have taken the first step toward assuring equitable access to care for all, articulating a standard for what counts as an “adequate level of care” to which all are entitled. These three misguided criticisms obscure the most fundamental ethical flaw of managed care: the fact that it operates in an institutional setting within which no connection can be made between the activity of rationing and the basic requirements of justice.
The Functions and Limitations of Trust in the Provision of Medical Care
Authors: Mechanic David
Published: June 2016

Trust, the expectation that institutions and professionals will act in one’s interests, contributes to the effectiveness of medical care. With the rapid privatization of medical care and the growth of managed care, trust may be diminished. Five important aspects of trust are examined: technical and interpersonal competence, physician agency, physician control, confidentiality, and open communication and disclosure. In each case, changing health care arrangements increase the risks of trusting and encourage regulatory interventions that substitute for some aspects of trust. With the increased size and centralization of health care plans, inevitable errors are attributed to health plans rather than to failures of individual judgment. Such generalized criticisms exacerbate distrust and encourage micromanagement of medical care processes.
Money and Trust: Relationships between Patients, Physicians, and Health Plans
Authors: Goold Susan Dorr
Published: June 2016

In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level.
The Influence of Governmental Policy on Community Health Partnerships and Community Care Networks: An Analysis of Three Cases
Authors: Gamm Larry D. , Benson Keith J.
Published: June 2016

This is a comparative analysis of hospitals’ efforts in three communities to pursue collaborative ventures to advance community health. The events occurred over a two-year period characterized by increasing market competition and national debate about comprehensive health carefinancing reform. The study objectives are to better understand factors that contributed to the initiation of the collaborative efforts, and factors that sustained, hindered, or thwarted theseefforts. The study explores how the collaborative ventures in these three communities fared in the face of multiple and conflicting policies and the simultaneous creation of larger, competing health systems. A number of concluding generalizations address the impact of interorganizationaldynamics and public policy initiatives on community health partnerships.
Whither the Almshouse? Overutilization and the Role of the Emergency Department
Authors: Malone Ruth E.
Published: June 2016

The problem of emergency department (ED) overutilization or “inappropriate” utilization is commonly conceptualized in terms of inadequate access to appropriate primary medical care. Although medical care access is a critical issue, a focus on increased access to medical care as the sole solution to “inappropriate” ED utilization may obscure other, perhaps equally relevant, issues from consideration. This article reports findings from an ethnographic study focusing on heavy users (HUs) of EDs in two inner-city hospitals. Drawing on fieldwork and on interviews with HU patients and ED clinicians, I argue that the emergence of heavy ED utilization as both a clinical and policy problem is a function not merely of unmet medical careneeds for individuals, but of “almshouse” needs in a changing health care context. The emergence of ED overutilization as a problem occurs in the context of market forces that are contributing to shifts in the role of EDs and in the moral boundaries of accepted ED practice. If the problem of heavy ED use is more broadly conceptualized in terms of this role shift, not solely in terms of medical care access, a different set of issues and priorities for research, policy, and clinical practice emerges.
“Changing Childbirth” In the United Kingdom: Lessons for U.s. Health Policy
Authors: Declercq Eugene
Published: June 2016

This article examines the process that led to the “changing childbirth” initiative in the United Kingdom and its possible lessons for U.S. health policy making. Changing childbirth involves substantial changes in maternity care policy, including increased independence for midwives; greater choice for mothers of birthplace and attendant; and a narrower, more specialized role for obstetricians. Potential lessons for U.S. health policy include the following points: Even narrow, targeted reform is generally slow to develop, and bureaucracies continue to show ingenuity in delaying their response to initiatives; systematic research and control over problem definition powerfully shapes the policy debate (in the United Kingdom the debate focused on normal birth, rather than on the traditional inquiry into perinatal death); a few well-placed individuals (e.g., female legislators) can bring maternity care issues to the policy agenda; and politically skilled consumer groups (which in the case of maternity care essentially do not exist in the United States) can influence the process.
The O-glycosylated ectodomain of FXYD5 impairs adhesion by disrupting cell–cell trans-dimerization of Na,K-ATPase β1 subunits
Authors: Tokhtaeva Elmira , Sun Haying , Deiss-Yehiely Nimrod , Wen Yi , Soni Pritin N. , Gabrielli Nieves M. , Marcus Elizabeth A. , Ridge Karen M. , Sachs George , Vazquez-Levin Mónica , Sznajder Jacob I. , Vagin Olga , Dada Laura A.
Published: June 2016

FXYD5 (also known as dysadherin), a regulatory subunit of the Na,K-ATPase, impairs intercellular adhesion by a poorly understood mechanism. Here, we determined whether FXYD5 disrupts the trans-dimerization of Na,K-ATPase molecules located in neighboring cells. Mutagenesis of the Na,K-ATPase β1 subunit identified four conserved residues, including Y199, that are crucial for the intercellular Na,K-ATPase trans-dimerization and adhesion. Modulation of expression of FXYD5 or of the β1 subunit with intact or mutated β1–β1 binding sites demonstrated that the anti-adhesive effect of FXYD5 depends on the presence of Y199 in the β1 subunit. Immunodetection of the plasma membrane FXYD5 was prevented by the presence of O-glycans. Partial FXYD5 deglycosylation enabled antibody binding and showed that the protein level and the degree of O-glycosylation were greater in cancer than in normal cells. FXYD5-induced impairment of adhesion was abolished by both genetic and pharmacological inhibition of FXYD5 O-glycosylation. Therefore, the extracellular O-glycosylated domain of FXYD5 impairs adhesion by interfering with intercellular β1–β1 interactions, suggesting that the ratio between FXYD5 and α1–β1 heterodimer determines whether the Na,K-ATPase acts as a positive or negative regulator of intercellular adhesion.
Αναζήτηση στο Διαδίκτυο με Χρήση Μεθόδων Γραμμικής Άλγεβρας
Authors: Αρβανιτογεώργος Ανδρέας
Published: June 2016

Τα τεχνολογικά προβλήματα που παρουσιάζονται στο σύγχρονο κόσμο είναι ιδιαίτερα περίπλοκα και προκειμένου να κατανοηθούν πληρέστερα, συχνά απαιτούν μια μαθηματική περιγραφή.  Ένα χαρακτηριστικό παράδειγμα είναι η αναζήτηση ιστοσελίδων στο διαδίκτυο  με τέτοιον τρόπο, ώστε να παρουσιάζονται στο χρήστη οι ιστοσελίδες που τον αφορούν περισσότερο.  Ο τεράστιος όγκος της διαθέσιμης πληροφορίας απαιτεί μια συντονισμένη μαθηματική προσέγγιση και μια τέτοια μαθηματική μέθοδος χρησιμοποιείται από τη μηχανή αναζήτησης Google.  Στην παρούσα εργασία παρουσιάζουμε τη θεμελίωση της μεθόδου αυτής χρησιμοποιώντας γραμμική άλγεβρα, καθώς και μερικές δυσκολίες που προκύπτουν κατά την εφαρμογή της.
Μελέτη της μη αγγειακής καρκινικής ανάπτυξης μέσω ενός πεπλατυσμένου σφαιροειδούς προτύπου
Authors: Γραικού Αικατερίνη
Published: June 2016

Στη μάχη για την αντιμετώπιση του καρκίνου  καλούνται τα μαθηματικά, σε συνεργασία με τη Βιολογία και την Κλινική Ιατρική, να αναπτύξουν θεωρητικά πλαίσια που να ενσωματώνουν και να ερμηνεύουν τα συνεχώς αυξανόμενα πειραματικά αποτελέσματα της Βιοτεχνολογίας και να δημιουργήσουν μοντέλα που θα ερμηνεύουν τους μηχανισμούς και θα προβλέπουν την εξέλιξη της νόσου. Πλήθος μαθηματικών προτύπων έχουν αναπτυχθεί τα τελευταία χρόνια, που μοντελοποιούν τις τρεις φάσεις της καρκινικής ανάπτυξης. Η μη αγγειακή φάση στα περισσότερα μοντέλα μελετάται σε σφαιρικό σχήμα γιατί στα in vitro πειράματα οι καλλιεργούμενοι όγκοι προσομοιάζουν σφαίρες. Υπάρχουν όμως όγκοι που θα μπορούσαν να περιγραφούν καλύτερα από μία γεωμετρία που παρέχει διπαραμετρική προσέγγιση του σχήματος τους, όπως η πεπλατυσμένη σφαιροειδής γεωμετρία. Η παρούσα εργασία εστιάζει στην περιγραφή των γενικών αρχών και φυσικών νόμων που διέπουν την ανάπτυξη ενός καρκινικού όγκου σε σχήμα πεπλατυσμένου σφαιροειδούς. Ο όγκος αναπτύσσεται υπό την επίδραση διαχεόμενων θρεπτικών συστατικών από το περιβάλλον, ενδογενών ανασταλτικών ουσιών που παράγονται από τη μεταβολική και αποσυνθετική διαδικασία των κυττάρων του καθώς και της πίεσης που έπεται από την ανάπτυξή του στο εσωτερικό πεπερασμένου φιλοξενούντος οργάνου. Κατά συνέπεια, το μαθηματικό πρόβλημα, το οποίο στην παρούσα εργασία αντιμετωπίζεται αναλυτικά, είναι ένα πρόβλημα ελευθέρου συνόρου με μερικές διαφορικές εξισώσεις.
Trophic application in CVI I with peripheral oedema compared with compression stockings
Authors: Kiesewetter H.
Published: June 2016

Aim In the warm season of 2015, the efficacy of Allga Med® Antiswelling Foot Spray and Allga Med® Warm Feet Balsam in combination with a class 2 compression stocking was compared with the efficacy of a compression stocking of the same class applied alone.

Method 40 women aged 23–78 years (mean 48 years) were included in the investigation. The women were all overweight (mean height: 166 cm, mean weight: 83 kg; mean BMI 30.1 kg/m2). For one month before their inclusion, they had not been permitted to take venous medication or wear compression stockings. Prior to the start of the study, class 2 compression stockings were prescribed. The compression stockings were worn consistently during the day for 14 days. In addition, the right leg was treated twice daily with foot spray and balsam. Before the start of the study and after 14 days, the foot and distal lower leg volume of both legs was measured by means of water plethysmography

Result On the stockinged left leg, the volume decreased by 152 ml. On the right leg, which was trophically treated and stockinged, the volume decreased by up to 335 ml.
Phylogeny and biogeography of Caryodaphnopsis (Lauraceae) inferred from low‐copy nuclear gene and ITS sequences
Authors: Li Lang , Madriñán Santiago , Li Jie
Published: June 2016

Caryodaphnopsis is a small genus of the Lauraceae. It contains 16 known species with a disjunct tropical amphi‐Pacific distribution; 8 species in tropical Asia and 8 species in tropical America. In the present study, RPB2, LEAFY and ITS sequences of 9 Caryodaphnopsis species and 22 other Lauraceae species were analyzed with maximum parsimony and Bayesian inference. Divergence time estimation employed the Bayesian Markov chain Monte Carlo method under a relaxed clock. Ancestral area reconstructions were conducted by using both the statistical dispersal‐vicariance analysis and likelihood approach under the dispersal‐extinction‐cladogenesis model. Based on the results of the phylogenetic analyses, the monophyly of Caryodaphnopsis is strongly supported. Asian and American Caryodaphnopsis species form two well‐supported monophyletic clades, respectively. Independent lineages for Caryodaphnopsis, Neocinnamomum and Cassytha are also suggested. According to the divergence time estimations and ancestral area reconstructions, we suggest that Caryodaphnopsis originated in Late Cretaceous Laurasia and its amphi‐Pacific disjunction results from the disruption of ancestral boreotropical lineages between Eurasia and North America during the first cooling period of the Eocene.
Typification of the Indo‐Pacific seagrass Enhalus acoroides (Hydrocharitaceae)
Authors: Boisset Fernando , Ferrer-Gallego Pablo P.
Published: June 2016

The typification of the ecologically important and widely distributed Indo‐Pacific seagrass Enhalus acoroides (≡ Stratiotes acoroides, Hydrocharitaceae) is discussed. An illustration from Rumphius's Herbarium Amboinense is designated as the lectotype.