bluuebunny/crossref_metadata_2025 huggingface dataset:
Antioxidant adaptive responses of extraembryonic tissues from cloned and non-cloned bovine conceptuses to oxidative stress during early pregnancy
Authors: Al-Gubory Kaïs H , Garrel Catherine , Delatouche Laurent , Heyman Yvan , Chavatte-Palmer Pascale
Published: May 2010

Placental oxidative stress has been suggested as a key factor in early pregnancy failure. Abnormal placental development limits success in pregnancies obtained by somatic cell nuclear transfer (SCNT). Malondialdehyde (MDA) content, an index of oxidative stress, and superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) activities were determined in bovine extraembryonic tissues of SCNT or artificial insemination (AI) conceptuses. Chorionic tissues of SCNT and AI conceptuses show no difference in MDA content at day 32 of pregnancy. MDA content in chorionic tissues of SCNT and AI conceptuses decreased from day 32 to 62 of pregnancy. MDA content was lower in chorionic tissues of SCNT conceptuses than that in chorionic tissues of AI conceptuses at day 62 of pregnancy. SOD1, SOD2 and GPX activities in chorionic tissues of SCNT conceptuses were not different from those in chorionic tissues of AI conceptuses at both gestational ages. CAT activity in chorionic tissues of SCNT conceptuses was lower at day 32, and it was higher at day 62 of pregnancy than that in chorionic tissues of AI conceptuses. CAT and GPX activities increased in chorionic tissues of SCNT conceptuses with gestational age. SOD1 activity decreased while that of SOD2 and GPX increased in chorionic tissues of AI conceptuses with gestational age. At day 62 of pregnancy, MDA content and enzyme activities in cotyledonary tissues were not different between AI and SCNT conceptuses. Different antioxidant mechanisms may operate within the chorion of AI and SCNT conceptuses. Further experiments are required to elucidate this point.
Stimulation of both estrogen and androgen receptors maintains skeletal muscle mass in gonadectomized male mice but mainly via different pathways
Authors: Svensson Johan , Movérare-Skrtic Sofia , Windahl Sara , Swanson Charlotte , Sjögren Klara
Published: May 2010

Testosterone is a major regulator of muscle mass. Little is known whether this is due to a direct stimulation of the androgen receptor (AR) or mediated by aromatization of testosterone to estradiol (E2), the ligand for the estrogen receptors (ERs), in peripheral tissues. In this study, we differentiated between the effects mediated by AR and ER by treating orchidectomized (orx) male mice for 5 weeks with E2 or the non-aromatizable androgen dihydrotestosterone (DHT). Both E2 and DHT increased muscle weight and lean mass, although the effect was less marked after E2 treatment. Studies of underlying mechanisms were performed using gene transcript profiling (microarray and real-time PCR) in skeletal muscle, and they demonstrated that E2 regulated 51 genes and DHT regulated 187 genes, with 13 genes (=25% of E2-regulated genes) being regulated by both treatments. Both E2 and DHT altered the expression of Fbxo32, a gene involved in skeletal muscle atrophy, affected the IGF1 system, and regulated genes involved in angiogenesis and the glutathione metabolic process. Only E2 affected genes that regulate intermediary glucose and lipid metabolism, and only DHT increased the expression of genes involved in synaptic transmission and heme and polyamine biosynthesis. In summary, ER activation by E2 treatment maintains skeletal muscle mass after orx. This effect is less marked than that of AR activation by DHT treatment, which completely prevented the effect of orx on muscle mass and was partly, but not fully, mediated via alternative pathways.
Problem Solving in a Polarized Age: Comparative Effectiveness Research and the Politicization of Evidence-Based Medicine
Authors: Gerber Alan S. , Patashnik Eric M
Published: May 2010

This essay uses the case of the "medical evidence gap" to illustrate how polarization and party competition can undermine efforts to solve a societal problem. Policy experts associated with both parties agree that the lack of hard evidence about what treatments work best for patients with different conditions is a significant health care problem, and that greater investments in "comparative effectiveness research" (CER) would enable patients, providers, and payers to make more informed decisions. Until recently, CER was a technocratic, third-tier issue. Over the past year, however, CER became highly politicized because it got caught up in the partisan struggle over universal health care reform. The story of how CER morphed into a symbol of crude rationing schemes and government interference with the doctor-patient relationship offers a cautionary lesson about the limits of pragmatic governance in an era of polarization.
Public Opinion on Health Care Reform
Authors: Gelman Andrew , Lee Daniel , Ghitza Yair
Published: May 2010

We use multilevel modeling to estimate support for health-care reform by age, income, and state. Opposition to reform is concentrated among higher-income voters and those over 65. Attitudes do not vary much by state. Unfortunately, our poll data only go to 2004, but we suspect that much can be learned from the relative positions of different demographic groups and different states, despite swings in national opinion. We speculate on the political implications of these findings.
Loss Aversion and the Framing of the Health Care Reform Debate
Authors: Eckles David L , Schaffner Brian F.
Published: May 2010

The high-stakes debate over health care reform captured the public's attention for nearly a year. Options ranging from fully nationalized insurance to maintaining the status quo were considered, though little consensus as to the appropriate solution emerged. Most surveys indicated an agreement that a problem existed with the current health care system and a clear and consistent majority favored taking some action on health care reform. However, clear public support for any specific reform proposal was difficult to muster since most individuals also indicated satisfaction with their own health care. This paper explores this disconnect in public opinion within the context of loss aversion. We note that even as elites actively attempted to frame the issue to counteract the public's loss averse tendencies, these strategies met with little success in generating support for Obama's reform plan. However, we also argue that these loss averse tendencies will now work against any Republican efforts to repeal the health reform legislation.
Simulating Representation: Elite Mobilization and Political Power in Health Care Reform
Authors: Shapiro Robert Y. , Jacobs Lawrence
Published: May 2010

The debate and the outcome in the Obama Administration's drive to enact national health care reform illustrate the conditional nature of democratic governance in the United States, a blend of partisan policy maximization and elite mobilization strategies that exploit core public policy preferences. The public's core policy preferences have, for some time, favored expanding access to health insurance, regulating private insurers to ensure reliable coverage, and increasing certain taxes to pay for these programs. Yet the intensely divisive debate over reform generated several notable gaps between proposed policies and public opinion for two reasons.First, Democratic policymakers and their supporters pushed for certain specific means for pursuing these broad policy goalsnamely, mandates on individuals to obtain health insurance coverage and the imposition of an excise tax on high-end health insurance plansthat the public opposed. Second, core public support for reform flipped into majority opposition in reaction to carefully crafted messages aimed at frightening Americans and especially by partisan polarization that cued Republican voters into opposition while they unnerved independents. The result suggests a critical change in American democracy, originating in transformations at the elite level and involving, specifically, increased incentives to attempt to move the public in the direction of policy goals favored by elites policies and to rally their partisan base, rather than to respond to public wishes.
After the "Housequake": Leadership and Partisanship in the Post-2006 House
Authors: Price David E
Published: May 2010

The congressional election of 2006 was arguably a "Housequake." But how momentous have the changes been for how the House operates and the policy it produces? An answer to that question requires particular attention to two interrelated institutional factors: leadership and partisanship. A closer look at three episodes involving the Appropriations Committeethe breakdown of the markup process in 2008 and battles over open rules and "motions to recommit" in 2009reveals the extent to which the struggle for partisan advantage is trumping norms that buttress the institutional role of Appropriations and of the House. Congress needs both partisan and bipartisan capacity, but the latter is in a dangerously weakened state.
Harry Reid and Health Care Reform in the Senate: Transactional Leadership in a Transformational Moment?
Authors: Moscardelli Vincent G.
Published: May 2010

On December 24, 2009, the United States Senate passed H.R. 3590, the Patient Protection and Affordable Care Act, by a vote of 60-39. Final passage was the culmination of over a month of behind-the-scenes negotiations and strategy sessions coordinated by Senate Majority Leader Harry Reid (D-NV). In this paper, I trace and evaluate Harry Reids coalition-building efforts on health care reform in the months leading up to the Christmas Eve vote using concepts drawn from the political science literature on legislative leadership. I conclude that Reid adopted precisely the transactional, "keep-the-chains-moving" leadership posture that matched both the institution he leads and his limited personal investment in the issue of health care prior to 2009. Efforts to paint Reid's performance on this issue as a failure of leadership ignore the extent to which contextual factors in the Senate were stacked against reform.
Why Major Health Reform in 2009-10 Won't Solve Our Problems
Authors: Weissert William G. , Weissert Carol S.
Published: May 2010

Though the Obama health reform has become law and many think it revolutionizes our health care system, the reality is that it will do very little about our two biggest problems, costs and quality. Our costs are the highest in the world, and our quality is mediocre at best. We are getting coverage of three-fourths of our uninsured, but nothing in the bill will force physicians to follow protocols to move care more toward science and away from art, and the cuts promised in Medicare payments to hospitals and physicians are no more likely to occur in the future than they have been in the past. Not angering powerful interests meant not really cutting their earnings or telling them how to practice. New taxes and employer inducements to provide insurance or pay a fine were an inevitable product of lacking the political muscle to cut costs while having taken the bold step of reforming the insurance industry. That reform committed the president to an individual mandate to buy insurance, the only way of protecting insurance companies against adverse selection of sick patients once they give up refusal to cover pre-existing conditions. Our permeable political system, our health care history and ideological intransigencies make it hard to adopt truly comprehensive reform that controls costs and assures quality care.
It Works for Mergers, Why not Finance
Authors: Edlin Aaron S. , Gilbert Richard J
Published: May 2010

Many in finance, particularly the more lightly regulated areas of finance like hedge funds, are shocked at the idea of the government's prying eyes and intrusion in their business affairs. They shouldn't be: the government has long been intrusive when it comes to large mergers because they can threaten the public's interest. Merger policy could provide a useful guide for financial reform according to Aaron Edlin and Richard Gilbert, two antitrust specialists from UC Berkeley.
The Ecology of Health Policymaking and Reform in the U.S.A.
Authors: Ubokudom Sunday E , Khubchandani Jagdish
Published: May 2010

This article demonstrates how constitutional, political, legal, economic, technological, social and cultural, physical, demographic, and global factors affect health policymaking in the U.S.A. The ecological factors that influence health policy in the U.S. are uniquely different from those of other countries. Therefore, even though a number of problems may be common to health systems worldwide, these problems may require different solutions in the different countries, or in different sections of the same country. The article concludes that the above ecological factors, individually or collectively, cause U.S. health policies to be inconsistent. For example, policies were adopted in the past to promote the concentrated interests of health providers. Recently, the rise of opposing concentrated interests, a lingering economic recession, a weakened resistance to change, and policy learning from the practices of other industrialized countries and from scholarly publications give us hope that reform, although still difficult to achieve, may finally be in sight.
A New Approach to Producing Geographic Profiles of HIV Prevalence: An Application to Malawi
Authors: Ivaschenko Oleksiy , Lanjouw Peter
Published: May 2010

Subnational estimates of HIV prevalence can inform the design of policy responses to the HIV epidemic. Such responses also benefit from a better understanding of the correlates of HIV status, including the association between HIV and geographical characteristics of localities. In recent years, several countries in Africa have implemented household surveys (such as DHS surveys) that include HIV testing of the adult population, providing estimates of HIV prevalence rates at the subnational level. These surveys are known to have nonresponse bias, but are nonetheless thought to represent a marked improvement over alternatives such as sentinel surveys. At present, however, most countries are not in a position to regularly field such household surveys. This paper proposes a new approach to the estimation of HIV prevalence for relatively small geographic areas in settings where national population‐based surveys of prevalence are not available. The proposed approach aims to overcome some of the difficulties with prevailing methods of deriving HIV prevalence estimates (at both national and subnational levels) directly from sentinel surveys. The paper also outlines some of the limitations of the proposed approach.
Public‐Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB Patients
Authors: Ullah Abu Naser Zafar , Huque Rumana , Begum Vikarunnessa , Newell James , Gerein Nancy
Published: May 2010

Background: Despite enormous efforts, Bangladesh has one of the highest burdens of tuberculosis (TB) in the world. Treatment in the private sector is common and popular among TB patients in South‐Asian countries, including Bangladesh, even though the quality of diagnosis and treatment of TB patients has been shown to be poor in several such countries. The Bangladesh National Tuberculosis Programme (NTP) has recently shown considerable interest in exploring policy options to address this problem. Consequently, the NTP and Non‐Governmental Organisation (NGO) partners planned to develop a public‐private partnership (PPP) model for effective involvement of private medical practitioners (PMPs) in TB control. However, there was a lack of solid data on TB case management practice by PMPs which was needed to appraise the potential role and contribution of PMPs in TB control. The purpose of the study is therefore to assess the knowledge, attitudes and practices of PMPs on TB control in an urban setting in Bangladesh in order to inform development of a public‐private collaboration model. Methods: A cross sectional study was carried out in four areas of Dhaka city involving the NTP and three NGO partners. A mapping of PMPs was carried out: of the 250 PMPs identified, 97 showed an interest in becoming involved in the public‐private collaboration model and agreed to be interviewed. Information was also collected from focus group discussions with PMPs, and through a workshop. Results: PMPs were not aware of the NTP‐recommended regimen for treating TB: their prescribing patterns varied widely and were not related to the TB case categorisation. X‐ray was the preferred investigation of PMPs, who sent TB suspects to their preferred private‐run laboratory for diagnostic tests. Virtually no PMP had knowledge of the Bangladesh national policy for TB control (based on the WHO DOTS strategy), and the great majority did not know the locations of neighbouring DOTS centres. The quality of care provided by the public sector was perceived as poor by PMPs, who were therefore reluctant to refer TB patients to the NTP. Conclusions: There is enormous potential for improving TB treatment and control through partnerships between the NTP and PMPs, if the issues identified in this study are adequately addressed. PMPs must be encouraged to follow NTP guidelines for diagnosis and treatment. They should be motivated to refer patients to nearby DOTS centres. Proper training is required for PMPs to enhance their knowledge on diagnosis, treatment, and follow‐up. Appropriate tools and protocols and customised training packages need to be developed, focusing on appropriate diagnosis and treatment, including ways to refer patients to DOTS centres for diagnosis and treatment supervision.
The Limited Role of Citizens in Shaping Healthcare Policies
Authors: Esfandiari Shahrokh
Published: May 2010

Citizens everywhere are seeking a greater role to influence their government decision‐making. This interest in policymaking decisions has forced governments to adopt new methods to involve citizens. Although most governments acknowledge the need of their citizens' active participation in their healthcare plans, they do very little to facilitate such involvements. The toughest challenge of most healthcare systems is to get providers to acknowledge the importance of patients' choices in the health decision‐making process and to develop strategies to disseminate this information into clinical decisions. There is no gold standard among actively participating citizens in choosing policies that affect their day‐to‐day lives. There is also no evidence to support the idea that citizens' participation in decision‐making undermines the role of democratically elected representatives. If governments are interested in eliminating the apparent democratic deficit in healthcare policymaking, they need to create a vehicle that safely transfers information to their citizens and make it physically, socially, and culturally accessible to the community.
Health System Strengthening Beyond the MDGs for Maternal and Child Health in Malawi: Lessons from Policy Analysis
Authors: Daire Judith Melinda , Khalil Doris D.
Published: May 2010

The article aims to draw the attention of advocators and policy makers in Malawi to consider the context of Malawi as they adopt and implement the components of health system strengthening. It analyzes the context of Maternal and Child Health (MCH) policies in Malawi from 1964 to 2008 and identifies constraints encountered in implementing MCH policies. In addition the article draws conclusion from the study results and makes recommendations. The study found out that the contextual factors that influence MCH policies in Malawi were similar to the constraints encountered in implementing the policies in the health system. Therefore the paper recommends that health systems strengthening that will sustain improved health outcomes beyond achieving the Millennium Development Goals (MDGs) need to take into consideration the influencing factors of the context in which health systems operate. Ultimately, health system strengthening for achieving MDGs should be regarded as means for achieving sustained health outcomes not an end in itself.
How to Find the Right Approach to Quality Measurement: Determinants of Quality and Its Measurement in Healthcare
Authors: Thielscher Christian
Published: May 2010

Measuring quality in health care is an important as well as frequent issue for polic makers and other parties. However, many attempts to measure quality fail. This paper analyzes typical reasons for failures and derives a set of determinants whose application decides on measurement success: the disease studied, the type of treatment studied, definition of “outcome,” purpose of quality measurement, time and location of treatment, measurement technique, and expected reasons for and amounts of quality differences. By discussing determinants in detail, a list of questions that should be answered before starting quality measurement is developed. Because determinants are equally important for investigators and policy makers, issues specific to the latter are discussed in an additional paragraph.
Social Capital and Health in Latin America: Ecological and Individual Level Analyses
Authors: Sapag Jaime C. , Kawachi Ichiro
Published: May 2010

Background: Several studies have evaluated the relationship between social capital and health in North America and Western Europe, although data remain scarce in Latin America. We examined the associations between indicators of social capital and health outcomes in nine Latin American countries. Methods: Design: Cross‐sectional ecological and individual‐level analyses of the relationships between social capital and health outcomes. Setting: Nine Latin American countries (Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Peru, Uruguay, and Venezuela), included in the World Values Survey. Subjects: 14,591 adults over 18 years. Main outcome measures: life expectancy at birth, infant mortality rate, under‐5 mortality rate, and maternal mortality rate (ecological analyses), and odds ratios of reporting good (as opposed to poor) self‐rated health (individual‐level analyses). Results: Trust was significantly correlated with life expectancy at the cross‐national level (r=0.72, p=0.03), and marginally significantly correlated with the maternal mortality rate (r=−0.61, p=0.09). Neither voluntary group participation nor church attendance was correlated with aggregate population health indicators. At the individual level, higher trust was significantly correlated with better self‐rated health in five of the nine countries. Group membership was correlated with better health in three countries. Church attendance was correlated with worse health in Mexico and the Dominican Republic. Conclusions: Our findings provide preliminary support for the relevance of social capital as a determinant of health in the Latin American region. However, further research is warranted on refining the measurement of social capital in this region.
Medical and Public Health Civic Action Programs: Using Health Engagement as a Tool of Foreign Policy
Authors: Avery George H , Boetig Bradley J
Published: May 2010

The problem of failing states and the resulting increase in armed conflict has provoked a reexamination of foreign and security policies used to support the legitimacy of the state. One set of tools that are used in this instance are health engagement programs such as military Medical Civic Action Programs. This article examines the logic of the programs from the perspective of social contract theory and proposes criteria for developing these interventions in a manner consistent with the strategic goal of stabilizing the state. Case studies in Iraq and Bangladesh are used to illustrate proper planning and implementation of health engagement programs.
Assessing the Potential Role of Indian Homeopathic Practitioners in HIV Education and Prevention
Authors: George Sheba , Nyamathi Adey , Lowe Ann , Singh Vijay , Khurana Anil , Taneja Divya
Published: May 2010

Based on eight focus group interviews with homeopathic practitioners in New Delhi and Pune, India, this study describes current HIV education/prevention practices of Indian homeopathic practitioners and qualitatively assesses the barriers and facilitators to integrating HIV prevention/education into homeopathic practice. We found that HIV/AIDS is in fact a subject of conversation and clinical evaluation in Indian homeopathic settings; yet practitioners are not well‐equipped to address this need. Our findings highlight the critical importance of (1) increasing theoretical and practical HIV knowledge and educational resources among practitioners, (2) integrating the unique features of homeopathy into the allopathic foundations of HIV education/prevention efforts, (3) addressing societal factors such as widespread stigma, fear, and ignorance among both patients and practitioners, and (4) addressing the challenges of dealing with socially sensitive and taboo topics such as sexuality through focused communication training. Education for Indian homeopaths may contribute to better prevention of HIV in India.
Disease Mongering in Psychiatry: Is It Fact or Fiction?
Authors: Saddichha Sahoo
Published: May 2010

Disease mongering starts at the top of recent accusations being hurled at psychiatry. It is used to refer to the attempts by pharmaceutical companies or others who have similar interests, to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. This paper critically analyses the ‘for’ and ‘against’ arguments of disease mongering in psychiatric disorders, both new and old, such as Bipolar disorders, ADHD, Restless legs syndrome, Premenstrual dysphoric disorder, female sexual dysfunction, social phobia, metabolic syndrome and road rage disorder.
The Global Role of the Doctor in Healthcare
Authors: Gordon David , Lindgren Stefan C.
Published: May 2010

Medical care is deficient in many parts of the world, while in richer countries the costs and complexities of health care are rising unsustainably. Thus, societies need to understand what it is that only doctors can do and what can or should be done by other members of the healthcare team. The duty of doctors to examine their accountability to society as a whole is critical, in order not to continue blindly to do what has always been done. We argue that doctors may not need, in the future to undertake all their traditional roles, while other new roles may emerge instead. A synthesis of these elements is necessary to propose a policy and philosophy for the future global role of the doctor. Only when we have defined this, is the stage set for medical education to produce a person equipped to fulfill that role.
Use of the Balanced Scorecard to Assess Provincial Hospital Performance in Afghanistan
Authors: Chang Christine S , Bonhoure Philippe , Alam Sahibullah , Hansen Peter , Burnham Gilbert
Published: May 2010

Objectives: An assessment of provincial hospitals in Afghanistan was carried out in 2007 to measure performance against the national standards and guidelines in the Essential Package of Hospital Services. Methods: Assessment instruments were developed through consultation with the Ministry of Public Health and key stakeholders. Teams of six persons spent three days at each of the 30 provincial hospitals. Results are displayed using a balanced score card approach. Results: Considerable variation exists across hospitals. Administrative management domains, patient satisfaction and community involvement tended to be higher scoring. Financial systems, quality and safety, and ethics and value domains and indicators were lower. Discussion: This assessment demonstrates a wide range of performance of provincial hospitals nationally. This may reflect the diversity of funding, funding levels, and characteristics of facilities. Despite these challenges the level of performance in many hospitals is surprisingly good. Conclusion: Assessment of hospital performance when displayed using the balanced score card approach can provide meaningful information for policy formulation and assist hospital management in improvement of services.
Global Perspectives of Pharmacy Education and Practice
Authors: Anderson Claire , Bates Ian , Futter Billy , Gal Diane , Rouse Mike , Whitmarsh Sarah
Published: May 2010

Pharmacists have been shown to reduce morbidity and mortality, reduce medication errors, improve rational use and prescribing of medicines, and increase access to health care and medicines. Unfortunately, in many countries there is a severe shortage of appropriately‐trained pharmacists and pharmaceutical human resources. The WHO UNESCO FIP Pharmacy Education Taskforce is steering sustainable pharmacy education and pharmacy workforce action to support and strengthen local, national, regional and international efforts. The Taskforce advocates for a needs‐based approach, which aims to meet the pharmaceutical needs of the local population. This paper explains the concept of needs‐based education, describes the work of the Pharmacy Education Taskforce, and explores key issues in pharmacy education development and quality assurance.
Reflections on the Pandemic Influenza A (H1N1) Experience in Argentina
Authors: Vazquez Hebe , Dignani Cecilia , Bologna Rosa , Rojas Magda , Stamboulian Daniel
Published: May 2010

The explosive outbreak of pandemic influenza A (H1N1) in Argentina lasted about six weeks, from mid May to late June, with widespread transmission across the country. Influenza virus represented 82.13% of the cases reporting respiratory virus. Consultations for influenza‐like illness in general practices and emergency departments peaked at 309 consultations for every 10,000 inhabitants. Children and young adults were the age groups most affected. From 7 May to 31 October, 2009, 10,248 confirmed cases, 12,471 hospitalizations for severe respiratory disease, and 600 deaths were reported to the Ministry of Health. The most affected group was children under 5 years of age (hospitalization rate 72.99/100,000), followed by the 45–54 year age group. In this latter group, the most frequent preexisting conditions were cardiovascular, respiratory, and metabolic diseases. As in other countries, obesity and pregnancy were risk factors for increased morbidity. The experience of this first pandemic wave has taught us that coordinated work, community education, early treatment with antiviral drugs, and vaccine administration during the next season for high‐risk groups are likely to be fundamental tools against the next pandemic wave.
Access to Care versus Access to Coverage: What Can We Learn from the Louisiana State Hospital Model?
Authors: Clark Mary A.
Published: May 2010

Publicly‐funded direct access‐to‐care models are so clearly inadequate in most of the United States that little attention has been devoted to them as alternatives to insurance expansions for low‐income populations. Louisiana's state hospital system is an unusually comprehensive access‐to‐care model in a particularly poor state. This paper describes a series of improvements made in the Louisiana State University (LSU) hospital system under the rubric of a healthcare effectiveness campaign begun in 1997. They have made Louisiana's access‐to‐care model a workable avenue for providing healthcare services for its low‐income population. But financial instability and shortfalls threaten the sustainability of the LSU hospital system both in terms of annual operating budgets and money for capital improvements.
A Review of T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
Authors: Mayer Jeremy D
Published: May 2010

The Healing of America, by T.R. Reid, is a deceptively simple, readable, and even entertaining book that contains within it vast and complex truths about global health policy.
Associative and Phonological Priming Effects after Letter Search on the Prime
Authors: Kahan Todd A. , Sellinger John J. , Broman-Fulks Joshua J.
Published: May 2010

Responses to target words typically are faster and more accurate after associatively related primes (e.g., "orange-juice") than after unrelated primes (e.g., "glue-juice"). This priming effect has been used as an index of semantic activation, and its elimination often is cited as evidence against semantic access. When participants are asked to perform a letter search on the prime, associative priming typically is eliminated, but repetition and morphological priming remain. It is possible that priming survives letter search when it arises from activity in codes that are represented before semantics. This experiment examined associative and phonological priming to determine whether priming from phonologically related rhymes would remain after letter search (e.g., "moose-juice"; rhyming items were orthographically dissimilar). When participants read the primes, equivalent associative and phonological priming effects were obtained; both effects were eliminated after letter search. The impact of letter search on semantic and phonological access and implications for the structural arrangement of lexical and semantic memory are discussed.
Things We Talk about, How Frequently, and to Whom: Frequency of Topics in Everyday Conversation as a Function of Gender, Age, and Marital Status
Authors: Sehulster Jerome R.
Published: May 2010

The questionnaire "Things I Talk About, How Frequently, and to Whom" measured the frequency with which people discussed 27 topics in everyday conversation. Twenty-three topics were subdivided into the topic in which content concerned a spectator perspective or a participant perspective. Factor analyses of 515 people yielded 5 factors for each perspective. Among the topic factors were beauty, worldly issues, everyday issues, hobbies, and sports and partying. Gender and age differences were observed not only in frequency of talk but also with whom people conversed. A detailed analysis of the kinds of spectator sports people talk about was included.
Electrocardiogram (EKG) Guided Peripherally Inserted Central Catheter Placement and Tip Position: Results of a Trial to Replace Radiological Confirmation
Authors: Moureau Nancy L. , Dennis Glenda L. , Ames Elizabeth , Severe Robyn
Published: May 2010

Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is radiological confirmation of terminal tip location. Tip location practices in Europe have used electrocardiographic (EKG) guided positioning for central venous catheters for more than twenty years with tip positioning safely confirmed over thousands of insertions (Madias, 2003). The goal of this group was to confirm the findings of a study performed by Pittiruti and his team; and to establish safe function in the use of EKG guidance for verification of terminal tip position with PICCs placed at McKenzie Willamette Medical Center.

Methods: In 2008/2009 McKenzie Willamette Medical Center conducted a study to determine whether or not EKG guidance can be used as a reliable means to accurately place and confirm terminal tip location of PICCs. A group of trained nurses performed PICC placement using EKG guidance followed by radiological confirmation of SVC position. All PICCs placed from October 2008 to December 2009 were included in the study. Tip location was confirmed using either radiological confirmation alone, EKG plus radiological confirmation, or EKG alone.

Results: A total of 417 PICCs were placed during the study period. EKG guidance alone was used in the placement and confirmation of 168 PICCs. Both EKG and chest x-ray confirmation were used in the placement of 82 of the PICCs; 240 of the PICCs were placed with the use of EKG and then position correlated using the traditional chest x-ray procedure.

Discussion: EKG guided PICC placement proved accurate in consistently guiding the terminal tip to the superior vena cava (SVC). The procedure was easily taught and duplicated by members of the PICC team. The study demonstrated a definite correlation between the height (size) of the P-wave and the location of the terminal tip within the SVC. With knowledge of this correlation, transition from placing PICCs using EKG guidance with chest x-ray confirmation to confirmation of tip placement using just EKG guidance without chest x-ray confirmation was attained. Application of EKG placement/confirmation performed during insertion saves time previously spent waiting for x-ray confirmation readings, saves cost of chest x-ray, prevents patient exposure to radiation and saves time required for tip repositioning of malpositioned tips found after the end of the procedure.
Rosiglitazone and Cognitive Stability in Older Individuals With Type 2 Diabetes and Mild Cognitive Impairment
Authors: Abbatecola Angela M. , Lattanzio Fabrizia , Molinari Anna M. , Cioffi Michele , Mansi Luigi , Rambaldi Pierfrancesco , DiCioccio Luigi , Cacciapuoti Federico , Canonico Raffaele , Paolisso Giuseppe
Published: May 2010

OBJECTIVE

Studies have suggested that insulin resistance plays a role in cognitive impairment in individuals with type 2 diabetes. We aimed to determine whether an improvement in insulin resistance could explain cognitive performance variations over 36 weeks in older individuals with mild cognitive impairment (MCI) and type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 97 older individuals (mean ± SD age 76 ± 6 years) who had recently (<2 months) started an antidiabetes treatment of metformin (500 mg twice a day) (n = 30) or metformin (500 mg/day)+rosiglitazone (4 mg/day) (n = 32) or diet (n = 35) volunteered. The neuropsychological test battery consisted of the Mini-Mental State Examination (MMSE), Rey Verbal Auditory Learning Test (RAVLT) total recall, and Trail Making Tests (TMT-A and TMT-B) performed at baseline and every 12 weeks for 36 weeks along with clinical testing.

RESULTS

At baseline, no significant differences were found between groups in clinical or neuropsychological parameters. Mean ± SD values in the entire population were as follows: A1C 7.5 ± 0.5%, fasting plasma glucose (FPG) 8.6 ± 1.3 mmol/l, fasting plasma insulin (FPI) 148 ± 74 pmol/l, MMSE 24.9 ± 2.4, TMT-A 61.6 ± 42.0, TMT-B 162.8 ± 78.7, the difference between TMT-B and TMT-A [DIFFBA] 101.2 ± 58.1, and RAVLT 24.3 ± 2.1. At follow-up, ANOVA models tested changes in metabolic control parameters (FPI, FPG, and A1C). Such parameters improved in the metformin and metformin/rosiglitazone groups (Ptrend < 0.05 in both groups). ANCOVA repeated models showed that results for the metformin/rosiglitazone group remained stable for all neuropsychological tests, and results for the diet group remained stable for the MMSE and TMT-A and declined for the TMT-B (Ptrend = 0.024), executive efficiency (DIFFBA) (Ptrend = 0.026), and RAVLT memory test (Ptrend = 0.011). Results for the metformin group remained stable for the MMSE and TMTs but declined for the RAVLT (Ptrend = 0.011). With use of linear mixed-effects models, the interaction term, FPI × time, correlated with cognitive stability on the RAVLT in the metformin/rosiglitazone group (β = −1.899; P = 0.009).

CONCLUSIONS

Rosiglitazone may protect against cognitive decline in older individuals with type 2 diabetes and MCI.
Survival of Patients With Type 1 Diabetes Receiving Renal Replacement Therapy in 1980–2007
Authors: Haapio Mikko , Helve Jaakko , Groop Per-Henrik , Grönhagen-Riska Carola , Finne Patrik
Published: May 2010

OBJECTIVE

Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care.

RESEARCH DESIGN AND METHODS

An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases.

RESULTS

Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980–1984 to >8 years in 2000–2005. In 2000–2005, the unadjusted relative risk of death was 0.55 compared with 1980–1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).

CONCLUSIONS

Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.
Factors Associated With Psychological Insulin Resistance in Individuals With Type 2 Diabetes
Authors: Nam Soohyun , Chesla Catherine , Stotts Nancy A. , Kroon Lisa , Janson Susan L.
Published: May 2010

OBJECTIVE

To describe the predictive relationships of selected sociodemographic, biomedical, and psychosocial variables to reluctance to use insulin among patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 178 patients with type 2 diabetes participated in this cross-sectional, observational study. Data were obtained by patient interview using validated measures of diabetes attitude, knowledge, self-efficacy, care communication, and perceived barriers to treatment, as well as sociodemographic and biomedical data.

RESULTS

Women and ethnic minorities with type 2 diabetes have more psychological barriers to insulin treatment (P < 0.05). The final regression model showed that individuals who believed in the value of tight glucose control, had strong self-efficacy, and had better interpersonal processes with their healthcare providers were less reluctant to use insulin treatment (R2 = 0.403; P < 0.0001).

CONCLUSIONS

Diabetes self-efficacy and better interaction with clinicians were important in decreasing patients' reluctance to use insulin, known as psychological insulin resistance.
Corneal Confocal Microscopy
Authors: Tavakoli Mitra , Quattrini Cristian , Abbott Caroline , Kallinikos Panagiotis , Marshall Andrew , Finnigan Joanne , Morgan Philip , Efron Nathan , Boulton Andrew J.M. , Malik Rayaz A.
Published: May 2010

OBJECTIVE

The accurate quantification of human diabetic neuropathy is important to define at-risk patients, anticipate deterioration, and assess new therapies.

RESEARCH DESIGN AND METHODS

A total of 101 diabetic patients and 17 age-matched control subjects underwent neurological evaluation, neurophysiology tests, quantitative sensory testing, and evaluation of corneal sensation and corneal nerve morphology using corneal confocal microscopy (CCM).

RESULTS

Corneal sensation decreased significantly (P = 0.0001) with increasing neuropathic severity and correlated with the neuropathy disability score (NDS) (r = 0.441, P < 0.0001). Corneal nerve fiber density (NFD) (P < 0.0001), nerve fiber length (NFL), (P < 0.0001), and nerve branch density (NBD) (P < 0.0001) decreased significantly with increasing neuropathic severity and correlated with NDS (NFD r = −0.475, P < 0.0001; NBD r = −0.511, P < 0.0001; and NFL r = −0.581, P < 0.0001). NBD and NFL demonstrated a significant and progressive reduction with worsening heat pain thresholds (P = 0.01). Receiver operating characteristic curve analysis for the diagnosis of neuropathy (NDS >3) defined an NFD of <27.8/mm2 with a sensitivity of 0.82 (95% CI 0.68–0.92) and specificity of 0.52 (0.40–0.64) and for detecting patients at risk of foot ulceration (NDS >6) defined a NFD cutoff of <20.8/mm2 with a sensitivity of 0.71 (0.42–0.92) and specificity of 0.64 (0.54–0.74).

CONCLUSIONS

CCM is a noninvasive clinical technique that may be used to detect early nerve damage and stratify diabetic patients with increasing neuropathic severity.
Mechanical loading of the distal end of the third metacarpal bone in horses during walking and trotting
Authors: Merritt Jonathan S. , Pandy Marcus G. , Brown Nicholas A. T. , Burvill Colin R. , Kawcak Christopher E. , McIlwraith C. Wayne , Davies Helen M. S.
Published: May 2010

Objective—To assess the net mechanical load on the distal end of the third metacarpal bone in horses during walking and trotting.

Animals—3 Quarter Horses and 1 Thoroughbred.

Procedures—Surface strains measured on the left third metacarpal bone of the Thorough-bred were used with a subject-specific model to calculate loading (axial compression, bending, and torsion) of the structure during walking and trotting. Forelimb kinematics and ground reaction forces measured in the 3 Quarter Horses were used with a musculoskeletal model of the distal portion of the forelimb to determine loading of the distal end of the third metacarpal bone.

Results—Both methods yielded consistent data regarding mechanical loading of the distal end of the third metacarpal bone. During walking and trotting, the distal end of the third metacarpal bone was loaded primarily in axial compression as a result of the sum of forces exerted on the metacarpal condyles by the proximal phalanx and proximal sesamoid bones.

Conclusions and Clinical Relevance—Results of strain gauge and kinematic analyses indicated that the major structures of the distal portion of the forelimb in horses acted to load the distal end of the third metacarpal bone in axial compression throughout the stance phase of the stride.
Evaluation of a portable clinical analyzer for the determination of blood gas partial pressures, electrolyte concentrations, and hematocrit in venous blood samples collected from cattle, horses, and sheep
Authors: Peiró Juliana R. , Borges Alexandre S. , Gonçalves Roberto C. , Mendes Luiz Claudio N.
Published: May 2010

Objective—To compare results reported for blood gas partial pressures, electrolyte concentrations, and Hct in venous blood samples collected from cattle, horses, and sheep and analyzed by use of a portable clinical analyzer (PCA) and reference analyzer (RA).

Animals—Clinically normal animals (24 cattle, 22 horses, and 22 sheep).

Procedures—pH; Pco2; Po2; total carbon dioxide concentration; oxygen saturation; base excess; concentrations of HCO3−, Na+, K+, and ionized calcium; Hct; and hemoglobin concentration were determined with a PCA. Results were compared with those obtained for the same blood sample with an RA. Bias (mean difference) and variability (95% confidence interval) were determined for all data reported. Data were also subjected to analyses by Deming regression and Pearson correlation.

Results—Analysis of Bland-Altman plots revealed good agreement between results obtained with the PCA and those obtained with the RA for pH and total carbon dioxide concentration in cattle, K+ concentration in horses and sheep, and base excess in horses. Except for Na+ concentration and Hct in horses and sheep, correlation was good or excellent for most variables reported.

Conclusions and Clinical Relevance—Data from blood gas and electrolyte analyses obtained by use of the PCA can be used to evaluate the health status of cattle, horses, and sheep. Furthermore, the handheld PCA device may have a great advantage over the RA device as a result of the ability to analyze blood samples on farms that may be located far from urban centers.