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PubMed2000

Mailing lists are preferred to newsgroups as teaching tools for undergraduate biology classes.

Effective communication between instructors and students is a challenge regardless of the instructor-to-student ratio. Instructors of large classes, in particular, have resorted to various forms of Internet communication, such as mailing lists and newsgroups, to supplement class time and office hours. Mailing lists are closed discussions among subscribers who receive and send messages via an electronic mail program (e.g., Eudora). Newsgroups are public discussions to which anyone can gain access and respond via a newsreader program (e.g., Nuntius). Newsgroup messages are posted to a bulletin board that the subscriber must visit to read. Mailing lists and newsgroups share many advantages (convenience, greater anonymity, and speed of communication) and disadvantages (computer access required, impersonal nature, junk mail, and lack of graphics in older programs). However, surveys of both faculty and students in biology indicate that mailing lists are generally favored over newsgroups. Reasons given for mailing list popularity included greater familiarity with the E-mail format and ease of access.

Biology↗
PubMed1994

Financing of end-stage renal disease care: past, present, and future.

The Medicare end-stage renal disease (ESRD) program has offered financial access to needed health care for ESRD patients, and it has given ESRD providers a reliable source of payment for their services. Total Medicare ESRD expenditures have increased since the inception of the program, due mainly to increased enrollment and changing patient mix. As a result, cost control is a dominant theme of payment policy. This article describes the history of Medicare ESRD financing policy and identifies related service delivery issues including treatment technology, service resources, treatment processes, and patient selection. It also discusses several options available to Medicare for managing the growth of ESRD program costs, including capitation payment methods, control of ESRD enrollment, and payment for erythropoietin treatment. Possible future changes in financing ESRD are identified. With a goal to control costs. Medicare probably will use payment methods to change service mix and reduce use by influencing provider incentives and marketplace competition. Health system reform also may affect ESRD benefits and payments, if the ESRD program is folded into a new financing system. ESRD patients and providers face a challenge of uncertainty during this period of change.

Health Care Costs↗
PubMed2005

Use of a wireless local area network in an orthodontic clinic.

Radiographic images and other patient records, including medical histories, demographics, and health insurance information, can now be stored digitally and accessed via patient management programs. However, digital image acquisition and diagnosis and treatment planning are independent tasks, and each is time consuming, especially when performed at different computer workstations. Networking or linking the computers in an office enhances access to imaging and treatment planning tools. Access can be further enhanced if the entire network is wireless. Thanks to wireless technology, stand-alone, desk-bound personal computers have been replaced with mobile, hand-held devices that can communicate with each other and the rest of the world via the Internet. As with any emerging technology, some issues should be kept in mind when adapting to the wireless environment. Foremost is network security. Second is the choice of mobile hardware devices that are used by the orthodontist, office staff, and patients. This article details the standards and choices in wireless technology that can be implemented in an orthodontic clinic and suggests how to select suitable mobile hardware for accessing or adding data to a preexisting network. The network security protocols discussed comply with HIPAA regulations and boost the efficiency of a modern orthodontic clinic.

Cell Phone↗
PubMedDate not supplied

Making the alternative the mainstream. Maintaining a family-centered focus in a large freestanding birth center for low-income women.

The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.

Birthing Centers↗
PubMed2004

Cardiac transplantation at Duke University Medical Center.

Since beginning cardiac transplantation in 1985, Duke University Medical Center has performed 485 de novo heart transplants in adult recipients. Our program has broadened the access of patients to transplantation through the aggressive use of ventricular assist devices as bridge to transplant in patients with acute heart failure and shock, as well as through the introduction of an alternate list program for suboptimal transplant candidates. Despite this broadening of the recipient pool, our long-term outcomes have remained good, with 5-year survival of 75% and 10-year survival of 51%. Continued advances in immunosuppression and treatment for cardiac allograft vasculopathy seem likely to continue to improve long-term outcomes from cardiac transplantation. Expanding indications for VAD support (such as destination therapy) and continued improvements in this technology seem certain to impact patient selection and therefore the results of transplantation in the future. Appropriate triage of patients with advanced heart failure among available therapies will be the cornerstone of optimizing outcomes in this critically ill patient population.

Academic Medical Centers↗
PubMed1990

Myths, maxims and universal health care.

There is considerable indirect evidence that our legislative bodies, because of inability to control costs, are reluctant to further expand government responsibilities into health care. There continues to be general societal, and limited professional, pressure to assure access to health care for the large segment of society which presently encounters barriers to care because of lack of insurance. Congress and state legislatures are actively proposing health care legislation but on the whole it is aimed at reducing the cost of the programs to which government is already committed, not for expansion into new fields. However, providers, physicians and hospitals are begging for relief from the burden of uncompensated care. A suggested solution is to require all employers to provide health insurance for their employees. This may become impossibly burdensome for many small employers and could still leave a sizeable uninsured group of unemployed or underemployed. Tax revenues would still be needed to fund a government administered program to assure their access. We have a problem. We must devise a method to assure needed care for the 13% to 15% of our population which is presently uninsured. It must be accomplished in a manner that will not direct too much money from other socially important programs such as education, law enforcement, transportation, and environmental preservation. A solution will be found; however, if my evaluation is correct, neither patients nor physicians are going to be very happy with it. If the myths and maxims are valid, both groups will be disappointed. Rationing in some form will be inevitable as will be control and regulation of doctors' practice styles and fees.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Expenditures↗
PubMed2003

Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis.

Minimal pediatric data describe hospitalization causes and associated costs for children who receive maintenance hemodialysis, and no data exist to evaluate methods to decrease hospitalization. In 1999, two common causes of hemodialysis patient hospitalization at Texas Children's Hospital were fluid overload/hypertension (FO/HTN) and vascular access thrombosis (VAT). Evaluated is the effect of two noninvasive monitoring programs, monitoring of hematocrit-guided ultrafiltration algorithm and vascular access flow using ultrasound dilution vascular access flow technology, on FO/HTN and VAT in the pediatric maintenance hemodialysis population. This prospective observational study reviewed all hospitalization data for all 51 patients who received maintenance hemodialysis from January 1999 through December 2001 obtained from unit monthly performance improvement meeting records. Hospitalization rates and related costs for FO/HTN and VAT were tracked before and after institution of the noninvasive monitoring programs. Application of the noninvasive monitoring of hematocrit-guided ultrafiltration algorithm since January 2000 significantly decreased hospitalization for FO/HTN (64 total days in 1999, 4 total days in 2000 and 2001 combined) while maintaining acceptable patient BP control and minimizing antihypertensive medication requirements. The vascular access monitoring program using ultrasound dilution vascular access flow technology to direct referral for angioplasty instituted in January 2001 led to a significant decrease in hospitalization for VAT (45 d in 2000 and 21 d in 2001). It is suggested that application of noninvasive technologies to assess patient target dry weight and access flow can significantly decrease pediatric maintenance dialysis patient morbidity and health care cost.

Adolescent↗
PubMed1985

[Conception of a program for the treatment and statistical interrogation of data, LOGIST].

This paper presents a general program which cannot only be used for the treatment and the statistical interrogations, but also for basic operations, such as the validity check and the preparation of data which is often necessary for other programs. Its use of language is simple, suitable and accessible to non-specialists. The program is sufficiently complete so that it can treat some complex problems without requiring complementary programs. It can treat several problems simultaneously. This allows one to gain data-reading time and the program is therefore economical. Its domain of use is large: epidemiological studies, psychological and sociological investigations, biological studies, clinical research, chronological follow-up, examinations of faculties, . . . . The program is written in FORTRAN IV and thus transferable. It contains more than 25 000 instructions but needs limited place in the core memory (less than 64 000 words). Its structure allows further evolution and addition of new procedures or new methods. A transformation into a conversational form is considered.

Computers↗
PubMed2005

Studying protein aggregation by programmed flow field-flow fractionation using ceramic hollow fibers.

Ceramic hollow fibers have been used as separation channels for flow field-flow fractionation. The fibers were made of alpha-alumina, with a gamma-alumina layer on the inside wall acting as a semipermeable (ultrafiltration) membrane. The fibers and the separation system were tested by determining the diffusion coefficients of a series of standard proteins under various experimental conditions. Even for the smallest protein studied, a complete recovery from the fiber was obtained. A single fiber could be used for several months without problems such as leakage or fouling. The precision of the diffusion coefficient measurements was in the order of 5-10%. A good agreement with literature data was found. Programming of the cross-flow, with a time-delayed exponential decay program, was applied to extend the accessible size range for the sample components. With flow programming, the observed retention times increased linearly with the logarithm of the molar mass of proteins and aggregates, as predicted by theory. Heat-induced aggregation of beta-lactoglobulin (beta-LG) in aqueous solution was studied with the system. Upon heating, not only the extent of aggregation but also the size of the beta-LG aggregates was found to increase with the original concentration of beta-LG in solution and with the heating time. After heating in the presence of salt, very large aggregates were formed, with molar masses over 100 million. A multiangle light scattering detector was used to estimate molar masses and sizes of the protein aggregates. From the relation between the apparent diffusion coefficients and the molar masses of the aggregates, as well as from the ratio of the rms (scattering) and the hydrodyamic radii, it was concluded that the larger beta-LG aggregates behave as flexible chains in solution.

Ceramics↗
PubMed2004

A complexity-scalable software-based MPEG-2 video encoder.

With the development of general-purpose processors (GPP) and video signal processing algorithms, it is possible to implement a software-based real-time video encoder on GPP, and its low cost and easy upgrade attract developers' interests to transfer video encoding from specialized hardware to more flexible software. In this paper, the encoding structure is set up first to support complexity scalability; then a lot of high performance algorithms are used on the key time-consuming modules in coding process; finally, at programming level, processor characteristics are considered to improve data access efficiency and processing parallelism. Other programming methods such as lookup table are adopted to reduce the computational complexity. Simulation results showed that these ideas could not only improve the global performance of video coding, but also provide great flexibility in complexity regulation.

Journal Article↗
PubMed1980

Health Care Financing Administration--Medicare and Medicaid programs, Medicare and Medicaid disclosure of provider information and access to provider records; correction notice. Correction of final regulation.

This document corrects a technical error in final regulations published in the Federal Register on July 17, 1974 (44 FR 41636) on requirements for disclosure of information by institutions and organizations providing services under Medicare and Medicaid (titles XVIII and XIX of the Social Security Act).

Health Services↗
PubMed1988

Reducing inpatient hospital costs: an attempt at Medicaid reform in Illinois.

While California's Medi-Cal program and Arizona's Health Care Cost Containment System have been subject to scholarly analysis, little has been written about a similar attempt at competitive bidding under Medicaid by Illinois. This article describes the process of implementing the Illinois Competitive Access and Reimbursement Equity (ICARE) program signed into law in 1984. The article examines hospital data and access implications for recipients and compares the Illinois program with other Medicaid contracting programs. A more thoughtful process of policy implementation is urged for such reform attempts in Medicaid.

Cost Control↗
PubMed1998

[New aspects of electric defibrillation].

Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient's needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. Both devices analyze the ECG signal internally, followed by a "shock" or "no shock" decision. Use of automated devices is the prerequisite for defibrillation by non-physicians. Chest impedance measurements and use of alternative shock waveforms, such as biphasic, aim at adaptation of energy or current to the patient's individual needs and avoid application of unnecessarily high amounts of energy to the myocardium. Calculation of median frequency is a non-invasive method for analyzing the heart's metabolic and electrical state. It helps to determine the optimal moment for defibrillation during cardiopulmonary resuscitation (CPR). Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association's Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.

Arrhythmias, Cardiac↗
PubMed2001

Adolescents' use of emergency contraception provided by Washington State pharmacists.

STUDY OBJECTIVE: To increase knowledge about adolescents who obtained emergency contraceptive pills (ECP) directly from a pharmacist without first contacting a physician. DESIGN: Cross-sectional self-administered survey. SETTING: Fifteen randomly selected pharmacies providing ECP in western Washington State. PARTICIPANTS: Adolescents 15-21 years old (n = 126) who obtained ECP directly from a pharmacist. OUTCOME MEASURES: Responses to a 20-item questionnaire examining adolescents' reasons for seeking care from a pharmacist, need for additional medical evaluation, risk for not receiving additional medical care, and satisfaction with care provided by the pharmacist. RESULTS: The most common reasons for using the pharmacy were convenience (44%), lack of knowledge about alternatives (38%), and privacy (31%). If the pharmacy service were not available, 58% said they would see a doctor, 22% said they would wait to see if they got pregnant, and 20% did not know. Based on self-report, 81% of adolescents needed a new method of ongoing contraception, an evaluation for sexually transmitted disease, or both. Among these adolescents, 36% had risk factors for not receiving this care. Adolescents were satisfied with the pharmacy service; 94% said they would recommend the service to a friend. CONCLUSIONS: ECP provision by pharmacists is a useful way to increase access to emergency contraception. However, many adolescents using ECP need additional medical care. Programs designed to increase ECP access should use these opportunities to link adolescents with more comprehensive reproductive health care services.

Adolescent↗