The Relation Between Managed Care Market Share and the Treatment of Elderly Fee-For-Service Patients with Myocardial Infarction

Managed care may affect medical treatments for non-managed-care patients if it alters local market structure or physician behavior. We investigate whether higher levels of overall managed care market share are associated with greater use of recommended therapies for fee-for-service patients with acute myocardial infarction using data on 112,900 fee-for-service Medicare beneficiaries residing in one of 320 metropolitan statistical areas, with age >= 65 years, and admitted with an acute myocardial infarction between February 1994 and July 1995 from the Cooperative Cardiovascular Project. After adjustment for patient characteristics, severity of illness, characteristics of the hospital of admission, specialty of treating physicians, and other area characteristics, patients treated in areas with high levels of managed care had greater relative use of beta-blockers during hospitalization and at discharge and aspirin during hospitalization and at discharge, consistent with more appropriate care. Patients in high HMO areas may be less likely to receive angiography when compared to areas with low levels of managed care, although this result was only marginally significant. In unadjusted comparisons, patients in high HMO market share areas had lower 30 day mortality, but there were no differences in 30 day mortality when all of the control variables were included in the model. We conclude that managed care can have widespread effects on the treatment of patients and the quality of care they receive, even for patients not enrolled in managed care organizations.

Nachhaltigkeitsbewertungen basierend auf den SAFA-Leitlinien: Reduzierung von Unsicherheiten in expertenbasierten Modellen

The SMART-Farm Tool is a globally applicable method for analysing the sustainability performance of organic and conventional farms according to the SAFA Guidelines by the FAO. The aim of the project is to validate and further develop the model algorithms of the SMART-Farm Tool (a) by basing the model algorithms on results of a structured expert survey and (b) by taking into account uncertainties related to the assessments. For the expert survey, an adaptation of the Nominal Group Technique was applied. In a three-step process, 67 international experts rated the relative importance of the 327 SMART indicators for the 58 SAFA subthemes in 11 theme- and region-specific expert groups. The remaining deviations were analysed with Monte-Carlo simulations and - inherent reasons like low numbers of indicators for certain subthemes, the identified uncertainty was partly affected by heterogeneous expert opinions on single indicators. - theme experts for periodical judgements of the indicators is recommended

Development of an integrated heat pipe-thermal storage system for a solar receiver

The Organic Rankine Cycle (ORC) Solar Dynamic Power System (SDPS) is one of the candidates for Space Station prime power application. In the low Earth orbit of the Space Station approximately 34 minutes of the 94-minute orbital period is spent in eclipse with no solar energy input to the power system. For this period the SDPS will use thermal energy storage (TES) material to provide a constant power output. An integrated heat-pipe thermal storage receiver system is being developed as part of the ORC-SDPS solar receiver. This system incorporates potassium heat pipe elements to absorb and transfer the solar energy within the receiver cavity. The heat pipes contain the TES canisters within the potassium vapor space with the toluene heater tube used as the condenser region of the heat pipe. During the insolation period of the Earth orbit, solar energy is delivered to the heat pipe in the ORC-SDPS receiver cavity. The heat pipe transforms the non-uniform solar flux incident in the heat pipe surface within the receiver cavity to an essentially uniform flux at the potassium vapor condensation interface in the heat pipe. During solar insolation, part of the thermal energy is delivered to the heater tube and the balance is stored in the TES units. During the eclipse period of the orbit, the balance stored in the TES units is transferred by the potassium vapor to the toluene heater tube

Non-linear rheology of active particle suspensions: Insights from an analytical approach

We consider active suspensions in the isotropic phase subjected to a shear flow. Using a set of extended hydrodynamic equations we derive a variety of {\em analytical} expressions for rheological quantities such as shear viscosity and normal stress differences. In agreement to full-blown numerical calculations and experiments we find a shear thickening or -thinning behaviour depending on whether the particles are contractile or extensile. Moreover, our analytical approach predicts that the normal stress differences can change their sign in contrast to passive suspensions.Comment: 11 pages, 10 figures, appear in PR

Racial disparity in cardiac procedures and mortality among long-term survivors of cardiac arrest

Background— It is unknown whether white and black Medicare beneficiaries have different rates of cardiac procedure utilization or long-term survival after cardiac arrest. Methods and Results— A total of 5948 elderly Medicare beneficiaries (5429 white and 519 black) were identified who survived to hospital discharge between 1990 and 1999 after admission for cardiac arrest. Demographic, socioeconomic, and clinical information about these patients was obtained from Medicare administrative files, the US census, and the American Hospital Association’s annual institutional survey. A Cox proportional hazard model that included demographic and clinical predictors indicated a hazard ratio for mortality of 1.30 (95% CI 1.09 to 1.55) for blacks aged 66 to 74 years compared with whites of the same age. The addition of cardiac procedures to this model lowered the hazard ratio for blacks to 1.23 (95% CI 1.03 to 1.46). In analyses stratified by race, implantable cardioverter-defibrillators (ICDs) had a mortality hazard ratio of 0.53 (95% CI 0.45 to 0.62) for white patients and 0.50 (95% CI 0.27 to 0.91) for black patients. Logistic regression models that compared procedure rates between races indicated odds ratios for blacks aged 66 to 74 years of 0.58 (95% CI 0.36 to 0.94) to receive an ICD and 0.50 (95% CI 0.34 to 0.75) to receive either revascularization or an ICD. Conclusions— There is racial disparity in long-term mortality among elderly cardiac arrest survivors. Both black and white patients benefited from ICD implantation, but blacks were less likely to undergo this potentially life-saving procedure. Lower rates of cardiac procedures may explain in part the lower survival rates among black patients

Abundant and equipotent founder cells establish and maintain acute lymphoblastic leukaemia

High frequencies of blasts in primary acute lymphoblastic leukaemia (ALL) samples have the potential to induce leukaemia and to engraft mice. However, it is unclear how individual ALL cells each contribute to drive leukaemic development in a bulk transplant and the extent to which these blasts vary functionally. We used cellular barcoding as a fate mapping tool to track primograft ALL blasts in vivo. Our results show that high numbers of ALL founder cells contribute at similar frequencies to leukaemic propagation over serial transplants, without any clear evidence of clonal succession. These founder cells also exhibit equal capacity to home and engraft to different organs, although stochastic processes may alter the composition in restrictive niches. Our findings enhance the stochastic stem cell model of ALL by demonstrating equal functional abilities of singular ALL blasts and show that successful treatment strategies must eradicate the entire leukaemic cell population

Identifying Factors Associated with Consumers’ Adoption of e-Mobility—A Systematic Literature Review

Electrification of road transport—replacing internal combustion engine vehicles with new energy vehicles such as electric vehicles (EVs)—seems to be a promising step towards achieving sustainable urban development, yet the diffusion of EVs is proceeding slowly. Investigating this phenomenon, researchers have provided numerous findings. However, these findings also created a fragmented and heterogeneous body of literature. This article applies a systematic literature review to establish a status quo of factors associated with the adoption of EVs. A total of 49 articles were identified and analyzed in detail for their contribution to EV adoption. The results from the systematic literature review were synthesized. The article ends with implications for policymakers and suggests fruitful research avenues for future investigations

The Niemann-Pick C1 and caveolin-1 proteins interact to modulate efflux of low density lipoprotein-derived cholesterol from late endocytic compartments

The Niemann-Pick C1 (NPC1) protein has a central role in regulating the efflux of lipoprotein-derived cholesterol from late endosomes/lysosomes and transport to other cellular compartments. Since the NPC1 protein has been shown to regulate the transport of cholesterol to cellular compartments enriched with the ubiquitous cholesterol-binding and transport protein caveolin-1, the present study was performed to determine whether the NPC1 and caveolin-1 proteins interact and function to modulate efflux of low density lipoprotein (LDL)-derived cholesterol from endocytic compartments. To perform these studies, normal human fibroblasts were grown in media with lipoprotein-deficient serum (LPDS) or media with LPDS supplemented with purified human LDL. The results indicated reciprocal co-immunoprecipitation and partial co-localization of the NPC1 and caveolin-1 proteins that was decreased when fibroblasts were grown in media with LDL. Consistent with interaction of the NPC1 and caveolin-1 proteins, a highly conserved caveolin-binding motif was identified within a cytoplasmic loop located adjacent to the sterol-sensing domain (SSD) of the NPC1 protein. To examine the functional relevance of this interaction, fibroblasts were transfected with caveolin-1 siRNA and found to accumulate increased amounts of LDL-derived cholesterol within late endosomes/lysosomes. Together, this report presents novel results demonstrating that the NPC1 and caveolin-1 proteins interact to modulate efflux of LDL-derived cholesterol from late endocytic compartments