Current Approaches to Improving the Value of Care: A Physician's Perspective

Evaluates the utility of judgment-based approaches to quality improvement -- pay-for-performance, public reporting, consumer-directed health plans, and tiering -- as ways to control costs. Recommends incentive- and accountability-based programs

Deviations from ozone photostationary state during the International Consortium for Atmospheric Research on Transport and Transformation 2004 campaign: Use of measurements and photochemical modeling to assess potential causes

Nitric oxide (NO) and nitrogen dioxide (NO2) were monitored at the University of New Hampshire Atmospheric Observing Station at Thompson Farm (TF) during the ICARTT campaign of summer 2004. Simultaneous measurement of ozone (O3), temperature, and the photolysis rate of NO2 (jNO2) allow for assessment of the O3 photostationary state (Leighton ratio, Φ). Leighton ratios that are significantly greater than unity indicate that peroxy radicals (PO2), halogen monoxides, nitrate radicals, or some unidentified species convert NO to NO2 in excess of the reaction between NO and O3. Deviations from photostationary state occurred regularly at TF (1.0 ≤ Φ ≤ 5.9), particularly during times of low NOx (NOx = NO + NO2). Such deviations were not controlled by dynamics, as indicated by regressions between Φ and several meteorological parameters. Correlation with jNO2 was moderate, indicating that sunlight probably controls nonlinear processes that affect Φ values. Formation of PO2 likely is dominated by oxidation of biogenic hydrocarbons, particularly isoprene, the emission of which is driven by photosynthetically active radiation. Halogen atoms are believed to form via photolysis of halogenated methane compounds. Nitrate radicals are believed to be insignificant. Higher Φ values are associated with lower mixing ratios of isoprene and chloroiodomethane and lower ratios of NOx to total active nitrogen, indicating that photochemical aging may very well lead to increased Φ values. PO2 levels calculated using a zero‐dimensional model constrained by measurements from TF can account for 71% of the observed deviations on average. The remainder is assumed to be associated with halogen atoms, most likely iodine, with necessary mixing ratios up to 0.6 or 1.2 pptv, for chlorine and iodine, respectively

Defining EEZ claims from islands: A potential South China Sea change

In the face of seemingly intractable territorial and maritime disputes in the South China Sea, the article examines how the 1982 United Nations Convention on the Law of the Sea (LOSC), sets out what maritime claims States can make in the South China Sea and how it establishes a framework that will enable States to either negotiate maritime boundary agreements or negotiate joint development arrangements (JDAs) in areas of overlapping maritime claims. It provides an avenue whereby the maritime claims of the claimants can be brought into line with international law, potentially allowing for meaningful discussions on cooperation and maritime joint development based on areas of overlapping maritime claims defined on the basis of the LOSC

Manual pages for SAGA software tools, appendix H

Several pages from the SAGA UNIX programmer's manual are presented. These pages are for SAGA software tools

Characterization of aerosol associated with enhanced small particle number concentrations in a suburban forested environment

Two elevated particle number/mass growth events associated with Aitken‐mode particles were observed during a sampling campaign (13–29 September 2004) at the Duke University Free‐Air CO2 Enrichment facility, a forested field site located in suburban central North Carolina. Aerosol growth rates between 1.2 and 4.9 nm hr−1 were observed, resulting in net increases in geometric mean diameter of 21 and 37 nm during events. Growth was dominated by addition of oxidized organic compounds. Campaign‐average aerosol mass concentrations measured by an Aerodyne quadrupole aerosol mass spectrometer (Q‐AMS) were 1.9 ± 1.6 (σ), 1.6 ± 1.9, 0.1 ± 0.1, and 0.4 ± 0.4 μg m−3 for organic mass (OM), sulfate, nitrate, and ammonium, respectively. These values represent 47%, 40%, 3%, and 10%, respectively, of the measured submicron aerosol mass. Based on Q‐AMS spectra, OM was apportioned to hydrocarbon‐like organic aerosol (HOA, likely representing primary organic aerosol) and two types of oxidized organic aerosol (OOA‐1 and OOA‐2), which constituted on average 6%, 58%, and 36%, respectively, of the apportioned OM. OOA‐1 probably represents aged, regional secondary organic aerosol (SOA), while OOA‐2 likely reflects less aged SOA. Organic aerosol characteristics associated with the events are compared to the campaign averages. Particularly in one event, the contribution of OOA‐2 to overall OM levels was enhanced, indicating the likelihood of less aged SOA formation. Statistical analyses investigate the relationships between HOA, OOA‐1, OOA‐2, other aerosol components, gas‐phase species, and meteorological data during the campaign and individual events. No single variable clearly controls the occurrence of a particle growth event

Hyperbaric Oxygenation in the Treatment of Traumatic Brain Injury

Hyperbaric Oxygen Therapy can help heal brain wounds: TBI/PTSD/Concussion. Peer-reviewed positive scientific and clinical evidence in over 7500 cases demonstrates that HBOT helps heal wounded brains and returns patients to a life denied them by DOD/VA/Army that will not talk about, or even use or pay for HBOT treatment for TBI/PTSD/PCS/Concussion. Successful treatment with HBOT [40 one-hour sessions] virtually eliminates suicidal ideation, an effective “suicide prevention” method. Patients also reduce their drug intake to nearly zero and experience 50% reduction in pain and time to withdrawal. The history of HBOT for TBI is littered with bad science, but evidence-based and clinical medicine data show the safety, efficacy and cost effectiveness of HBOT as a standard of care that should be put on-label and insured

Quantification and expert evaluation of evidence for chemopredictive biomarkers to personalize cancer treatment.

Predictive biomarkers have the potential to facilitate cancer precision medicine by guiding the optimal choice of therapies for patients. However, clinicians are faced with an enormous volume of often-contradictory evidence regarding the therapeutic context of chemopredictive biomarkers.We extensively surveyed public literature to systematically review the predictive effect of 7 biomarkers claimed to predict response to various chemotherapy drugs: ERCC1-platinums, RRM1-gemcitabine, TYMS-5-fluorouracil/Capecitabine, TUBB3-taxanes, MGMT-temozolomide, TOP1-irinotecan/topotecan, and TOP2A-anthracyclines. We focused on studies that investigated changes in gene or protein expression as predictors of drug sensitivity or resistance. We considered an evidence framework that ranked studies from high level I evidence for randomized controlled trials to low level IV evidence for pre-clinical studies and patient case studies.We found that further in-depth analysis will be required to explore methodological issues, inconsistencies between studies, and tumor specific effects present even within high evidence level studies. Some of these nuances will lend themselves to automation, others will require manual curation. However, the comprehensive cataloging and analysis of dispersed public data utilizing an evidence framework provides a high level perspective on clinical actionability of these protein biomarkers. This framework and perspective will ultimately facilitate clinical trial design as well as therapeutic decision-making for individual patients