Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

<p>Abstract</p> <p>Background</p> <p>Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation') whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated.</p> <p>Methods</p> <p>Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance.</p> <p>Results</p> <p>The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care, gynecology, pediatrics and for psychiatrists whereas "prescription only" areas had lowest cost for specialists with non-invasive and invasive activities.</p> <p>Conclusions</p> <p>The results indicate that payment methods for services and for prescription drugs are associated with variations in treatment cost that are unlikely warranted by different medical needs of patients alone. Promoting physician accountability of care by linking reimbursements to quality, not quantity, of services are important policy measures to be considered for health care in Switzerland.</p

Influence of MAX-Phase Deformability on Coating Formation by Cold Spraying

As solid-state deposition technique avoiding oxidation, cold gas spraying is capable of retaining feedstock material properties in the coatings, but typically fails to build up coatings of brittle materials. Ceramic MAX phases show partial deformability in particular lattice directions and may thus successfully deposit in cold spraying. However, deformation mechanisms under high strain rate, as necessary for cohesion and adhesion, are not fully clear yet. A MAX-phase deposit only builds up, if the specific mechanical properties of the MAX phase allow for, and if suitable spray parameter sets get realized. To investigate the influence of material properties and deposition conditions on coating microstructure and quality, three MAX phases, Ti3SiC2, Ti2AlC and Cr2AlC, were selected. Up to ten passes under different spray parameters yielded Ti2AlC and Cr2AlC coatings with thicknesses of about 200-500&nbsp;\ub5m. In contrast, Ti3SiC2 only forms a monolayer, exhibiting brittle laminar failure of the impacting particles. In all cases, the crystallographic structure of the MAX-phase powders was retained in the coatings. Thicker coatings show rather low porosities (&lt; 2%), but some laminar cracks. The deposition behavior is correlated with individual mechanical properties of the different MAX-phase compositions and is discussed regarding the particular, highly anisotropic deformation mechanisms

Resposta fisiológica de ovinos da raça Santa Inês alimentados com diferentes níveis de farelo de manga em substituição ao milho.

O experimento foi delineado para avaliar o efeito da substituição do milho por farelo de manga e medir os efeitos das condições climáticas ao longo do dia sobre os parâmetros fisiológicos: temperatura retal (TR), temperatura Superficial (TS) e freqüência respiratória (FR), em ovinos da raça Santa Inês, criados em confinamento em clima semi-árido. Ovinos machos castrados (n = 16) foram submetidos a quatro dietas com diferentes níveis de substituição do milho por farelo de manga. A TR, TS e FR foram medidas a cada hora durante dois períodos de 24 horas. Adotou-se o delineamento de blocos casualizados, com quatro repetições, em esquema fatorial 4 x 12 (níveis de inclusão de farelo de manga x horários de avaliação dos parâmetros fisiológicos). Não foi observado influência da dieta na TR, TS e FR dos ovinos, entretanto observou-se a influência das condições climáticas

In vitro characterization of physico-chemical properties, cytotoxicity, bioactivity of urea-crosslinked hyaluronic acid and sodium ascorbyl phosphate nasal powder formulation

An innovative lyophilized dry powder formulation consisting of urea-crosslinked hyaluronic acid (HA-CL) and sodium ascorbyl phosphate (SAP) – LYO HA-CL – SAP- was prepared and characterized in vitro for physico-chemical and biological properties. The aim was to understand if LYO HA-CL – SAP could be used as adjuvant treatment for nasal inflammatory diseases. LYO HA-CL – SAP was suitable for nasal delivery and showed to be not toxic on human nasal septum carcinoma-derived cells (RPMI 2650 cells) at the investigated concentrations. It displayed porous, polygonal particles with unimodal, narrow size distribution, mean geometric diameter of 328.3 ± 27.5 µm, that is appropriate for nasal deposition with no respirable fraction and 88.7% of particles with aerodynamic diameter &gt;14.1 µm. Additionally, the formulation showed wound healing ability on RPMI 2650 cells, and reduced interleukin-8 (IL-8) level in primary nasal epithelial cells pre-induced with lipopolysaccharide (LPS). Transport study across RPMI 2650 cells showed that HA-CL could act not only as carrier for SAP and active ingredient itself, but potentially also as mucoadhesive agent. In conclusion, these results suggest that HA-CL and SAP had anti-inflammatory activity and acted in combination to accelerate wound healing. Therefore, LYO HA-CL – SAP could be a potential adjuvant in nasal anti-inflammatory formulations

Highly Pluripotent Adipose-Derived Stem Cell–Enriched Nanofat: A Novel Translational System in Stem Cell Therapy

Fat graft is widely used in plastic and reconstructive surgery. The size of the injectable product, the unpredictable fat resorption rates, and subsequent adverse effects make it tricky to inject untreated fat into the dermal layer. Mechanical emulsification of fat tissue, which Tonnard introduced, solves these problems, and the product obtained was called nanofat. Nanofat is widely used in clinical and aesthetic settings to treat facial compartments, hypertrophic and atrophic scars, wrinkle attenuation, skin rejuvenation, and alopecia. Several studies demonstrate that the tissue regeneration effects of nanofat are attributable to its rich content of adipose-derived stem cells. This study aimed to characterize Hy-Tissue Nanofat product by investigating morphology, cellular yield, adipose-derived stem cell (ASC) proliferation rate and clonogenic capability, immunophenotyping, and differential potential. The percentage of SEEA3 and CD105 expression was also analyzed to establish the presence of multilineage-differentiating stress-enduring (MUSE) cell. Our results showed that the Hy-Tissue Nanofat kit could isolate 3.74 × 104 ± 1.31 × 104 proliferative nucleated cells for milliliter of the treated fat. Nanofat-derived ASC can grow in colonies and show high differentiation capacity into adipocytes, osteocytes, and chondrocytes. Moreover, immunophenotyping analysis revealed the expression of MUSE cell antigen, making this nanofat enriched of pluripotent stem cell, increasing its potential in regenerative medicine. The unique characteristics of MUSE cells give a simple, feasible strategy for treating a variety of diseases

Gluteal femoral subcutaneous and dermal adipose tissue in female

Background: During the sexual maturation, gluteal femoral adipose tissue is subjected to numerous modifications, not observable in other regions, in particular in women and less in men. Other authors described this region, but they used imaging techniques having lower resolution, than MRI proposed in this study. High resolution imaging techniques might provide important and more detailed information about the anatomy of gluteal femoral region. Methods: This study has been performed using 7 T-magnetic resonance imaging and ultrastructural analysis in order to provide accurate description of the subcutaneous adipose tissue and dermis of gluteal femoral region. In this study specimens harvested from cadavers and form living patients have been analyzed. Results: The results showed the presence of three layers: superficial, middle, and deep, characterized by different organization of fat lobules. High resolution imaging showed the adipose papilla that originates from dermis and protrude in subcutaneous adipose tissue. Adipose papilla is characterized by a peculiar morphology with a basement, a neck and a head and these elements represent the functional subunits of adipose papilla. Moreover, ultrastructural study evidenced the relationship between adipocytes and sweat glands, regulated by lipid vesicles. Conclusions: This study provides important information about subcutaneous and dermal fat anatomy of gluteal femoral region, improving the past knowledge, and move toward a better understanding of the cellulite physiopathology

Cross-taxon congruence between predatory arthropods and plants across Mediterranean agricultural landscapes

Although arthropods are among the most diverse, abundant and ecologically important animals in terrestrial ecosystems, they are generally neglected in most biodiversity inventories due to their complex systematics and overwhelming diversity, coupled with the current decline in the number of taxonomists. For this reason, several surrogate groups for arthropod diversity have been proposed, with plants being identified as a good putative cross-taxon indicator. By sampling plants and three groups of ground-dwelling arthropods (rove beetles, ground beetles and spiders) in 300 sites across 15 landscapes including multiple semi-natural and agricultural habitats, we tested for habitat-dependence and scale-dependence in the cross-taxon congruence. Plant species richness was a poor predictor of the species richness of predatory arthropods. Among the predator groups, ground beetles appeared as the best potential surrogate for the other ground-dwelling predators. This is backed by the fact that ground beetles were extremely diverse and abundant in all habitats and are usually easier to identify than both rove beetles and spiders. Decreasing the scale at which the cross-taxon congruence was tested improved the strength of the cross-taxon congruence. Although plant species richness was not a suitable indicator for the diversity of predatory arthropods, vegetation structure played a significant role in influencing cross-taxon congruence in both natural and agricultural habitats. Our results highlight the need to explore the cross-taxon relationships at a fine habitat resolution scale, as strong correlations were obtained only by taking into account habitat identity