Justification for the Continuance of a Pediatric Physician\u27s Office Laboratory

The continued viability of the Physician\u27s Office Laboratory (POL) has been questioned because of barriers imposed by managed care organizations, oversight by regulatory agencies and competition for professionally trained laboratory staff. Pediatricians view the POL as an important adjunct to quality healthcare services for children and do not consider the POL as a profit center , whose priority is generation of revenues for the The practice. parents of pediatric patients consider an on-site laboratory a convenience and valuable service. Through an analysis of patients\u27 satisfaction, physicians\u27 perceptions of enhancement to quality care, managed care reimbursement data and costs associated with maintenance of a POL, this study justifies the continuance of in-office laboratory services by pediatricians. In addition, issues regarding POL regulation, .. waived testing and professionally trained laboratory staffing, are addressed. The physician office laboratory (POL) has been an integral part of physicians\u27 practices for decades. ln general, testing consisted of a few basic manual tests, which were run by the physicians or a physician-trained aide or nurse. The POL was considered an enhancement to the physician\u27s practice, which was reimbursed by non-discounted fee­ for-service indemnity insurance plans. Clinical testing by physician in the POL was a profitable adjunct to a physician\u27s practice. However, as the result of increasing regulations and oversight by the federal government, limitations posed by managed care and increasing difficulty accessing trained laboratory personnel, many have questioned continued viability of the POL

Justification for the Continuance of a Pediatric Physician\u27s Office Laboratory

The continued viability of the Physician\u27s Office Laboratory (POL) has been questioned because of barriers imposed by managed care organizations, oversight by regulatory agencies and competition for professionally trained laboratory staff. Pediatricians view the POL as an important adjunct to quality healthcare services for children and do not consider the POL as a profit center , whose priority is generation of revenues for the The practice. parents of pediatric patients consider an on-site laboratory a convenience and valuable service. Through an analysis of patients\u27 satisfaction, physicians\u27 perceptions of enhancement to quality care, managed care reimbursement data and costs associated with maintenance of a POL, this study justifies the continuance of in-office laboratory services by pediatricians. In addition, issues regarding POL regulation, .. waived testing and professionally trained laboratory staffing, are addressed. The physician office laboratory (POL) has been an integral part of physicians\u27 practices for decades. ln general, testing consisted of a few basic manual tests, which were run by the physicians or a physician-trained aide or nurse. The POL was considered an enhancement to the physician\u27s practice, which was reimbursed by non-discounted fee­ for-service indemnity insurance plans. Clinical testing by physician in the POL was a profitable adjunct to a physician\u27s practice. However, as the result of increasing regulations and oversight by the federal government, limitations posed by managed care and increasing difficulty accessing trained laboratory personnel, many have questioned continued viability of the POL

Lagrangian versus Quantization

We discuss examples of systems which can be quantized consistently, although they do not admit a Lagrangian description.Comment: 8 pages, no figures; small corrections, references adde

Further insights on predictors of environmental tobacco smoke exposure during the pediatric age

Background: The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. Methods: A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. Results: 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the “worst case” is represented by both parents who smoke. Conclusions: More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke

Isotopic Grand Unification with the Inclusion of Gravity (revised version)

We introduce a dual lifting of unified gauge theories, the first characterized by the isotopies, which are axiom- preserving maps into broader structures with positive-definite generalized units used for the representation of matter under the isotopies of the Poincare' symmetry, and the second characterized by the isodualities, which are anti-isomorphic maps with negative-definite generalized units used for the representation of antimatter under the isodualities of the Poincare' symmetry. We then submit, apparently for the first time, a novel grand unification with the inclusion of gravity for matter embedded in the generalized positive-definite units of unified gauge theories while gravity for antimatter is embedded in the isodual isounit. We then show that the proposed grand unification provides realistic possibilities for a resolution of the axiomatic incompatibilities between gravitation and electroweak interactions due to curvature, antimatter and the fundamental space-time symmetries.Comment: 20 pages, Latex, revised in various details and with added reference

Differential Transgene Silencing of Myeloid-Specific Promoters in the AAVS1 Safe Harbor Locus of Induced Pluripotent Stem Cell-Derived Myeloid Cells

Targeted integration into a genomic safe harbor, such as the AAVS1 locus on chromosome 19, promises predictable transgene expression and reduces the risk of insertional mutagenesis in the host genome. The application of gamma-retroviral LTR-driven vectors, which semi-randomly integrate into the genome, has previously caused severe adverse events in some clinical studies due to transactivation of neighboring proto-oncogenes. Consequently, the site-specific integration of a therapeutic transgene into a genomic safe harbor locus would allow stable genetic correction with a reduced risk of insertional mutagenesis. However, recent studies revealed that transgene silencing, especially in case of weaker cell type-specific promoters, can occur in the AAVS1 locus of human pluripotent stem cells (PSC) and can impede transgene expression during differentiation. In this study, we aimed to correct p47phox-deficiency, which is the second most common cause of chronic granulomatous disease, by insertion of a therapeutic p47phox transgene into the AAVS1 locus of human induced PSC (iPSC) using CRISPR-Cas9. We analyzed transgene expression and functional correction from three different myeloid-specific promoters (miR223, CatG/cFes and MRP8). Upon myeloid differentiation of corrected iPSC clones, we observed that the miR223 and CatG/cFes promoter achieved therapeutic-relevant levels of p47phox expression and NADPH oxidase activity, whereas the MRP8 promoter was less efficient. Analysis of the different promoters revealed high CpG methylation of the MRP8 promoter in differentiated cells, which correlated with the transgene expression data. In summary, we identified the miR223 and CatG/cFes promoters as cell type-specific promoters that allow stable transgene expression in the AAVS1 locus of iPSC-derived myeloid cells. Our findings further indicate that promoter silencing can occur in the AAVS1 safe harbor locus in differentiated hematopoietic cells and that a comparison of different promoters is necessary to achieve optimal transgene expression for therapeutic application of iPSC-derived cells

Direct Transactivation of the Anti-apoptotic Gene Apolipoprotein J (Clusterin) by B-MYB

B-MYB is a ubiquitously expressed transcription factor involved in the regulation of cell survival, proliferation, and differentiation. In an attempt to isolate B-MYB-regulated genes that may explain the role of B-MYB in cellular processes, representational difference analysis was performed in neuroblastoma cell lines with different levels of B-MYB expression. One of the genes, the mRNA levels of which were enhanced in B-MYB expressing cells, was ApoJ/Clusterin(SGP-2/TRMP-2) (ApoJ/Clusterin), previously implicated in regulation of apoptosis and tumor progression. Here we show that the human ApoJ/Clusterin gene contains a Myb binding site in its 5\' flanking region, which interacts with bacterially synthesized B-MYB protein and mediates B-MYB-dependent transactivation of the ApoJ/Clusterin promoter in transient transfection assays. Endogenous ApoJ/Clusterin expression is induced in mammalian cell lines following transient transfection of a B-MYB cDNA. Blockage of secreted clusterin by a monoclonal antibody results in increased apoptosis of neuroblastoma cells exposed to the chemotherapeutic drug doxorubicin. Thus, activation of ApoJ/Clusterin by B-MYB may be an important step in the regulation of apoptosis in normal and diseased cell