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.

How ATP Inhibits the Open KATP Channel

ATP-sensitive potassium (KATP) channels are composed of four pore-forming Kir6.2 subunits and four regulatory SUR1 subunits. Binding of ATP to Kir6.2 leads to inhibition of channel activity. Because there are four subunits and thus four ATP-binding sites, four binding events are possible. ATP binds to both the open and closed states of the channel and produces a decrease in the mean open time, a reduction in the mean burst duration, and an increase in the frequency and duration of the interburst closed states. Here, we investigate the mechanism of interaction of ATP with the open state of the channel by analyzing the single-channel kinetics of concatenated Kir6.2 tetramers containing from zero to four mutated Kir6.2 subunits that possess an impaired ATP-binding site. We show that the ATP-dependent decrease in the mean burst duration is well described by a Monod-Wyman-Changeux model in which channel closing is produced by all four subunits acting in a single concerted step. The data are inconsistent with a Hodgkin-Huxley model (four independent steps) or a dimer model (two independent dimers). When the channel is open, ATP binds to a single ATP-binding site with a dissociation constant of 300 μM

Review of recent research on Southern Resident Killer Whales to detect evidence of poor body condition in the population

Prepared for: The SeaDoc Society, Karen C. Drayer Wildlife Health Center, Eastsound, WA 98245This review was commissioned by the SeaDoc Society in light of major concern for the population trajectory of the SRKW population. The review focuses on identifying evidence for poor body condition in the SRKW population from information presented in Seattle, March 6 2017 (see Appendix 1 Agenda). Body condition can be influenced by food availability (quantity and quality), energy balance, disease, toxin exposure, physiological status, genetics and stress from noise and vessel traffic, amongst other factors, although food availability is the most common cause in wild mammalian populations. For SRKW, food availability to individuals is determined by both prey availability and time to find, catch, share and consume prey. Anthropogenic disturbance will reduce food consumption and thus influence body condition. The small population size and complex social structure of SRKW complicate detection of associations between measures of body condition and population dynamics. Stochastic events can skew population-wide trends substantially. Therefore, individual cases must be considered rather than analyses of trends and correlations on limited-sample-sizes. The small sample size problem hinders many analyses of this population's ecology. A recent shift in distribution of Northern Resident Killer Whales (NRKW) into offshore SRKW range complicates choice of a control population. NRKW could compete for space and prey, and may be influenced by environmental variables that influence SRKW. Thus when using a case control approach, and comparing parameters between SRKW and a reference population, care should be taken when using the NRKW, and another population should be used such as the southern Alaskan residents

Influence of lime and crop rotation on soil nitrogen, dry matter production and microbial biomass; a field trial, Merredin, WA

Nitrogen (N) fertilisers are applied to the soil to meet crop N demands. A large proportion of Western Australian (WA) cropping soils are acidic, decreasing access to plant available nutrients. Application of lime is generally the most effective means of ameliorating increasing soil acidity

Labor History Symposium: Gerald Friedman, Reigniting the Labor Movement

When trade union growth worldwide came to a halt in the 1980s, a wide body of literature appeared on the causes of trade union decline. Since that time an even more substantial number of books and articles have been penned on the possibility of trade union revitalization: which combination of factors might lead to resurgence; what organizational forms are best suited to the new political and economic landscape; which goals, strategies and tactics are most likely to spark a reversal of trade unionism’s fortunes. Gerald Friedman, Professor of Economics at the University of Massachusetts and the US editor of this journal, has contributed impressively to these ongoing debates in his Reigniting the Labor Movement. One of the strengths of this important book is its historical and transnational approach. Friedman skilfully weaves together a century’s worth of data from 16 countries to support his principal argument that strikes hold the key to any understanding of the rise, decline and possible resurgence of the labour movement. Trade unions, he argues, must enhance internal democracy in order to facilitate militancy. An indispensible book for all concerned with the present and future prospects of trade unionism, Reigniting the Labor Movement is here examined by four of the leading authorities on that subject

Pilbara coastal flora

The Pilbara coastal region is an area which will have increased human pressure both for work and recreation. In recent years, rapid expansion of townsites along the coast has meant that areas which were once stable have come under threat. Conservation measures will be needed to protect the coastline, and to ensure that the beauty of the coastal landscape: an be enjoyed by future generations

Caring for older people as a social determinant of health: findings from a scoping review of observational studies

Background: Unpaid care is a critical source of support for people with health and social care needs. Unpaid carers are a group facing increasing demands and are at risk of adverse outcomes. Objectives: To assess the breadth of evidence on older carers/carers of older people in UK cohort studies. Methods: Using scoping review methods, we developed a targeted search strategy in three bibliographic databases (Medline, PsycInfo and CINAHL) for studies reporting carer characteristics and outcomes. Data were mapped using Evidence for Policy and Practice Information (EPPI) Reviewer, a web-based programme for managing and analysing data in reviews. The impacts of caring were explored and synthesised. Findings: Eighty-five studies were included. Where studies examined the impact of caring, outcomes were typically health-related; findings were inconsistent. Fewer studies reported the socioeconomic, disability-related, quality of life, or social impacts of caring. Fewer than half of studies reported subgroup analyses or care recipient information, and only five studies stratified carers’ outcomes by a measure of socioeconomic status. Limitations: Relying on data from observational studies means that key outcomes or caring pathways may be overlooked due to data collection methods. We therefore cannot infer causation/reverse causation regarding caring and carer outcomes. Implications: Our work highlights specific gaps in evidence regarding the social, economic, health and quality of life outcomes for carers. We also suggest methodological considerations to improve our understanding of care recipients, carers’ trajectories, and those at greatest risk of adverse outcomes. This information is vital to the development of research design, policies and interventions to support carers’ wellbeing

New Working Group: Teaching Mathematics for Social Justice in the Context of University Mathematics Content and Methods Courses

There are three goals for this new working group: 1) To create a community of mathematics teacher educators (MTEs) who are (or are interested in) collaboratively teaching mathematics for social justice (TMfSJ) in their university content and/or methods classes. 2) To collaboratively select/develop/modify TMfSJ tasks and implement those in mathematics content/methods classes. 3) To research the implementation of TMfSJ tasks in content and methods classes

Investigating the Expression and Function of the Glucose Transporter GLUT6 in Obesity

Obesity-related insulin resistance is a highly prevalent and growing health concern, which places stress on the pancreatic islets of Langerhans by increasing insulin secretion to lower blood glucose levels. The glucose transporters GLUT1 and GLUT3 play a key role in glucose-stimulated insulin secretion in human islets, while GLUT2 is the key isoform in rodent islets. However, it is unclear whether other glucose transporters also contribute to insulin secretion by pancreatic islets. Herein, we show that SLC2A6 (GLUT6) is markedly upregulated in pancreatic islets from genetically obese leptin-mutant (ob/ob) and leptin receptor-mutant (db/db) mice, compared to lean controls. Furthermore, we observe that islet SLC2A6 expression positively correlates with body mass index in human patients with type 2 diabetes. To investigate whether GLUT6 plays a functional role in islets, we crossed GLUT6 knockout mice with C57BL/6 ob/ob mice. Pancreatic islets isolated from ob/ob mice lacking GLUT6 secreted more insulin in response to high-dose glucose, compared to ob/ob mice that were wild type for GLUT6. The loss of GLUT6 in ob/ob mice had no adverse impact on body mass, body composition, or glucose tolerance at a whole-body level. This study demonstrates that GLUT6 plays a role in pancreatic islet insulin secretion in vitro but is not a dominant glucose transporter that alters whole-body metabolic physiology in ob/ob mice

Induction of Cytotoxic T Lymphocyte Antigen 4 (Ctla-4) Restricts Clonal Expansion of Helper T Cells

Cytotoxic T lymphocyte antigen (CTLA)-4 plays an essential role in immunologic homeostasis. How this negative regulator of T cell activation executes its functions has remained controversial. We now provide evidence that CTLA-4 mediates a cell-intrinsic counterbalance to restrict the clonal expansion of proliferating CD4+ T cells. The regulation of CTLA-4 expression and function ensures that, after ∼3 cell divisions of expansion, most progeny will succumb to either proliferative arrest or death over the ensuing three cell divisions. The quantitative precision of the counterbalance hinges on the graded, time-independent induction of CTLA-4 expression during the first three cell divisions. In contrast to the limits imposed on unpolarized cells, T helper type 1 (Th1) and Th2 effector progeny may be rescued from proliferative arrest by interleukin (IL)-12 and IL-4 signaling, respectively, allowing appropriately stimulated progeny to proceed to the stage of tissue homing. These results suggest that the cell-autonomous regulation of CTLA-4 induction may be a central checkpoint of clonal expansion of CD4+ T cells, allowing temporally and spatially restricted growth of progeny to be dictated by the nature of the threat posed to the host