Legal Issues in Creating PPO\u27s

The development of alternate health care delivery and reimbursement mechanisms, particularly those known as Preferred Provider Organizations (PPOs), raise a multitude of legal issues. Each PPO will exist in different market conditions and under different state laws. Therefore, while this Article seeks to identify and discuss the legal issues, it cannot provide definitive answers. This Article can, however, serve as a guideline or checklist for PPO analysis and provide recommendations and alternatives for dealing with the legal roadblocks that occur in the formation and operation of PPOs. This discussion will be general in nature and cannot substitute for legal advice regarding any particular factual situations encountered

Legal Issues in Creating PPO\u27s

The development of alternate health care delivery and reimbursement mechanisms, particularly those known as Preferred Provider Organizations (PPOs), raise a multitude of legal issues. Each PPO will exist in different market conditions and under different state laws. Therefore, while this Article seeks to identify and discuss the legal issues, it cannot provide definitive answers. This Article can, however, serve as a guideline or checklist for PPO analysis and provide recommendations and alternatives for dealing with the legal roadblocks that occur in the formation and operation of PPOs. This discussion will be general in nature and cannot substitute for legal advice regarding any particular factual situations encountered

Between Worlds, Between Times: Thinking with Trans Narratives at the Limits of Ontology and Temporality

My thesis offers up an explicitly transfeminist mobilization of the theoretical notions of ontological pluralism and queer temporality against the pervasive cultural norm of cis-normativity and the dominant temporal logic of chrono-normativity. First, I critique the blatantly transphobic and fallacious rhetoric of Kathleen Stock, the face of the “gender critical” feminist movement in the UK, which I contextualize as part of a contemporary resurgence of the hateful legacy of trans-exclusion rooted in the second wave feminist movement of the ‘60s and ‘70s and cemented in academic theory by Janice Raymond’s (1979) Transsexual Empire. I then delve deeper, aiming to expose a subtle and under interrogated trend of transphobia and trans-resistant presuppositions endemic to Anglo-American and French feminist philosophy through an extended engagement with the work and thought of Luce Irigaray and Judith Butler. Next I trace an evolution of philosophical treatments of the notions of ontology and temporality, from the early groundbreaking interventions of Immanuel Kant and Martin Heidegger in the historically masculinist continental philosophical tradition, to the contemporary notions of ontological pluralism and queer temporalities. Finally, I engage in an affirmatively critical analysis of a selection of autoethnographic and autobiographical accounts of transsexual femininity and transfeminine transitioning. Ultimately I argue that the embracement of diverse and even seemingly conflictual narratives of gendered existence, including both transsexual narratives and narratives of gender variance or nonconformity – a possibility predicated on broadened and radically inclusive understandings of ontology and temporality – is crucial to both the theoretical goal of expanding and transforming hegemonic cultural understandings of gender in relation to personal identity, and to the political aim of fostering equitable and just conditions for persons who occupy nonhegemonic subject positions – specifically trans and nonbinary identities – in society

Detection of multiple respiratory pathogens during primary respiratory infection: nasal swab versus nasopharyngeal aspirate using real-time polymerase chain reaction

In this study, we present the multiple detection of respiratory viruses in infants during primary respiratory illness, investigate the sensitivity of nasal swabs and nasopharyngeal aspirates, and assess whether patient characteristics and viral load played a role in the sensitivity. Healthy infants were included at signs of first respiratory tract infection. Paired nasopharyngeal aspirates and nasal swabs were collected. Real-time polymerase chain reaction (PCR) was carried out for 11 respiratory pathogens. Paired nasopharyngeal aspirates and nasal swabs were collected in 98 infants. Rhinovirus (n = 67) and respiratory syncytial virus (n = 39) were the most frequently detected. Co-infection occurred in 48% (n = 45) of the infants. The sensitivity of the nasal swab was lower than the nasopharyngeal aspirate, in particular, for respiratory syncytial virus (51% vs. 100%) and rhinovirus (75% vs. 97%). The sensitivity of the nasal swab was strongly determined by the cycle threshold (CT) value (p < 0.001). The sensitivity of the swab for respiratory syncytial virus, but not rhinovirus, was 100% in children with severe symptoms (score ≥11). It is concluded that, for community-based studies and surveillance purposes, the nasal swab can be used, though the sensitivity is lower than the aspirate, in particular, for the detection of mild cases of respiratory syncytial virus (RSV) infection

Radiation-Enhanced Therapeutic Targeting of Galectin-1 Enriched Malignant Stroma in Triple Negative Breast Cancer

Currently there are no FDA approved targeted therapies for Triple Negative Breast Cancer (TNBC). Ongoing clinical trials for TNBC have focused primarily on targeting the epithelial cancer cells. However, targeted delivery of cytotoxic payloads to the non-transformed tumor associated-endothelium can prove to be an alternate approach that is currently unexplored. The present study is supported by recent findings on elevated expression of stromal galectin-1 in clinical samples of TNBC and our ongoing findings on stromal targeting of radiation induced galectin-1 by the anginex-conjugated arsenic-cisplatin loaded liposomes using a novel murine tumor model. We demonstrate inhibition of tumor growth and metastasis in response to the multimodal nanotherapeutic strategy using a TNBC model with orthotopic tumors originating from 3D tumor tissue analogs (TTA) comprised of tumor cells, endothelial cells and fibroblasts. The ‘rigorous’ combined treatment regimen of radiation and targeted liposomes is also shown to be well tolerated. More importantly, the results presented provide a means to exploit clinically relevant radiation dose for concurrent receptor mediated enhanced delivery of chemotherapy while limiting overall toxicity. The proposed study is significant as it falls in line with developing combinatorial therapeutic approaches for stroma-directed tumor targeting using tumor models that have an appropriate representation of the TNBC microenvironment

Coronavirus HKU1 Infection in the United States

Virus is associated with respiratory tract disease in children <5 years of age

RNA and DNA Bacteriophages as Molecular Diagnosis Controls in Clinical Virology: A Comprehensive Study of More than 45,000 Routine PCR Tests

Real-time PCR techniques are now commonly used for the detection of viral genomes in various human specimens and require for validation both external and internal controls (ECs and ICs). In particular, ICs added to clinical samples are necessary to monitor the extraction, reverse transcription, and amplification steps in order to detect false-negative results resulting from PCR-inhibition or errors in the technical procedure. Here, we performed a large scale evaluation of the use of bacteriophages as ICs in routine molecular diagnosis. This allowed to propose simple standardized procedures (i) to design specific ECs for both DNA and RNA viruses and (ii) to use T4 (DNA) or MS2 (RNA) phages as ICs in routine diagnosis. Various technical formats for using phages as ICs were optimised and validated. Subsequently, T4 and MS2 ICs were evaluated in routine real-time PCR or RT-PCR virological diagnostic tests, using a series of 8,950 clinical samples (representing 36 distinct specimen types) sent to our laboratory for the detection of a variety of DNA and RNA viruses. The frequency of inefficient detection of ICs was analyzed according to the nature of the sample. Inhibitors of enzymatic reactions were detected at high frequency in specific sample types such as heparinized blood and bone marrow (>70%), broncho-alveolar liquid (41%) and stools (36%). The use of T4 and MS2 phages as ICs proved to be cost-effective, flexible and adaptable to various technical procedures of real-time PCR detection in virology. It represents a valuable strategy for enhancing the quality of routine molecular diagnosis in laboratories that use in-house designed diagnostic systems, which can conveniently be associated to the use of specific synthetic ECs. The high rate of inhibitors observed in a variety of specimen types should stimulate the elaboration of improved technical protocols for the extraction and amplification of nucleic acids

Terrain, politics, history

This article is based on the 2019 Dialogues in Human Geography plenary lecture at the Royal Geographical Society. It has four parts. The first discusses my work on territory in relation to recent work by geographers and others on the vertical, the volumetric, the voluminous, and the milieu as ways of thinking space in three-dimensions, of a fluid and dynamic earth. Second, it proposes using the concept of terrain to analyse the political materiality of territory. Third, it adds some cautions to this, through thinking about the history of the concept of terrain in geographical thought, which has tended to associate it with either physical or military geography. Finally, it suggests that this work is a way geographers might begin to respond to the challenge recently made by Bruno Latour, where he suggests that ‘belonging to a territory is the phenomenon most in need of rethinking and careful redescription; learning new ways to inhabit the Earth is our biggest challenge’. Responding to Latour continues this thinking about the relations between territory, Earth, land, and ground, and their limits