Response to Draft Recommendations for Health System Reform

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November, 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period of time. Commission members were mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations Reactions to the MHCRC report were invited from individuals who represent constituencies which often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. Dale Gordon and Kim Boothby-Ballantyne offer a nursing perspective in this commentary

HIV infection significantly reduces lipoprotein lipase which remains low after 6 months of antiretroviral therapy

Purpose of the study Fractional clearance rate of apolipoprotein B100-containing lipoproteins is reduced in HIV infection before and after antiretroviral (ARV) treatment [1]. We compared lipoprotein lipase (LPL) activity and gene expression in HIV-positive subjects before and 6 months after ARV with HIV-negative controls. Methods Fasting blood post heparin total and hepatic lipase activity,adiponectin, leptin, insulin, glucose, and lipid measurementswere made in 32 HIV-infected and 15 HIVnegative controls. LPL was estimated by subtractinghepatic lipase from total lipase. Adiponectin, LPL andhormone sensitive lipase (HSL) gene expression weremeasured from iliac crest subcutaneous fat biopsies.Patients were tested before, and 6 months after randomisation to AZT/3TC (n = 15) or TDF/FTC (n = 17) with EFV.Between-group comparison was by Mann-Whitney andpaired samples by the Wilcoxon signed rank tests. Summary of results There were no differences in gender, ethnicity, baseline BMI, regional fat distribution (whole body DEXA) and visceral (VAT) and subcutaneous fat (SAT) measured by abdominal CT scans between controls and patients. Trunk fat/BMI ratio, VAT and VAT:SAT ratio significantly increased after 6-month ARV therapy (p = 0.01). There were no differences between groups in serum NEFA,HOMA and leptin levels. Selected other results are shown in Table 1. Conclusion Post heparin lipoprotein lipase activity is reduced in HIV and does not return to control levels after 6 months of ARV therapy. AZT-containing regimens are associated with a greater increase in LPL, LPL gene expression and plasma adiponectin than TDF

Depth of maximum of extensive air showers and cosmic ray composition above 10**17 eV in the geometrical multichain model of nuclei interactions

The depth of maximum for extensive air showers measured by Fly's Eye and Yakutsk experiments is analysed. The analysis depends on the hadronic interaction model that determine cascade development. The novel feature found in the cascading process for nucleus-nucleus collisions at high energies leads to a fast increase of the inelasticity in heavy nuclei interactions without changing the hadron-hadron interaction properties. This effects the development of the extensive air showers initiated by heavy primaries. The detailed calculations were performed using the recently developed geometrical multichain model and the CORSIKA simulation code. The agreement with data on average depth of shower maxima, the falling slope of the maxima distribution, and these distribution widths are found for the very heavy cosmic ray mass spectrum (slightly heavier than expected in the diffusion model at about 3*10**17 eV and similar to the Fly's Eye composition at this energy).Comment: 11pp (9 eps figures

A New Measurement of Cosmic Ray Composition at the Knee

The Dual Imaging Cerenkov Experiment (DICE) was designed and operated for making elemental composition measurements of cosmic rays near the knee of the spectrum at several PeV. Here we present the first results using this experiment from the measurement of the average location of the depth of shower maximum, , in the atmosphere as a function of particle energy. The value of near the instrument threshold of ~0.1 PeV is consistent with expectations from previous direct measurements. At higher energies there is little change in composition up to ~5 PeV. Above this energy is deeper than expected for a constant elemental composition implying the overall elemental composition is becoming lighter above the knee region. These results disagree with the idea that cosmic rays should become on average heavier above the knee. Instead they suggest a transition to a qualitatively different population of particles above 5 PeV.Comment: 7 pages, LaTeX, two eps figures, aas2pp4.sty and epsf.sty included, accepted by Ap.J. Let

Clinical Outcomes Associated With Melanocytic Lesions Assessed Via Ancillary Gene Expression Profiling (GEP)

Aims/Objectives: Compare GEP assay prediction of 434 melanocytic lesions with dermatopathologist interpretation. Methods: Sensitivity and specificity of assay were calculated based on disagreement of assay prediction with dermatopathologist interpretation. Histologic features were recorded in disagreeing cases. Results: Eighty-five percent of lesions (369/434) had sufficient RNA for scoring. 74.2% 274/369 lesions were classified as “benign”, 11.9% (44/369) “indeterminate”, and 13.8% (51/369) “malignant”. 38/51 of lesions rendered “malignant” by dermatopathologists were classified “malignant” by assay (sensitivity = 74.5%). Lesions rendered by assay as “benign” but “malignant” by dermatopathologists were more likely to have rarer cytologic features. (13/51) lesions rendered “malignant” by dermatopathologists were classified by assay as “benign,” (4/13) or “indeterminate” (9/13). 270/318 lesions rendered “benign” by dermatopathologists were “benign” by assay (specificity = 84.9%). Of 44/369 “indeterminate” lesions, dermatopathologists rendered 9/44

Structural Analysis of Historical Constructions by Graphic Methodologies based on Funicular and Projective Geometry

This paper presents a graphic methodology for the structural analysis of domes and other surfaces of revolution, based on a combined use of funicular and projective geometry. By considering a dome as a network of lines of latitude and longitude, the equilibrium of the network is analyzed in both horizontal and vertical projection. The resulting dual configuration is also a spatial system that can be considered by its projection in a horizontal and a vertical plane. The dome is divided by latitude and longitude into an arbitrary number of sectors, and the equilibrium is enforced at each node. The tangential forces can be considered for their net effect at each node; the net effect of two tangential forces, equal in magnitude, at a node is a radially directed force in the plane of the line of latitude, acting outwards (compression) or inwards (tension). Considering their horizontal projection, and its dual form, it is possible to choose the shape of the radial force diagram (the vertical projection and the force diagram), and identify the radial forces associated with it, and thus the tangential forces. The new methodology is presented through its application to a hemispherical brick dome of small thickness. The hemispherical brick dome has been also analyzed by applying the slicing technique, considering different hypotheses regarding the structural behavior of the haunch filling, according to its morphological characterization. The structural analysis of the brick dome using both methodologies allows us to contrast the results obtained

Inequivalent contact structures on Boothby-Wang 5-manifolds

We consider contact structures on simply-connected 5-manifolds which arise as circle bundles over simply-connected symplectic 4-manifolds and show that invariants from contact homology are related to the divisibility of the canonical class of the symplectic structure. As an application we find new examples of inequivalent contact structures in the same equivalence class of almost contact structures with non-zero first Chern class.Comment: 27 pages; to appear in Math. Zeitschrif

Why do people avoid talking to strangers? A mini meta-analysis of predicted fears and actual experiences talking to a stranger

People are often reluctant to talk to strangers, despite the fact that they are happier when they do so. We investigate this apparent paradox, meta-analyzing pre-conversation predictions and post-conversation experiences across seven studies (N=2304). We examine: fears of not enjoying the conversation, not liking one’s partner, and lacking conversational skills; fears of the partner not enjoying the conversation, not liking oneself, and lacking conversational skills. We examine the relative strength of these fears, and show that the fears are related to talking behaviour. We report evidence that people’s fears are overblown. Finally, we report two interventions designed to reduce fears: conversation tips, and the experience of a pleasant conversation. Ultimately, this research shows that conversations go better than expected