Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market

Copyright © 2016 John Wiley & Sons, Ltd. This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd

Students' Metacognitive Skill in Mathematics Learning with Cabri Geometry II Plus

Metacognitive skill is the awareness of one's thinking about the thinkingprocess itself, whereas consciousness is the awareness of one's thinking about what to do. The subjects for this research were five students from class VII-1 SMP 1 Banda Aceh. Research data collection used the sheet metacognitive questions. Data were analyzed descriptively to interpret students' metacognitive skills in learning how to use Cabri Geometry II Plus software. The results showed that the metacognitive abilities of students increased from the first meeting to the fourth meetin

Anaesthetic management in a patient with osteogenesis imperfecta and a fractured femur

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Low-Balling on Goals to Regulate Future Affect: a Functional Strategy?

This paper questions the lay theory that future affect can be managed by lowering one's expected performance standard. This strategy can work only if performance is compared to the initially set standard. We argue that performance potential is instead spontaneously evoked at the time of performance feedback and used as the benchmark instead of one's initial goals. Even when goals are met, this comparison results in lower levels of satisfaction and greater disappointment when goals are set low (vs. high). Such negative impact of "low-balling" on goals persists even when performance outcome is held constant and counterfactual thoughts are prevented

Displacement rate effects on mixed-mode I/II delamination of laminated carbon/epoxy composites

Mixed-mode delamination is one of the common failures of composites which has not been studied under low-impact loading. This paper studies the influence of displacement rate on mixed-mode I/II delamination of unidirectional carbon/epoxy composites. Single leg bending test is performed at displacement rates of 1, 10, 100, and 500 mm/min. Experimental results reveal that the mixed-mode I/II fracture toughness is invariant with the displacement rate. In addition, scanning electron micrographs shows that shear cusps are more obvious at 1, 10, and 100 mm/min. At 500 mm/min, significant matrix debris is noticed. Furthermore, the proposed three-dimensional rate-dependent fracture criterion is found to well predict the fracture toughness. Numerical simulation using cohesive zone model suggests that the lower numerical peak load is due to lower damage dissipated energy. In addition, the theoretical and numerical traction-separation responses show significant differences, which is also reflected in the numerical phase angle. This implies that the local mixed-mode ratio is not constant throughout the simulation process

Magnetic Table Interface and Magnetic Foods

This poster paper discuss the concept of magnetic table interface and magnetic foods. This interface introduces new human-food interactions such as modifying weight, levitation, movement, and dynamic textures for our daily used food and utensils using a strong magnetic field formed by an array of Bitter electromagnets. To make foods and cutleries interactive, we add edible magnetic material on the food such as iron and iron oxides, and make cutleries with magnetic materials. We expect that this system will alter our food consumption behaviours and make the whole experience much more interactive and enjoyable

Influence of simulation in Malaysian healthcare education and research (ISIM-HERE): a two-decade experience

The use of simulation as a teaching methodology in medical institutions has been in Malaysia for over two decades. This study aimed to evaluate the current scenarios of simulation impact and utilization in Malaysian academic healthcare institutions (AHIs). We conducted a population-based survey on all AHIs in Malaysia including public and private. We performed an online survey followed by a face-to-face interview evaluating the number of institutions that used simulation, duration of experience, purpose, funding, users’ category and healthcare domain, research activities, dedicated-trained staff and the challenges faced. Out of 75 healthcare institutions approached, 38 agreed to participate in this study. Twenty-two (57.9%) were public hospitals while 16 (42.1%) were private institutions. Thirty-five (92.1%) out of 38 institutions used simulation as a teaching method. The majority (15, 42.9%) had less than five years’ experience, and about a third (11, 31.4%) used simulation for teaching, training and performance assessment. Nurses (30, 26.1%) were the main users followed by physicians and paramedic (19, 16.5% each respectively). In-hospital and procedural group were the top two domains of utilizers. Almost three quarters (25, 71.4%) have dedicated support staff to manage the centre. Funding was mainly from internal institutional support mechanisms. Seven different categories of challenges were identified, the biggest being financial support. In summary, even though healthcare simulation has been in Malaysia for the past two decades but the most substantial impact happened over the last five years. Utilization was mainly for teaching, training, and performance assessment with minimal use in research

Comparative effectiveness of S-adenosylmethionine and etoricoxib in newly diagnosed patients of knee osteoarthritis

Background: Knee osteoarthritis is an important cause for morbidity in elderly people. Therapy is largely symptomatic with nonsteroidal anti-inflammatory drugs which pose risk in the elderly. Methionine is natural body constituent with novel property of blunting S-adenosylmethionine (SAMe) inflammatory process and cartilage degradation. The aim of this study was to compare effectiveness of SAMe, with standard etoricoxib therapy in newly diagnosed knee osteoarthritis cases.Methods: 127 newly diagnosed knee osteoarthritis patients were randomized into two groups. 55 participants received treatment  of etoricoxib 600 mg extended release once daily for 90 days (group 1) and 72 received  etoricoxib 600 mg extended release once daily and SAMe 400 mg twice daily  for initial 15 days followed by SAMe once daily 400 mg as maintenance dose for next 75 days  (group 2). The outcomes were measured by knee injury and osteoarthritis outcome score (KOOS). Pre and post treatment KOOS scores of all cases were separately pooled to define the median for whole as well as components of KOOS parameters. Relative frequencies of cases with values around respective medians were compared by MOODS median test. Patient characteristics, disease characteristics were also examined for bearing on outcomes besides the treatment.Results: SAMe treatment was associated with significantly greater improvement in symptoms, activities of daily life, spontaneous recreational activities and the quality of life compared to etoricoxib therapy. The therapy was well-tolerated.Conclusions: The study confirms SAMe as superior therapeutic option in osteoarthritis. SAMe indeed has been reported to have specific anti-arthritic effects and promotive to general well-being

Application of Genetic Algorithm to the Design Optimization of Complex Energy Saving Glass Coating Structure

Attenuation of GSM, GPS and personal communication signal leads to poor communication inside the building using regular shapes of energy saving glass coating. Thus, the transmission is very low. A brand new type of band pass frequency selective surface (FSS) for energy saving glass application is presented in this paper for one unit cell. Numerical Periodic Method of Moment approach according to a previous study has been applied to determine the new optimum design of one unit cell energy saving glass coating structure. Optimization technique based on the Genetic Algorithm (GA) is used to obtain an improved in return loss and transmission signal. The unit cell of FSS is designed and simulated using the CST Microwave Studio software at based on industrial, scientific and medical bands (ISM). A unique and irregular shape of an energy saving glass coating structure is obtained with lower return loss and improved transmission coefficient

Thermochemical CO2 reduction catalyzed by homometallic and heterometallic nanoparticles generated from the thermolysis o supramolecularly assembled porous metal-adenine precursors

A family of unprecedented supramolecularly assembled porous metal–organic compounds (SMOFs), based on [Cu6M(μ-adeninato)6(μ3-OH)6(μ-H2O)6]2+ cations (MII: Cu, Co, Ni, and Zn) and different dicarboxylate anions (fumarate, benzoate, and naphthalene-2,6-dicarboxylate), have been employed as precursors of catalysts for the thermocatalytic reduction of CO2. The selected metal–organic cation allows us to tune the composition of the SMOFs and, therefore, the features and performance of the final homometallic and bimetallic catalysts. These catalysts were obtained by thermolysis at 600 °C under a N2 atmosphere and consist of big metal particles (10–20 μm) placed on the surface of the carbonaceous matrix and very tiny metal aggregates (<10 nm) within this carbonaceous matrix. The latter are the most active catalytic sites for the CO2 thermocatalytic reduction. The amount of this carbonaceous matrix correlates with the organic content present in the metal–organic precursor. In this sense, CO2 thermocatalytic reduction experiments performed over the homometallic, copper only, catalysts with different carbon contents indicate that above a certain value, the increase of the carbonaceous matrix reduces the overall performance by encapsulating the nanoparticles within this matrix and isolating them from interacting with CO2. In fact, the best performing homometallic catalyst is that obtained from the precursor containing a small fumarate counterion. On the other hand, the structural features of these precursors also provide a facile route to work with a solid solution of nanoparticles as many of these metal–organic compounds can replace up to 1/7 of the copper atoms by zinc, cobalt, or nickel. Among these heterometallic catalysts, the best performing one is that of copper and zinc, which provides the higher conversion and selectivity toward CO. XPS spectroscopy and EDX mappings of the latter catalyst clearly indicate the presence of Cu1–xZnx nanoparticles covered by small ZnO aggregates that provide a better CO2 adsorption and easier CO release sites.Eusko Jaurlaritza/Gobierno Vasco (IT1291-19; IT1722-22 and Investigo program for S.M.G. funded by the European Union-Next Generation EU). Universidad del País Vasco/Euskal Herriko Unibertsitatea (predoctoral fellowship for J.P.C. 17/051), Ministerio de Ciencia e Innovación (project PID2019-108028GB-C21 funded by MCIN/AEI/10.13039/501100011033; PID2022-138968NB-C22 funded by MCIN/AEI/10.13039/501100011033/FEDER/FEDER, and TED2021-129810B-C22 funded by MCIN/AEI/10.13039/501100011033 and by the European Union NextGeneration EU/PRTR)