Allowing FDA Regulation of Communications Software Used in Telemedicine: A Potentially Fatal Misdiagnosis?

Communications technology is changing and improving the way that health care services are delivered to patients. Telemedicine, or the use of communications technology to provide medical care, allows doctors to treat patients in rural areas who otherwise would not have access to medical services. With the development and use of telemedicine, however, comes the burden of government regulation. The Food and Drug Administration (FDA) is just beginning to assert its jurisdiction over telemedicine, seeking to regulate telemedicine systems as medical devices under 21 U.S.C. § 321(h). Should the FDA strongly assert its jurisdiction, it has the ability to regulate entire telemedicine systems, including all of the communications technology used in such systems. Potential regulation by the FDA poses serious problems for the telecommunications industry, and may have a deleterious effect in the research and use of telemedicine. The jurisdiction of the FDA to regulate communications technology used in telemedicine should be limited in order to encourage the widespread development of telemedicine

The effects of an antiseritonergic drug and antihistamine in an experimental model of feline asthma

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Vita."May 2007"Includes bibliographical references.Thesis (M.S.) University of Missouri-Columbia 2007.Dissertations, Academic -- University of Missouri--Columbia -- Veterinary medicine and surgery.Use of cyproheptadine, a serotonin antagonist, and cetirizine a selective histamine (H1) antagonist, in feline asthma has not been previously described. We tested the hypotheses 1) 5 mg of oral cetirizine would be adequately absorbed by the cat and would reach therapeutic levels 2) oral cyproheptadine and cetirizine would blunt eosinophilc airway inflammation in cats sensitized to BGA. For hypothesis 1, heparinized blood (2 mL) was collected from 9 cats at baseline, and at 0.5, 1, 2, 4, 6, 8, 10 and 24 hours after oral administration of 5 mg of cetirizine. A reverse-phase HPLC assay was developed. The plasma concentrations were analyzed with a compartmental pharmacokinetic model. For hypothesis 2, nine research cats were sensitized to BGA. Cats received 1 week treatments of placebo, cyproheptadine or cetirizine. On day 7 of each treatment period, cats were anesthetized for sample collection. BALF % eosinophils was determined. ELISAs were performed to evaluate blood and BALF immunoglobulin, IL-4 and IL-10, histamine concentrations. Plasma and BALF serotonin was measured using a fluorometric method. Results: hypothesis 1- Mean plasma concentrations of cetirizine were maintained above 0.85 mcg/mL for 24 hours; hypothesis 2- No significant difference between treatment groups was found with respect percent BALF eosinophils or the other measured immunologic variables. These results indicate that a single dose of cetirizine administered orally to cats produced high plasma concentrations compared to what has been reported in humans. Administration of cyproheptadine and cetirizine did not decrease airway eosinophilia or alter other immune variables

A Behavioral Life-Cycle Approach to Understanding the Wealth Effect

The somewhat surprising strength in consumer spending in recent years has focused renewed attention on the much-debated wealth effect, the notion that when individuals feel wealthier, they consume more. This study utilizes survey data to examine the wealth effect within the context of the behavioral life-cycle model of savings. The results indicate that the likelihood of households spending more when their assets increase in value decreases with the portion of assets held in home equity. This unexpected finding is due to homeowners responding to the perceived wealth gain from increased home values by cashing out their equity. The likelihood increases with the portion of assets held in stock outside of retirement accounts, but is not significantly related to the portion of assets held in stock overall. Moreover, households that have a full-time income earner, are homeowners, have more education, have a younger household head, or expect economic growth, are more likely to report a wealth effect. Households that utilize savings “rules of thumb” are less likely to report a wealth effect. These results can be used to improve the wealth effect specification in consumer demand models and assist firms to target consumer markets

Fueling the Credit Crisis: Who Uses Consumer Credit and What Drives Debt Burden?

Excessive household debt contributed to the worst recession in decades. Insights about borrowing and spending behavior can inform economic recovery forecasts, policy decisions, and financial education. This study identifies life cycle and credit attitude as key determinants of who uses debt. Younger households are more likely to borrow for consumption, as are those who believe that it is all right to borrow to purchase luxury goods or cover living expenses. Furthermore, households that condone borrowing for these purposes have a higher consumer debt burden. Debt capacity (or creditworthiness) and financial discipline are also significant factors in determining household debt use

Perceived and Realized Risk Tolerance: Changes During the 2008 Financial Crisis

Using the 2007–2009 Survey of Consumer Finances panel data, this study examined changes in perceived and realized risk tolerance after the financial crisis. Households who perceived less risk tolerance were more likely to have reduced their portfolio risk and vice versa. Furthermore, households whose wealth decreased were more likely to perceive less risk tolerance and vice versa. Regression analysis revealed that change in risk tolerance as measured by the change in financial portfolio risk is related to perceived risk tolerance, education, life cycle stage, and employment status. Single households, or those households whose head is less educated, or self-employed or unemployed, may need financial advice to prevent them from reducing their portfolio risk in reaction to a financial crisis

Achieving Zero Liquid Discharge in SAGD Heavy Oil Recovery

Abstract Designing a plant for maximum water recycle and reuse (i.e., zero liquid discharge) is not the mystery it once was. Planning to implement zero liquid discharge right from the start wins faster community acceptance, streamlines the permitting process, eliminates the need for deep well injection or other disposal methods, and minimizes make-up water requirements. Over 100 mechanical zero liquid discharge systems are now in operation worldwide using RCC* Brine Concentrator and Crystallizer technologies., including two SAGD heavy oil recovery projects currently underway in Alberta. Wastewater is converted by the Brine Concentrator to extremely pure distilled water for reuse in the steam generator or other process applications. The waste from the Brine Concentrator is reduced to dry solids in the Crystallizer, while recovering the remaining wastewater for reuse. This paper will discuss the various applications of Brine Concentrators and Crystallizers as they apply to SAGD heavy oil recovery produced water treatment. Specific examples will be used to illustrate the wastewater recycling process and demonstrate how the zero liquid discharge system is integrated into the SAGD heavy oil recovery process

Use of a Point-of-Care Progesterone Assay to Predict Onset of Parturition in the Bitch

An assay of circulating progesterone (P4) is commonly used to estimate progress through late gestation in the bitch. Point-of-care assays provide rapid results, a major advantage over laboratory-based assays. This study aims to compare P4 levels determined by the Catalyst® Progesterone point-of-care assay with those determined by chemiluminescent immunoassay (CLIA) and to identify the expected distribution of Catalyst P4 levels at time intervals 3 days prior to the onset of parturition in pregnant bitches. Twenty-eight pregnant bitches carrying two or more fetuses were admitted to a specialist veterinary reproduction hospital 53 days after the onset of cytological diestrus or, when that date was not known, 57 days after the last mating. Vaginal speculum examinations were performed every 6 h until the onset of cervical dilatation (TCD). Serum samples were collected twice daily (08h00 and 18h00) until TCD. For most samples, fresh serum was assayed for P4 immediately using the Catalyst assay (CatP4), then frozen until assayed by CLIA (IMMULITE 2000; ImmP4). However, for some samples, CatP4 was not analyzed prior to freezing. For these data points (n = 33), CatP4 for fresh serum was estimated from CatP4 assayed on frozen-thawed serum, based on a comparison between CatP4 on fresh vs. frozen-thawed sera. In comparison to ImmP4, CatP4 levels up to and including 7 nmol/L appear to have a constant bias of −1.69 nmol/L (limits of agreement −4.91 to 1.52), while levels >7 nmol/L appear to have a proportional bias of −17.9% (limits of agreement −68.6% to 32.7%). Bootstrapped percentiles of CatP4 results spanned 0.4–9 nmol/L within 12 h of TCD, 0.9–11 nmol/L 12–24 h from TCD, and 2.2–13.5 nmol/L 24–36 h from TCD. A CatP4 >9 nmol/L indicates a bitch that is unlikely to reach TCD within 12 h. Bitches with CatP4s below 3.5 nmol/L are likely to reach TCD within 36 h and bitches with a CatP4 below 2.2 nmol/L are likely to reach TCD within 24 h. In conclusion, the Catalyst Progesterone assay provides rapid assessment of circulating P4 in the bitch, with clinical application in the monitoring of late term pregnant bitches