Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Idealogy

Background U.S. healthcare spending will reach 20% of GDP by 2026. Despite this spending, almost 14% of our under-65 population still lacks health insurance and out-of-pocket healthcare spending is high. To date, much of the healthcare reform debate has focused on who pays—the government, employers or individuals. Objective To review current healthcare reform issues and evidence. Method We address the questions of how much we pay, how we pay and what we receive for the money as a potential foundation for constructive dialogue. Results U.S. healthcare spending continues to exceed that of other countries, without offering universal coverage. Notwithstanding coverage expansions implemented under the Affordable Care Act, uninsurance rates have been rising. Rapid growth of high deductible plans has also significantly increased rates of underinsurance. There is very little evidence that specific policies or interventions employed to date will significantly reduce cost, especially under a fee for service system, where volume makes up for cuts. Global risk payments hold the greatest promise for real cost containment because they can drive true delivery system reform. Conclusion Meaningful, long-term healthcare reform cannot be successful until comprehensive, evidence-based policies that address healthcare costs are fully embraced and implemented

Doctors in space (ships): biomedical uncertainties and medical authority in imagined futures

There has been considerable interest in images of medicine in popular science fiction and in representations of doctors in television fiction. Surprisingly little attention has been paid to doctors administering space medicine in science fiction. This article redresses this gap. We analyse the evolving figure of ‘the doctor’ in different popular science fiction television series. Building upon debates within Medical Sociology, Cultural Studies and Media Studies we argue that the figure of ‘the doctor’ is discursively deployed to act as the moral compass at the centre of the programme narrative. Our analysis highlights that the qualities, norms and ethics represented by doctors in space (ships) are intertwined with issues of gender equality, speciesism and posthuman ethics. We explore the signifying practices and political articulations that are played out through these cultural imaginaries. For example, the ways in which ‘the simple country doctor’ is deployed to help establish hegemonic formations concerning potentially destabilising technoscientific futures involving alternative sexualities, or military dystopia. Doctors mostly function to provide the ethical point of narrative stability within a world in flux, referencing a nostalgia for the traditional, attentive, humanistic family physician. The science fiction doctor facilitates the personalisation of technological change and thus becomes a useful conduit through which societal fears and anxieties concerning medicine, bioethics and morality in a ‘post 9/11’ world can be expressed and explored

BORIS expression in ovarian cancer precursor cells alters the CTCF cistrome and enhances invasiveness through GALNT14

High-grade serous carcinoma (HGSC) is the most aggressive and predominant form of epithelial ovarian cancer and the leading cause of gynecological cancer death. We have previously shown that CTCFL (also known as BORIS, Brother of the Regulator of Imprinted Sites) is expressed in most ovarian cancers, and is associated with global and promoter-specific DNA hypomethylation, advanced tumor stage, and poor prognosis. To explore its role in HGSC, we expressed BORIS in human fallopian tube secretory epithelial cells (FTSEC), the presumptive cells of origin for HGSC. BORIS-expressing cells exhibited increased motility and invasion, and BORIS expression was associated with alterations in several cancer-associated gene expression networks, including fatty acid metabolism, TNF signaling, cell migration, and ECM-receptor interactions. Importantly, GALNT14, a glycosyltransferase gene implicated in cancer cell migration and invasion, was highly induced by BORIS, and GALNT14 knockdown significantly abrogated BORIS-induced cell motility and invasion. In addition, in silico analyses provided evidence for BORIS and GALNT14 co-expression in several cancers. Finally, ChIP-seq demonstrated that expression of BORIS was associated with de novo and enhanced binding of CTCF at hundreds of loci, many of which correlated with activation of transcription at target genes, including GALNT14. Taken together, our data indicate that BORIS may promote cell motility and invasion in HGSC via upregulation of GALNT14, and suggests BORIS as a potential therapeutic target in this malignancy

HDAC Inhibitors Act with 5-aza-2′-Deoxycytidine to Inhibit Cell Proliferation by Suppressing Removal of Incorporated Abases in Lung Cancer Cells

5-aza-2′-deoxycytidine (5-aza-CdR) is used extensively as a demethylating agent and acts in concert with histone deacetylase inhibitors (HDACI) to induce apoptosis or inhibition of cell proliferation in human cancer cells. Whether the action of 5-aza-CdR in this synergistic effect results from demethylation by this agent is not yet clear. In this study we found that inhibition of cell proliferation was not observed when cells with knockdown of DNA methyltransferase 1 (DNMT1), or double knock down of DNMT1-DNMT3A or DNMT1-DNMT3B were treated with HDACI, implying that the demethylating function of 5-aza-CdR may be not involved in this synergistic effect. Further study showed that there was a causal relationship between 5-aza-CdR induced DNA damage and the amount of [3H]-5-aza-CdR incorporated in DNA. However, incorporated [3H]-5-aza-CdR gradually decreased when cells were incubated in [3H]-5-aza-CdR free medium, indicating that 5-aza-CdR, which is an abnormal base, may be excluded by the cell repair system. It was of interest that HDACI significantly postponed the removal of the incorporated [3H]-5-aza-CdR from DNA. Moreover, HDAC inhibitor showed selective synergy with nucleoside analog-induced DNA damage to inhibit cell proliferation, but showed no such effect with other DNA damage stresses such as γ-ray and UV, etoposide or cisplatin. This study demonstrates that HDACI synergistically inhibits cell proliferation with nucleoside analogs by suppressing removal of incorporated harmful nucleotide analogs from DNA

Media actors' perceptions of their roles in reporting food incidents

Background: Previous research has shown that the media can play a role in shaping consumer perceptions during a public health crisis. In order for public health professionals to communicate well-informed health information to the media, it is important that they understand how media view their role in transmitting public health information to consumers and decide what information to present. This paper reports the perceptions of media actors from three countries about their role in reporting information during a food incident. This information is used to present ideas and suggestions for public health professionals working with media during food incidents. Methods: Thirty three semi-structured interviews with media actors from Australia, New Zealand and the United Kingdom were conducted and analysed thematically. Media actors were recruited via purposive sampling using a sampling strategy, from a variety of formats including newspaper, television, radio and online. Results: Media actors said that during a food incident, they play two roles. First, they play a role in communicating information to consumers by acting as a conduit for information between the public and the relevant authorities. Second, they play a role as investigators by acting as a public watchdog. Conclusion: Media actors are an important source of consumer information during food incidents. Public health professionals can work with media by actively approaching them with information about food incidents; promoting to media that as public health professionals, they are best placed to provide the facts about food incidents; and by providing angles for further investigation and directing media to relevant and correct information to inform such investigations. Public health professionals who adapt how they work with media are more likely to influence media to portray messages that fit what they would like the public to know and that are in line with public health recommendations and enable consumers to engage in safe and health promoting behaviours in response to food incidents

A targeted synthesis of chiral modified stationary phases for capillary GC by oligocyclosiloxane bricks

Durch anionische Co- und Terpolymerisation von chiralen Cyclosiloxan- und Peralkylcyclosiloxan-Monomeren lassen sich chirale Polysiloxane nach einem Baukastenprinzip darstellen. Diese neuen Materialien sind durch spektroskopische Techniken strukturell eindeutig und vollständig charakterisierbar. Sie können als stationäre Phasen in der Kapillargaschromatographie eingesetzt werden. Die allgemeinen chromatographischen Eigenschaften und das enantioselektive Trennverhalten der neuen chiralen Phasen werden mit dem kommerziell erhältlichen GROB-Test und speziellen Chiraltests ermittelt und für einzelne Phasen einander gegenübergestellt. Die besten Ergebnisse liefern Amid- oder Cyclodextrin-Phasen, die durch Copolymerisation der reinen chiralen Cyclosiloxane mit Hexamethylcyclotrisiloxan dargestellt werden. Diese Phasen zeigen gutes Benetzungs- und Konditionierungsverhalten, besitzen eine hohe Inertie und sind ohne Immobilisierung oder Quervernetzung problemlos bis 250° C belastbar. So lassen sich an Amid-Phasen beispielsweise alle vier chiralen Homologe von derivatisiertem Norephedrin vollständig auftrennen. An den Cyclodextrin-Phasen werden die Enantiomere von unpolaren Kohlenwasserstoffen wie Limonen, 3,4-Dimethylhexan oder Heptamethylnonan, aber auch die Racemate von zahlreichen underivatisierten und daher polaren primären bzw. sekundären Alkoholen und von Diolen getrennt. Die Terpolymerisation der reinen chiralen Cyclosiloxane mit Hexamethylcyclotrisiloxan führt zu einer neuen Dimension chiraler Polysiloxanphasen mit zwei unterschiedlichen Selektortypen (AMIDEX-Phasen). Je nach Verhältnis von Cyclodextrin zu Amid-Selektor weisen AMIDEX-Phasen eine ähnliche Trenncharakteristik wie Amid- bzw. Cyclodextrin-Phasen auf (AMIDEX-A und AMIDEX-C) oder zeigen eine universelle Enantioselektivität. AMIDEX-B trennt beispielsweise chirale Alkane, Cyanhydrine, Alkohole, Aminoalkohole, Aminosäuren, Ester und Amide. Da jede einzelne dieser AMIDEX-Phase generell mehr Enantiomere zu trennen vermag als eine reine Amid- oder Cyclodextrin-Phase, sollte ihr Einsatz im Analytik-Labor für ein generelles Screening zu einer erheblichen Zeit- und Kostenersparnis führen

Detection of cracks in concrete using near-IR fluorescence imaging

Abstract Structural health monitoring of civil infrastructure is a crucial component of assuring the serviceability and integrity of the built environment. A primary material used in the construction of civil infrastructure is concrete, a material that is susceptible to cracking due to a variety of causes, such as shrinkage, creep, overloading, and temperature change. Cracking reduces the durability of concrete structures, as it allows deleterious environmental agents to penetrate the surface, causing such damage as corrosion of steel reinforcement and delamination of the concrete itself. Conventional crack detection techniques are limited in scope due to issues relating to pre-planning, accessibility, and the need for close proximity to the test surface. Contactless optical image monitoring techniques offer the opportunity to overcome these limitations and have the potential to detect cracks at a distance. Concrete has been reported to have a near-infrared (Near-IR) fluorescence line at a wavelength of 1140 nm when excited with red light. This work investigates the use of fluorescence imaging for the detection of cracks in cementitious surfaces using shallow angle incidence excitation red light. Light oriented at a shallow angle does not excite interior surfaces of cracks, which appear as darker features in images of fluorescing concrete. Artificial cracks with widths of 0.2–1.5 mm were readily imaged using a near-IR camera at distances of 0.5 and 1.3 m. An additional concrete sample with a 0.08 mm wide crack was produced using a flexure apparatus and was also imaged. It is worth noting that the 0.08 mm crack was detected despite its width being below the 0.1 mm pixel resolution of the camera, with the aid of digital image enhancement algorithms