Control of the Mechanical Properties of the Synthetic Anterior Longitudinal Ligament and its Effect on the Mechanical Analogue Lumbar Spine Model

The development and validation of an anatomically correct mechanical analogue spine model would serve as a valuable tool in helping researchers and implant designers understand and alleviate low back pain. Advanced composite ligaments were designed to mimic the tensile mechanical properties of human spinal ligaments. By changing the composite properties, the stiffness and deformation at toe were controlled in a repeatable manner. Five analogue spine models, with three different Anterior Longitudinal Ligament (ALL) stiffness configurations, were tested in bending and compression using displacement control in a MTS load frame. The bending stiffness and kinematic ranges of motion of the spines were compared for each ALL stiffness configuration. The ALL stiffness had a significant effect on the stiffness and peak moment in extension of the overall spine model. The study demonstrated that a change in the synthetic ligament properties successfully controls the biomechanics of the analogue spine model and the model effectively mimics the human cadaveric biomechanical response

Designation of Medically Underserved and Health Professional Shortage Areas: Analysis of the Public Comments on the Withdrawn Proposed Regulation

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers at the George Washington University School of Public Health and Health Services and the RCHN Community Health Foundation. Of the total 725 comments filed, 205 comments were received prior to the end of the first comment period (April 29, 2008), while the majority - 520 - were received subsequent to the extension of the initial comment period. Analysis of the comments underscores that opposition was broad, particularly once the comment period was extended and commenters had the opportunity to offer specific analysis beyond a simple extension request. Seventy-eight percent of post-extension commenters specifically recommended that the regulation be withdrawn and/or recommended increased stakeholder involvement in the rulemaking. Our review of the comments suggests that while redesigning the regulation, the agency should: Consider engaging stakeholders through a more formal engagement process; Provide a complete explanation of the policy effects of any proposed changes; Develop specific approaches to designating communities experiencing medical underservice separately from communities that experience an actual shortage of primary health care professionals; and Devise a provider shortage measure that reflects an appropriate standard of care

Effectiveness and safety of asynchronous telemedicine consultations in general practice: systematic review

Background There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later, but limited evidence of the quality of care it allows in general practice hinders this. Aim Investigate uses and effectiveness of asynchronous telemedicine in general practice according to the domains of healthcare quality and describe how the COVID-19 pandemic changed its use. Design & setting Systematic review in general practice. Method A systematic search carried out across four databases using terms related to general practice, asynchronous telemedicine, uses and effectiveness, and supported by citation searching. Followed by screening according to pre-defined criteria, data extraction and critical appraisal. Narrative synthesis guided by the six domains of healthcare quality and exploring differences in use before and following the COVID-19 pandemic. Results Searches yielded 6,864 reports; 27 reports from 23 studies were included. Asynchronous telemedicine is used by a range of staff and patients across many countries. Safety and equity are poorly reported but there were no major safety concerns. Evidence from other domains of healthcare quality show effectiveness in making diagnoses, prescribing medications, replacing other consultations, providing timely care and increased convenience for patients. Efficiency is impacted by negative effects on workflow, through poor implementation and patient non-adherence, limiting usability and requiring new administrative approaches from healthcare staff. Asynchronous telemedicine use increased rapidly from March 2020, following the COVID-19 pandemic outbreak. Conclusions Asynchronous telemedicine provides quality care for patients but is limited by reports of increased workload and inefficient workflow compared to face-to-face consultations. Limits of evidence include heterogeneity and small-scale studies. Further research into cost effectiveness, equity, safety, and sustained implementation will influence future policy and practice