Fast field-cycling NMR of cartilage : a way toward molecular imaging

Peer reviewedPublisher PD

Beyond spinal manipulation: should Medicare expand coverage for chiropractic services? A review and commentary on the challenges for policy makers

Objectives: Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions: (1) What are the barriers to expand coverage for chiropractic services? (2) What could potentially be done to address these issues? (3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services? Methods: A literature search was conducted of Google and PubMed for peer-reviewed articles and US government reports relevant to the provision of chiropractic care under Medicare. We reviewed relevant articles and reports to identify key issues concerning the expansion of coverage for chiropractic under Medicare, including identification of barriers and rationale for expanded coverage. Results: The literature search yielded 29 peer-reviewed articles and 7 federal government reports. Our review of these documents revealed 3 key barriers to full coverage of chiropractic services under Medicare: inadequate documentation of chiropractic claims, possible provision of unnecessary preventive care services, and the uncertain costs of expanded coverage. Our recommendations to address these barriers include the following: individual chiropractic physicians, as well as state and national chiropractic organizations, should continue to strengthen efforts to improve claims and documentation practices; and additional rigorous efficacy/effectiveness research and clinical studies for chiropractic services need to be performed. Research of chiropractic services should target the triple aim of high-quality care, affordability, and improved health. Conclusions: The barriers that were identified in this study can be addressed. To overcome these barriers, the chiropractic profession and individual physicians must assume responsibility for correcting deficiencies in compliance and documentation; further research needs to be done to evaluate chiropractic services; and effectiveness of extended episodes of preventive chiropractic care should be rigorously evaluated. Centers for Medicare and Medicaid Services policies related to chiropractic reimbursement should be reexamined using the same standards applicable to other health care providers. The integration of chiropractic physicians as fully engaged Medicare providers has the potential to enhance the capacity of the Medicare workforce to care for the growing population. We recommend that Medicare policy makers consider limited expansion of Medicare coverage to include, at a minimum, reimbursement for evaluation and management services by chiropractic physicians

Carbenicillin-Induced Coagulopathy

In high dosage, carbenicillin may interfere with the conversion of fibrinogen to fibrin and result in a haemorrhagic diathesis. The effect is dose-dependent and requires a high concentration of carbenicillin in plasma. Such a level may be attained in renal failure unless the dose of the drug is appropriately reduced. In such situations the screening coagulation tests may be prolonged and this should alert one to the development of a haemorrhagic diathesis due to the drug.S. Afr. Med. J., 48, 457 (1974

Carbenicillin-induced coagulopathy

In high dosage, carbenicillin may interfere with the conversion of fibrinogen to fibrin and result in a haemorrhagic diathesis. The effect is dose-dependent and requires a high concentration of carbenicillin in plasma. Such a level may be attained in renal failure unless the dose of the drug is appropriately reduced. In such situations the screening coagulation tests may be prolonged and this should alert one to the development of a haemorrhagic diathesis due to the drug.S. Afr. Med. J., 48, 457 (1974)

Homotopy Theoretic Models of Type Theory

We introduce the notion of a logical model category which is a Quillen model category satisfying some additional conditions. Those conditions provide enough expressive power that one can soundly interpret dependent products and sums in it. On the other hand, those conditions are easy to check and provide a wide class of models some of which are listed in the paper.Comment: Corrected version of the published articl

Feasibility study of positive gauging systems. Phase 2 - Design and analysis

Resonant infrasonic gauging system investigated for Apollo project propulsion syste

Pilot Comparative Effectiveness Study of Surface Perturbation Treadmill Training to Prevent Falls in Older Adults

Falls are the leading cause of fatal and non-fatal injuries among older adults. Exercise programs appear to reduce fall risk, but the optimal type, frequency, and duration of exercise is unknown. External perturbations such as tripping and slipping are a major contributor to falls, and task-specific perturbation training to enhance dynamic stability has emerged as a promising approach to modifying fall risk. The purpose of this pilot study was 1) to determine the feasibility of conducting a large pragmatic randomized trial comparing a multidimensional exercise program inclusive of the surface perturbation treadmill training (SPTT) to multidimensional exercise alone (Standard PT); and 2) to assess fall outcomes between the two groups to determine whether an effect size large enough to warrant further study might be present

Space power distribution system technology. Volume 2: Autonomous power management

Electrical power subsystem requirements, power management system functional requirements, algorithms, power management subsystem, hardware development, and trade studies and analyses are discussed

Space power distribution system technology. Volume 1: Reference EPS design

The multihundred kilowatt electrical power aspects of a mannable space platform in low Earth orbit is analyzed from a cost and technology viewpoint. At the projected orbital altitudes, Shuttle launch and servicing are technically and economically viable. Power generation is specified as photovoltaic consistent with projected planning. The cost models and trades are based upon a zero interest rate (the government taxes concurrently as required), constant dollars (1980), and costs derived in the first half of 1980. Space platform utilization of up to 30 years is evaluated to fully understand the impact of resupply and replacement as satellite missions are extended. Such lifetimes are potentially realizable with Shuttle servicing capability and are economically desirable