332 research outputs found
736–3 Costs and Complications of Non-thoracotomy Defibrillator Systems: Impact of Health Care Financing Administration Guidelines
Non-thoracotomy implantable defibrillator (ICD) systems have been shown to have lower costs and fewer complications than thoracotomy systems. Recent interpretation of Health Care Financing Administration regulations has challenged reimbursement for investigational devices or combinations of components not approved by the Food and Drug Administration (“off-label”). We compared the costs and complications associated with approved pulse generator/lead systems (CPI 1600/Endotak, CPl 1705/Endotak and Medtronic 7217/Transvene, n=136) with investigational and “off-label” systems (CPI 1625/Endotak, CPI 1715/Endotak, Medtronic 7219/Transvene and Ventritex V100 or V110/TVL and Vl00/Endotak, n=79). Age [63±12 years versus 63±11 years (mean±SD)] and ejection fraction (31±15% versus 31±11%) were similar for patients with approved and investigational systems, respectively. However, total hospital charges including preoperative care and evaluation, implant procedure and hardware, postoperative testing and revisions were 57±16,000 for non-approved devices (p=0.02) despite higher overall costs of newer pulse generators and leads. Total length of stay was 17±10 days versus 14±8 days (p=0.03) and complications including lead dislodgement, increased defibrillation threshold, hematoma and infection were 25/136 versus 4/77 (p<0.005) for approved and investigational or “off-label” systems, respectively. Based on data provided by the manufacturers, anticipated average battery longevity is 3.8 years for approved systems and 5.5 years for investigational or “off-label” systems.ConclusionsThe prudent use of current investigational or “off-label” nonthoracotomy ICD systems is more cost-effective and is associated with fewer complications than approved ICD systems. When increased battery longevity is considered, long term costs of non-thoracotomy ICD therapy may be improved dramatically with the use of investigational or “off-label” systems. Review of reimbursement regulations may be warranted
Hypoxia Regulates BMP4 Expression in the Murine Spleen during the Recovery from Acute Anemia
Bone marrow erythropoiesis is primarily homeostatic, producing new erythrocytes at a constant rate. However at times of acute anemia, new erythrocytes must be rapidly produced much faster than bone marrow steady state erythropoiesis. At these times stress erythropoiesis predominates. Stress erythropoiesis occurs in the fetal liver during embryogenesis and in the adult spleen and liver. In adult mice, stress erythropoiesis utilizes a specialized population of stress erythroid progenitors that are resident in the spleen. In response to acute anemia, these progenitors rapidly expand and differentiate in response to three signals, BMP4, SCF and hypoxia. In absence of acute anemic stress, two of these signals, BMP4 and hypoxia, are not present and the pathway is not active. The initiating event in the activation of this pathway is the up-regulation of BMP4 expression in the spleen.In this paper we analyze the regulation of BMP4 expression in the spleen by hypoxia. Using stromal cell lines, we establish a role for hypoxia transcription factor HIFs (Hypoxia Inducible Factors) in the transcription of BMP4. We identified putative Hypoxia Responsive Elements (HREs) in the BMP4 gene using bioinformatics. Analysis of these elements showed that in vivo, Hif2alpha binds two cis regulatory sites in the BMP4 gene, which regulate BMP4 expression during the recovery from acute anemia.These data show that hypoxia plays a key role in initiating the BMP4 dependent stress erythropoiesis pathway by regulating BMP4 expression
Usability and digital inclusion: standards and guidelines
This article aims at discussing e-government website usability in relation to concerns about
digital inclusion. E-government web design should consider all aspects of usability, including
those that make it more accessible to all. Traditional concerns of social exclusion are being
superseded by fears that lack of digital competence and information literacy may result in dangerous
digital exclusion. Usability is considered as a way to address this exclusion and should
therefore incorporate inclusion and accessibility guidelines. This article makes an explicit link
between usability guidelines and digital inclusion and reports on a survey of local government
web presence in Portugal
New life sciences innovation and distributive justice: rawlsian goods versus senian capabilities
The successful decoding of human genome and subsequent advances in new life sciences innovation create technological presuppositions of a new possibility of justice i.e. the just distribution of both social (income, wealth, etc.) and natural (rationality, intelligence, etc.) goods. Although Rawlsians attempt to expand their theory to include this new possibility, they fail to provide plausible metrics of social justice in the genomics and post-genomics era. By contrast, Senians seem to succeed to do so through their index of basic capabilities. This paper explores what might be regarded as a Senian perspective of distributive justice in new life sciences innovation. The argument is that, by comparing freedoms (different functionings) instead of primary goods, the capability theory allows not only for the identification of injustices linked to natural lottery but also for their elimination through the use of new genomic technologies, including gene-based diagnostics, gene therapy, somatic cell engineering (SCE) and germ-line engineering (GLE). These innovative technologies seem to have the potential to reduce variability in natural goods and therefore enable individuals to convert social goods into well-being or welfare
Unintended learning in primary school practical science lessons from Polanyi’s perspective of intellectual passion
This study explored, from the perspective of intellectual passion developed by
Michael Polanyi, the unintended learning that occurred in primary practical science lessons.
We use the term ‘unintended’ learning to distinguish it from ‘intended’ learning that
appears in teachers’ learning objectives. Data were collected using video and audio
recordings of a sample of twenty-four whole class practical science lessons, taught by five
teachers, in Korean primary schools with 10- to 12-year-old students. In addition, video
and audio recordings were made for each small group of students working together in order
to capture their activities and intra-group discourse. Pre-lesson interviews with the teachers
were undertaken and audio-recorded to ascertain their intended learning objectives.
Selected key vignettes, including unintended learning, were analysed from the perspective
of intellectual passion developed by Polanyi. What we found in this study is that unintended
learning could occur when students got interested in something in the first place and
could maintain their interest. In addition, students could get conceptual knowledge when
they tried to connect their experience to their related prior knowledge. It was also found
that the processes of intended learning and of unintended learning were different. Intended
learning was characterized by having been planned by the teacher who then sought to
generate students’ interest in it. In contrast, unintended learning originated from students’
spontaneous interest and curiosity as a result of unplanned opportunities. Whilst teachers’
persuasive passion comes first in the process of intended learning, students’ heuristic
passion comes first in the process of unintended learning. Based on these findings, we argue that teachers need to be more aware that unintended learning, on the part of individual
students, can occur during their lesson and to be able to better use this opportunity
so that this unintended learning can be shared by the whole class. Furthermore, we argue
that teachers’ deliberate action and a more interactive classroom culture are necessary in
order to allow students to develop, in addition to heuristic passion, persuasive passion
towards their unintended learning
Celebrating 20 Years of the ExCEEd Teaching Workshop
In response to the clear need for faculty training, the American Society of Civil Engineers (ASCE) developed and funded Project ExCEEd (Excellence in Civil Engineering Education) which is celebrating its twentieth year of existence. For the past two decades, 38 ExCEEd Teaching Workshops (ETW) have been held at six different universities. The program has 910 graduates from over 267 different U.S. and international colleges and universities. The ExCEEd effort has transformed from one that relied on the grass roots support of its participants to one that is supported and embraced by department heads and deans. This paper summarizes the history of Project ExCEEd, describes the content of the ETW, assesses its effectiveness, highlights changes in the program as a result of the assessment, and outlines the future direction of the program
Human–agent collaboration for disaster response
In the aftermath of major disasters, first responders are typically overwhelmed with large numbers of, spatially distributed, search and rescue tasks, each with their own requirements. Moreover, responders have to operate in highly uncertain and dynamic environments where new tasks may appear and hazards may be spreading across the disaster space. Hence, rescue missions may need to be re-planned as new information comes in, tasks are completed, or new hazards are discovered. Finding an optimal allocation of resources to complete all the tasks is a major computational challenge. In this paper, we use decision theoretic techniques to solve the task allocation problem posed by emergency response planning and then deploy our solution as part of an agent-based planning tool in real-world field trials. By so doing, we are able to study the interactional issues that arise when humans are guided by an agent. Specifically, we develop an algorithm, based on a multi-agent Markov decision process representation of the task allocation problem and show that it outperforms standard baseline solutions. We then integrate the algorithm into a planning agent that responds to requests for tasks from participants in a mixed-reality location-based game, called AtomicOrchid, that simulates disaster response settings in the real-world. We then run a number of trials of our planning agent and compare it against a purely human driven system. Our analysis of these trials show that human commanders adapt to the planning agent by taking on a more supervisory role and that, by providing humans with the flexibility of requesting plans from the agent, allows them to perform more tasks more efficiently than using purely human interactions to allocate tasks. We also discuss how such flexibility could lead to poor performance if left unchecked
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