Innovations in the Organization of Health Services: Inhibiting vs. Permissive Regulation

This Article concerns the effect of current legal rules upon the possibility of developing non-profit, consumer-sponsored, prepaid comprehensive health-service programs. Concomitantly considered are the effects of existing law upon physician sponsored plans, such as Blue Shield, and upon institutional practice under which non-profit hospitals or other institutions employ salaried physicians. The legal areas covered include: (1) Rules prohibiting the corporate practice of medicine; (2) Enabling acts permitting the operation of prepaid health-service plans; (3) Insurance codes and regulations protecting the public against fraudulent or financially unstable prepayment plans; and (4) Restraint-of-trade rules protecting prepayment plans against harassment and interference

Licensure of Pysicians

This Article examines the most significant features of state medical licensure laws: the scope of mandatory licensure, including the important question of authority for delegations of functions; the nature and role of state licensing agencies; qualifications for licensure candidates, including accreditation of medical schools; license registration and renewal, and reinstatement of lapsed licenses; recognition of licenses of other jurisdictions; and license suspension or revocation, and reinstatement of removed licenses

3-Acetyl­benzoic acid

In the crystal structure of the title compound, C9H8O3, essentially planar mol­ecules [the carboxyl group makes a dihedral angle of 4.53 (7)° with the plane of the ring, while the acid group forms a dihedral angle of 3.45 (8)° to the ring] aggregate by centrosymmetric hydrogen-bond pairing of ordered carboxyl groups. This yields dimers which have two orientations in a unit cell, creating a herringbone pattern. In addition, two close C—H⋯O inter­molecular contacts exist: one is between a methyl H atom and the ketone of a symmetry-related mol­ecule and the other involves a benzene H atom and the carboxyl group O atom of another mol­ecule. The crystal studied was a non-merohedral twin with twin law [100, 00, 0] and a domain ratio of 0.8104(14): 0.1896(14)

Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study

Background: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis. Methods: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on livebirths, antenatal care coverage, and syphilis testing, seropositivity, and treatment in antenatal care. For 2012 estimates, we used data collected between 2009 and 2012. We updated the 2008 estimates using data collected between 2000 and 2008, compared these with 2012 estimates using data collected between 2009 and 2012, and performed subanalyses to validate results. Findings: In 2012, an estimated 930 000 maternal syphilis infections caused 350 000 adverse pregnancy outcomes including 143 000 early fetal deaths and stillbirths, 62 000 neonatal deaths, 44 000 preterm or low weight births, and 102 000 infected infants worldwide. Nearly 80% of adverse outcomes (274 000) occurred in women who received antenatal care at least once. Comparing the updated 2008 estimates with the 2012 estimates, maternal syphilis decreased by 38% (from 1 488 394 cases in 2008 to 927 936 cases in 2012) and congenital syphilis decreased by 39% (from 576 784 to 350 915). India represented 65% of the decrease. Analysis excluding India still showed an 18% decrease in maternal and congenital cases of syphilis worldwide. Interpretation: Maternal and congenital syphilis decreased worldwide from 2008 to 2012, which suggests progress towards the elimination of mother-to-child transmission of syphilis. Nonetheless, maternal syphilis caused substantial adverse pregnancy outcomes, even in women receiving antenatal care. Improved access to quality antenatal care, including syphilis testing and treatment, and robust data are all important for achieving the elimination of mother-to child transmission of syphilis. Funding: The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction in WHO, and the US Centers for Disease Control and Prevention

Prevalence of Antibodies against Hantaviruses in Serum and Saliva of Adults Living or Working on Farms in Yorkshire, United Kingdom

We acknowledge Clement and colleagues for their comments [1] on our paper [2]. We agree that many controversies are being discussed by the hantavirus community, particularly surrounding the interpretation of serological results and the designation of new species and strains. Within this setting, we are grateful for the opportunity to respond to the key factual and methodological points raised by Clements et al. [...

Oxford SWIFT IFS and multi-wavelength observations of the Eagle galaxy at z=0.77

The `Eagle' galaxy at a redshift of 0.77 is studied with the Oxford Short Wavelength Integral Field Spectrograph (SWIFT) and multi-wavelength data from the All-wavelength Extended Groth strip International Survey (AEGIS). It was chosen from AEGIS because of the bright and extended emission in its slit spectrum. Three dimensional kinematic maps of the Eagle reveal a gradient in velocity dispersion which spans 35-75 +/- 10 km/s and a rotation velocity of 25 +/- 5 km/s uncorrected for inclination. Hubble Space Telescope images suggest it is close to face-on. In comparison with galaxies from AEGIS at similar redshifts, the Eagle is extremely bright and blue in the rest-frame optical, highly star-forming, dominated by unobscured star-formation, and has a low metallicity for its size. This is consistent with its selection. The Eagle is likely undergoing a major merger and is caught in the early stage of a star-burst when it has not yet experienced metal enrichment or formed the mass of dust typically found in star-forming galaxies.Comment: accepted for publication in MNRA

Confluence and Convergence in Probabilistically Terminating Reduction Systems

Convergence of an abstract reduction system (ARS) is the property that any derivation from an initial state will end in the same final state, a.k.a. normal form. We generalize this for probabilistic ARS as almost-sure convergence, meaning that the normal form is reached with probability one, even if diverging derivations may exist. We show and exemplify properties that can be used for proving almost-sure convergence of probabilistic ARS, generalizing known results from ARS.Comment: Pre-proceedings paper presented at the 27th International Symposium on Logic-Based Program Synthesis and Transformation (LOPSTR 2017), Namur, Belgium, 10-12 October 2017 (arXiv:1708.07854

Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study.

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500

The JWST Resolved Stellar Populations Early Release Science Program VI. Identifying Evolved Stars in Nearby Galaxies

We present an investigation of evolved stars in the nearby star-forming galaxy WLM, using NIRCam imaging from the JWST resolved stellar populations early-release science (ERS) program. We find that various combinations of the F090W, F150W, F250M, and F430M filters can effectively isolate red supergiants (RSGs) and thermally-pulsing asymptotic giant branch (TP-AGB) stars from one another, while also providing a reasonable separation of the primary TP-AGB subtypes: carbon-rich C-type stars and oxygen-rich M-type stars. The classification scheme we present here agrees very well with the well-established Hubble Space Telescope (HST) medium-band filter technique. The ratio of C to M-type stars (C/M) is 0.8$\pm$0.1 for both the new JWST and the HST classifications, which is within one sigma of empirical predictions from optical narrow-band CN and TiO filters. The evolved star colors show good agreement with the predictions from the PARSEC$+$COLIBRI stellar evolutionary models, and the models indicate a strong metallicity dependence that makes stellar identification even more effective at higher metallicity. However, the models also indicate that evolved star identification with NIRCam may be more difficult at lower metallicies. We test every combination of NIRCam filters using the models and present additional filters that are also useful for evolved star studies. We also find that $\approx$90\% of the dusty evolved stars are carbon-rich, suggesting that carbonaceous dust dominates the present-day dust production in WLM, similar to the findings in the Magellanic Clouds. These results demonstrate the usefulness of NIRCam in identifying and classifying dust-producing stars without the need for mid-infrared data.Comment: 15 page, 12 figures, submitted to AAS Journal

Inferring Epidemic Contact Structure from Phylogenetic Trees

Contact structure is believed to have a large impact on epidemic spreading and consequently using networks to model such contact structure continues to gain interest in epidemiology. However, detailed knowledge of the exact contact structure underlying real epidemics is limited. Here we address the question whether the structure of the contact network leaves a detectable genetic fingerprint in the pathogen population. To this end we compare phylogenies generated by disease outbreaks in simulated populations with different types of contact networks. We find that the shape of these phylogenies strongly depends on contact structure. In particular, measures of tree imbalance allow us to quantify to what extent the contact structure underlying an epidemic deviates from a null model contact network and illustrate this in the case of random mixing. Using a phylogeny from the Swiss HIV epidemic, we show that this epidemic has a significantly more unbalanced tree than would be expected from random mixing