Comprehensive Health Insurance: The Reality

In his article, Dr. O\u27Keefle outlines the major proposals (both generic and specIfic) in the area of national health insurance. He then describes in depth the proposed Warren County Plan and the Foundation Concept in relation to three fundamental concepts: availability, utilization and financing of medical care

Role of the Hospitalist and Maternal Fetal Medicine Physician in Obstetrical Inpatient Care.

OBJECTIVE: The objective of this study was to evaluate the role of hospitalists and Maternal Fetal Medicine (MFM) subspecialists in obstetrical inpatient care. STUDY DESIGN: This electronic survey study was offered to members of the American College of Obstetrics & Gynecology (ACOG; n = 1,039) and the Society for Maternal-Fetal Medicine (SMFM; n = 1,813). RESULTS: Overall, 607 (21%) respondents completed the survey. Overall, 35% reported that hospitalists provided care in at least one of their hospitals. Compared with ACOG respondents, a higher frequency of SMFM respondents reported comfort with hospitalists providing care for all women on labor and delivery (74.4 vs. 43.5%, p = 0.005) and women with complex issues (56.4 vs. 43.5%, p = 0.004). The majority of ACOG respondents somewhat/completely agreed that hospitalists were associated with decreased adverse events (69%) and improved safety/safety culture (70%). Overall, 35% of ACOG respondents have MFM consultation available with 53% having inpatient coverage. Of these, 85% were satisfied with MFM availability. CONCLUSION: Over one-third of respondents work in units staffed with hospitalists and more than half have inpatient MFM coverage. It is important to evaluate if and how hospitalists can improve maternal and perinatal outcomes, and the types of hospitals that are best served by them

Object Music

My music expresses my feelings. To express emotion is different from conveying it. My music does not seek to make a listener feel my feelings or help a listener understand me. The expression of emotion happens while I write the piece. My feelings stop mattering once the piece has been written. I’m not trying to say anything universal. The concert hall or headphone setting is essential for my music because it is meant to be experienced alone. What I want to do is create a musical space capable of eliciting real emotional reflection. I have no idea what kind of emotions a listener may have to reflect upon. Music is an echo chamber for an individual’s psyche. I try to build a space that echoes all kinds of thoughts and feelings, although in any given space some thoughts and feelings will sound louder then others. I don’t worry which thoughts and feelings may be loudest. Music has the power to transcend a listeners intellect and have a visceral and immediate emotional impact. This emotional impact comes from musics ability to resonate with a listeners thoughts and feelings and by resonating amplify them. Music cannot induce feelings in a listener which the listener has not already felt to some extent. It can make those feelings stronger or weaker. Music exists in time and thus moves linearly, from point A to point B and so on. Each musical moment has two significances: the first is the significance of the moment itself and the second is the significance of the relation between this moment and the moments that proceeded it. The impact of a piece of music is the cumulative impact of each differentiated musical moment. This is the plane on which musical manipulation may occur. The goal of object music is to take time out of music (as it is impossible to remove music from time). Point A and point B (and C, D etc.) are constantly and dynamically superimposed such that each individual moment has exact same musical significance as every other moment. There are basically two steps in writing object music: I express myself musically by writing melodies harmonies and timbres. I then compose the piece, a process of superimposing what I have written onto itself and obfuscating that material with various rhythmic and formal devices. The final product is the original material stripped of its original teleological significance. One no longer needs to hear the entire melody, or follow the harmonic/timbral progression to understand the piece. 15 seconds will express the piece as accurately as 25 minutes, although a listener will obviously take more out of the piece the longer its duration

Transplantation of novel human GDF5-expressing CHO cells is neuroprotective in models of Parkinson\u27s disease

Growth/differentiation factor 5 (GDF5) is a neurotrophic factor that promotes the survival of midbrain dopaminergic neurons in vitro and in vivo and as such is potentially useful in the treatment of Parkinson\u27s disease (PD). This study shows that a continuous supply of GDF5, produced by transplanted GDF5-overexpressing CHO cells in vivo, has neuroprotective and neurorestorative effects on midbrain dopaminergic neurons following 6-hydroxydopamine (6-OHDA)-induced lesions of the adult rat nigrostriatal pathway. It also increases the survival and improves the function of transplanted embryonic dopaminergic neurons in the 6-OHDA-lesioned rat model of PD. This study provides the first proof-of-principle that sustained delivery of GDF5 in vivo may be useful in the treatment of PD

A randomised trial of the effect of different fluid consistencies used in the management of dysphagia on quality of life: a time trade-off study: table 1.

Methods: the risk of aspiration with thin fluids was explained to consecutive hospital patients without dysphagia (n = 76) and to a convenience sample of healthcare professionals (n = 75) who were then randomly allocated to drink as much as possible of 200 ml of pre-prepared water of Grade 1 (very mildly thick) or Grade 2 (mildly thick) consistency. A standardised script with a ping-pong approach was then used to elicit TTO utilities for use of thickened fluids using a 10-year horizon. Results: median (inter-quartile range) utilities were 0.7 (0.5-0.9) for those receiving Grade 1 and 0.5 (0.3-0.7) for those receiving Grade 2 consistency fluid (Mann-Whitney test, P = 0.001). Thus, for example, on average those allocated to Grade 2 fluid would be willing to sacrifice 5 years of a 10-year lifespan not to be restricted to fluid of that consistency. There were no significant differences between patient and professional values. Conclusion: patients and professionals judge that long-term use of thickened fluids would significantly impair quality of life. Utilities associated with more viscous fluids are particularly low