Health Care in America: In Perspective, in Reality

The conditions that must be satisfied in order to implement a system of universal health care for the people of the United States are: (1) access to a basic package of health care services for all Americans irrespective of their economic or social status; (2) administrative streamlining that would reduce costs and reallocate more resources to medical care giving, while maintaining total expenditures to the current fourteen percent of the gross domestic product (GDP); and (3) free choice of physician and hospital

Unravelling the factors decisive to the implementation of EPODE-derived community approaches targeting childhood obesity: a longitudinal, multiple case study

Abstract Background Implementation of intersectoral community approaches often fails due to a translational gap between the approach as intended and the approach as implemented in practice. Knowledge about the implementation determinants of such approaches is needed to facilitate future implementation processes. Methods The implementation of five EPODE-derived intersectoral community approaches was studied longitudinally. Semi-structured interviews were held with 189 community stakeholders from four sectors to elucidate which determinants influenced implementation, and if an to which extent determinants differed across communities, sectors and over time. A framework approach was used to analyze our data. Results Twenty-two key determinants of implementation were identified. Facilitators named were mostly proximal (stakeholder level), and barriers were mostly distal (context level). Key determinants varied greatly across sectors and over time, especially between the educational & health care sector and the private, welfare & sports sector. Only ‘perceived importance of IACO goals’ was identified as an universal implementation facilitator. Conclusions Striking differences in determinants were found across sectors and over time. Also, stakeholders expressed that possibilities to adapt the approach to the local context were needed to improve implementation. We therefore propose to develop sector- and time specific leads for implementation, which should be approved and amended (over time) by stakeholders. This so-called ‘mutual adaptation’ allows for the use of both scientific insights and practice-based knowledge, enabling program management and community stakeholders to collaboratively improve their implementation efforts

Land use affects lowland stream ecosystems through dissolved oxygen regimes

The aim of the present study was to assess the impact of surrounding land use on the structure and functioning of lowland stream ecosystems. To this end, five different land use types were selected (forest, extensive grassland, intensive grassland, cropland and wastewater treatment plant) each represented by four replicate streams, in which diel dissolved oxygen concentrations were recorded, sediment and water quality parameters were measured and macroinvertebrate community composition was determined. Chironomus sp., Oligochaeta and Gastropoda dominated the cropland and wastewater treatment plant (WWTP) streams, while Plecoptera and most Trichoptera only occurred in forest and extensive grassland streams. Forest streams communities were related to a high oxygen saturation, a high C/N ratio in the sediment and woody debris and coarse particulate organic matter (CPOM) substrate cover. Macroinvertebrate communities in cropland and WWTP streams were related to a low oxygen saturation in water and sediment and high concentrations of dissolved nitrogen, phosphorus and carbon. It is concluded that land use specific impacts on lowland streams are likely exerted via fine sediment accumulation in deposition zones, affecting oxygen regimes, sediment oxygen demand and stream metabolism, ultimately changing macroinvertebrate community composition. This study supports therefore the importance of including the catchment scale in ecological stream quality assessments, combining structural and functional endpoints

Successful prehospital ECMO in drowning resuscitation after prolonged submersion

An 18-year-old drowning victim was successfully resuscitated using prehospital veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Despite 24 min of submersion in water with a surface temperature of 15 °C, the patient was cannulated on-scene and transported to a trauma center. After ICU admission on VA-ECMO, he was decannulated and extubated by day 5. He was transferred to a peripheral hospital on day 6 and discharged home after 3.5 weeks with favorable neurological outcome of a Cerebral Performance Categories (CPC) score of 1 out of 5. This case underscores the potential of prehospital ECMO in drowning cases within a well-equipped emergency response system.</p

Molecular mechanism of influenza A NS1-mediated TRIM25 recognition and inhibition

RIG-I is a viral RNA sensor that induces the production of type I interferon (IFN) in response to infection with a variety of viruses. Modification of RIG-I with K63-linked poly-ubiquitin chains, synthesised by TRIM25, is crucial for activation of the RIG-I/MAVS signalling pathway. TRIM25 activity is targeted by influenza A virus non-structural protein 1 (NS1) to suppress IFN production and prevent an efficient host immune response. Here we present structures of the human TRIM25 coiled-coil-PRYSPRY module and of complexes between the TRIM25 coiled-coil domain and NS1. These structures show that binding of NS1 interferes with the correct positioning of the PRYSPRY domain of TRIM25 required for substrate ubiquitination and provide a mechanistic explanation for how NS1 suppresses RIG-I ubiquitination and hence downstream signalling. In contrast, the formation of unanchored K63-linked poly-ubiquitin chains is unchanged by NS1 binding, indicating that RING dimerisation of TRIM25 is not affected by NS1

Unusual features of coarsening with detachment rates decreasing with cluster mass

We study conserved one-dimensional models of particle diffusion, attachment and detachment from clusters, where the detachment rates decrease with increasing cluster size as gamma(m) ~ m^{-k}, k>0. Heuristic scaling arguments based on random walk properties show that the typical cluster size scales as (t/ln(t))^z, with z=1/(k+2). The initial symmetric flux of particles between neighboring clusters is followed by an effectively assymmetric flux due to the unbalanced detachement rates, which leads to the above logarithmic correction. Small clusters have densities of order t^{-mz(1)}, with z(1) = k/(k+2). Thus, for k<1, the small clusters (mass of order unity) are statistically dominant and the average cluster size does not scale as the size of typically large clusters does. We also solve the Master equation of the model under an independent interval approximation, which yields cluster distributions and exponent relations and gives the correct dominant coarsening exponent after accounting for the effects of correlations. The coarsening of large clusters is described by the distribution P_t(m) ~ 1/t^y f(m/t^z), with y=2z. All results are confirmed by simulation, which also illustrates the unusual features of cluster size distributions, with a power law decay for small masses and a negatively skewed peak in the scaling region. The detachment rates considered here can apply in the presence of strong attractive interactions, and recent applications suggest that even more rapid rate decays are also physically realistic.Comment: 12 pages, with 9 figures include