Can I Skype My Doctor? Limited Medicare Coverage Hinders Telemedicine’s Potential to Improve Health Care Access

Telemedicine services, such as virtual consultations and remote patient monitoring, are revolutionizing health care delivery. The Patient Protection and Affordable Care Act of 2010 (“ACA”) promotes the use of technology in health care reform as a means to increase quality and access while reducing costs. Despite the excitement around telemedicine, the lack of Medicare reimbursement hinders access and innovation. This Note analyzes the utilization of telemedicine to promote health care access for Medicare beneficiaries, and argues that legislative and regulatory changes are needed to reconcile current Medicare policies with the ACA’s encouragement of using telemedicine services. Specifically, this Note recommends that Congress expand telemedicine reimbursement by increasing the number of covered telemedicine services, and by lifting site restrictions and geographical limitations on reimbursement

Evolving Lorentzian Wormholes

Evolving Lorentzian wormholes with the required matter satisfying the Energy conditions are discussed. Several different scale factors are used and the corresponding consequences derived. The effect of extra, decaying (in time) compact dimensions present in the wormhole metric is also explored and certain interesting conclusions are derived for the cases of exponential and Kaluza--Klein inflation.Comment: 10 pages( RevTex, Twocolumn format), Two figures available on request from the first author. transmission errors corrected

The Quark Gluon Pion Plasma

While it is commonly believed that there is a {\it direct} transition from the hadronic to a quark gluon phase at high temperature, it would be prejudicial to rule out a sequence of dynamically generated intermediate scales. Using as guide, an effective lagrangian with unconfined gluons and constituent quarks, interacting with a chiral multiplet, we examine a scenario in which the system undergoes first-order transitions at $T_{comp}$, the compositeness scale of the pions, at $T_{\chi}$, the scale for spontaneous chiral symmetry breaking, and at $T_c$, the confinement temperature. We find that at current energies, it is likely that the formation temperature of the plasma, $T_0 < T_{comp}$, and that this is therefore a quark gluon pion plasma (QGPP) rather than the usual quark gluon plasma (QGP). We propose some dilepton-related signatures of this scenario.Comment: Rewritten, new figure

Quantum Perfect-Fluid Kaluza-Klein Cosmology

The perfect fluid cosmology in the 1+d+D dimensional Kaluza-Klein spacetimes for an arbitrary barotropic equation of state $p= n \rho$ is quantized by using the Schutz's variational formalism. We make efforts in the mathematics to solve the problems in two cases. For the first case of the stiff fluid $n=1$ we exactly solve the Wheeler-DeWitt equation when the $d$ space is flat. After the superposition of the solutions we analyze the Bohmian trajectories of the final-stage wave-packet functions and show that the flat $d$ spaces and the compact $D$ spaces will eventually evolve into finite scale functions. For the second case of $n \approx 1$, we use the approximated wavefunction in the Wheeler-DeWitt equation to find the analytic forms of the final-stage wave-packet functions. After analyzing the Bohmian trajectories we show that the flat $d$ spaces will be expanding forever while the scale function of the contracting $D$ spaces would not become zero within finite time. Our investigations indicate that the quantum effect in the quantum perfect-fluid cosmology could prevent the extra compact $D$ spaces in the Kaluza-Klein theory from collapsing into a singularity or that the "crack-of-doom" singularity of the extra compact dimensions is made to occur at $t=\infty$.Comment: Latex 18 pages, add section 2 to introduce the quantization of perfect flui

D-branes, String Cosmology and Large Extra Dimensions

D-branes are fundamental in all scenarios where there are large extra dimensions and the string scale is much smaller than the four-dimensional Planck mass. We show that this current picture leads to a new approach to string cosmology where inflation on our brane is driven by the large extra dimensions and the issue of the graceful exit becomes inextricably linked to the problem of the stabilization of the extra dimensions, suggesting the possibility of a common solution. We also show that branes may violently fluctuate along their transverse directions in curved spacetime, possibly leading to a period of brane-driven inflation. This phenomenon plays also a crucial role in many other cosmological issues, such as the smoothing out of the cosmological singularities and the generation of the baryon asymmetry on our three brane.Comment: LaTeX file, 4 page

Accelerating Universe from an Evolving Lambda in Higher Dimension

We find exact solutions in five dimensional inhomogeneous matter dominated model with a varying cosmological constant. Adjusting arbitrary constants of integration one can also achieve acceleration in our model. Aside from an initial singularity our spacetime is regular everywhere including the centre of the inhomogeneous distribution. We also study the analogous homogeneous universe in (4+d) dimensions. Here an initially decelerating model is found to give late acceleration in conformity with the current observational demands. We also find that both anisotropy and number of dimensions have a role to play in determining the time of flip, in fact the flip is delayed in multidimensional models. Some astrophysical parameters like the age, luminosity distance etc are also calculated and the influence of extra dimensions is briefly discussed. Interestingly our model yields a larger age of the universe compared to many other quintessential models.Comment: 18 pages, 9 figure

Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis

Objectives: To review the management and clinical outcomes of uni- or bilateral non-visualization of inguinal lymph nodes during dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0), and to develop an algorithm for the management of patients in which non-visualization occurs. Patients and Methods: This is a retrospective observational study over a period of 4 years, comprising 166 patients with penile squamous cell carcinoma undergoing DSNB and followed up for a minimum of 6 months. All cases diagnosed with uni- or bilateral non-visualization of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes after non-visualization and the oncological outcomes including local and regional recurrence rates were documented. Results: Out of 166 consecutive patients undergoing DSNB, 20 patients (12%) had unilateral non-visualization after injection of intradermal 99mTc. Of these 20 patients, seven underwent repeat DSNB at a later date, with six having successful visualization. One patient had persistent non-visualization and proceeded to a superficial modified inguinal lymphadenectomy (SML). None of these patients experienced recurrence at follow-up. A further seven patients underwent modified SML with on-table frozen-section analysis of the lymph node packet; none of these patients were found to have micrometastatic disease in the inguinal lymph nodes, although one patient developed metastatic inguinal node disease at a later date. Six patients elected to undergo clinical surveillance and have remained disease-free. Conclusion: Patients with impalpable inguinal lymph nodes undergoing DSNB with ≥G2 T1 disease should ideally have bilateral visualization of the sentinel lymph nodes, reflecting the drainage pattern from the primary tumour. In the present series, 12% of patients were found to have unilateral non-visualization after DSNB. Among patients offered a repeat DSNB at a later date, localizing the sentinel node was successful in 86% of cases. Patients with favourable histological characteristics can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that SML may be carried out if there is repeated non-visualization. Larger cohorts are required to validate this proposed algorithm