The Shadows of Life: Medicaid\u27s Failure of Health Care\u27s Moral Test

North Carolina Medicaid covers one-fifth of the state’s population and makes up approximately one-third of the budget. Yet the state has experienced increasing costs and worsening health outcomes over the past decade, while socioeconomic disparities persist among communities. In this article, the authors explore the factors that influence these trends and provide a series of policy lessons to inform the state’s current reform efforts following the recent approval of North Carolina’s Section 1115 waiver by the Centers for Medicare and Medicaid Services. The authors used health, social, and financial data from the state Department of Health and Human Services, the Robert Wood Johnson Foundation, and the University of North Carolina to identify the highest cost counties in North Carolina. They found higher per beneficiary spending to be inversely related to population health, with many counties with the most expensive beneficiaries also reporting poor health outcomes. These trends appear to be attributed to a breakdown in access to basic health services, with high cost counties often lacking adequate numbers of health care providers and possessing limited health care services, leading patients to primarily engage the health care system in a reactive manner and predominantly in institutional care settings. To illustrate this pattern, the authors developed case studies of Tyrrell County and Graham County, which respectively are home to the state’s worst health outcomes and most expensive Medicaid beneficiaries. The authors combined stories of these counties with the larger historical trends to offer policy recommendations to help reorient North Carolina Medicaid around patient needs. The results shed light on traditionally understudied hotspots of cost and poor outcomes in North Carolina, while proposing tangible steps to support reform

Fluorides, orthodontics and demineralization: a systematic review

Objectives: To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery. Data sources: The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data. Data selection: The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Data extraction: Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial. Data synthesis: Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference –70.0 µm; 95% CI –118.2 to –21.8 µm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15–0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria. Conclusions: There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient

On the resource allocation for D2D underlaying uplink cellular networks

Device-to-Device (D2D) communications has attracted research interests as an emerging technology towards 5G and beyond cellular networks. In this paper, we investigate the power allocation in D2D underlaying cellular networks with uplink channel reuse. We first develop an optimization problem to minimize the total power consumption subject to per- user Quality-of-Service (QoS) constraints. A distributed power allocation algorithm is proposed to allocate the power for both D2D and cellular users by exploiting the property of strictly non-negative inverse of a Z-matrix. It is shown that the power allocated for users can be considerably saved for low QoS requirements, especially with a large number of D2D users. The proposed algorithm is validated through simulation to realize the impacts of noise power, distance between D2D users and the number of D2D pairs in the network

An optimal power allocation for D2D communications over multi-user cellular uplink channels

Device-to-Device (D2D) communications has emerged as a promising technology for optimizing spectral efficiency, reducing latency, improving data rate and increasing system capacity in cellular networks. Power allocation in D2D communication to maintain Quality-of-Service (QoS) remains as a challenging task. In this paper, we investigate the power allocation in D2D underlaying cellular networks with multi-user cellular uplink channel reuse. Specifically, this paper aims at minimizing the total transmit power of D2D users and cellular users (CUs) sub- ject to QoS requirement at each user in terms of the required signal-to- interference-plus-noise ratio (SINR) at D2D users and base station (BS) over uplink channel as well as their limited transmit power. We first derive expressions of SINR at the D2D users and BS based on which an optimization framework for power allocation is developed. We then propose an optimal power allocation algorithm for all D2D users and CUs by taking into account the property of non-negative inverse of a Z- matrix. The proposed algorithm is validated through simulation results which show the impacts of noise power, distance between D2D users, the number of D2D pairs and the number of CUs on the power allocation in the D2D underlaying cellular networks

Chylous Leak During Posterior Approach to Juvenile Scoliosis Surgery: A Case Report.

CaseWe report the first documented case of chylous leak recognized intraoperatively during posterior spinal instrumentation and fusion for juvenile scoliosis in a female patient with a history of thoracotomy and decortication for an empyema.ConclusionsThoracic duct injury can lead to severe morbidity and mortality because of chylothorax formation. Although chylous leaks are a well-documented complication of the anterior approach to spine surgery, leaks during the posterior approach are rarely reported. When these chylous leaks are recognized intraoperatively, the likelihood of serious complications may be minimized by drain placement before closure