Health Policy: Universal Pre-existing Conditions

Next to food policy, perhaps no domestic policy issue has raised the ire of more people than that related to the healthcare system. The US Affordable Care Act, which was based in and otherwise formulated with a heavy orientation towards the shared Other-interest in health, has been rejected outright by many who see the healthcare system is only to facilitate maximizing one’s own Self-interest. The latter perspective is easily understood, as there is perhaps nothing more in one’s own Self-interest then taking care of one’s health. So, it would be easily expected that many people would consider mainly their own Self-interest, selfishly guarding their money to provide that care, and not willing to be selfless about something so essential. People focused on Self-interest want to personalize their health care, and seek the best doctors and facilities that would help serve their own health goals. It will also mean they probably would not much care to pay for anybody else’s healthcare. So, any move to a universal healthcare kind of policy and program, which recognizes that we are in effect “all in it together,” that is, there is a shared Other-interest at work, will be resisted

Voltammetric screening of electrodes in fused salt electrolytes

Measuring conductivity, freezing point, and volt-ampere characteristics of halide melts for battery feasibilit

THERMODYNAMIC CONSIDERATIONS IN METAL-METAL SALT INTERACTIONS

BS>The free energies of interaction between isolated metal atoms and the molten chloride of taat metal were calculated from thermodynamic considerations. Based on the values of these standard free energies of interaction, metal-salt systems can be classified into two categories. First are those systems exhibiting relatively weak interaction energies (less than 30 kcal); these include primarily the monoand divalent metals. In the second group are solutions with relatively strong interaction energies (greater than 40 kcal); these consist of the transition metals and the metals that are normally trivalent. Solutions of the first category appear to consist of strongly-solvated atoms whereas several of the systems in the second group are known to undergo chemical reaction to form a soluble lower-valent cation species in the melt. This classification of metalsalt systems in terms of weak or strong interactions is considered more reasonable than that based on a nonquantitative property such as subhalide formation. For example, it is shown that the interaction energies of systems containing known solid subhalides, e.g., Hg-- HgCl/sub 2/ and Bi- BiCl/sub 3/, are no larger and in many cases much less than those for other systems with no known subhalide. (auth

Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions

Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. It causes a quarter of all ischemic strokes, is the commonest cause of vascular dementia, and the cause is incompletely understood. Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. Further, intensive antiplatelet therapy is known to be hazardous in small vessel disease through enhanced bleeding. Whether acetylcholinesterase inhibitors, which delay the progression of Alzheimer's dementia, are relevant in small vessel disease remains unclear. Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. Potential interventions include endothelin antagonists, neurotrophins, nitric oxide donors and phosphodiesterase 5 inhibitors, peroxisome proliferator-activated receptor-gamma agonists, and prostacyclin mimics and phosphodiesterase 3 inhibitors. Several drugs that have relevant properties are licensed for other disorders, offering the possibility of drug repurposing. Others are in development. Since influencing multiple targets may be most effective, using multiple agents and/or those that have multiple effects may be preferable. We focus on potential small vessel disease mechanistic targets, summarize drugs that have relevant actions, and review data available from randomized trials on their actions and on the available evidence for their use in lacunar stroke

Variations in the topography of the infraorbital canal/groove complex: a proposal for classification and its potential usefulness in orbital floor surgery

Background: The aim of the study was to precisely describe and classify the infraorbital canal/groove (IOC/G) complex in dry human skulls and to evaluate the presence of asymmetry in the IOC/G complex.Materials and methods: Seventy orbits of 35 human skulls were investigated.The following distances were measured: the distance between the posterior and anterior margin of the infraorbital groove (S-C); the posterior margin of the infraorbital canal and the infraorbital foramen (C-IOF); and the total length of the infraorbital canal-groove complex (S-C-IOF). The symmetry of the contralateral measurements was analysed.Results: Three types of the IOC/G complex were distinguished: types I, II, III, whose respective incidences were 11.4%, 68.6%, 20.0%. The mean length of the infraorbital groove plus canal complex on the right and left with standard deviation were 27.78 ± 3.69 mm and 28.06 ± 3.37 mm, respectively.Conclusions: The results presented in this study may be particularly helpful for surgery in patients with blow-out fractures and different endoscopic and reconstructive procedures in the region of the inferior orbital wall. The type III IOC/G complex, according to our classification, seems the most likely to be exposed to trauma during surgical manipulations.

Klingler’s method of brain dissection: review of the technique including its usefulness in practical neuroanatomy teaching, neurosurgery and neuroimaging

Klingler’s technique was discovered in the 1930s. It is a modified method of brain fixation and dissection, based on freezing and thawing of the brain tissue, subsequent peeling away of white matter fibres and the gradual exposure of white matter tracts. The added value of this technique is that it is carried out in a stratigraphic manner. This fact makes it an invaluable tool for an in-depth understanding of the complex anatomical organisation of the cerebral hemispheres. The purpose of this paper is to provide a review of Klingler’s method while taking into account the original description of the technique and its value for medical training. The historical background, the concise outline of white matter organisation, as well as our own experience in using this procedure for research and teaching activities were also included. The fibre dissection technique may still be considered an excellent complementary research tool for neuroanatomical studies. Numerous detailed observations about the white matter topography and spatial organisation have been recently made by applying this method. Using this technique may also improve understanding of the three-dimensional intrinsic structure of the brain, which is particularly important both in under- and postgraduate training in the field of neuroanatomy

Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting

The prose reporting of trial information could be powerfully augmented by a computable repository of trial information-a global "trial bank.

The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications

Background: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localisation of the major duodenal papilla, duodenal diverticula, and some particular clinical issues. Materials and methods: In total, 628 patients (408 females and 220 males; aged 21–91 years), who underwent endoscopic retrograde cholangiopancreatography were included in this study. The patients were divided into two groups: a study group comprising 66 (10.5%) patients with periampullary position of diverticula (group A), and a control group comprising 562 (89.5%) patients without diverticula (group B). Results: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52–91 years) and 25 men (aged 54–83 years). Conclusions: Three types of localisation were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis

Abciximab reduces mortality in diabetics following percutaneous coronary intervention

AbstractOBJECTIVESWe sought to determine whether abciximab therapy at the time of percutaneous coronary intervention (PCI) would favorably affect one-year mortality in patients with diabetes.BACKGROUNDDiabetics are known to have increased late mortality following PCI.METHODSData from three placebo-controlled trials of PCI, EPIC, EPILOG, and EPISTENT, were pooled. The one-year mortality rate for patients with a clinical diagnosis of diabetes mellitus was compared with the rate for nondiabetic patients treated with either abciximab or placebo.RESULTSIn the 1,462 diabetic patients, abciximab decreased the mortality from 4.5% to 2.5%, p = 0.031, and in the 5,072 nondiabetic patients, from 2.6% to 1.9%, p = 0.099. In patients with the clinical syndrome of insulin resistance—defined as diabetes, hypertension, and obesity—mortality was reduced by abciximab treatment from 5.1% to 2.3%, p = 0.044. The beneficial reduction in mortality with abciximab use in diabetics classified as insulin-requiring was from 8.1% to 4.2%, p = 0.073. Mortality in diabetics who underwent multivessel intervention was reduced from 7.7% to 0.9% with use of abciximab, p = 0.018. In a Cox proportional hazards survival model, the risk ratio for mortality with abciximab use compared with placebo was 0.642 (95% confidence interval 0.458–0.900, p = 0.010).CONCLUSIONSAbciximab decreases the mortality of diabetic patients to the level of placebo-treated nondiabetic patients. This beneficial effect is noteworthy in those diabetic patients who are also hypertensive and obese and in diabetics undergoing multivessel intervention. Besides its potential role in reducing repeat intervention for stented diabetic patients, abciximab therapy should be strongly considered in diabetic patients undergoing PCI to improve their survival