Physician Quality and Health Care for the Poor and Uninsured

Many studies have documented adverse health outcomes for uninsured patients in U.S. hospitals. These poor outcomes have been attributed to their health status and limited access to healthcare. A measure of treatment that remains unexplored is the quality of the physicians treating uninsured patients. We examine whether uninsured and poor patients are treated by lower quality physicians with four measures of physician quality. Using a hospital fixed-effects model, we find that cardiac patients are matched to physician quality based on their ability to pay. Even after controlling for average physician quality within a hospital and patient characteristics, we find that uninsured and Medicaid patients are generally treated by lower quality physicians. We also find that while for-profit and not-for-profit hospitals treat the uninsured with lower quality physicians, government hospitals do not. However, there is evidence that hospitals of all ownership types treat Medicaid patients with lower quality physicians.Uninsured, Medicaid, Physician Quality, Hospital Ownership

Asymmetric Information and the Mode of Entry In Foreign Credit Markets

In a newly liberalized credit market, foreign banks with cost advantages are likely to be less informed than domestic banks that hold information on credit risks. These relative advantages may generate incentives for a foreign bank to negotiate acquisition of a domestic bank in order to capture information endowments. However, if it is difficult to assess the value of information held by banks, the foreign bank will face important choices about the optimal mode of entry and what acquisition price to pay. These choices have implications for the survival of domestic banks and how capital is allocated after liberalization.Foreign entry, bank competition, information

Block Copolymer Based Magnetic Nanoclusters for Cancer-Theranostics: Synthesis, Characterization and In Vitro Evaluation

“There is plenty of room at the bottom”. In this visionary lecture in 1959 Prof. Richard Feynman spoke of the interesting ramifications of working with matter at the atomic scale. Since then, scientists have worked relentlessly towards realizing his vision. The influence of nanobiotechnology on material science and polymer chemistry has given rise to a new field called ‘theranostics’, combining drug delivery and diagnostics within the same nanostructures, thereby enabling simultaneous diagnosis, targeted drug delivery and continued therapy monitoring. Iron oxide nanoparticles (MNPs) are one such class of MRI contrast agents that can be converted into theranostic nanomedicines for cancer therapy. However, development of a stable theranostic contrast system comprising of MNPs is complex and requires a careful balance between the therapeutic diagnostic components. We explored the potential of biodegradable hydrophilic block ionomers such as anionic poly (glutamic acid-b-ethylene glycol) and cationic poly (l-lysine-b-ethylene glycol) in formulating stable magnetic nanoclusters (MNCs). These MNCs were extensively characterized for their composition, colloidal stability and factors influencing their MRI capability. Extensive in vitro studies revealed that the anionic cisplatin-loaded MNCs showed minimal non-specific uptake, a highly preferred feature for targeted cancer therapy. Luteinizing hormone releasing hormone receptor (LHRHr) targeting significantly enhanced the uptake of these formulations in LHRHr-positive ovarian cancer cells. LHRHr targeting also helped improve the theranostic efficacy in cisplatin resistant ovarian cancer cells. One the other hand, cationic MNCs were used to demonstrate the potential of MNCs to function as stimuli-responsive theranostic systems capable of releasing the payload in the acidic milieu breast and ovarian cancer cells. These cationic MNCs also exhibited significantly enhanced T2-weighted MRI contrasts at much lower concentrations than the anionic counterparts. Finally, we successfully evaluated the feasibility of kinetically controlled flash nanoprecipitation technique using multi-inlet vortex mixer (MIVM) to formulate well-defined MNCs from non-ionic amphiphilic Pluronic tri-block copolymers. In comparison to self-assembly techniques, flash nanoprecipitation resulted in significant reduction in polydispersity. It was observed that the hydrophobic block-length of the copolymer dictates the extent of encapsulation hydrophobic therapeutic agents along with the MNPs. exhibited the potential to function as both T1 and T2 contrast agents. In summary, looking at the bigger picture, the work presented here emphasizes on the importance of product development in establishing a critical balance between the therapeutic and imaging functionalities when designing an efficient targeted theranostic nanosystems

Impact of Integrated Child Development Scheme (ICDS) on morbidity status of children and knowledge, attitude, and practice of mothers towards ICDS: A comparative study

Background: Nutrition during the early age of life has a prominent impact on growth and development during childhood period and serves as a key determinant of health and nutritional status in adolescent and adulthood life. Objectives: The objectives of the study were to assess the health status and morbidity pattern of children attending and not attending Integrated Child Development Services (ICDS) center and to find out the knowledge, attitude, and practice (KAP) of the respective mothers regarding ICDS scheme. Materials and Methods: A community-based cross-sectional study was carried among children between 0 and 6 years of age residing in an urban slum area of Karad Municipal Corporation of district Satara, attending and not attending Anganwadies. The study was conducted over a period of 6 months during the year 2017. A total of 500 children were studied for clinical examination and anthropometric measurements with pre-tested, self-administered, and structured questionnaire. The data were computerized in a rational database management system and analyzed using Chi-square tests for statistical significance. Results: Out of a total of 500 children, maximum 58.8% were from age group 37 to 72 months with apparent differences in male and female proportions. The prevalence of undernutrition was significantly high among children not attending Anganwadis (32.4%) and showed 1.8 times the risk of developing under-malnutrition as compared to Anganwadis attendance. The morbidities such as malnutrition (32.40%), anemia (42.40%), Vitamin A deficiency (39.20%), Vitamin B complex deficiency (28.80%), diarrhea (15.20%), and acute respiratory infections (11.60%) were significantly higher in children not attending Anganwadi as compared to those attending Anganwadis (p < 0.05). The mothers of children attending Anganwadis had higher (18.40%) good KAP score regarding ICDS services as compared to those not attending Anganwadis. Conclusion: Children attending Anganwadis have lesser morbidities than those not attending Anganwadis and their mothers had better knowledge about these services

Study Efficacy and Safety of Intravenous Palonosetron against Ondansetron in Post Surgical patients undergoing General Anaesthesia

BACKGROUND : Post operative nausea vomiting (PONV) is an alarming surgical complication1 with critical clinical consequences leading to delayed recovery in patients undergoing general anaesthesia. In general population, incidence of PONV is very high (i.e.30-40%) and which increases further in high risk individuals7. Ondansetron, a 5HT3 receptor antagonist is used in PONV due to its better safety profile in comparison to other anti-emetics. Palonosetron, a second generation 5 HT3 receptor antagonist with unique action and longer half life can be better alternative in treatment of PONV. As minimal data is available on efficacy of palonosetron, study was undertaken to compare its safety and efficacy with ondansetron in all adult patients planned for surgical procedures under general anaesthesia. OBJECTIVES : To assess the efficacy and safety of IV Palonosetron compared to IV ondansetron in relation to adverse effects in post surgical patients undergoing GA. METHODS : In a double blinded randomized controlled study, about 116 patients were enrolled and divided into two equal groups. Patients were received either palonosetron or ondansetron before induction of anaesthesia and its efficacy was assessed by complete response, severity of nausea,80, 98 use of rescue medication, and overall satisfaction score by 5 point Likert scale within 48 hrs of surgery98. Mean, standard deviations and proportions were calculated among the groups. Statistical analysis was done by Chi-square test and Student t-test. (p< 0.05 was considered significant) Results: P value for CR, use of rescue medications, nausea severity and overall satisfaction was statistically significant in palonosetron group. CONCLUSION : The present study showed that Palonosetron was more efficacious than ondansetron in controlling PONV and as safe as ondansetron

Comparative Studies of Photochemical and Electrochemical Methods on Mineralization of Picric Acid

The effluents generated from synthesis and processing plant of Picric acid is reported to be carcinogenic and hence needs to be treated to reduce its concentration below safe discharge limit. Present paper deals with studies on mineralization of Picric acid by adopting photochemical and electrochemical processes and the efficacy of the both processes have been explored in details. Crucial process parameters viz. pH, concentration of oxidizer and catalyst for mineralization of Picric acid are optimized. In photochemical method, It is observed that Picric acid is treated to bring down its concentration from 100 ppm to ≤ 1 ppm under Photo-Fenton process &nbsp;in 2 hrs whereas same treatment carried out under Photo- catalytic process takes only 1 hr. It is also observed that TiO2 xerogel and beads of nano-TiO2 are more efficient compared to that of commercially available TiO2. The TiO2–Polysulfone (PS) beads show less efficiency than TiO2 xerogel. However, the Picric acid oxidation efficiency for TiO2–PS beads is comparable and advantage of TiO2–PS beads is that it can easily be recovered from the treated solution and can be reused in the next experiments. &nbsp;Electrochemical process is user’s friendly and economical. In case of electrochemical treatments at optimized process parameters under Electro-Fenton reaction picric acid is completely mineralized below its drain discharge limit where as under Electro-peroxide reaction picric acid is mineralized upto 3 ppm within 3 hrs. The treated solution has been characterized by using UV-Visible spectrophotometer, High performance Liquid Chromatography (HPLC) and Total Organic Carbon (TOC) Analyzer. The observed results have been interpreted and reported in the present paper

Degradation of Mononitrotoluene by Electrochemical Method

Present paper deals with studies on the degradation of Mononitrotoluene (MNT) by electrochemical method. The Electro-Fenton and Electro-Peroxide methods are explored to degrade MNT upto its drain discharge limit of 1 ppm. Effects of some important parameters which ultimately decide the rate of degradation of MNT viz. oxidizer, pH, catalyst and voltage etc. have been critically studied. The detailed studies have been carried out which includes variation in different parameters viz. pH from acidic range to basic range, catalyst concentration from 10 ppm to 50 ppm, Oxidizer concentration from 5 mM to 40 mM and potential across electrodes from 4 V to 24 V for efficient degradation of MNT. It is observed that optimised values of precursors viz. catalyst (FeSO4 ) concentration of 40 ppm, pH of 3, potential across electrodes of 12V and oxidizer (H2 O2 ) concentration of 25 mM; Electro-Fenton reaction has been carried out to degrade 50 ppm MNT solution up to its drain discharge limit of 1 ppm and on other hand under Electro-Peroxide reaction results in degradation of MNT from 50 ppm to 12 ppm. The comparative studies of Electro-Fenton and Electro-Peroxide reactions have been carried out for MNT solution and the treated solution has been characterised by using UV-Visible spectrophotometer and Total Organic Carbon (TOC) analyzer and the obtained data on MNT effluent studies may be applicable to explore the efficient mineralisation of 2-Methyl-1, 3, 5-trinitrobenzene effluent. The observed results have been interpreted and reported in the present study

A comparative study of simple ligation and simple ligation with invagination of appendicular stump

Background: Acute appendicitis is the most common abdominal emergency. During open appendicectomy the best treatment of the appendicular stump has not been defined. This is a randomized control trial of simple ligation and simple ligation with invagination of appendicular stump.Methods: The diagnosis of acute appendicitis was based on the MASS (Modified Alvardo Score System). ECG and X-Ray chest were done when needed. All the patients were operated under spinal anesthesia.Results: Total 313 patients were operated and randomly divided into two groups, in group A appendicular stump was treated with simple ligation (n=166) and group B underwent ligation and invagination (n=147). Post-operative complications like pyrexia, vomiting, serous discharge, wound infection, peritonitis, residual abscess and post-operative pain in right iliac fossa are comparable in both the groups. Mean operating time in group A was shorter but statistically insignificant. The incidence of paralytic ileus was 3 (1.81%) and 8 (5.44%) patients in group A and group B respectively and was statistically significant.Conclusions: During open appendicectomy simple ligation of appendicular stump is recommended as it is safe, simple and having shorter operative time.