Cardiovascular group

As a starting point, the group defined a primary goal of maintaining in flight a level of systemic oxygen transport capacity comparable to each individual's preflight upright baseline. The goal of maintaining capacity at preflight levels would seem to be a reasonable objective for several different reasons, including the maintenance of good health in general and the preservation of sufficient cardiovascular reserve capacity to meet operational demands. It is also important not to introduce confounding variables in whatever other physiological studies are being performed. A change in the level of fitness is likely to be a significant confounding variable in the study of many organ systems. The principal component of the in-flight cardiovascular exercise program should be large-muscle activity such as treadmill exercise. It is desirable that at least one session per week be monitored to assure maintenance of proper functional levels and to provide guidance for any adjustments of the exercise prescription. Appropriate measurements include evaluation of the heart-rate/workload or the heart-rate/oxygen-uptake relationship. Respiratory gas analysis is helpful by providing better opportunities to document relative workload levels from analysis of the interrelationships among VO2, VCO2, and ventilation. The committee felt that there is no clear evidence that any particular in-flight exercise regimen is protective against orthostatic hypotension during the early readaptation phase. Some group members suggested that maintenance of the lower body muscle mass and muscle tone may be helpful. There is also evidence that late in-flight interventions to reexpand blood volume to preflight levels are helpful in preventing or minimizing postflight orthostatic hypotension

Towards common European health policies: what are the implications for the Nordic countries?

Health care is an area that remains formally outside the competence of the EU. Despite this, the union’s influence on national health care policies has increased substantially over the past decade. In a series of rulings, the European Court of Justice (ECJ) established a de facto system of patient rights, which, under certain conditions, entitle European citizens to receive health care in other member states at the expense of the social insurance system of their home country. This undermines the autonomy of the member states in the area of health, a key sector in national welfare systems. In 2008, the Commission proposed a new directive on patients’ rights which builds directly on the ECJ rulings, thus consolidating politically the legal precedent set by the Court. The ECJ Court rulings have also spurred the initiation of a so-called OMC process in the area of health care, whereby the member states commit themselves to policy harmonization on a voluntary basis. In this paper, we review the contents of emerging EU policies in the area of health and discuss their implications for the Nordic health care systems. A central question is whether any coherent, common European policy may be discerned and, if so, how it will affect health care systems of the Nordic type, which are tax-based and universalistic in orientation?European Union; Health care; European Court of Justice; Open Method of Coordination

Patent Races, “Me-Too” Drugs, and Generics: A Developing-World Perspective

We build a model of pharmaceutical markets in the light of a patent race among competing firms. The incentive for R&D is the patent on either the breakthrough or the me-too drug. A feature of our model that has not been analyzed before is the prevalence of insurance in developed countries as opposed to developing countries, such that the true burden of financing R&D falls to a greater extent on the former than the latter. We suggest that generics drugs be allowed in low-income countries, particularly since most of them do not have a well-established and functioning pharmaceutical industry.

The public role in private post-secondary education : a review of issues and options

This paper considers whether private educational institutions can play an expanded role in helping attain society's objective with respect to the efficiency and equity of the system of post-secondary education. The authors focus on how public subsidies can be used to meet the social objectives of private education. In recent years there hasbeen increasing evidence of a growing problem of graduate unemployment. Higher education has also been perceived as a socially unproductive but privately profitable screening device. The paper argues that public subsidies should be targeted toward disciplines that have high social returns. If subsidies are to be used to make private higher education more accessible to the poor, a strong case can be made for scholarships and/or loan guarantees. The paper also discusses ways to promote quality among private institutions. The most efficient way to make schools better is to design an incentive system that rewards institutions on the basis of how their graduates perform -- although this might favor students from high-income families. In addition, inappropriate labor market legislation and government behavior as an employer may have contributed to problems of graduate unemployment, credentialism, and a swollen bureaucracy in some countries.Teaching and Learning,Gender and Education,Health Monitoring&Evaluation,Curriculum&Instruction,Environmental Economics&Policies

Information Asymmetry, Insurance, and the Decision to Hospitalize

In a theoretical model, we analyze the effects of various kinds of demand- and supply-side incentives in the context of a model in which patients and doctors must decide not only on an aggregate quantity of health services to use in treating various kinds of illness, but also have a choice between different kinds of providers (in particular, outpatient services rendered by primary-care physicians or inpatient services provided by hospital-based specialists). We present two broad models, the traditional fee-for-service payment scheme and a managed care setup where physicians are paid via capitation, and analyze them both with and without information asymmetry. We find that under certain plausible conditions, second-best optimal managed care plans may dominate second-best optimal conventional plans that rely on cost control through demand-side cost sharing. À l'aide d'un modèle théorique dans lequel patients et médecins doivent choisir la quantité de service à utiliser ainsi que celui, de l'omnipraticien ou du spécialiste uvrant à l'hôpital, qui fournira ces services, nous analysons différents mécanismes d'incitation agissant sur l'offre et la demande. Nous étudions essentiellement deux modes d'organisation : le système conventionnel de rémunération à l'acte et le système de gestion intégrée des soins avec une rémunération per capita; à la fois en présence et en l'absence d'asymétrie d'information. Nous obtenons comme résultat qu'à certaines conditions plausibles, l'optimum de second-rang auquel mène le système de gestion intégrée est supérieur à celui que donne le système conventionnel de rémunération à l'acte qui répercute une partie des coûts sur l'utilisateur.Primary Care, Specialty Care, Hospitalization, Insurance, HMOs, Capitation, Asymmetric Information, Omnipraticiens, Spécialistes, Hospitalisation, Assurance, Paiements à l'acte et per capita, Asymétrie d'information

Information Asymmetry, Insurance, and the Decision to Hospitalize

We analyze the effects of various kinds of demand- and supply-side incentives in the context of a model in which patients and doctors must decide not only on an aggregate quantity of health services to use in treating various kinds of illness, but also have a choice between different kinds of providers (in particular, outpatient services rendered by primary-care physicians or inpatient services provided by hospital-based specialists). We consider well -informed patients’ choices of provider when they have conventional insurance so they only pay part of the cost of their health services, as well as the equilibrium strategies of doctors and patients when there is patient-provider asymmetry; in the latter case we also analyze a managed-care insurance setup under which doctors are paid by capitation. We find that under certain plausible conditions, second-best optimal managed-care plans dominate second -best optimal conventional plans that rely on cost control through demand-side cost sharing.Primary Care, Specialty Care, Hospitalization, Insurance, HMOs, Capitation, Asymmetric Information.

Fe/V and Fe/Co (001) superlattices: growth, anisotropy, magnetisation and magnetoresistance

Some physical properties of bcc Fe/V and Fe/Co (001) superlattices are reviewed. The dependence of the magnetic anisotropy on the in-plane strain introduced by the lattice mismatch between Fe and V is measured and compared to a theoretical derivation. The dependence of the magnetic anisotropy (and saturation magnetisation) on the layer thickness ratio Fe/Co is measured and a value for the anisotropy of bcc Co is derived from extrapolation. The interlayer exchange coupling of Fe/V superlattices is studied as a function of the layer thickness V (constant Fe thickness) and layer thickness of Fe (constant V thickness). A region of antiferromagnetic coupling and GMR is found for V thicknesses 12-14 monolayers. However, surprisingly, a 'cutoff' of the antiferromagnetic coupling and GMR is found when the iron layer thickness exceeds about 10 monolayers.Comment: Proceedings of the International Symposium on Advanced Magnetic Materials (ISAMM'02), October 2-4, 2002, Halong Bay, Vietnam. REVTeX style; 4 pages, 5 figure

Cardiovascular Adjustments to Gravitational Stress

The effects of gravity on the cardiovascular system must be taken into account whenever a hemodynamic assessment is made. All intravascular pressure have a gravity-dependent hydrostatic component. The interaction between the gravitational field, the position of the body, and the functional characteristics of the blood vessels determines the distribution of intravascular volume. In turn this distribution largely determines cardiac pump function. Multiple control mechanisms are activated to preserve optimal tissue perfusion when the magnitude of the gravitational field or its direction relative to the body changes. Humans are particularly sensitive to such changes because of the combination of their normally erect posture and the large body mass and blood volume below the level of the heart. Current aerospace technology also exposes human subjects to extreme variations in the gravitational forces that range from zero during space travel to as much an nine-times normal during operation of high-performance military aircraft. This chapter therefore emphasizes human physiology

Cardiovascular effects of variations in habitual levels of physical activity

Mechanisms involved in human cardiovascular adaption to stress, particularly adaption to different levels of physical activity are determined along with quantitative noninvasive methods for evaluation of cardiovascular function during stess in normal subjects and in individuals with latent or manifest cardiovascular disease. Results are summarized