Health Insurance Take-up by the Near Elderly

This study examines the effect of price on the demand for health insurance by early retirees between the ages of 55 and 64. The analysis is based on administrative data from a medium sized employer and takes advantage of a natural experiment created by the firm's health insurance contribution policy. The amount the firm contributes toward retiree health insurance coverage depends on when a person retired and her years of service at that date. As a result of this policy, there is considerable variation in out-of-pocket premiums faced by individuals in the data, but this variation is independent of the non-price attributes of the health insurance plans offered, and plausibly exogenous to individual characteristics that are likely to affect the demand for insurance. We find that price has a statistically significant but small effect on the decision to take up coverage. The implied elasticities are very similar to results found in previous studies using very different data.

A preliminary investigation of the sterile-filterability of BCS class II drug nanosuspensions prepared via wet stirred media milling

Drug nanoparticles can achieve targeting capabilities, enhanced dissolution rates and improved bioavailability when injected intravenously. Sterile filtration of drug nanoparticle suspensions (nanosuspensions) is critically needed for administration by intravenous delivery route. Avoiding gamma irradiation and high temperatures, sterile filtration could be an effective process to sterilize drug nanosuspensions. On the other hand, two major challenges must be tackled: drug particles must at least be smaller than the filter pore size and minimum amount of non-toxic stabilizers must be used to prevent side effects like pain on the injection site. The aim of this study is to prepare naproxen (NPX) nanosuspensions via wet stirred media milling using various polymers and surfactants as stabilizers and to assess their physical stability with the ultimate goal of achieving the sterile filterability of such produced suspensions. An intensified milling process was investigated for fast production of sub-200 nm drug particles. In the second part, various formulations to stabilize NPX nanoparticles were screened. Lastly, the suspensions with NPX particle size less than 220 nm were filtered through a sterile 0.22 μm disposable capsule filter. Laser diffraction, scanning electron microscopy, rheometry, and surface tension measurement were used to evaluate the breakage kinetics and storage stability. Although NPX nanosuspensions were stabilized using stabilizers acceptable for injection, their sterile filtration was not successful, indicating a critical need for further research regarding the use of acceptable stabilizers and filter type/processing

Increasing EFNEP Program Outreach and Enhancing Program Content Through Local Partnerships

The Expanded Food and Nutrition Education Program (EFNEP) has been shown to be a cost-effective investment of federal dollars. The funding for the program has not increased significantly since the 1980\u27s. Growing rates of poverty in cities like Cleveland have increased the demand for the program. This article describes some innovative strategies that EFNEP in Cuyahoga County, Ohio has used to enhance program quality and expand program outreach

How Syria\u27s Failure to Uphold the Kyoto Protocol and Paris Agreement Exacerbated the Effects of Climate Change in the Levant

The drought in the Levant Region of the Arab Republic of Syria has caused massive destruction by disrupting agriculture and forcing migration to cities. The drought, induced by climate change, has destroyed livelihoods, structures, and health of scores of people. Environmental tensions fed a political discontent that had long been simmering in rural areas, and was a trigger for the Syrian Revolution. Syrians even turned to USAID for help in 2008 when the Syrian minister of agriculture stated publicly, the economic and social fallout from the drought was \u27beyond [Syria\u27s] capacity as a country to deal with. However, the impacts of climate change and the drought in the Levant are still felt today in both Syria and its surrounding countries. Syria\u27s failure to uphold commitments under inter- national environmental declarations such as the Kyoto Protocol and the Paris Agreement exacerbated the drought in the Levant Region of Syria

Gastrointestinal injury following cardiopulmonary bypass

The gastrointestinal (GI) tract may be the source of a number of bacterial and non-bacterial mediators, which may contribute to the development of morbidity and mortality following episodes of gut hypoperfusion/ ischaemia. The aim of this thesis has been to identify the changes in gut blood flow, oxygenation and function following cardiopulmonary bypass (CPB) and their relationship to the development of post-CPB morbidity. The findings are summarised below: The retrospective study identified age (>65 yr) and CPB time as risk factors for the development of post-CPB intra-abdominal complications . Tonometrically determined values for intramucosal pH (pHi) need temperature correction to avoid calculation of erroneously high values during hypothermic CPB. Considerable hypoperfusion occurs during hypothermic CPB, with laser Doppler flowmetry (LDF) falling to approximately 45% of pre-CPB values. The gastric and colonic pHi becomes acidotic (<7.35) during the re-warming and immediate post-CPB period. Intramucosal acidosis occurs at a time when mucosal LDF blood flow is normal or supranormal. CPB increases gut permeability and reduces the absorption of the monosaccharides, 3-O-m-D-glucose, D-xylose & L-rhamnose. Post-CPB gut permeability has a temporal relationship with the CPB time. Pulsatile flow attenuates the increase in post-CPB gut permeability. Endotoxaemia occurs during CPB but is not associated with the production of TNFα; pulsatile flow attenuates this endotoxaemia. When examining perfusion and patient factors, the best predictor for a protracted ventilation & ICU stay for patients was a low gastric pHi (<7.35). A canine model of CPB supported the clinical findings, but also found that: (a) changes in large vessel blood flow do not indicate more dynamic alterations in small vessel blood flow (b) blood flow is prioritised to the mucosa at the expense of the serosal aspects of the bowel wall (c) in the re-warming phase of hypothermic CPB & the immediate post-CPB period, when intramucosal acidosis occurs, there is a disparity between gut oxygen consumption & delivery (b) increased expression of vasoactive intestinal peptide was found in the neural plexus of the submucosa post-CPB, which may indicate a role in preserving mucosal blood flow during periods of hypoperfusion

Oral manifestations of Type I Neurofibromatosis in a family

Neurofibroma is a benign peripheral nerve sheath tumor. It is one of the most frequent tumors of neural origin and its presence is one of the clinical criteria for the diagnosis of neurofibromatosis type I (NF-I). Neurofibromatosis type I is an autosomal dominantly inherited disease due to an alteration in the long arm of chromosome 17. About 50% of NF-I patients have no family history of the disease. NF-I patients have skin lesions (café au lait spots and neurofibromas) as well as bone malformations and central nervous system tumors. Diagnosis is based on a series of clinical criteria. NF-I presents with certain definite oral manifestations which confers to the dentists a major responsibility for accurate diagnosis and report of the disease. The paper aims to highlight the role of an oral diagnostician in first recognition of NF-I in a family via manifestations in the oral cavit

Novel m-PSO-SVM based Interface Controller Design for Haptic System

The haptic system has two key performance issues: stability and transparency. A haptic interface controller (HIC) is designed to address these issues. Addressing these issues becomes a complex problem as both are complementary to each other. Here, when transparency of the system is increased, its stability degrades and vice-versa. To overcome this problem, intelligent optimized solutions are used in this paper to design a HIC controller for the haptic system. SVM and NN techniques have been employed to identify the performance of the controller, ensuring stability and transparency both. The disadvantages of NN in terms of the number of neurons and hidden layers are overcome by SVM. Further, the performance of SVM is highly dependent upon the selection of free parameters. So, further, a modified PSO technique is employed for the optimal selection of these parameters to enhance the performance of SVM. Hence, this novel proposed hybrid technique of m-PSO optimized SVM is applied for the optimal design of the HIC to find out an optimal solution between trade-off the transparency and stability of the haptic device simultaneously. To appreciate the efficacy of the proposed technique, the result obtained with this is compared with HIC design using neural network and conventional ZN method also. This designed controller ensures stability as well as transparency, even under the presence of uncertainty, delay, and quantization error

Beating heart coronary surgery and renal function: a prospective randomised study (Presented at 18th Spring Meeting of the Association of Cardiothoracic Anaesthetists: Selected abstracts, Cambridge, UK. 22 June 2001)

Introduction Cardiopulmonary bypass (CPB) is widely regarded as an important contributor to renal failure, a well recognised complication, following coronary artery surgery (CABG). Off-pump coronary surgery (OPCAB) is intuitively considered renoprotective. We examine the extent of renal glomerular and tubular injury in low-risk patients undergoing either OPCAB or on-pump coronary artery bypass (ONCAB).Methods Forty patients awaiting elective CABG were prospectively randomized into those undergoing OPCAB (n = 20) and ONCAB (n = 20). Table 1 illustrates the exclusion criteria. Glomerular and tubular injury were assessed, respectively, by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to urinary creatinine [1]. Daily measurements were made from admission to postoperative day 5. Fluid balance, serum creati-nine and blood urea were also monitored. Results No mortality or renal complication was observed. Both groups had similar demographic make-up. The OPCAB group received fewer coronary grafts than their counterparts (1.8 versus 2.8; P = 0.002). Serum creatinine and blood urea remained normal in both groups throughout the study. A dramatic and similar rise in mean ± 2SD urinary RBP:creatinine ratio occurred in both groups peaking on day 1 (3183 ± 2534 versus 4035 ± 4078; P = 0.43) before returning to baseline levels. These trends were also observed with the urinary microalbumin:creatinine ratio (5.05 ± 2.66 versus 6.77 ± 5.76; P = 0.22). ONCAB patients had a significantly more negative fluid balance on postoperative day 2 (-183 ± 1118 versus 637 ± 847 ml; P &lt; 0.05). Conclusions Although renal dysfunction did not clinically occur in any patient, sensitive indicators revealed significant and similar injury to both renal tubules and glomeruli following either OPCAB or ONCAB. These suggest that avoidance of CPB per se does not offer additional renoprotection to patients at low risk of perioperative renal insult during CABG