Financing the U.S. Health System: Issues and Options for Change

Explores key issues of health reform and options for financing health care -- redirecting funds to more effective uses, rolling back tax cuts, modifying tax exclusions for health benefits, an employer play-or-pay model, and a value-added tax

A comparative study of maternal and perinatal outcome in patients with and without HELLP syndrome

Background: A prospective study of feto maternal outcome in severe preeclampsia and eclampsia with and without HELLP syndrome. The aim of the study was to compare the feto maternal outcome in pregnant woman with severe preeclampsia and eclampsia with HELLP syndrome and without HELLP syndrome.Methods: 100 cases of severe preeclampsia/eclampsia with and without HELLP syndrome were analyzed in Government Tirunelveli Medical College Hospital. Maternal morbidity and mortality were compared between the two groups.Results: 83.7% of cases among HELLP group had normal maternal outcome. 11.6% maternal mortality among the HELLP syndrome group. 54.5% babies among HELLP group had abnormal perinatal outcome and 24.6% among non HELLP group.Conclusions: HELLP syndrome has a significant influence on maternal and perinatal mortality and morbidity

Accidental Death due to Carbon Monoxide: Case Report

Background: Carbon monoxide (CO) is a colorless, odorless gas produced as a by-product of incomplete combustion of hydrocarbons. CO binds rapidly to Haemoglobin (Hb), leading to the formation of carboxyhemoglobin (COHb), so the oxygen carrying capacity of the blood will be decreased and causing tissue hypoxia.Case Report: A 35-years-old male mechanic was found unconscious at automobile garage and he was dead after hospitalization on same day after one hour. On external examination, Rigor mortis had occurred all over the body. Cherry red postmortem lividity was present over back. Hypostasis, sub-scalpel tissue, muscles of chest and abdominal wall were cherry red in color suggestive of carbon monoxide toxicity. The chemical analysis report of blood and viscera confirmed toxicity due to carbon monoxide poisoning.Conclusion: Accidental carbon monoxide poisoning in vehicles can occur due to leaking exhausts and inadequate ventilation, but some cases in fatal concentration of CO was found even with garage door had opened or in the absence of defective exhaust systems. Each of the CO poisoning hazard scenarios reflects either product malfunction resulting in high CO emissions and/or some failure to adequately remove CO from the living or recreational environment. Use of catalytic converters in vehicles has reduced carbon monoxide emission considerably. The sudden death of a mechanic due to excessive inhalation of the carbon monoxide gas due to defective exhaust systems and poorly ventilated in automobile garage.

Comparison of incidences and indications of multi primary caesarean with primi caesarean mothers in a tertiary care teaching hospital

Background: The incidences and indications of caesarean sections between the primary caesarean multies and caesarean primies were comparable in respect of their demographical and clinical variables of mothers and their foetal outcomes. Aim and objective of the study was to analyze the incidences and indications of primary caesarean multies and caesarean primies. To compare the incidences and indications of mothers between the primary caesarean multies and caesarean primies. To compare the demographic and clinical profiles of the mothers and babies.Methods: During January to June 2016 total of 3583 deliveries were conducted in Tiruneleli Medical College Hospital, Tamil Nadu, India. Among them 89 and 1168 were primary caesarean multies and caesarean primies respectively. They had been compared according to the objectives.Results: The caesarean incidences were 62.5% among the primies and 4.8% among the multies as Primary. The primary caesarean incidences among the multies were statistically significantly lesser in the 15-24 ages than the primi (P0.05). After 30 years of age, the incidences were statistically significantly increased among the multies (P0.05). The indications of Foetal distress, Severe Oligo hydration and others did not show any statistically significantly difference between the groups (P>0.05). Mal presentation and Ante Partum hemorrhage were significantly more among the multies than primies (p<0.05) and Failed indication and CPD were the significantly lesser indication than the primies (P<0.05).Conclusions: Without reducing the caesarean section rate in primi we cannot bring down the overall caesarean rate of delivery

Changing and Unchanging strong efficient edge domination number of some standard graphs when a vertex is removed or an edge is added

Let G=(V,\ E) be a simple graph. A subset S of E(G) is a strong (weak) efficient edge dominating set of G if │Ns[e] S│ = 1 for all e E(G)(│Nw[e] S│ = 1 for all e E(G)) where Ns(e) ={f / f E(G), f is adjacent to e & deg f ≥ deg e}(Nw(e) ={f / f E(G), f is adjacent to e & deg f ≤ deg e}) and Ns[e]=Ns(e){e}(Nw[e] = Nw(e){e}). The minimum cardinality of a strong efficient edge dominating set of G (weak efficient edge dominating set of G) is called a strong efficient edge domination number of G and is denoted by {\gamma\prime}_{se}(G) ({\gamma^\prime}_{we}(G)).When a vertex is removed or an edge is added to the graph, the strong efficient edge domination number may or may not be changed. In this paper the change or unchanged of the strong efficient edge domination number of some standard graphs are determined, when a vertex is removed or an edge is added

Impact assessment of frontline demonstrations on green gram: Experience from rainfed condition of Rajasthan

Pulses being rich in quality protein, minerals and vitamins are inseparable ingredients of diet of majority of Indian population. Despite high nutritive value of pulses and their role in sustainable agriculture desired growth rate in production could not be witnessed. The domestic production of pulses is consistently below the targets and actualdomestic requirements are also higher, due to these pulses are being imported. The Krishi Vigyan Kendra Pali has carried out frontline demonstrations on green gram covering an area of 26.5 ha of farmers’ field to exhibit latest production technologies and compared it with farmer’s practice. The study in total 40 frontline demonstrations were conducted on farmers’ fields in villages viz., Kishanagar, Bedkallan, Boyal, Kushalpura and Balara of Pali district of Rajasthan state during 2014, 2015 and 2016, to demonstrate production potential and economic benefit of improved technologies comprising sowing method, nutrient management and chemical weed control and adoption of whole package of practices for the crop. After sowing of seed application of weedicide Pendimethalin (within two days after sowing) at 1.0 kg/ha in 500 liters of water used for effective control of the weeds during kharif season in rainfed condition. The findings of the study revealed that the demonstrated technology recorded a mean yield of 982 kg/ha which was 35.5% higher than obtained with farmers’ practice (755 kg/ha). Higher mean net income of Rs. 46030/ha with a Benefit: Cost ratio of 4.3 was obtained with improved technologies in comparison to farmers’ practices (Rs. 38775/ha). The frontline demonstrations conducted on green gram at the farmers’ field revealed that the adoption of improved technologies significantly increased the yield as well as yield attributing traits of crop and also the net returns higher than the farmers’ practices. So, there is a need to disseminate the improved technologies among the farmers with effective extension methods like training and demonstrations. The farmers’ should be encouraged to adopt the recommended package of practices realizing for higher returns

Case Study 1: Movement Groups with Flat, Innovative Governance Structures

Black Lives Matter, Occupy Wall Street, the global justice/anti-globalization movement, the radical environmental movement of the 1990s, and other organizations have moved away from traditional hierarchical models of leadership within their movements in favor of more horizontal, “leader-full” structures or network models. More horizontal or network models have been used even when a group of people is engaged in what might ordinarily be considered “service” work, like disaster recovery and feeding the hungry. Relatedly, organizers of mass mobilizations may engage the support of lawyers even before these actions crystallize into a movement or formally structured organization—as informal governance structures exist in the planning and execution of these mobilizations. One example is the Ferguson Legal Defense Network, which formed under the direction of trusted lawyer contacts amidst the mass mobilizations in Ferguson in the aftermath of the police killing of Michael Brown Jr. This short contribution examines some of these non-traditional, social movement-based lawyer-client relationships, evaluates the accompanying professional responsibility challenges, and offers preliminary approaches. These challenges—though not insurmountable—require thought and a foundational understanding of the goals and methods of social movement organizations

Drug utilization research: a review

Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research

Excretion of lysine by Micrococcus glutamicus

Analysis of intracellular and extracellular lysine concentration during lysine fermentation by Micrococcus glutamicus AEC RN-13-6/1 indicated that lysine excretion occurs against a concentration gradient towards the end of the fermentation period. The capacity to excrete lysine against a concentration gradient may be a factor contributing to the high yield of lysine