WorldWideScience

Sample records for care reform hinges

  1. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

    Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  2. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  3. Reforms of health care system in Romania

    NARCIS (Netherlands)

    Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.

    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of

  4. Reforms of health care system in Romania

    NARCIS (Netherlands)

    Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.

    2002-01-01

    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th

  5. Oncology payment reform to achieve real health care reform.

    Science.gov (United States)

    McClellan, Mark B; Thoumi, Andrea I

    2015-05-01

    Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.

  6. Concrete Hinges

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Schmidt, Jacob Wittrup

    2014-01-01

    In the first part of the 20th century concrete hinges developed by Freyssinet and Mesnager were widely tested and implemented in concrete structures. The concrete hinges were used a great deal in closed-spandrel arch bridges. Since such a bridge type has not been competitive for the past 40 years......, the research in concrete hinges has not evolved significantly in that period. But introducing a new state-of-the-art concrete arch bridge solution (Pearl-Chain arches invented at the Technical University of Denmark) creates a necessity of a concrete hinge research based on modern standards. Back when research...... in concrete hinges was more common different designs were proposed for the geometry and reinforcement. Previous research focused on fatigue, multi-axial stresses around the hinge throat, and the relation between rotation- and moment. But many different test-setups were proposed by different researchers...

  7. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  8. Evolution of US Health Care Reform.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2017-03-01

    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  9. The new architects of health care reform.

    Science.gov (United States)

    Schaeffer, Leonard D

    2007-01-01

    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  10. Health care system reform in developing countries

    Directory of Open Access Journals (Sweden)

    Wei Han

    2012-10-01

    Full Text Available This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms.

  11. Working on reform. How workers' compensation medical care is affected by health care reform.

    OpenAIRE

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform ...

  12. Medical liability and health care reform.

    Science.gov (United States)

    Nelson, Leonard J; Morrisey, Michael A; Becker, David J

    2011-01-01

    We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

  13. Integrating Comprehensive Reform with Quality of Care

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Xianyang City is located in the center of northwest China's Shaanxi Province. In 2001, it was designated as one of the pilot cities for comprehensive reform of family planning work initiated by the National Population and Family Planning Commission. This has provided a good opportunity for the city to better implement the quality of care approach.

  14. Health care reform: perspectives from large employers.

    Science.gov (United States)

    Darling, Helen

    2010-06-01

    Recently enacted health reform legislation will have mostly positive effects on large employers, as millions more Americans gain access to affordable insurance and, potentially, primary care. But the law will impose new administrative burdens and financing costs on employers, while raising concerns about provisions that could allow their lower-wage employees to obtain coverage through insurance exchanges. Given the need to restrain the rate of growth of health spending, the private sector, especially large employers, must collaborate with the public sector to drive delivery system reform. And every public program and exchange should appoint a chief value officer who reports quarterly on spending, cost drivers, and potential ways to contain costs.

  15. Working on reform. How workers' compensation medical care is affected by health care reform.

    Science.gov (United States)

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

  16. The German health care system and health care reform.

    Science.gov (United States)

    Kamke, K

    1998-02-01

    This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.

  17. Reforming health care in Canada: current issues

    Directory of Open Access Journals (Sweden)

    Baris Enis

    1998-01-01

    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

  18. Evaluation of Health Care System Reform in Hubei Province, China

    OpenAIRE

    2014-01-01

    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio met...

  19. [Problems in reforming health care centers].

    Science.gov (United States)

    Shemetova, M V; Blokhin, A B; Polzik, E V

    2000-01-01

    Reformation of therapeutic and prophylactic institutions attached to various institutions and ministries is and important problem of public health at the modern stage of its development. A model developed and tried in Magnitogorsk can serve as a perspective trend of such reforms. A medical institution with mixed form of property has been created. The institution was set up by administration of the territory and a plant (Magnitogorsk metallurgical plant). Creation of a new health center as a non-commercial institution promoted its integration in the municipal public health system; the institution possesses all the potentialities of a budget organization and retains close contact with the plant. Such a solution of the problem improved the financial status of the health center and promoted its adaptation to marketing conditions. Attraction of additional finances from industry to municipal public health allowed the administration of the health center start and carry out internal restructuring aimed at priority development of outpatient care, restructuring of the bed fund, technological updating, and, in general, more rational utilization of the available resources.

  20. Managed care: how economic incentive reforms went wrong.

    Science.gov (United States)

    Powers, Madison

    1997-12-01

    In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.

  1. An overview of the intentions of health care reform.

    Science.gov (United States)

    Tuma, Pepin Andrew

    2012-03-01

    If upheld as constitutional, the Patient Protection and Affordable Care Act that passed in 2010 promises to change health care delivery systems in the United States, partly by shifting focus from disease treatment to disease prevention. Registered dietitians (RDs) have already taken an active role in health care areas that stand to be directly affected by provisions in the health care reform bill. However, nutrition's vital role in preventing diseases and conditions potentially could translate to additional opportunities for RDs as a result of this reform. Specific dietetics-related areas targeted by health care reform include medical nutrition therapy for chronic conditions and employee wellness incentive programs. However, dietetics practitioners are not necessarily established in the language of the bill as the essential providers of specific services or as reimbursable practitioners. Thus, although it is possible health care reform could affect demand-and, in turn, supply-of RDs, the actual effect of this legislation is difficult to predict.

  2. Market reforms in Swedish health care

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    1993-01-01

    This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...

  3. Quality Reforms in Danish Home Care

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2012-01-01

    . This reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, including contract management and performance management. Recent reforms have instead attempted...

  4. Attitudes of Washington State physicians toward health care reform.

    OpenAIRE

    Malter, A D; Emerson, L L; Krieger, J. W.

    1994-01-01

    Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton's reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the sta...

  5. Student specialty plans, clinical decision making, and health care reform.

    Science.gov (United States)

    Williams, Robert L; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina; Susman, Andrew L; Zyzanski, Stephen J

    2014-05-01

    Health care reform aims to increase evidence-based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost and comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims. We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection, or initial chronic disease management scenarios, representing in turn evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses. Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost conscious and more patient centered. We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes. This study provides preliminary evidence suggesting that students planning to enter family medicine may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes.

  6. Primary Health Care Reform in Portugal: Portuguese, modern and innovative.

    Science.gov (United States)

    Biscaia, André Rosa; Heleno, Liliana Correia Valente

    2017-03-01

    The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.

  7. No theory of justice can ground health care reform.

    Science.gov (United States)

    Trotter, Griffin

    2012-01-01

    This essay argues that no theory or single conception of justice can provide a fundamental grounding for health care reform in the United States. To provide such a grounding, (1) there would need to be widespread support among citizens for a particular conception of justice, (2) citizens would have to apprehend this common conception of justice as providing the strongest available rationale for health care reform, and (3) this rationale would have to overwhelm countervailing values. I argue that neither of the first two conditions is met.

  8. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  9. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  10. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

    Science.gov (United States)

    2010-05-05

    ... health insurance coverage options in that State. In implementing these requirements, we seek to develop a... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 159 RIN 0991-AB63 Health Care Reform Insurance Web...

  11. Integration of care systems in Portugal: anatomy of recent reforms

    Directory of Open Access Journals (Sweden)

    Silvina Santana

    2014-07-01

    Full Text Available Background: Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years. Methods: We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms. Results: Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI – Rede Nacional de Cuidados Continuados Integrados. The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and

  12. Integration of care systems in Portugal: anatomy of recent reforms

    Directory of Open Access Journals (Sweden)

    Silvina Santana

    2014-07-01

    Full Text Available Background: Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years.Methods: We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms.Results: Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI – Rede Nacional de Cuidados Continuados Integrados. The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and

  13. Price and quality transparency: how effective for health care reform?

    Science.gov (United States)

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  14. The readiness of addiction treatment agencies for health care reform

    Directory of Open Access Journals (Sweden)

    Molfenter Todd

    2012-05-01

    Full Text Available Abstract The Patient Protection and Affordable Care Act (PPACA aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system. To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback. On a scale of “Needs to Begin,” “Early Stages,” “On the Way,” and “Advanced,” the mean scores for respondents (n = 276 ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of  $5 million to have information technology (patient records, patient health technology, and administrative information technology, evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA. The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

  15. The readiness of addiction treatment agencies for health care reform.

    Science.gov (United States)

    Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K

    2012-05-02

    The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of  $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

  16. Four proposals for market-based health care system reform.

    Science.gov (United States)

    Sumner, W

    1994-08-01

    A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.

  17. [The context of health care reforms].

    Science.gov (United States)

    Vergara, C

    2000-01-01

    In Latin America, health sector reforms have gone hand in hand with social and economic trends during the latter half of the twentieth century and have reflected the particular concept of "development" that has been in vogue at different times. Economic stagnation and increased social spending, both hallmarks of the 1960s, led to the decline of the "import substitution" development model, which had prevailed since the beginning of the century, and slowly gave way in the 1980s to the "globalization" model. From the earlier model, a transition took place toward a restructuring of production and a series of economic adjustment policies that led, ironically, to an increase in poverty in Latin America. Implementation of the new model has occurred in two phases. The first, known as the "social reform" or "first generation" phase, sprang from the notion that poverty is the sum of a number of material shortages that can be corrected through an equitable redistribution of a fixed volume of goods belonging to society. This conceptual framework, which was completely devoid of all historical linkages and separated from economic policy, led to social policies whose entire purpose was to mitigate poverty through subsidies targeting the poorest persons in the society. In the second phase of the globalization model, which arose in the 1990s and became known as the "second generation" or "postadjustment" phase, new economic rules came into play that were based primarily on international competition, efficiency in production, and openness and fairness in the capital markets. And if during the initial stage the conceptual strategy behind all social policy was to fight poverty, in the second stage the strategy became one of achieving equity, which was no longer interpreted as the even distribution of a fixed volume of capital goods, but as the sustained provision of greater and better opportunities for all. Having grown accustomed to the protectionism inherent in the earlier

  18. Summary of Consultations on Child Care Reform = Sommaire des consultations sur la reforme des services de garde d'enfants.

    Science.gov (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This document contains the English and French language versions of a report summarizing the results of a public consultation process on the subject of child care reform in Ontario, Canada. The process began with province-wide distribution of a public document called "Setting the Stage" which outlined a child care reform agenda as a focus for…

  19. Health care reform and care at the behavioral health--primary care interface.

    Science.gov (United States)

    Druss, Benjamin G; Mauer, Barbara J

    2010-11-01

    The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

  20. Health care reform 2009-2010: a neurosurgeon's perspective.

    Science.gov (United States)

    Tippett, Troy M

    2010-12-01

    Organized neurosurgery through its Washington Committee developed a number of principles against which all health care reform legislation was measured, and none of the bills were acceptable. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) worked through multiple venues to modify or reject the legislation. In the author's view, the American Medical Association (AMA) supported the bills because its board of trustees was too focused on eliminating the sustainable growth rate, or SGR. Physicians failed to shape the health care debate. The leadership of many medical organizations was not prepared for the debate. Many had no experience in this arena and thus were too willing to let lobbyists dictate their position. In the future there are 3 things organized neurosurgery must do: be prepared, never give in, and stick with their principles. Organized neurosurgery must be prepared by developing leaders that have experience in the full spectrum of organized medicine. Neurosurgeons must not count on others, and because the specialty is small all must be involved. Neurosurgeons must never give in. Organized neurosurgery started 2009 with little support for its positions but by the end of the debate had convinced many other organizations, representing almost 500,000 physicians, to take their position. From an organizational point of view, neurosurgeons should now do 3 things: 1) reform or reject the AMA; 2) develop a real surgical coalition; and 3) change the current political environment. Neurosurgeons must also follow their principles. In the author's opinion the most important principles are: health care as a responsibility, medical liability reform, and the right to privately contract. In the United Kingdom and Germany, where health care is considered a right rather than a responsibility, bureaucratic entities determine whether you have the right to health care just as the Independent Payment Advisory Board, established under

  1. [Health care reform in Chile: 2005 to 2009].

    Science.gov (United States)

    Valdivieso D, Vicente; Montero L, Joaquín

    2010-08-01

    Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specified, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.

  2. Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

    Science.gov (United States)

    Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

    2015-09-01

    The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.

  3. Toward meaningful reform. National Association for Home Care.

    Science.gov (United States)

    1993-03-01

    This paper was prepared by the National Association for Home Care, representing the nation's home care providers--including home care agencies, home care aide organizations, and hospices--and the individuals they serve. NAHC is committed to assuring the availability of humane, cost-effective, high-quality home care services to all individuals who require them. Toward this end, NAHC has long advocated the development of a national plan to ensure universal access to basic acute-care and long-term care services. This paper outlines the specific recommendations of NAHC to ensure the appropriate inclusion of home care and hospice services in health care reform proposals. NAHC believes that no health care proposal is complete without ensuring access to high-quality home care and hospice in both the acute and long-term care setting. These vital services provide millions of individuals--the aged, infirm, disabled, and children--the ability to receive care in the settings that allow them the highest level of satisfaction, independence, and dignity--in their homes.

  4. After Medicare: regionalization and Canadian health care reform.

    Science.gov (United States)

    Boychuk, Terry

    2009-01-01

    In the immediate postwar era the primary object of health reform among the advanced industrial democracies was to expand, if not universalize, access to a broad spectrum of health services through sustained, high levels of government-mandated spending. The fiscal crises of the 1970s and 1980s ushered in a new generation of policies devoted to balancing the imperatives of guaranteeing access to basic health and social services and to improving the accountability, efficiency, and effectiveness of health care industries. In Canada, the regionalization of health care administration emerged as the most prominent strategy for grappling with the contradictions and paradoxes of contemporary health reform. This essay traces the historical evolution of federal-provincial deliberations that elevated regionalization to the forefront of health policy-making in the new era of fiscal restraint, and further, assesses recent efforts to institutionalize regional health authorities.

  5. Medical care reform: lessons from around the world.

    Science.gov (United States)

    Rohrer, J E

    1997-01-01

    Once again the United States is in a ferment of health policy reform. Proposals abound but sage observers remark that national health insurance has been "just around the corner" more than once in the last forty years. This time may be different, however. Proposals from all across the ideological spectrum are converging on the notion of "managed care" which is perhaps best known in its guise as a health maintenance organization (HMO). Other forms of managed care exist but they have neither the history nor the incentives found in traditional HMOs. The discussion on national health insurance (NHI) proposals has focused on financing issues to the virtual exclusion of public health concerns. In this article, the author addresses rural health and public hospitals in the United States; two problems that have been with us for a long time. Then articles examining the Canadian and English medical care systems are reviewed, illustrating some of the weaknesses of these approaches to national medical care. Research studies relating to Europe and the developing nations are next. Once again, these are intended to highlight public health problems found in differing medical care systems. Finally, the author examines utopian views of the United States medical care system of the future: the reform proposal offered by the National Association for Public Health Policy, the experimental policy in Washington State, and a vision of a planned system. The review is intended to draw together the lessons offered by public health policy research in other countries and the United States and apply them to the issue at hand: reforming the United States medical care system.

  6. Elliptical flexure hinges

    Science.gov (United States)

    Smith, Stuart T.; Badami, Vivek G.; Dale, Jami S.; Xu, Ying

    1997-03-01

    This paper presents closed form equations based on a modification of those originally derived by Paros and Weisbord in 1965, for the mechanical compliance of a simple monolithic flexure hinge of elliptic cross section, the geometry of which is determined by the ratio ɛ of the major and minor axes. It is shown that these equations converge at ɛ=1 to the Paros and Weisbord equations for a hinge of circular section and at ɛ ⇒∞ to the equations predicted from simple beam bending theory for the compliance of a cantilever beam. These equations are then assessed by comparison with results from finite element analysis over a range of geometries typical of many hinge designs. Based on the finite element analysis, stress concentration factors for the elliptical hinge are also presented. As a further verification of these equations, a number of elliptical hinges were manufactured on a CNC milling machine. Experimental data were produced by applying a bending moment using dead weight loading and measuring subsequent angular deflections with a laser interferometer. In general, it was found that predictions for the compliance of elliptical hinges are likely to be within 12% for a range of geometries with the ratio βx(=t/2ax) between 0.06 and 0.2 and for values of ɛ between 1 and 10.

  7. The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe.

    Science.gov (United States)

    Sitek, Michał

    2010-08-01

    This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

  8. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  9. Analytic Support for Washington Citizens' Work Group on Health Care: Evaluation of Health Care Reform Proposals.

    OpenAIRE

    Deborah Chollet; Jeffrey Ballou; Alison Wellington; Thomas Bell; Allison Barrett; Gregory Peterson; Stephanie Peterson

    2009-01-01

    Mathematica evaluated five health care reform proposals for the state of Washington in 2008. The proposals featured, respectively: reduced regulation in the current market; Massachusetts-style insurance reforms with a health insurance connector; a health partnership program similar to the current state employee health plan; a state-operated single payer plan; and a program that would guarantee catastrophic coverage for all residents. This report provides estimates of the changes in coverage a...

  10. Evidence-based medicine in health care reform.

    Science.gov (United States)

    Hughes, Gordon B

    2011-10-01

    The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care.

  11. Massachusetts health care reform and orthopaedic trauma: lessons learned.

    Science.gov (United States)

    Harris, Mitchel B

    2014-10-01

    Massachusetts was the first state to implement its own version of the Affordable Care Act (ACA), when it passed the Massachusetts Health Care Reform (MHR) in 2006. Similar to the ACA, its explicit purpose was universal access to health care to all residents of Massachusetts. We believe that the influence of MHR on orthopaedic trauma in Massachusetts will have implications on trauma systems across the country, given the similarities between ACA and MHR. Therefore, in this article, we discuss our experiences as Orthopaedic trauma surgeons with regard to MHR. In this regard, we reviewed the effects of the implementation of MHR on the orthopaedic trauma services at 3 of the 4 level one trauma centers in Boston, MA. Our results demonstrate a dramatic reduction in the proportion of uncompensated care at these centers in addition to the number of uninsured patients with orthopaedic trauma injuries.

  12. Hinged Dissections Exist

    CERN Document Server

    Abbott, Timothy G; Charlton, David; Demaine, Erik D; Demaine, Martin L; Kominers, Scott D

    2007-01-01

    We prove that any finite collection of polygons of equal area has a common hinged dissection. That is, for any such collection of polygons there exists a chain of polygons hinged at vertices that can be folded in the plane continuously without self-intersection to form any polygon in the collection. This result settles the open problem about the existence of hinged dissections between pairs of polygons that goes back implicitly to 1864 and has been studied extensively in the past ten years. Our result generalizes and indeed builds upon the result from 1814 that polygons have common dissections (without hinges). We also extend our common dissection result to edge-hinged dissections of solid 3D polyhedra that have a common (unhinged) dissection, as determined by Dehn's 1900 solution to Hilbert's Third Problem. Our proofs are constructive, giving explicit algorithms in all cases. For a constant number of planar polygons, both the number of pieces and running time required by our construction are pseudopolynomial...

  13. Health Care Reform, Care Coordination, and Transformational Leadership.

    Science.gov (United States)

    Steaban, Robin Lea

    2016-01-01

    This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.

  14. Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

    Directory of Open Access Journals (Sweden)

    Widström Eeva

    2008-01-01

    Full Text Available Abstract Background In Finland, dental services are provided by a public (PDS and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS. A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period. Methods National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform and in 2004 (after the reform were compared. Results In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees. The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5% and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private

  15. Physician workforce planning in an era of health care reform.

    Science.gov (United States)

    Grover, Atul; Niecko-Najjum, Lidia M

    2013-12-01

    Workforce planning in an era of health care reform is a challenge as both delivery systems and patient demographics change. Current workforce projections are based on a future health care system that is either an identified "ideal" or a modified version of the existing system. The desire to plan for such an "ideal system," however, may threaten access to necessary services if it does not come to fruition or is based on theoretical rather than empirical data.Historically, workforce planning that concentrated only on an "ideal system" has been centered on incorrect assumptions. Two examples of such failures presented in the 1980s when the Graduate Medical Education National Advisory Committee recommended a decrease in the physician workforce on the basis of predetermined "necessary and appropriate" services and in the 1990s, when planners expected managed care and health maintenance organizations to completely overhaul the existing health care system. Neither accounted for human behavior, demographic changes, and actual demand for health care services, leaving the nation ill-prepared to care for an aging population with chronic disease.In this article, the authors argue that workforce planning should begin with the current system and make adjustments based on empirical data that accurately reflect current trends. Actual health care use patterns will become evident as systemic changes are realized-or not-over time. No single approach will solve the looming physician shortage, but the danger of planning only for an ideal system is being unprepared for the actual needs of the population.

  16. Comparative effectiveness research and health care reform in C hina

    Institute of Scientific and Technical Information of China (English)

    Yilong Wang; Yongjun Wang

    2016-01-01

    China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council in-troduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the gov-ernment, how to implement them remains to be chal-lenging. Like evidence-based medicine, comparative effective research ( CER ) which started in the US in 2000 ’s can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both indi-vidual and population. It also may apply to the condi-tions of healthcare reform in China. And there are op-portunities and challenges of conducting CER in our country. We suggest that the government should estab-lish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.

  17. Failure of health care reform in the USA.

    Science.gov (United States)

    Mechanic, D

    1996-01-01

    The failure of health reform in the USA reflects the individualism and lack of community responsibility of the American political culture, the power of interest groups, and the extraordinary process President Clinton followed in developing his highly elaborate plan. Despite considerable initial public support and a strong start, the reform effort was damaged by the cumbersome process, the complexity of the plan itself, and the unfamiliarity of key components such as alliances for pooled buying of health insurance. In addition, the alienation of important interest groups and the loss of presidential initiative in framing the public discussion as a result of international, domestic and personal issues contributed to the failure in developing public consensus. This paper considers an alternative strategy that would have built on the extension of the Medicare program as a way of exploring the possibilities and barriers to achieving health care reform. Such an approach would build on already familiar and popular pre-existing components. The massive losses in the most recent election and large budget cuts planned by the Republican majority makes it unlikely that gaps in insurance or comprehensiveness of coverage will be corrected in the foreseeable future.

  18. Federal mandatory spending caps vital for health care reform.

    Science.gov (United States)

    Domenici, P V

    1992-01-01

    Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.

  19. Health care reform and Connecticut's non-profit hospitals.

    Science.gov (United States)

    Cohen, Jeffrey R; Gerrish, William; Galvin, J Robert

    2010-01-01

    The recent federal Health Care Reform Act signed into law by President Obama is expected to lead to greater patient volumes at non-profit hospitals in Connecticut (and throughout the country). The financial implications for these hospitals depend on how the costs per patient are expected to change in response to the anticipated higher patient volumes. Using a regression analysis of costs with annual data on 30 Connecticut hospitals over the period 2006 to 2008, we find that there are considerable differences between outpatient and inpatient unit cost structures at these hospitals. Based on the results of our analysis, and assuming health care reform leads to an overall increase in the number of outpatients, we would expect Connecticut hospitals to experience lower costs per outpatient treated (economies of scale). On the other hand, an influx of additional inpatients would be expected to raise unit costs (diseconomies of scale). After controlling for other cost determinants, we find that the marginal cost of an inpatient is about $8,000 while the marginal cost of an outpatient is about $44. This disparity may provide an explanation for our finding that the effect of additional patient volumes overall (combining inpatient and outpatient) is an increase in hospitals' unit costs.

  20. Sub-national health care financing reforms in Indonesia.

    Science.gov (United States)

    Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S

    2017-02-01

    Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Cognitive Behavior Therapy with Youth and Health Care Reform: A Congenial Union

    Directory of Open Access Journals (Sweden)

    Robert D. Friedberg

    2014-06-01

    Full Text Available This short opinion paper discusses cognitive behavioral therapy (CBT with youth in the era of health care reform. The commentary addresses the ways CBT is consistent with health care reform imperatives. Further, CBT's focus on accountability, credentialing, early intervention, and interdisciplinary collaboration is emphasized.

  2. Subsidizing "Stayers"? Effects of a Norwegian Child Care Reform on Marital Stability

    Science.gov (United States)

    Hardoy, Ines; Schone, Pal

    2008-01-01

    Since January 1999, all parents in Norway with children aged 1 to 3 years who do not attend publicly subsidized day care are eligible for "cash-for-care" (CFC). One important purpose of the reform is to enable parents to spend more time with their children. We analyze whether the CFC reform has affected marital stability, using individual register…

  3. Defining the road ahead: thinking strategically in the new era of health care reform.

    Science.gov (United States)

    Pudlowski, Edward M

    2011-01-01

    Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

  4. The study of nursing students’ learning initiative in the course reform of aged caring

    Directory of Open Access Journals (Sweden)

    Sun Wenjing

    2017-01-01

    Full Text Available Purpose: Analyzing the influence of nursing students’ learning initiative in the course reform of aged caring. Discuss the way of the aged care reform. Method: To reform the course of aged care in our school level 2013 88 nursing undergraduate. The specific content: learning aged care theory, learning Japanese care technology basic knowledge, adding Japanese and Taiwan’s nursing concepts to the traditional aged care teaching, performing sitcoms about old people’s disease and nursing way , reporting the plan of aged care by PowerPoint, organizing student volunteers to visit the nursing home and so on. The specific content lasted four months. Adopting the learning initiative (ALS scale developed by Zang Yuli and others after course reform. Measure the students’ learning initiative before and after the teaching. Result: Nursing student’s self-study ability was in the middle and lower level before the course reform(59.26±7.38; After the course reform, nursing student gain higher score than before learning on the three aspects contain “Learning motivation”,“Learning goals” and “Solid study”. The difference has statistically significant.(P<0.05.Conclusion: Through the aged care course reform, nursing students strengthen the study enthusiasm and initiative; enhance nursing student’s self-study ability. It is conducive to improve the learning interest of aged care course for nursing students.

  5. A democratic responsiveness approach to real reform: an exploration of health care systems' resilience.

    Science.gov (United States)

    Grignon, Michel

    2012-08-01

    Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized.

  6. Shape Memory Composite Hybrid Hinge

    Science.gov (United States)

    Fang, Houfei; Im, Eastwood; Lin, John; Scarborough, Stephen

    2012-01-01

    There are two conventional types of hinges for in-space deployment applications. The first type is mechanically deploying hinges. A typical mechanically deploying hinge is usually composed of several tens of components. It is complicated, heavy, and bulky. More components imply higher deployment failure probability. Due to the existence of relatively moving components among a mechanically deploying hinge, it unavoidably has microdynamic problems. The second type of conventional hinge relies on strain energy for deployment. A tape-spring hinge is a typical strain energy hinge. A fundamental problem of a strain energy hinge is that its deployment dynamic is uncontrollable. Usually, its deployment is associated with a large impact, which is unacceptable for many space applications. Some damping technologies have been experimented with to reduce the impact, but they increased the risks of an unsuccessful deployment. Coalescing strain energy components with shape memory composite (SMC) components to form a hybrid hinge is the solution. SMCs are well suited for deployable structures. A SMC is created from a high-performance fiber and a shape memory polymer resin. When the resin is heated to above its glass transition temperature, the composite becomes flexible and can be folded or packed. Once cooled to below the glass transition temperature, the composite remains in the packed state. When the structure is ready to be deployed, the SMC component is reheated to above the glass transition temperature, and it returns to its as-fabricated shape. A hybrid hinge is composed of two strain energy flanges (also called tape-springs) and one SMC tube. Two folding lines are placed on the SMC tube to avoid excessive strain on the SMC during folding. Two adapters are used to connect the hybrid hinge to its adjacent structural components. While the SMC tube is heated to above its glass transition temperature, a hybrid hinge can be folded and stays at folded status after the temperature

  7. Does it really care? The Harvard report on health care reform for Hong Kong.

    Science.gov (United States)

    Po-wah, J T

    1999-12-01

    This paper aims to provide a rendition of the care ethic in Confucian philosophy and to argue that social policy developments in Hong Kong society, including health care policy, have been significantly shaped and justified in terms of the ideal of care in the Confucian moral tradition. On the basis of this analysis, the paper raises a number of questions about a recent proposal for health care reform for Hong Kong put forth by the Harvard School of Public Health which argues for adopting the principle of equity as the overriding value for the moral foundation of Hong Kong's health care system. The paper examines how the over-emphasis on equity in the Harvard Report proposals can lead to the erosion of care and ultimately the eclipse of the vision of care in Hong Kong's health care system. It argues that the pursuit of equity, which is itself a valuable principle, should not displace the importance of the value of care or undermine the ideal of care and that health care decisions must be firmly embedded in local cultures and moral traditions.

  8. Health Care Reform: Understanding Individuals’ Attitudes and Information Sources

    Directory of Open Access Journals (Sweden)

    Carolyn K. Shue

    2014-01-01

    Full Text Available Since passage of the Affordable Care Act (ACA was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals’ own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent’s political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed.

  9. Child Care Reform Consultation Infopack = Consultation sur la reforme des services de garde d'enfants. Trousse d'information.

    Science.gov (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This information packet presented here in both the English and French language versions, summarizes the results of a public consultation on the subject of child care reform in Ontario, Canada. The packet consists of: (1) a table that describes the six modes of consultation that were used in the consultation process (public meetings, round table…

  10. Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities.

    Science.gov (United States)

    Lorant, Vincent; Grard, Adeline; Nicaise, Pablo

    2016-04-01

    Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

  11. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    Science.gov (United States)

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  12. Managing between the agendas: implementing health care reform policy in an acute care hospital.

    Science.gov (United States)

    Sorensen, Roslyn; Paull, Glenn; Magann, Linda; Davis, JanMaree

    2013-01-01

    This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance. A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units. This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised. The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect. While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation. This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

  13. Undocumented Immigrants and Access to Health Care: Making a Case for Policy Reform.

    Science.gov (United States)

    Edward, Jean

    2014-02-01

    The growth in undocumented immigration in the United States has garnered increasing interest in the arenas of immigration and health care policy reform. Undocumented immigrants are restricted from accessing public health and social service as a result of their immigration status. The Patient Protection and Affordability Care Act restricts undocumented immigrants from participating in state exchange insurance market places, further limiting them from accessing equitable health care services. This commentary calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of immigrant health policies and their impact on health care expenditures, public health, and the role of health care providers. The intersectional nature of immigration and health care policy emphasizes the need for nurse policymakers to advocate for comprehensive policy reform aimed at improving the health and well-being of immigrants and the nation as a whole. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

  14. Care systematization in psychiatric nursing within the psychiatric reform context.

    Science.gov (United States)

    Hirdes, A; Kantorski, L P

    2002-02-01

    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  15. Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?

    Science.gov (United States)

    Wong, Edwin S; Maciejewski, Matthew L; Hebert, Paul L; Batten, Adam; Nelson, Karin M; Fihn, Stephan D; Liu, Chuan-Fen

    2016-09-20

    Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA-Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter (p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC. © The Author(s) 2016.

  16. Quality reforms in Danish home care - balancing between standardisation and individualisation.

    Science.gov (United States)

    Rostgaard, Tine

    2012-05-01

    Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed a strong emphasis on quality since the 1990s. This reform strategy represents a shift from the welfare state modernisation programme of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management principles, including contract management and performance management. Recent reforms have instead attempted to increase the overall quality of care by increasing the transparency at the political, administrative and user levels. However, reforms have revolved around the conflicting principles of standardisation and the individualisation of care provision. This approach has succeeded in increasing the political and administrative control over home help at the expense of the control by users, care workers and case managers.

  17. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    Science.gov (United States)

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.

  18. Payment systems and incentives in primary care: implications of recent reforms in Estonia and Romania.

    Science.gov (United States)

    Dan, Sorin; Savi, Riin

    2015-01-01

    Since the early 1990s, major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than 20 years after, reform in healthcare still draws much interest from policy makers and academics alike. One of the dynamic components of reform has been the reform of payment systems in primary care. This article looks at recent developments in payment systems and financial incentives in Estonia and Romania. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is no easy solution for healthcare policy makers who need to carefully weigh in the advantages and inherent problems of various payment arrangements. In a transitional, rapidly changing healthcare system and society, and a context of financial stringency, the theoretical effects of payment mechanisms may be more difficult to predict and manage than it is expected.

  19. Getting what we pay for: innovations lacking in provider payment reform for chronic disease care.

    Science.gov (United States)

    Tynan, Ann; Draper, Debra A

    2008-06-01

    Despite wide recognition that existing physician and hospital payment methods used by health plans and other payers do not foster high-quality and efficient care for people with chronic conditions, little innovation in provider payment strategies is occurring, according to a new study by the Center for Studying Health System Change (HSC) commissioned by the California HealthCare Foundation. This is particularly disconcerting because the nation faces an increasing prevalence of chronic disease, resulting in continued escalation of related health care costs and diminished quality of life for more Americans. To date, most efforts to improve care of patients with chronic conditions have focused on paying vendors, such as disease management firms, to intervene with patients or redesigning care delivery without reforming underlying physician and hospital payment methods. While there is active discussion and anticipation of physician and hospital payment reform, current efforts are limited largely to experimental or small-scale pilot programs. More fundamental payment reform efforts in practice are virtually nonexistent. Existing payment systems, primarily fee for service, encourage a piecemeal approach to care delivery rather than a coordinated approach appropriate for patients with chronic conditions. While there is broad agreement that existing provider payment methods are not well aligned with optimal chronic disease care, there are significant barriers to reforming payment for chronic disease care, including: (1) fragmented care delivery; (2) lack of payment for non-physician providers and services supportive of chronic disease care; (3) potential for revenue reductions for some providers; and (4) lack of a viable reform champion. Absent such reform, however, efforts to improve the quality and efficiency of care for chronically ill patients are likely to be of limited success.

  20. Which moral hazard? Health care reform under the Affordable Care Act of 2010.

    Science.gov (United States)

    Mendoza, Roger Lee

    2016-06-20

    Purpose - Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated. Design/methodology/approach - This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization. Findings - Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of "health." Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations. Originality/value - This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable

  1. Toward a 21st-century health care system: recommendations for health care reform.

    Science.gov (United States)

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Brownlee, Shannon; Casalino, Lawrence P; Cooper, Jim; Crosson, Francis J; Enthoven, Alain; Falcone, Elizabeth; Feldman, Robert C; Fuchs, Victor R; Garber, Alan M; Gold, Marthe R; Goldman, Dana; Hadfield, Gillian K; Hall, Mark A; Horwitz, Ralph I; Hooven, Michael; Jacobson, Peter D; Jost, Timothy Stoltzfus; Kotlikoff, Lawrence J; Levin, Jonathan; Levine, Sharon; Levy, Richard; Linscott, Karen; Luft, Harold S; Mashal, Robert; McFadden, Daniel; Mechanic, David; Meltzer, David; Newhouse, Joseph P; Noll, Roger G; Pietzsch, Jan B; Pizzo, Philip; Reischauer, Robert D; Rosenbaum, Sara; Sage, William; Schaeffer, Leonard D; Sheen, Edward; Silber, B Michael; Skinner, Jonathan; Shortell, Stephen M; Thier, Samuel O; Tunis, Sean; Wulsin, Lucien; Yock, Paul; Nun, Gabi Bin; Bryan, Stirling; Luxenburg, Osnat; van de Ven, Wynand P M M

    2009-04-07

    The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges

  2. The Affordable Care Act: How Nixon's Health Reform Proposal Became Democrats' Albatross.

    Science.gov (United States)

    Woolhandler, Steffie; Himmelstein, David U

    2017-01-01

    President Obama's signature health care reform, the Affordable Care Act (ACA), was passed in 2010 and fully implemented in 2014. Two years later, Republicans' attacks on the ACA as a failed reform helped fuel their recent electoral victory. The legislation significantly expanded insurance coverage. But it was built on, and fortified, private health insurance firms, and it accelerated the corporate takeover of hospitals and physicians' practices. This obeisance to corporate interests precluded making coverage universal or care affordable. As a result, the reform failed to address the grave health care problems faced by most working- and middle-class Americans and left many of them feeling betrayed by Democrats who oversold the ACA's benefits.

  3. Monastic retreat and pastoral care in the Dutch Reformed tradition

    Directory of Open Access Journals (Sweden)

    C.H. (Kaaiman Schutte

    2006-10-01

    Full Text Available Of late, there has been a growing interest in retreat among clergy and members of congregations in the Dutch Reformed tradition in South Africa. The article investigates the relevance of the monastic traditions for this growing interest in Reformed circles. It focuses on aspects of retreat such as the role of holy places in the monastic traditions (e.g., monasteries, cathedrals, retreat centers and the experience of silence, solitude, regeneration, divine presence and spiritual formation. Proceeding from an epistemological reflection on the subject as described in a previous article, the aim of this article is to explore the “action of retreat” as a narrative research journey and pilgrimage in order to investigate the relevance of the Benedictine, Franciscan and Taizé monastic-mystic traditions (seen as an associative/mystic spirituality for retreat in the Dutch Reformed tradition (which is seen as a disassociative/rational/ dogmatic spirituality.

  4. The policy and politics of the 2015 long-term care reform in the Netherlands.

    Science.gov (United States)

    Maarse, J A M Hans; Jeurissen, P P Patrick

    2016-03-01

    As of 2015 a major reform in LTC is taking place in the Netherlands. An important objective of the reform is to reign in expenditure growth to safeguard the fiscal sustainability of LTC. Other objectives are to improve the quality of LTC by making it more client-tailored. The reform consists of four interrelated pillars: a normative reorientation, a shift from residential to non-residential care, decentralization of non-residential care and expenditure cuts. The article gives a brief overview of these pillars and their underlying assumptions. Furthermore, attention is paid to the political decision-making process and the politics of implementation and evaluation. Perceptions of the effects of the reform so far widely differ: positive views alternate with critical views. Though the reform is radical in various aspects, LTC care will remain a largely publicly funded provision. A statutory health insurance scheme will remain in place to cover residential care. The role of municipalities in publicly funded non-residential care is significantly upgraded. The final section contains a few policy lessons.

  5. The monopolistic integrated model and health care reform: the Swedish experience.

    Science.gov (United States)

    Anell, A

    1996-07-01

    This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a discussion of incentives within Swedish county councils, and of how these incentives have influenced reforms in the direction of more choices for consumers and a separation between purchasers and providers. It is argued that the current incentives, in combination with criticism against county council activities in the early 1990's, account for the present inconsistencies as regards reforms. Furthermore, the article maintains that a weak form of separation between purchasers and providers will lead to distorted incentives, restricting innovative behaviour and structural change. In conclusion, the process of reforming the Swedish monopolistic integrated health-care model in the direction of some form of internal market is said to rest on shaky ground.

  6. Grounds of necessity to carry out reforms in health care system in Ukraine: historical aspect

    Directory of Open Access Journals (Sweden)

    I. P. Krynychna

    2015-03-01

    Full Text Available The article studies the historical experience of reforming the health care system in Ukraine, which allow clearing up the basic problems of public administration. Thus, the health care legislation is characterized as a fragmentary and complex thing with common overlaps and vaguely defined areas of accountability of financial and material resources and a significant deficit of funding. In turn, there is an urgent need for a fundamental change in strategy of the state policy concerning the restructuring of the health care system, which would involve fundamentally new mechanisms of public administration that must be adapted to the specific social problems and opportunities, particularly in conditions of limited resources. It is determined that reforming the health care systems of the former Soviet Union countries has similar nature with Ukraine, namely: the lack of government funding, poor quality of medical care, high level of medical services payment by citizens, the low level of wages of health care employees, and, as a consequence, the limited availability of the population to qualitative health services. On the basis of the results of the analysis of existing and not solved problems of the health care system it is proved the necessity to introduce new mechanisms of control in this field: the development of a system of compulsory medical insurance; the combination of budget and insurance sources of financing the health care system; the growing funding for the health care system; the development of initial care; adjustment of the state guarantees, according to the state financial opportunities; increasing the wages of health care employees; search for new organizational forms of health care institutions; increase the efficiency of health care resources; privatization and improvement of the structure of the medical care system . Keywords: public administration, health care reform, health insurance, initial care, medical care, medical services

  7. [Reform of long-term care in the Netherlands: solidarity maintained?].

    Science.gov (United States)

    van der Aa, Maartje J; Evers, Silvia M A A; Klosse, Saskia; Maarse, J A M Hans

    2014-01-01

    The reform of long-term care (LTC) in the Netherlands is a much debated topic. The reform essentially comes down to a shift in healthcare claims and a cutback. As of 1 January 2015, the Long-Term Care Act (WLZ) shall replace the Exceptional Medical Expenses Act (AWBZ). In doing so, parts of the AWBZ will shift to the Health Care Insurance Act (ZVW) and the renewed Social Support Act (WMO 2015), which will be carried out by municipalities. This is a significant change: whereas the AWBZ provides a right to care, the WMO commands delivery of tailor-made support. Care that falls under the WMO is only awarded if the capacity of persons seeking care, among others their financial resources and social network, are insufficient. Higher contributions than in the AWBZ may also be requested. These developments influence the experienced level of solidarity.

  8. The Norwegian Cash-for-Care Reform. Changing behaviour and stable attitudes

    Directory of Open Access Journals (Sweden)

    Lars Gulbrandsen

    2009-03-01

    Full Text Available In 1998 Norway introduced a cash-for-care scheme. Parent with children aged one or two were offered
    a cash-for-care benefit if they did not make use of public funded day care centres. The reform was supported by
    political parties of the centre and right and strongly opposed by parties on the left. Since 1999 ever fewer parents
    have made use of the opportunity to claim the benefit and have instead sent their children to a day care centre. At-
    titudes towards the cash-for-care reform, however, have remained very stable up to now. The principle of freedom
    of choice appears to be strongly rooted among Norwegians. The political agreement on maximum prices made
    this freedom a reality even for parents who wanted to make use of child care centres.

  9. The Norwegian Cash-for-Care Reform. Changing behaviour and stable attitudes

    Directory of Open Access Journals (Sweden)

    Lars Gulbrandsen

    2009-03-01

    Full Text Available In 1998 Norway introduced a cash-for-care scheme. Parent with children aged one or two were offered a cash-for-care benefit if they did not make use of public funded day care centres. The reform was supported by political parties of the centre and right and strongly opposed by parties on the left. Since 1999 ever fewer parents have made use of the opportunity to claim the benefit and have instead sent their children to a day care centre. Attitudes towards the cash-for-care reform, however, have remained very stable up to now. The principle of freedom of choice appears to be strongly rooted among Norwegians. The political agreement on maximum prices made this freedom a reality even for parents who wanted to make use of child care centres.

  10. Managerial reforms and specialised psychiatric care: a study of resistive practices performed by mental health practitioners.

    Science.gov (United States)

    Saario, Sirpa

    2012-07-01

    Throughout Western Europe, psychiatric care has been subjected to 'modernisation' by the implementation of various managerial reforms in order to achieve improved mental health services. This paper examines how practitioners resist specific managerial reforms introduced in Finnish outpatient clinics and a child psychiatry clinic. The empirical study involves documentary research and semi-structured interviews with doctors, psychologists, nurses and social workers. The analysis draws on notions of Foucault's conception of resistance as subtle strategies. Three forms of professional resistance are outlined: dismissive responses to clinical guidelines; a critical stance towards new managerial models; and improvised use of newly introduced information and communications technologies (ICTs). Resistance manifests itself as moderate modifications of practice, since more explicit opposition would challenge the managerial rhetoric of psychiatric care which is promoted in terms of positive connotations of client-centredness, users' rights, and the quality of the care. Therefore, instead of strongly challenging managerial reforms, practitioners keep them 'alive' and ongoing by continuously improvising, criticising and dismissing reforms' non-functional features. In conclusion it is suggested that managerial reforms in psychiatric care can only be implemented successfully if frontline practitioners themselves modify and translate them into clinical practice. The reconciliation between this task and practitioners' therapeutic orientation is proposed for further study. © 2012 The Author. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  11. An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough

    OpenAIRE

    Wilson, Robert Lee; Blandamer, Will

    2016-01-01

    Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively ...

  12. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    Science.gov (United States)

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  13. Patients' rights to care under Clinton's Health Security Act: the structure of reform.

    Science.gov (United States)

    Mariner, W K

    1994-08-01

    Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform.

  14. [Primary health care reform and implications for the organizational culture of Health Center Groups in Portugal].

    Science.gov (United States)

    Leone, Claudia; Dussault, Gilles; Lapão, Luís Velez

    2014-01-01

    The health sector's increasing complexity poses major challenges for administrators. There is considerable consensus on workforce quality as a key determinant of success for any health reform. This study aimed to explore the changes introduced by an action-training intervention in the organizational culture of the 73 executive directors of Health Center Groups (ACES) in Portugal during the primary health care reform. The study covers two periods, before and after the one-year ACES training, during which the data were collected and analyzed. The Competing Values Framework allowed observing that after the ACES action-training intervention, the perceptions of the executive directors regarding their organizational culture were more aligned with the practices and values defended by the primary health care reform. The study highlights the need to continue monitoring results over different time periods to elaborate further conclusions.

  15. Professional responses to post bureaucratic hospital reforms and their impact on care provision.

    Science.gov (United States)

    Johnsen, Helle

    2015-06-01

    Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers. To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Data builds on nine mini group interviews with midwives (n=three), nurses (n=three) and physiotherapists (n=three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy. Two overarching themes were identified: 'Time, tasks and institutional duties' which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. 'Managerial control of work' which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. The institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  16. Careful or lenient : welfare reform for lone mothers in the Netherlands

    NARCIS (Netherlands)

    Knijn, Trudie; Wel, Frits van

    2001-01-01

    The 1996 welfare reform that attempted to get lone parents out of social assistance represents a major shift in social policy in the Netherlands. Instead of having the financial right to care for their children, lone mothers are now obliged to earn their living by paid work as soon as their youngest

  17. Market reforms in health care and sustainability of the welfare state

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    1995-01-01

    Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. ...

  18. The Impact of Health Care and Immigration Reform on Latino Support for President Obama and Congress

    Science.gov (United States)

    Sanchez, Gabriel R.; Medeiros, Jillian; Sanchez-Youngman, Shannon

    2012-01-01

    At the start of their term, the Obama administration pledged to reform two failing policy systems in the United States: immigration and health care. The Latino populations' attitudes toward these two critical policy areas are particularly relevant due to the large foreign born population in the Latino community and the large number of Latinos who…

  19. The health care reform in Mexico: before and after the 1985 earthquakes.

    Science.gov (United States)

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-06-01

    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary.

  20. The health care reform in Mexico: before and after the 1985 earthquakes.

    Science.gov (United States)

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-01-01

    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. PMID:3706595

  1. Careful or lenient : welfare reform for lone mothers in the Netherlands

    NARCIS (Netherlands)

    Knijn, Trudie; Wel, Frits van

    2001-01-01

    The 1996 welfare reform that attempted to get lone parents out of social assistance represents a major shift in social policy in the Netherlands. Instead of having the financial right to care for their children, lone mothers are now obliged to earn their living by paid work as soon as their youngest

  2. Japan's universal long-term care system reform of 2005: containing costs and realizing a vision.

    Science.gov (United States)

    Tsutsui, Takako; Muramatsu, Naoko

    2007-09-01

    Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies.

  3. Rural health care in Vietnam and China: conflict between market reforms and social need.

    Science.gov (United States)

    Huong, Dang Boi; Phuong, Nguyen Khanh; Bales, Sarah; Jiaying, Chen; Lucas, Henry; Segall, Malcolm

    2007-01-01

    China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance. As a result, the integrity of China's planned health service has been disrupted, especially in poor rural areas. In Vietnam the government has been an important financer of public health facilities and the pre-reform health service is largely intact, although user fees finance an increasing share of facility expenditure. Over-servicing of patients to generate revenue occurs in both countries, but more seriously in China. In both countries government health expenditure has declined as a share of total health expenditure and total government expenditure, while out-of-pocket health spending has become the main form of health finance. This has particularly affected the rural poor, deterring them from accessing health care. Assistance for the poor to meet public-sector user fees is more beneficial and widespread in Vietnam than China. China is now criticizing the degree of commercialization of its health system and considers its health reforms "basically unsuccessful." Market reforms that stimulate growth in the economy are not appropriate to reform of social sectors such as health.

  4. Professional responses to post bureaucratic hospital reforms and their impact on care provision

    DEFF Research Database (Denmark)

    Johnsen, Helle

    2015-01-01

    receivers. Question To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Method Data builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing...... of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. Conclusion The institutional context appears to play a key role shaping care practices....... Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care...

  5. Lessons for health care reform from the less developed world: the case of the Philippines.

    Science.gov (United States)

    Obermann, Konrad; Jowett, Matthew R; Taleon, Juanito D; Mercado, Melinda C

    2008-11-01

    International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

  6. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  7. Can biosimilars help achieve the goals of US health care reform?

    Science.gov (United States)

    Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

    2017-01-01

    The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

  8. Why public health services? Experiences from profit-driven health care reforms in Sweden.

    Science.gov (United States)

    Dahlgren, Göran

    2014-01-01

    Market-oriented health care reforms have been implemented in the tax-financed Swedish health care system from 1990 to 2013. The first phase of these reforms was the introduction of new public management systems, where public health centers and public hospitals were to act as private firms in an internal health care market. A second phase saw an increase of tax-financed private for-profit providers. A third phase can now be envisaged with increased private financing of essential health services. The main evidence-based effects of these markets and profit-driven reforms can be summarized as follows: efficiency is typically reduced but rarely increased; profit and tax evasion are a drain on resources for health care; geographical and social inequities are widened while the number of tax-financed providers increases; patients with major multi-health problems are often given lower priority than patients with minor health problems; opportunities to control the quality of care are reduced; tax-financed private for-profit providers facilitate increased private financing; and market forces and commercial interests undermine the power of democratic institutions. Policy options to promote further development of a nonprofit health care system are highlighted.

  9. Translating ideas into actions: entrepreneurial leadership in state health care reforms.

    Science.gov (United States)

    Oliver, T R; Paul-Shaheen, P

    1997-06-01

    States are often touted as "laboratories" for developing national solutions to social problems. In this article we examine the appropriateness of this metaphor for comprehensive health care reform and attempt to draw lessons about policy innovation from recent state actions. We present evidence from six states that enacted major pieces of health care legislation in the late 1980s or early 1990s: Massachusetts, Oregon, Florida, Minnesota, Vermont, and Washington State. The variation in design casts doubt on the proposition that states can invent plans and programs for other states and the federal government to adopt for themselves. Instead, we argue that it is more accurate to think of states as specialized political markets in which individuals and groups develop and promote innovative products. We examine the factors that might create receptive markets for comprehensive health care reforms and conclude that the critical factor these states shared in common was skilled and committed leadership from "policy entrepreneurs" who formulated the plans for system reform and prominent "investors" who contributed substantial political capital to the development of the reforms. We illustrate different strategies that leaders in these states used to carry out the entrepreneurial tasks of identifying a market opportunity, designing an innovation, attracting political investment, marketing the innovation, and monitoring its early production.

  10. Implementing health care reform in the United States: intergovernmental politics and the dilemmas of institutional design.

    Science.gov (United States)

    Béland, Daniel; Rocco, Philip; Waddan, Alex

    2014-05-01

    The Affordable Care Act (ACA) was enacted, and continues to operate, under conditions of political polarization. In this article, we argue that the law's intergovernmental structure has amplified political conflict over its implementation by distributing governing authority to political actors at both levels of the American federal system. We review the ways in which the law's demands for institutional coordination between federal and state governments (and especially the role it preserves for governors and state legislatures) have created difficulties for rolling out health-insurance exchanges and expanding the Medicaid program. By way of contrast, we show how the institutional design of the ACA's regulatory reforms of the insurance market, which diminish the reform's political salience, has allowed for considerably less friction during the implementation process. This article thus highlights the implications of multi-level institutional designs for the post-enactment politics of major reforms.

  11. Financing long-term care for frail elderly in France: the ghost reform.

    Science.gov (United States)

    Chevreul, Karine; Berg Brigham, Karen

    2013-08-01

    Like many welfare states, France is faced with increasing demand for long term care (LTC) services. Public LTC coverage has evolved over the past 15 years, reaching a coverage depth of 70%. Nonetheless, it does not provide adequate and equitable financial protection for the growing number of frail elderly individuals, who are expected to constitute 3% of the population by the year 2060. Since 2005, various financing reform proposals have been debated, ranging from a newly covered risk under the social security system to targeted subsidies for private LTC insurance. However, to date no reform measure has been enacted. This article provides a brief history of publicly financed LTC in France in order to provide a context for the ongoing debate, including the positions and relative political power of the various stakeholders and the doubtful short-term prospect for reform.

  12. High accuracy flexural hinge development

    Science.gov (United States)

    Santos, I.; Ortiz de Zárate, I.; Migliorero, G.

    2005-07-01

    This document provides a synthesis of the technical results obtained in the frame of the HAFHA (High Accuracy Flexural Hinge Assembly) development performed by SENER (in charge of design, development, manufacturing and testing at component and mechanism levels) with EADS Astrium as subcontractor (in charge of doing an inventory of candidate applications among existing and emerging projects, establishing the requirements and perform system level testing) under ESA contract. The purpose of this project has been to develop a competitive technology for a flexural pivot, usuable in highly accurate and dynamic pointing/scanning mechanisms. Compared with other solutions (e.g. magnetic or ball bearing technologies) flexural hinges are the appropriate technology for guiding with accuracy a mobile payload over a limited angular ranges around one rotation axes.

  13. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

    Science.gov (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  14. Privatizing the welfarist state: health care reforms in Malaysia.

    Science.gov (United States)

    Khoon, Chan Chee

    2003-01-01

    In Malaysia, the shifting balance between market and state has many nuances. Never a significant welfare state in the usual mold, the Malaysian state nonetheless has been a dominant social and economic presence dictated by its affirmative action-type policies, which eventually metamorphosed into state-led indigenous capitalism. Privatisation is also intimately linked with emergence of an indigenous bourgeoisie with favored access to the vast accumulation of state assets and prerogatives. Internationally, it is conditioned by the fluid relationships of converging alliances and contested compromise with international capital, including transnational health services industries. As part of its vision of a maturing, diversified economy, the Malaysian government is fostering a private-sector advanced health care industry to cater to local demand and also aimed at regional and international patrons. The assumption is that, as disposable incomes increase, a market for such services is emerging and citizens can increasingly shoulder their own health care costs. The government would remain the provider for the indigent. But the key assumption remains: the growth trajectory will see the emergence of markets for an increasingly affluent middle class. Importantly, the health care and social services market would be dramatically expanded as the downsizing of public-sector health care proceeds amid a general retreat of government from its provider and financing roles.

  15. Nursing and Health Care Reform: Implications for Curriculum Development.

    Science.gov (United States)

    Bowen, Mary; Lyons, Kevin J.; Young, Barbara E.

    2000-01-01

    A survey of registered nurses who graduated in 1986 (n=50) and 1991 (n-58) revealed these opinions: insurance companies increasingly control patient care; workload and paperwork have increased; and there are fewer jobs and less job security. A significant number reported decreased job satisfaction. (SK)

  16. Analysis of Private Sector Care Reform Authorities and Savings

    Science.gov (United States)

    2016-12-01

    Samuelson . "Vermont’s Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High- Quality Care...T. Tremblay, M. K. Mohlman, B. Tanzman, M. Hazard, S. Maier, and J. Samuelson . “Vermont’s Community-Oriented All-Payer Medical Home Model Reduces

  17. Health-care reforms in the People's Republic of China--strategies and social implications.

    Science.gov (United States)

    Wong, V C; Chiu, S W

    1998-01-01

    Analyses the features, strategies and characteristics of health-care reforms in the People's Republic of China. Since the 14th Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health-care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de-linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi-public health-care insurance is able to resolve these problems. Finally, cooperative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health-care needs of the people.

  18. Stigma as a Structural Power in Mental Health Care Reform: An Ethnographic Study Among Mental Health Care Professionals in Belgium.

    Science.gov (United States)

    Sercu, Charlotte; Bracke, Piet

    2016-12-01

    The growing interest among scholars and professionals in mental health stigma is closely related to different mental health care reforms. This article explores professionals' perceptions of the dehospitalization movement in the Belgian context, paying particular attention to the meaning of stigma. Combined participant observation and semi-structured interviews were used to both assess and contextualize the perceptions of 43 professionals. The findings suggest that stigma may function as a structural barrier to professionals' positive evaluation of de-hospitalization, depending on the framework they are working in. It is important to move beyond a unilateral understanding of the relationship between stigma and de-hospitalization in order to attain constructive health care reform. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011

    Directory of Open Access Journals (Sweden)

    Li Zhijian

    2012-06-01

    Full Text Available Abstract Background Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Methods Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Results Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1 the health insurance system; 2 essential drugs; 3 basic clinical services; and 4 public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied and the public health/preventive services (average score=3.62; but less satisfied with the provision of essential drugs (average score=3.20 and health insurance schemes (average score=3.23. The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes had overall poorer satisfaction levels on these four aspects of health care (P Conclusion The respondents showed more satisfaction with the clinical services (average score=3.79 and public health services/interventions (average score=3.79; and less satisfaction with the health insurance system (average score=3.23 and the essential drug system

  20. Pharmacy waste, fraud, and abuse in health care reform.

    Science.gov (United States)

    Carpenter, Laura A; Edgar, Zachary; Dang, Christopher

    2011-01-01

    To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations. Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice. H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.

  1. Physician payment disclosure under health care reform: will the sun shine?

    Science.gov (United States)

    Mackey, Tim K; Liang, Bryan A

    2013-01-01

    Pharmaceutical marketing has become a mainstay in U.S. health care delivery and traditionally has been directed toward physicians. In an attempt to address potential undue influence of industry and conflicts of interest that arise, states and the recently upheld health care reform act have passed transparency, or "sunshine," laws requiring disclosure of industry payments to physicians. The Centers for Medicare & Medicaid Services recently announced the final rule for the Sunshine Provisions as part of the reform act. However, the future effectiveness of these provisions are questionable and may be limited given the changing landscape of pharmaceutical marketing away from physician detailing to other forms of promotion. To address this changing paradigm, more proactive policy solutions will be necessary to ensure adequate and ethical regulation of pharmaceutical promotion.

  2. Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario.

    Science.gov (United States)

    Randall, Glen E; Williams, A Paul

    2006-04-01

    The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a "managed competition" model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario's managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms.

  3. Ensuring access to health care--Germany reforms supply structures to tackle inequalities.

    Science.gov (United States)

    Ozegowski, Susanne; Sundmacher, Leonie

    2012-07-01

    Germany's ruling coalition has recently introduced a new bill to Parliament, the Care Structures Act (CSA), which aims to improve outpatient care supply structures, decentralize decision-making, facilitate cross-sectoral treatment, and strengthen innovation in the nation's health care sector. These objectives are to be achieved through a variety of measures, including changes in financial incentives for physicians, the transfer of decision-making to the regional level, and the creation of a new sector for highly specialized care. The opposition parties in Parliament and most health care stakeholders agree on the objectives of the reform package, but their evaluation of the bill is mixed. Physicians' representative organizations generally deem the law to be headed in the right direction, while the opposition parties, sickness funds, patients' rights groups and a majority of German federal states (Bundesländer) feel it does not adequately address the issues of supply inequity and sectoral division. This skepticism seems well founded. The reforms aimed at attracting physicians to high-need regions have significant shortcomings, and the measures to overcome sectoral barriers between the outpatient care and hospital sectors remain weak. Furthermore, the new procedure for including innovative treatment methods in the SHI benefits catalogue falls short of internationally recognized standards.

  4. Managed care in Latin America: the new common sense in health policy reform.

    Science.gov (United States)

    Iriart, C; Merhy, E E; Waitzkin, H

    2001-04-01

    This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.

  5. Mental health reform at a systems level: widening the lens on recovery-oriented care.

    Science.gov (United States)

    Kidd, Sean A; Mckenzie, Kwame J; Virdee, Gursharan

    2014-05-01

    This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.

  6. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    Directory of Open Access Journals (Sweden)

    Zhang X

    2016-03-01

    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  7. Arkansas: a leading laboratory for health care payment and delivery system reform.

    Science.gov (United States)

    Bachrach, Deborah; du Pont, Lammot; Lipson, Mindy

    2014-08-01

    As states' Medicaid programs continue to evolve from traditional fee-for-service to value-based health care delivery, there is growing recognition that systemwide multipayer approaches provide the market power needed to address the triple aim of improved patient care, improved health of populations, and reduced costs. Federal initiatives, such as the State Innovation Model grant program, make significant funds available for states seeking to transform their health care systems. In crafting their reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state's particular health care landscape.

  8. The Impact of the Health Care System Reform on the Romanian Nurses Professionalization Process

    Directory of Open Access Journals (Sweden)

    Silvia POPOVICI

    2012-06-01

    Full Text Available The Romanian health sector went through a process of reform began in 2000 which entered into a final adjustment phase in 2010 when the economic crisis, the health professionals accelerated trend of labour migration, the precarious health of the population brought new challenges to the unsolved existing problems. Nurses are numerically the most important category of health professionals. Since 1994 they experienced a convergent movement of professionalization in the interior of the nurse profession. The aim of the study is to explore the nurses’ perceptions of the impact of the health care system reform on their own profession and on the internal process of professionalization. As a result a quantitative research was conducted on a sample including 411 nurses of different specialties working in Iasi county. The results of the research point out the significant impact of factors related to the reform of the health care system on the quality of the care process, on the nurses’ work conditions and professional satisfaction. The external disruptive factors produce negative effects on nurses’ group cohesion, despite the centripetal efforts of the professional organization and induce a slowdown movement of the nurses professionalization process.

  9. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    Science.gov (United States)

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  10. On Rural Medical Care and Health Undertaking Development during New Medical Reform

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yi-huan

    2012-01-01

    Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

  11. Condliff v North Staffordshire Primary Care Trust: can human rights redress inequities in United Kingdom and Australian cost-containment-driven health care reforms?

    Science.gov (United States)

    Townsend, Ruth; Faunce, Thomas

    2011-12-01

    A recent case from the English Court of Appeal (R (on the application of Condliff) v North Staffordshire Primary Care Trust [2011] EWCA Civ 910, concerning denial by a regional health care rationing committee of laparoscopic gastric bypass surgery for morbid obesity) demonstrates the problems of attempting to rely post hoc on human rights protections to ameliorate inequities in health care reforms that emphasise institutional budgets rather than universal access. This column analyses the complexities of such an approach in relation to recent policy debates and legislative reform of the health systems in the United Kingdom and Australia. Enforceable human rights, such as those available in the United Kingdom to the patient Tom Condliff, appear insufficient to adequately redress issues of inequity promoted by such "reforms". Equity may fare even worse under Australian cost-containment health care reforms, given the absence of relevant enforceable human rights in that jurisdiction.

  12. Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act.

    Science.gov (United States)

    Cseh, Attila; Koford, Brandon C; Phelps, Ryan T

    2015-12-01

    The Affordable Care Act is currently in the roll-out phase. To gauge the likely implications of the national policy we analyze how the Massachusetts Health Care Reform Act impacted various hospitalization outcomes in each of the 25 major diagnostic categories (MDC). We utilize a difference-in-difference approach to identify the impact of the Massachusetts reform on insurance coverage and patient outcomes. This identification is achieved using six years of data from the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. We report MDC-specific estimates of the impact of the reform on insurance coverage and type as well as length of stay, number of diagnoses, and number of procedures. The requirement of universal insurance coverage increased the probability of being covered by insurance. This increase was in part a result of an increase in the probability of being covered by Medicaid. The percentage of admissions covered by private insurance fell. The number of diagnoses rose as a result of the law in the vast majority of diagnostic categories. Our results related to length of stay suggest that looking at aggregate results hides a wealth of information. The most disparate outcomes were pregnancy related. The length of stay for new-born babies and neonates rose dramatically. In aggregate, this increase serves to mute decreases across other diagnoses. Also, the number of procedures fell within the MDCs for pregnancy and child birth and that for new-born babies and neonates. The Massachusetts Health Care Reform appears to have been effective at increasing insurance take-up rates. These increases may have come at the cost of lower private insurance coverage. The number of diagnoses per admission was increased by the policy across nearly all MDCs. Understanding the changes in length of stay as a result of the Massachusetts reform, and perhaps the Affordable Care Act, requires MDC-specific analysis. It appears that the most important distinction

  13. Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status.

    Science.gov (United States)

    Villelli, Nicolas W; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M

    2017-01-01

    OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care

  14. High performance work systems: the gap between policy and practice in health care reform.

    Science.gov (United States)

    Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline

    2011-01-01

    Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform. The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia. The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health

  15. cura, care, C A R E, Care: Dimensions and Qualities of Care (re)forming an Ecology of Care

    DEFF Research Database (Denmark)

    Coxon, Ian Robert; Bremner, Craig; Jensen, Jesper

    that it serves to inform is to begin a process of concretizing the otherwise lost but vitally important concept we call Care. In writing this paper we will attempt to adopt a 'position' through an extensive but not complete review of existing and past thinking in order to "find a line and then to hang...... fully acknowledge that they and the sub-elements that constitute them are never discrete or fixed at any point. Like the relationship between light particles and light waves, these 'parts' constitute an evolving system of living interaction and Being that defines Care, where any or all of Cares parts...... at any given point in time are continually co-constituting each other within a dynamic and interactive whole we call everyday life. In a highly abbreviated form our two key propositions are presented as follows; PROPOSITION 1: DIMENSIONS OF CARE Care is informed and shaped by everyday experience...

  16. Health Care Access among Latinos: Implications for Social and Health Care Reforms

    Science.gov (United States)

    Perez-Escamilla, Rafael

    2010-01-01

    According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

  17. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

    Science.gov (United States)

    2014-01-01

    other countries faced with the challenge of drafting reforms to tackle the issue of chronic care. PMID:24742204

  18. Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.

    Science.gov (United States)

    Van Durme, Thérèse; Macq, Jean; Anthierens, Sibyl; Symons, Linda; Schmitz, Olivier; Paulus, Dominique; Van den Heede, Koen; Remmen, Roy

    2014-04-18

    drafting reforms to tackle the issue of chronic care.

  19. Comparative effectiveness research: evidence-based medicine meets health care reform in the USA.

    Science.gov (United States)

    Tanenbaum, Sandra J

    2009-12-01

    Rationale Comparative effectiveness research (CER) is the study of two or more approaches to a health problem to determine which one results in better health outcomes. It is viewed by some in the USA as a promising strategy for health care reform. Aims and Objectives In this paper, nascent US CER policy will be described and analysed in order to determine its similarities and differences with EBM and its chances of success. Methods Document review and process tracing Results CER shares the logic of policies promoting evidence-based medicine, but invites greater methodological flexibility to ensure external validity across a range of health care topics. Conclusions This may narrow the inferential distance from knowledge to action, but efforts to change the US health care system through CER will face familiar epistemological quandaries and 'patient-centred' politics on the left and right.

  20. An automatic hinge system for leg orthoses

    NARCIS (Netherlands)

    Rietman, J.S.; Goudsmit, J.; Meulemans, D.; Halbertsma, J.P.K.; Geertzen, J.H.B.

    2004-01-01

    This paper describes a new, automatic hinge system for leg orthoses, which provides knee stability in stance, and allows knee-flexion during swing. Indications for the hinge system are a paresis or paralysis of the quadriceps muscles. Instrumented gait analysis was performed in three patients, fitte

  1. Why institutions are not the only thing that matters: twenty-five years of health care reform in New Zealand.

    Science.gov (United States)

    Starke, Peter

    2010-08-01

    The literature on the causes of health care reform is dominated by institutionalist accounts, and political institutions are among the most prominent factors cited to explain why change takes place. However, institutionalist accounts have difficulty explaining both the timing and the content of reforms. By applying a range of explanatory approaches to a case study of health reform in New Zealand since the 1970s, this article explores some of the theories of reform beyond institutionalism, particularly those that take into account problem pressure, policy ideas, and the more agency-centered factor of partisan ideology. The aim is not to dismiss institutionalism but to try to fill some of the gaps that cannot be addressed with institutionalist theories alone. The detailed analysis shows that various factors played a role in conjunction, namely, problem pressure, policy ideas, and the ideology of parties in government. Partisan ideology, in particular, has perhaps been prematurely ignored by health care scholars.

  2. Market reforms in English primary medical care: medicine, habitus and the public sphere.

    Science.gov (United States)

    McDonald, Ruth

    2009-07-01

    Drawing on interviews with English primary care doctors (GPs), this paper examines GP responses to reforms intended to introduce a market in primary health care. GPs' reactions are conceptualised in terms of a GP habitus, which takes for granted the superiority of 'public' providers (i.e. GP partnerships) in the provision of care. GPs are actively involved in the defence of the public sphere, which is neither a neo-liberal minimalist market state, nor a wholly altruistic state, responding to consumers' wants. The public sphere they defend is one in which boundaries are drawn about entitlements and GPs are actively engaged in defining and policing these boundaries. The GP habitus can be seen as shaping responses in ways which serve GP interests. In the context of struggles involving various social actors (e.g. private providers, third-party payers, patients) with different stakes in the field of general medical practice; this public service orientation may enable GPs to reap cultural capital. At the same time, the habitus constrains action in a way which limits resistance to reforms threatening GPs' interests, with GPs responding by coping, rather than downing tools or engaging in active confrontation.

  3. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    Science.gov (United States)

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.

  4. Primary care reform in Central and Eastern Europe: can Belarus be taken as the control group in international comparison?

    NARCIS (Netherlands)

    Boerma, W.G.W.; Rousovich, V.S.; Schellevis, F.G.; Egorov, K.

    2005-01-01

    Background: Health care reform proceeds differently in Belarus. The country has not followed trends visible in most other countries. Financing and provision of health care is still in the hands of the state. Health insurance funds are unknown, private practices are rare and operating outside the sys

  5. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform

    NARCIS (Netherlands)

    Bikker, Jaap; Popescu, Adelina

    2014-01-01

    This paper investigates the cost efficiency and competitive behaviour of the non-life – or property and casualty – insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance se

  6. Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007.

    NARCIS (Netherlands)

    Campbell, S.M.; Kontopantelis, E.; Reeves, D.; Valderas, J.M.; Gaehl, E.; Small, N.; Roland, M.O.

    2010-01-01

    PURPOSE: Major primary care reforms have been introduced in recent years in the United Kingdom, including financial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. We examine patient reports of qua

  7. Reform of the Individual Insurance Market in New Jersey: Lessons for the Affordable Care Act.

    Science.gov (United States)

    Cantor, Joel C; Monheit, Alan C

    2016-08-01

    The individual health insurance market has played a small but important role in providing coverage to those without access to group insurance or public programs. With implementation of the Affordable Care Act (ACA), the individual market has attained a more prominent role. However, achieving accessible and affordable coverage in this market is a long-standing challenge, in large part due to the threat of adverse risk selection. New Jersey pursued comprehensive reforms beginning in the 1990s to achieve a stable, accessible, and affordable individual market. We review how adverse risk selection can pose a challenge to achieving such objectives in the individual health insurance market. We follow this discussion by describing the experience of New Jersey through three rounds of legislative reform and through the first year of the implementation of the ACA coverage provisions. While the New Jersey reforms did not require individuals to purchase coverage, its experiences with direct and indirect market subsidies and regulations guiding plan design, issuance, and rating have important implications for how the ACA may achieve its coverage goals in the absence of the controversial individual purchase mandate.

  8. Postneoliberal Public Health Care Reforms: Neoliberalism, Social Medicine, and Persistent Health Inequalities in Latin America.

    Science.gov (United States)

    Hartmann, Christopher

    2016-12-01

    Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.

  9. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care.

    Science.gov (United States)

    White, Joseph

    2013-07-01

    This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

  10. Reforming the Health Care System for Children and the Elderly to Balance Cure and Care.

    Science.gov (United States)

    Callahan, Daniel

    1992-01-01

    Issues in balancing health services and costs in a changing society, where groups have differential access to health care, are discussed, including need for a universal health care system, growing cost of health care for the elderly, prolongation of life among older adults, and the claims of children on services. (MSE)

  11. Who pays for health care in the United States? Implications for health system reform.

    Science.gov (United States)

    Holahan, J; Zedlewski, S

    1992-01-01

    This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

  12. Notch flexure hinges: An effective theory

    Science.gov (United States)

    Tseytlin, Yakov M.

    2002-09-01

    This article presents effective tractable equations for rotational compliance (stiffness) of a simple monolithic flexure hinge with circular (radius R and crosspiece thickness t), elliptical [at semiaxis ax, ay, elliptical ratio epsilon (=ax/ay)] and other cross sections. These equations and the method by inverse conformal mapping of circular approximating contour used to derive them are different from the known and widely used theoretical equations originally derived in 1965 by Paros and Weisbord for circular notch hinges. Later it was found that the circular hinge represents the worst case error between known theoretical and finite element models. The conformal mapping equations data presented in this article are likely to be much closer (within less than 10%) to the finite element analysis and experimental data than other theoretical equations. In particular this is the case for circular notch hinges at relative thickness beta(=t/2R) in the range 0.01 to 0.3 and for elliptical hinges at the elliptical ratio epsilon=1 to 10. The derived general equation is common for all types of notch hinges whose profiles can be approximated by two shifted contiguous circles and includes material parameters with Young's modulus and Poisson's ratio. The latter is totally omitted in known theoretical solutions by other authors. New tractable equations are derived from the general equation on the basis of trigonometric functions' simplified series expansion in certain ranges of hinge crosspiece relative thickness. The corresponding graphs are presented. Experimental data were received by holographic interference and autocollimator measurement.

  13. Reform and the politics of hybridization in mature health care states.

    Science.gov (United States)

    Tuohy, Carolyn Hughes

    2012-08-01

    This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.

  14. A comparison of how behavioral health organizations utilize training to prepare for health care reform.

    Science.gov (United States)

    Stanhope, Victoria; Choy-Brown, Mimi; Barrenger, Stacey; Manuel, Jennifer; Mercado, Micaela; McKay, Mary; Marcus, Steven C

    2017-02-14

    Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation. This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received. Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p organizational readiness for health care reform initiatives among behavioral health organizations.

  15. Challenges Faced by Health Care Reform%医保改革面临挑战

    Institute of Scientific and Technical Information of China (English)

    桑吉·古普塔; 本尼迪克特·克莱门茨; 戴维·科迪; 王宇(译)

    2015-01-01

    At present, poor medical service availability, high health care costs and inefficient of public health spending are exsiting in many countries, and health care reform still faces big challenges. To improve people's health and to make a control of the costs are dilemma of health-care reform, and thus improving the efficiency of public health expenditure is the optimal choice to improve social health. The forms of government intervention and the level of public health expenditure are different due to different countries and period. Emerging economies should expand basic health care coverage on the premise of fiscal sustainable development while developed economies should pay attention to improve the public health spending efficiency and limit the spending growth.%当前,许多国家仍存在医疗服务可得性差、医疗成本高昂、公共卫生支出效率低下等问题,医保改革面临重大挑战。医保改革目标存在两难—既要改善人们的健康状况,又要控制支出成本,因而提高公共卫生支出效率是改善社会健康状况的最优选择。各国政府的干预形式和公共卫生支出水平因国别、时间等的不同而变化。财政状况较好的新兴经济体需在保证财政可持续的前提下扩大基本医保覆盖面;发达经济体则应注重提升公共卫生支出的效率并限制支出增长速度。

  16. Lost in the Health Care Reform Discussion: Health Care as a Right or Privilege

    Science.gov (United States)

    O'Rourke, Thomas W.

    2017-01-01

    Health care has been an ongoing issue of public concern for decades, well before President Obama took office. Passage of the Affordable Care Act (ACA), also known as Obamacare, in March 2010 and upheld by a Supreme Court in June 2012. With Republicans now in control of both the House and Senate as well as the presidency, the ACA in its current…

  17. Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades.

    Science.gov (United States)

    Filc, Dani; Davidovitch, Nadav

    2016-10-01

    To analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades. We used mixed methods including quantitative analysis of trends in health expenditures in Israel and qualitative critical analysis of documents describing the main health reforms. Israel epitomizes how boundaries between the private and public sector become blurred when health care services are subject to privatization, both of finance and supply. Additionally, the continuous growth of public-private relationships in health care results in systems that lack both equity and efficiency. More than three decades of experience show that such private-public partnerships increase both inequality and inefficiency. While most discussion surrounding the private-public mix in health care focuses on financing infrastructure, in Israel, the public-private mix has become a central way of financing and delivering services, making its damaging influence more pervasive. © The Author(s) 2016.

  18. Posterior Dislocation of the Hinge-Post Extension in a Rotating Hinge Total Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Givenchy Manzano

    2013-01-01

    Full Text Available The rotating hinge knee prosthesis is a popular intervention in patients lacking stability with highly constrained total knee arthroplasty. Despite improvements in design, nonmechanical and mechanical complications continue to be a problem. Dislocation of the hinge has been widely described, mainly due to the component fracture. Few reports describe isolated dislocation of the rotating stem. We report a case of isolated disengagement of the rotating hinge mechanism, due to severe flexion gap imbalance, leading to subsequent posterior dislocation of the hinge and anterior knee dislocation, in a patient with a history of multiple total knee arthroplasty revisions. This case suggests the importance of the soft tissue balancing, the adequate patellar tracking, and use of a long cylindrical, minimally tapered rotating stem in hinge arthroplasty to minimize hinge dislocation.

  19. The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

    Science.gov (United States)

    Feldman, Roger

    2015-08-01

    A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private payers are experimenting with payment systems that combine the basic element of FFS - a fee for each service - with arrangements that allow providers to share the savings if they hold total spending per patient below a targeted amount. Medicare's accountable care organizations (ACOs) embody the shared savings approach to payment reform. Private payers have introduced total cost of care contracting (TCOC) in several locations. This article questions the consensus that FFS must go. If the fees are too high, then someone needs to "bite the bullet" and reduce fees in key areas. Hoping to control overspending by investment in ACOs is wishful thinking. I describe the theory and practice of shared savings payment systems and summarize recent TCOC contracting initiatives in the private sector. Medicare's shared savings approach is likely to be less effective than private contracts. Cutting providers' fees would be more efficient. Finally, the new payment models in the Affordable Care Act will not ease the problem of high prices for private payers. Copyright © 2015 by Duke University Press.

  20. Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces

    Science.gov (United States)

    Haggerty, Jeannie L.; Hogg, William; Burge, Frederick; Wong, Sabrina T.; Katz, Alan; Grimard, Dominique; Weenink, Jan-Willem; Pineault, Raynald

    2015-01-01

    Introduction: Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized. The aim of this study is to identify the factors that have facilitated or hindered implementation of reforms in Canadian provinces between 2000 and 2010. Methods: A literature and policy scan identified evaluation studies across Canadian jurisdictions. Experts from British Columbia, Manitoba, Nova Scotia, Ontario and Quebec were asked to review the scope of published evaluations and draft provincial case descriptions. A one-day deliberative forum was held, bringing together researchers (n = 40) and decision-makers (n = 20) from all the participating provinces. Results: Despite a relative lack of published evaluations, our results suggest that PC reform has varied with regard to the scope and the policy levers used to implement change. Some provinces implemented specific PC models, while other provinces designed overarching policies aiming at changing professional behaviour and practice. The main perceived barriers to reform were the lack of financial investment, resistance from professional associations, too overtly prescriptive approaches lacking adaptability and an overly centralized governance model. The main perceived facilitators were a strong financial commitment using various allocation and payment approaches, the cooperation of professional associations and an incremental emergent change philosophy based on a strong decentralization of decisions allowing adaptation to local circumstances. So far the most beneficial results of the reforms seem to be an increase in patients' affiliation with a usual source of care, improved experience of care by patients and a higher workforce satisfaction. Conclusion: PC reforms currently under consideration in other jurisdictions could learn from the

  1. Care and treatment of the mentally ill in the United States: historical developments and reforms.

    Science.gov (United States)

    Morrissey, J P; Goldman, H H

    1986-03-01

    Three major cycles of reform in public mental health care in the United States--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence is suggestive that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system and the agenda for policy-relevant research on issues involving the legal and mental health fields.

  2. Reform of how health care is paid for in China: challenges and opportunities.

    Science.gov (United States)

    Hu, Shanlian; Tang, Shenglan; Liu, Yuanli; Zhao, Yuxin; Escobar, Maria-Luisa; de Ferranti, David

    2008-11-22

    China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.

  3. 奥巴马医改三问%Analysis of Obam's Health Care Reform

    Institute of Scientific and Technical Information of China (English)

    汤晓莉

    2014-01-01

    There are many obstacles standing on the way to formulate and implement the Patient Protection and Affordable Act. Some of the obstacles resulted from the external factors, such as partisan politics, market orientated conception and bi-federalism, etc.;some of them were caused by the imperfection of Obam's Health Care Reform itself. This article makes a comprehensive analysis of these problems from three aspects:universal coverage targeting, funds-raising mechanism and executive capacity.%奥巴马医改一波三折,既有党派政治、市场理念、二元联邦制等外在因素的影响,也有改革本身的一些问题。本文从目标定位、筹资机制和实施能力三个方面对此进行了深入分析。

  4. The public's views on health care reform in the 2008 presidential election.

    Science.gov (United States)

    Collins, Sara R; Kriss, Jennifer L

    2008-01-01

    A Commonwealth Fund survey of adults age 19 and older,conducted from June 2007 to October 2007, finds that large majorities of the public, regardless of political affiliation or income level, say that the candidates' views on health care reform will be very important or somewhat important in their voting decision. Moreover, they believe employers--long the cornerstone of the health insurance system--should retain responsibility for providing health insurance, or at least contribute financially to covering the country's working families. A majority of adults would also favor a requirement that everyone have health insurance, with the government helping those who are unable to afford it; support for such a requirement, however, is not strong and varies by political affiliation, geographic region, and income. There is overwhelming agreement that financing for health insurance coverage for all Americans should be a responsibility shared by employers, government, and individuals.

  5. Incremental health system reform policy: Ecuador's law for the provision of free maternity and child care.

    Science.gov (United States)

    Chiriboga, Sonia Ruiz

    2009-01-01

    This study assessed the impact that the Ley de Maternidad Gratuita y Atencion a la Infancia (LMGAI) [Law for the Provision of Free Maternity and Child Care] in Ecuador has had on health services utilization and infant mortality. These outcomes were also examined by socioeconomic status. This retrospective study used demographic and health surveys, ENDEMAIN 1999 and 2004, with multivariate logistic regression to assess the impact post-LMGAI, controlling for mother's socioeconomic status, maternal and birth history, and demographic characteristics. Primary healthcare services utilization outcomes significantly improved post-LMGAI. Neonatal mortality decreased post-LMGAI. Further evaluation is needed as implementation continues to understand the expansion of primary healthcare services in future health system reforms.

  6. Emerging patient safety issues under health care reform: follow-on biologics and immunogenicity

    Directory of Open Access Journals (Sweden)

    Liang BA

    2011-12-01

    Full Text Available Bryan A Liang1-3, Timothy Mackey1,41Institute of Health Law Studies, California Western School of Law, 2Department of Anesthesiology, University of California, San Diego School of Medicine, 3San Diego Center for Patient Safety, University of California, San Diego School of Medicine,4Joint Program in Global Health, University of California San Diego-San Diego State University, San Diego, CA, USAAbstract: US health care reform includes an abbreviated pathway for follow-on biologics, also known as biosimilars, in an effort to speed up access to these complex therapeutics. However, a key patient safety challenge emerges from such an abbreviated pathway: immunogenicity reactions. Yet immunogenicity is notoriously difficult to predict, and even cooperative approaches in licensing between companies have resulted in patient safety concerns, injury, and death. Because approval pathways for follow-on forms do not involve cooperative disclosure of methods and manufacturing processes by innovator companies and follow-on manufacturers, the potential for expanded immunogenicity must be taken into account from a risk management and patient safety perspective. The US Institute of Safe Medication Practices (ISMP has principles of medication safety that have been applied in the past to high-risk drugs. We propose adapting ISMP principles to follow-on biologic forms and creating systems approaches to warn, rapidly identify, and alert providers regarding this emerging patient safety risk. This type of system can be built upon and provide lessons learned as these new drug forms are developed and marketed more broadly.Keywords: biosimilars, follow-on biologics, immunogenicity, patient safety, law, health care reform

  7. Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

    Science.gov (United States)

    Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

    2015-10-01

    Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

  8. The emergence of managed care in Europe. Some thoughts on the politics of healthcare reform.

    Science.gov (United States)

    Elze, C

    1998-01-01

    It is the purpose of this paper to demonstrate that healthcare reform in Europe can be successful only if it leads to more efficient resource use while maintaining a large degree of equity in the system. Globalisation is undermining the social contracts that established Europe's egalitarian societies after World War II. While socialised healthcare will continue to be an essential building block of social cohesion, public expenditures must be contained. The only approach to maintaining equity of access and financing in the face of a mounting resource constraint is to embark upon a radical re-engineering of the entire healthcare supply chain, introducing and adapting proven US managed-care techniques to the European environment. Through enabling legislation, most European countries are in a phase of testing the feasibility, cost effectiveness and quality enhancement potential of managed-care approaches, before applying them more broadly. While political opposition to change on the part of those whose current positions are threatened continues to run high, the practice of medicine can be expected to converge on the basis of standards of care and information technology over the next 10 to 15 years.

  9. Using clinical governance levers to support change in a cancer care reform.

    Science.gov (United States)

    Brault, Isabelle; Denis, Jean-Louis; Sullivan, Terrence James

    2015-01-01

    Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers. This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

  10. Are lessons from the education sector applicable to health care reforms? The case of Uganda.

    Science.gov (United States)

    Okuonzi, S A; Birungi, H

    2000-01-01

    The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

  11. The impact of market-based 'reform' on cultural values in health care.

    Science.gov (United States)

    Curtin, L L

    1999-12-01

    The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks

  12. [PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

    Science.gov (United States)

    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

    2014-01-01

    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

  13. Dynamic requirements for a functional protein hinge.

    Science.gov (United States)

    Kempf, James G; Jung, Ju-Yeon; Ragain, Christina; Sampson, Nicole S; Loria, J Patrick

    2007-04-20

    The enzyme triosephosphate isomerase (TIM) is a model of catalytic efficiency. The 11 residue loop 6 at the TIM active site plays a major role in this enzymatic prowess. The loop moves between open and closed states, which facilitate substrate access and catalysis, respectively. The N and C-terminal hinges of loop 6 control this motion. Here, we detail flexibility requirements for hinges in a comparative solution NMR study of wild-type (WT) TIM and a quintuple mutant (PGG/GGG). The latter contained glycine substitutions in the N-terminal hinge at Val167 and Trp168, which follow the essential Pro166, and in the C-terminal hinge at Lys174, Thr175, and Ala176. Previous work demonstrated that PGG/GGG has a tenfold higher Km value and 10(3)-fold reduced k(cat) relative to WT with either d-glyceraldehyde 3-phosphate or dihyrdroxyacetone phosphate as substrate. Our NMR results explain this in terms of altered loop-6 dynamics in PGG/GGG. In the mutant, loop 6 exhibits conformational heterogeneity with corresponding motional rates hinge design in proteins: structural rigidity is essential for focused motional freedom of active-site loops.

  14. Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time.

    Science.gov (United States)

    Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

    2014-04-01

    Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Cultures for mental health care of young people: an Australian blueprint for reform.

    Science.gov (United States)

    McGorry, Patrick D; Goldstone, Sherilyn D; Parker, Alexandra G; Rickwood, Debra J; Hickie, Ian B

    2014-12-01

    Mental ill health is now the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10-24 years, contributing 45% of the overall burden of disease in this age group. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, structural and cultural flaws within the existing care systems, and the failure of society to recognise the importance of this issue and invest in youth mental health. We outline the case for a specific youth mental health stream and describe the innovative service reforms in youth mental health in Australia, using them as an example of the processes that can guide the development and implementation of such a service stream. Early intervention with focus on the developmental period of greatest need and capacity to benefit, emerging adulthood, has the potential to greatly improve the mental health, wellbeing, productivity, and fulfilment of young people, and our wider society.

  16. Future European health care: cost containment, health care reform and scientific progress in drug research.

    Science.gov (United States)

    Emilien, G

    1997-01-01

    The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.

  17. Large employers that have lived through transformation say payment reform alone won't cut costs and reengineer care.

    Science.gov (United States)

    Sepúlveda, Martín J; Darling, Helen

    2012-09-01

    As payment reform in health care gathers momentum, employers, as major payers, endorse the effort to move away from volume-driven payment to incentivizing and rewarding the delivery of better health care at lower cost. In this commentary we discuss large employers' perspectives on three particular challenges that payment reform alone, as important as it is, may not be sufficient to address: high health care prices, inefficient and complex systems, and an outdated work environment ill designed to meet the pressing goals of better health care at lower cost. We believe that policies that support health care organizations in redesigning work processes will be essential to reducing prices and simplifying interactions in care delivery. We also believe that health care organizations will need to redesign their compensation systems to align their employees' pay with improvements in performance. To that end, we describe the major transformation that IBM underwent in the 1990s to position itself to compete in a radically changed computer marketplace. We also offer several policy recommendations to support health care organizations in making the necessary changes.

  18. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009

    Science.gov (United States)

    Cornejo-Ovalle, Marco; Paraje, Guillermo; Vásquez-Lavín, Felipe; Pérez, Glòria; Palència, Laia; Borrell, Carme

    2015-01-01

    The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage. PMID:25749319

  19. CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

    Directory of Open Access Journals (Sweden)

    Dragoi Mihaela Cristina

    2011-12-01

    Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

  20. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

    Directory of Open Access Journals (Sweden)

    Lígia Giovanella

    2014-11-01

    Full Text Available The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date, and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

  1. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

    Science.gov (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

    2014-07-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  2. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  3. Triangle-hinge models for unoriented membranes

    Science.gov (United States)

    Fukuma, Masafumi; Sugishita, Sotaro; Umeda, Naoya

    2016-07-01

    Triangle-hinge models [M. Fukuma, S. Sugishita, and N. Umeda, J. High Energy Phys. 1507, 088 (2015)] are introduced to describe worldvolume dynamics of membranes. The Feynman diagrams consist of triangles glued together along hinges and can be restricted to tetrahedral decompositions in a large-N limit. In this paper, after clarifying that all the tetrahedra resulting in the original models are orientable, we define a version of triangle-hinge models that can describe the dynamics of unoriented membranes. By regarding each triangle as representing a propagation of an open membrane of disk topology, we introduce a local worldvolume parity transformation which inverts the orientation of a triangle, and define unoriented triangle-hinge models by gauging the transformation. Unlike two-dimensional cases, this local transformation generally relates a manifold to a nonmanifold, but still is a well-defined manipulation among tetrahedral decompositions. We further show that matter fields can be introduced in the same way as in the original oriented models. In particular, the models will describe unoriented membranes in a target spacetime by taking matter fields to be the target space coordinates.

  4. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009

    OpenAIRE

    Marco Cornejo-Ovalle; Guillermo Paraje; Felipe Vásquez-Lavín; Glòria Pérez; Laia Palència; Carme Borrell

    2015-01-01

    The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), a...

  5. Foul weather friends: big business and health care reform in the 1990s in historical perspective.

    Science.gov (United States)

    Swenson, Peter; Greer, Scott

    2002-08-01

    Existing accounts of the Clinton health reform efforts of the early 1990s neglect to examine how the change in big business reform interests during the short period between the late 1980s and 1994 might have altered the trajectory of compulsory health insurance legislation in Congress. This article explores evidence that big employers lost their early interest in reform because they believed their private remedies for bringing down health cost inflation were finally beginning to work. This had a discouraging effect on reform efforts. Historical analysis shows how hard times during the Great Depression also aligned big business interests with those of reformers seeking compulsory social insurance. Unlike the present case, however, the economic climate did not quickly improve, and the social insurance reform of the New Deal succeeded. The article speculates, therefore, that had employer health expenditures not flattened out, continuing and even growing big business support might have neutralized small business and other opposition that contributed heavily to the failure of reform. Thus in light of the Clinton administration's demonstrated willingness to compromise with business on details of its plan, some kind of major reform might have succeeded.

  6. Hinge Atlas: relating protein sequence to sites of structural flexibility

    OpenAIRE

    Yang Julie; Lu Long J; Flores Samuel C; Carriero Nicholas; Gerstein Mark B

    2007-01-01

    Abstract Background Relating features of protein sequences to structural hinges is important for identifying domain boundaries, understanding structure-function relationships, and designing flexibility into proteins. Efforts in this field have been hampered by the lack of a proper dataset for studying characteristics of hinges. Results Using the Molecular Motions Database we have created a Hinge Atlas of manually annotated hinges and a statistical formalism for calculating the enrichment of v...

  7. Thin film solar cell inflatable ultraviolet rigidizable deployment hinge

    Science.gov (United States)

    Simburger, Edward J. (Inventor); Matsumoto, James H. (Inventor); Giants, Thomas W. (Inventor); Garcia, III, Alec (Inventor); Perry, Alan R. (Inventor); Rawal, Suraj (Inventor); Marshall, Craig H. (Inventor); Lin, John K. H. (Inventor); Day, Jonathan Robert (Inventor); Kerslake, Thomas W. (Inventor)

    2010-01-01

    A flexible inflatable hinge includes curable resin for rigidly positioning panels of solar cells about the hinge in which wrap around contacts and flex circuits are disposed for routing power from the solar cells to the power bus further used for grounding the hinge. An indium tin oxide and magnesium fluoride coating is used to prevent static discharge while being transparent to ultraviolet light that cures the embedded resin after deployment for rigidizing the inflatable hinge.

  8. Hinge(ga) Brand - tõhusaim relv mõrtsukate ja varaste vastu / Hinge Brand ; interv. Kaarel Kressa

    Index Scriptorium Estoniae

    Brand, Hinge, 1940-2007

    2006-01-01

    Intervjuu 40 aastat prokuröriametit pidanud ja pensionile siirduva Hinge Brandiga. Lisatud: Hinge Brandi CV ning Põhja ringkonnaprokuratuuri erisasjade prokuröri Jüri Kasesalu, siseministeeriumi arendusjuhi Lauri Taburi ja keskkriminaalpolitsei politseijuhtivinspektori Margus Maasepa kommentaarid

  9. Hinge(ga) Brand - tõhusaim relv mõrtsukate ja varaste vastu / Hinge Brand ; interv. Kaarel Kressa

    Index Scriptorium Estoniae

    Brand, Hinge, 1940-2007

    2006-01-01

    Intervjuu 40 aastat prokuröriametit pidanud ja pensionile siirduva Hinge Brandiga. Lisatud: Hinge Brandi CV ning Põhja ringkonnaprokuratuuri erisasjade prokuröri Jüri Kasesalu, siseministeeriumi arendusjuhi Lauri Taburi ja keskkriminaalpolitsei politseijuhtivinspektori Margus Maasepa kommentaarid

  10. Did capitation payment reform make a difference in Chinese rural primary health care?

    Directory of Open Access Journals (Sweden)

    Jing Sun

    2014-02-01

    Full Text Available This paper evaluated the effect of capitation payment reform in New Rural Cooperative Medical Scheme designating primary facilities in Qianjiang 2007-2009. Retrospective administrative claims were analyzed. Intercepts changes of cost per visit in facilities started the reform in different stages and of overall Qianjiang were compared. Referral rate, prescribing indicators, hospitalization rate, income of facility and individuals were compared pre- and post- the reform. Growth rate of cost per visit in health centers was contained in 2008, kept unchanged in 2009. Cost containment effect on village clinics was observed in each starting stage of reforms, but vanished later on. Except for the fact the proportion of essential medicines used in health centers significantly increased (X2 test, P<0.05, prescription indicators were not improved significantly in all facilities. After a slight increase in 2007, the hospitalization rate continuously dropped. The monthly income and outpatient revenue continuously increased in 2006-2009. Cost containment objective of the capitation reform was achieved immediately following the reform, but was not sustainable. Provider behaviors were partially improved with limited effects on prescriptions behaviors. The reform brought no financial loss to both the facilities and individuals.

  11. Commentary: Personalized health planning and the Patient Protection and Affordable Care Act: an opportunity for academic medicine to lead health care reform.

    Science.gov (United States)

    Dinan, Michaela A; Simmons, Leigh Ann; Snyderman, Ralph

    2010-11-01

    The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application.

  12. Wisconsin's BadgerCare Plus reform: impact on low-income families' enrollment and retention in public coverage.

    Science.gov (United States)

    Leininger, Lindsey Jeanne; Friedsam, Donna; Dague, Laura; Mok, Shannon; Hynes, Emma; Bergum, Alison; Aksamitauskas, Milda; Oliver, Thomas; DeLeire, Thomas

    2011-02-01

    To examine the impact of a Wisconsin health care reform enacted in early 2008 on public insurance enrollment and retention. Administrative data covering the period January 2007 to November 2009. We calculate unadjusted enrollment trends and exit rates stratified by age, income group, and enrollment mode. Kaplan-Meier curves and Cox proportional hazards models are estimated to assess the impact of the reform on program exits. Overall enrollment increased by approximately one-third and exit rates decreased by approximately one-fifth. The majority of new enrollment came from the previously income eligible. Wisconsin's enactment of eligibility expansions coupled with administrative simplification and targeted marketing and outreach efforts were successful in enrolling and retaining low-income children and families in public coverage. © Health Research and Educational Trust.

  13. Change of government: one more big bang health care reform in England's National Health Service.

    Science.gov (United States)

    Hunter, David J

    2011-01-01

    Once again the National Health Service (NHS) in England is undergoing major reform, following the election of a new coalition government keen to reduce the role of the state and cut back on big government. The NHS has been undergoing continuous reform since the 1980s. Yet, despite the significant transaction costs incurred, there is no evidence that the claimed benefits have been achieved. Many of the same problems endure. The reforms follow the direction of change laid down by the last Conservative government in the early 1990s, which the recent Labour government did not overturn despite a commitment to do so. Indeed, under Labour, the NHS was subjected to further market-style changes that have paved the way for the latest round of reform. The article considers the appeal of big bang reform, questions its purpose and value, and critically appraises the nature and extent of the proposed changes in this latest round of reform. It warns that the NHS in its current form may not survive the changes, as they open the way to privatization and a weakening of its public service ethos.

  14. On mechanical properties of planar flexure hinges of compliant mechanisms

    Directory of Open Access Journals (Sweden)

    F. Dirksen

    2011-06-01

    Full Text Available The synthesis of compliant mechanisms yield optimized topologies that combine several stiff parts with highly elastic flexure hinges. The hinges are often represented in finite element analysis by a single node (one-node hinge leaving doubts on the physical meaning as well as an uncertainty in the manufacturing process.

    To overcome this one-node hinge problem of optimized compliant mechanisms' topologies, one-node hinges need to be replaced by real flexure hinges providing desired deflection range and the ability to bear internal loads without failure. Therefore, several common types of planar flexure hinges with different geometries are characterized and categorized in this work providing a comprehensive guide with explicit analytical expressions to replace one-node hinges effectively.

    Analytical expressions on displacements, stresses, maximum elastic deformations, bending stiffness, center of rotation and first natural frequencies are derived in this work. Numerical simulations and experimental studies are performed validating the analytical results. More importance is given to practice-oriented flexure hinge types in terms of cost-saving manufacturability, i.e. circular notch type hinges and rectangular leaf type hinges.

  15. Hinge Atlas: relating protein sequence to sites of structural flexibility

    Directory of Open Access Journals (Sweden)

    Yang Julie

    2007-05-01

    Full Text Available Abstract Background Relating features of protein sequences to structural hinges is important for identifying domain boundaries, understanding structure-function relationships, and designing flexibility into proteins. Efforts in this field have been hampered by the lack of a proper dataset for studying characteristics of hinges. Results Using the Molecular Motions Database we have created a Hinge Atlas of manually annotated hinges and a statistical formalism for calculating the enrichment of various types of residues in these hinges. Conclusion We found various correlations between hinges and sequence features. Some of these are expected; for instance, we found that hinges tend to occur on the surface and in coils and turns and to be enriched with small and hydrophilic residues. Others are less obvious and intuitive. In particular, we found that hinges tend to coincide with active sites, but unlike the latter they are not at all conserved in evolution. We evaluate the potential for hinge prediction based on sequence. Motions play an important role in catalysis and protein-ligand interactions. Hinge bending motions comprise the largest class of known motions. Therefore it is important to relate the hinge location to sequence features such as residue type, physicochemical class, secondary structure, solvent exposure, evolutionary conservation, and proximity to active sites. To do this, we first generated the Hinge Atlas, a set of protein motions with the hinge locations manually annotated, and then studied the coincidence of these features with the hinge location. We found that all of the features have bearing on the hinge location. Most interestingly, we found that hinges tend to occur at or near active sites and yet unlike the latter are not conserved. Less surprisingly, we found that hinge residues tend to be small, not hydrophobic or aliphatic, and occur in turns and random coils on the surface. A functional sequence based hinge predictor was

  16. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Science.gov (United States)

    Harris, Mark F; Advocat, Jenny; Crabtree, Benjamin F; Levesque, Jean-Frederic; Miller, William L; Gunn, Jane M; Hogg, William; Scott, Cathie M; Chase, Sabrina M; Halma, Lisa; Russell, Grant M

    2016-01-01

    Context A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood. Objective To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices. Design Collaborative synthesis of 12 mixed methods studies. Setting Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec). Methods We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context. Results There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups. Conclusion The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that

  17. The effects of national health care reform on local businesses--Part III: secondary research questions--discoveries and implications.

    Science.gov (United States)

    Rotarius, Timothy; Liberman, Aaron; Perez, Bianca

    2012-01-01

    This is the third part of a 3-part examination of what may potentially be expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that nationally members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (years 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

  18. The effects of national health care reform on local businesses--part II: study methodology and primary research questions.

    Science.gov (United States)

    Liberman, Aaron; Rotarius, Timothy; Perez, Bianca

    2012-01-01

    This is the second part of a 3-part examination of what may be potentially expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that, nationally, members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be-newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

  19. Patient turnover and nursing employment in Massachusetts hospitals before and after health insurance reform: implications for the Patient Protection and Affordable Care Act.

    Science.gov (United States)

    Shindul-Rothschild, Judith; Gregas, Matt

    2013-01-01

    The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (phospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.

  20. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Kristin M Huntoon

    Full Text Available CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA, legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7% were unsure if quality will be improved. Two thirds (67.6% believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8% opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

  1. Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

    Science.gov (United States)

    Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

    2017-03-22

    Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

    Directory of Open Access Journals (Sweden)

    Zakaria Kiaei

    2015-11-01

    Full Text Available Background The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84. Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA, Pearson correlation test and one sample t-test. Results A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05 and the average score of these fields were upper than average. Conclusions The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.

  3. The basis for improving and reforming long-term care. Part 4: identifying meaningful improvement approaches (segment 2).

    Science.gov (United States)

    Levenson, Steven A

    2010-03-01

    While many aspects of nursing home care have improved over time, numerous issues persist. Presently, a potpourri of approaches and a push to "fix" the problem have overshadowed efforts to correctly define the problems and identify their diverse causes. This fourth and final article in the series (divided between last month's issue and this one) recommends strategies to make sense of improvement and reform efforts. This month's concluding segment covers additional proposed approaches. Despite the challenges of the current environment, all of the proposed strategies could potentially be applied with little or no delay. Despite having brought vast increases in knowledge, the research effort may be losing its traction as a formidable force for meaningful change. It is necessary to rethink the questions being asked and the scope of answers being sought. A shift to overcoming implementation challenges is needed. In addition, it is essential to address issues of jurisdiction (the apparent "ownership" of assessment and decision making over patient problems or body parts) and reductionism (the excessive management of these issues and problems without proper context) that result in fragmented and problematic care. Issues of knowledge and skill also need to be addressed, with greater emphasis on key generic and technical competencies of staff and practitioners, in addition to factual knowledge. There is a need to rethink the approach to measuring performance and trying to improve quality of care and services. There are significant limits to trying to use quality measures to improve outcomes and performance. Ultimately, vast improvement is needed in applying care principles and practices, independent of regulatory sources. Reimbursement needs to be revamped so that it helps promote care that is consistent with human biology and other key concepts. Finally, improving long-term care will require a coordinated societal effort. All social institutions and health care settings need

  4. Influence of the cardiac myosin hinge region on contractile activity.

    OpenAIRE

    Margossian, S S; Krueger, J W; Sellers, J R; Cuda, G; Caulfield, J B; Norton, P.; Slayter, H. S.

    1991-01-01

    The participation of cardiac myosin hinge in contractility was investigated by in vitro motility and ATPase assays and by measurements of sarcomere shortening. The effect on contractile activity was analyzed using an antibody directed against a 20-amino acid peptide within the hinge region of myosin. This antibody bound specifically at the hinge at a distance of 55 nm from the S1/S2 junction, was specific to human, dog, and rat cardiac myosins, did not crossreact with gizzard or skeletal myos...

  5. Creating incentives to move upstream: developing a diversified portfolio of population health measures within payment and health care reform.

    Science.gov (United States)

    Auerbach, John

    2015-03-01

    I examined the feasibility of developing a balanced portfolio of population health measures that would be useful within the current deliberations about health care and payment reform. My commentary acknowledges that an obstacle to the selection of population health metrics is the differing definitions of population health. Rather than choosing between these definitions, I identified five categories of indicators, ranging from traditional clinical care prevention interventions to those that measure investment in community-level nonclinical services, that in various combinations might yield the most promising results. I offer concrete examples of markers in each of the categories and show that there is a growing number of individuals eager to receive concrete recommendations and implement population health pilot programs.

  6. Impact of Alabama's immigration law on access to health care among Latina immigrants and children: implications for national reform.

    Science.gov (United States)

    White, Kari; Yeager, Valerie A; Menachemi, Nir; Scarinci, Isabel C

    2014-03-01

    We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama's 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children's access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women's increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

  7. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective.

    Science.gov (United States)

    Levenson, Steven A; Desai, Abhilash K

    2017-02-24

    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed.

  8. Precision Hinge Actuator for Advanced Telescope Systems Project

    Data.gov (United States)

    National Aeronautics and Space Administration — CTD proposes to investigate the deployment repeatability and microdynamic stability of a hinge and demonstration this repeatability in a deployable mirror test...

  9. Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat; Comment on “Governance, Government, and the Search for New Provider Models”

    Directory of Open Access Journals (Sweden)

    Monica Andersson Bäck

    2016-08-01

    Full Text Available Recognizing the advantages of primary care as a means of improving the entire health system, this text comments on reforms of publicly funded primary health centers, and the rapid development of private forprofit providers in Sweden. Many goals and expectations are connected to such reforms, which equally require critical analyses of scarce resources, professional trust/motivation and business logic in the wake of freedom and control of ownership and management. In line with Saltman and Duran, this article calls for research and a methodologically developed approach to capture everyday practice in-depth and how regulation, market incentives and patient demands are met by professionals and primary care leaders.

  10. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Directory of Open Access Journals (Sweden)

    Harris MF

    2016-01-01

    Full Text Available Mark F Harris,1 Jenny Advocat,2 Benjamin F Crabtree,3 Jean-Frederic Levesque,1,4 William L Miller,5 Jane M Gunn,6 William Hogg,7 Cathie M Scott,8 Sabrina M Chase,9 Lisa Halma,10 Grant M Russell11 1Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia; 3Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 4Bureau of Health Information, NSW Government, Sydney, NSW, Australia; 5Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA; 6Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia; 7The CT Lamont Primary Care Research Center, The University of Ottawa, Ottawa, ON, 8Alberta Centre for Child, Family, and Community Research, University of Calgary, AB, Canada; 9Rutgers University, Rutgers School of Nursing, Rutgers, NJ, USA; 10Alberta Health Services, Lethbridge, AB, Canada; 11School of Primary Health Care, Monash University, Notting Hill, VIC, Australia Context: A key aim of reforms to primary health care (PHC in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.Objective: To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.Design: Collaborative synthesis of 12 mixed methods studies.Setting: Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec.Methods: We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they

  11. "A campaign won as a public issue will stay won": using cartoons and comics to fight national health care reform, 1940s and beyond.

    Science.gov (United States)

    Knoblauch, Heidi Katherine

    2014-02-01

    On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption "Result of ObamaCare" to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word "socialism." The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform.

  12. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2015-06-01

    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  13. Synthesis and Optimisation of Large Stroke Flexure Hinges

    NARCIS (Netherlands)

    Grootens, Martijn; Aarts, Ronald; Brouwer, Dannis; Wenger, Philippe; Flores, Paulo

    2016-01-01

    Flexure hinges are advantageous for use in high-precision applications because of their lack of hysteresis, friction and backlash. However, their range of motion is limited due to increasing stresses and a decreasing support stiffness at large strokes. Currently available hinges are typically design

  14. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

    Directory of Open Access Journals (Sweden)

    Donald Murphy R

    2011-07-01

    Full Text Available Abstract It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs. Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

  15. Study on the Hinge-joined Plate Method

    Directory of Open Access Journals (Sweden)

    Li Sha

    2015-01-01

    Full Text Available In order to verify and perfect the theory of hinge-joined plate method and make it serve the bridge design better, this paper was written based on an actual bridge, and the ANSYS finite element model was established. Compared the hinge-joined plate method results with the analysis results and through the investigation and data analysis, it could be found that the assumption that the hinge-joined plate theory for the board lateral force transmission is reasonable, but the assuming hinge joints that only withstand shear stress and just have the shear checking is unreasonable. At the same time, this paper also proved that the strength reduction getting from the old and new concrete interface should be taken into account when using the hinge-joined plate method to calculate the transverse distribution coefficient and the effects on overall stiffness that the joint depth and thickness of deck pavement to the beam bridge.

  16. Vibration control of flexible beams using an active hinge

    Science.gov (United States)

    Cudney, H. H., Jr.; Inman, D. J.; Horner, G. C.

    1985-01-01

    The use of an active hinge to attenuate the transverse vibrations of a flexible beam is examined. A slender aluminum beam is suspended vertically, cantilevered at the top. An active hinge is placed at the node of the second vibration mode. The active hinge consists of a torque motor, strain gauge, and tachometer. A control law is implemented using both beam-bending strain and the relative angular velocity measured at this hinge, thereby configuring the hinge to act as an active damper. Results from implementing this control law show little improvement in the first mode damping ratio, 130 percent increase in the second mode damping ratio, and 180 percent increase in the third mode damping ratio. The merits of using a motor with a gearbox are discussed.

  17. Accountable care organizations and kidney disease care: health reform innovation or more same-old, same-old?

    Science.gov (United States)

    Pauly, Mark V

    2012-10-01

    The conceptual model for an accountable care organization imagines that care will be rendered to a defined population by an entity that receives bundled payment for that care, coordinates the individual services involved in that care, provides measures of outcomes and quality, and divides the bundled payment among those who supply services. How does this concept differ from earlier efforts, and what, if anything, does it mean for the care of patients with end-stage renal disease? The concept is similar to the largely abandoned integrated delivery networks of the 1990s. The support from Medicare may make a difference, but Medicare's need to constrain spending growth will pose a challenge. Kidney disease care is already much more coordinated than health care for the rest of the population. There are some potential gains from greater coordination, especially with care for comorbid conditions associated with hospitalization. However, economic analysis suggests that the absence of large populations of patients in given geographic sites and the relatively smaller gain from incremental improvements in coordination might mean that the accountable care organization model are not ideal for the dialysis market.

  18. What's at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care.

    Science.gov (United States)

    Rambur, Betty A

    2017-01-01

    The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven "volume to value" reimbursement changes. Moreover, popular and controversial elements of the ACA-for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision-are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses' capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.

  19. “A Campaign Won as a Public Issue Will Stay Won”: Using Cartoons and Comics to Fight National Health Care Reform, 1940s and Beyond

    Science.gov (United States)

    Knoblauch, Heidi Katherine

    2014-01-01

    On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption “Result of ObamaCare” to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word “socialism.” The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform. PMID:24328659

  20. Care for chronic illness in Australian general practice – focus groups of chronic disease self-help groups over 10 years: implications for chronic care systems reforms

    Directory of Open Access Journals (Sweden)

    Martin Carmel M

    2009-01-01

    themes around chronic illness experience and care needs remained consistent over the 10 year period. Reforms did not appear to alleviate the burden of chronic illness across disease groups, yet some were more privileged than others. Thus in the future, chronic care reforms should build from greater understanding of the needs of people with chronic illness.

  1. Building a health care workforce for the future: more physicians, professional reforms, and technological advances.

    Science.gov (United States)

    Grover, Atul; Niecko-Najjum, Lidia M

    2013-11-01

    Traditionally, projections of US health care demand have been based upon a combination of existing trends in usage and idealized or expected delivery system changes. For example, 1990s health care demand projections were based upon an expectation that delivery models would move toward closed, tightly managed care networks and would greatly decrease the demand for subspecialty care. Today, however, a different equation is needed on which to base such projections. Realistic workforce planning must take into account the fact that expanded access to health care, a growing and aging population, increased comorbidity, and longer life expectancy will all increase the use of health care services per capita over the next few decades--at a time when the number of physicians per capita will begin to drop. New technologies and more aggressive screening may also change the equation. Strategies to address these increasing demands on the health system must include expanded physician training.

  2. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

    Science.gov (United States)

    Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

    2017-01-01

    One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

  3. 奥巴马医疗改革管窥%On President Obama's health care reform

    Institute of Scientific and Technical Information of China (English)

    梁兴莉

    2011-01-01

    US President Obama's health care reform,approved with great difficulties,is not only Democrats' victory over Republicans,but also liberals' victory over conservatives.Behind victory,the competition against perception and group benefits is worth considering.In Democrats' opinion,health care is part of basic human rights,but Republicans don't agree.In the old health care system,insurance companies and medicine producers benefit most,but in the new system,more competition occurs in the market and at the same time federal government is under more financial pressure.%奥巴马总统力推的医疗改革方案冲破重重阻力艰难通过,这不仅是奥巴马政府中民主党在与共和党斗争中的胜利,也是美国历史上自由派对保守派的胜利。其背后的理念之争和利益集团之争值得深思:民主党认为医疗保险是一项基本人权,而共和党完全反对;保险业和医药界是旧体制的最大获益者,而新体制鼓励市场竞争,同时政府的负担也大增。

  4. Event Attention, Environmental Sensemaking, and Change in Institutional Logics: An Inductive Analysis of the Effects of Public Attention to Clinton's Health Care Reform Initiative.

    OpenAIRE

    Nigam, A; Ocasio, W.

    2010-01-01

    We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, hig...

  5. God of the hinge: treating LGBTQIA patients.

    Science.gov (United States)

    Boland, Annie

    2017-11-01

    This paper looks at systems of gender within the context of analysis. It explores the unique challenges of individuation faced by transsexual, transgender, gender queer, gender non-conforming, cross-dressing and intersex patients. To receive patients generously we need to learn how a binary culture produces profound and chronic trauma. These patients wrestle with being who they are whilst simultaneously receiving negative projections and feeling invisible. While often presenting with the struggles of gender conforming individuals, understanding the specifically gendered aspect of their identity is imperative. An analyst's unconscious bias may lead to iatrogenic shaming. The author argues that rigorous, humble inquiry into the analyst's transphobia can be transformative for patient, analyst, and the work itself. Analysis may, then, provide gender-variant patients with their first remembered and numinous experience of authentic connection to self. Conjuring the image of a hinge, securely placed in the neutral region of a third space, creates a transpositive analytic temenos. Invoking the spirit of the Trickster in the construction of this matrix supports the full inclusion of gender-variant patients. Nuanced attunement scaffolds mirroring and the possibility of play. Being mindful that gender is sturdy and delicate as well as mercurial and defined enriches the analyst's listening. © 2017, The Society of Analytical Psychology.

  6. Hinged distraction of the adolescent arthritic hip.

    Science.gov (United States)

    Thacker, Mihir M; Feldman, David S; Madan, Sanjeev S; Straight, Joseph J; Scher, David M

    2005-01-01

    From 1996 to 2000, 11 adolescents with hip joint arthritis secondary to osteonecrosis or idiopathic chondrolysis were treated with articulated hinged distraction arthroplasty. Indications for surgery were severe pain and limited ambulation. Charts and radiographs were reviewed. Clinical status was assessed preoperatively and at latest follow-up (mean 4.8 years after surgery) using criteria of pain, range of motion, and ambulation level. Ten patients showed improved clinical status, with seven having an excellent outcome and three a good outcome. One patient failed distraction. Mean joint space was 2.6 mm before surgery and 4.8 mm at latest follow-up. Average duration of fixator use was 4.4 months. Four patients (36.4%) had complications. Articulated hip distraction was effective in eliminating pain, improving function, and preventing progressive degenerative changes in young patients' hips. It should be considered a salvage procedure for arthritic hips and an alternative to arthrodesis in this difficult-to-treat group of patients.

  7. Opportunities and Threats for College Women's Health: Health Care Reform and Higher Education

    Science.gov (United States)

    Yakaboski, Tamara; Hunter, Liz; Manning-Ouellette, Amber

    2014-01-01

    The Patient Protection and Affordable Care Act (PPACA) of 2010 (P.L. 118-148) has already changed college students' health care options and has a larger impact on women as they outnumber men in college enrollment and require unique services. Through a feminist policy framework, we discuss how the PPACA impacts college women's health and…

  8. Specialty, political affiliation, and perceived social responsibility are associated with U.S. physician reactions to health care reform legislation.

    Science.gov (United States)

    Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

    2014-02-01

    Little is known about how U.S. physicians’ political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians’ impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S.physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6–46.2]; OR 5.0 [95 % CI, 3.7–6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2–2.5])or salary plus bonus (OR 1.4 [95 % CI, 1.1–1.9)compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0–2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI,1.3–2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8

  9. Organization and functioning of primary care for women in Croatia: in relation to the health care reforms introduced between 1995 and 2012.

    Science.gov (United States)

    Nižetić, Vlatka Topolovec; Srček, Igor; Rodin, Urelija; Tiljak, Hrvoje

    2014-12-01

    The main aim of this study was to investigate trends in the organization and functioning of the HC service. The Croatian Health Service Yearbooks, from 1995 to 2012, served as the basis for the data. The results showed that the HC reforms aimed at the organization and functioning of primary care for women somehow compromised their accessibility. A general lack of around 100 gynecologists, the huge number of women on the lists, from 4, 350 to 8,061 women, and excessively heavy daily consultations, between 23.8 and 28.4, were all observed. The location of the majority of gynecological practices in the big cities also makes the service inaccessible to women from the rural areas. A flow of service away from the public to the private providers was also observed. Since, the results of this study can be viewed only in terms of trends and more detailed research will be needed in future.

  10. INFLUENCING OF FRICTION IN HINGES FORCE SIZE OF BARS

    Directory of Open Access Journals (Sweden)

    BOHOMAZ V. N.

    2016-04-01

    Full Text Available Formulation of the problem. The size of critical force of bar on the traditional method of calculation is determined in supposition of ideal hinge in the place of fixing of bar. There are both a hinge resistance at the turn of bar ends and their moving in the real hinges. Thus, there is the necessity of influencing character determination of these hinge imperfections on the size of critical force. In the existent scientific labours is devoted the alike problems, influencing of friction in the hinges of bar fastening on the size of critical force was not taken into account. At determination of bars stability with no ideality of hinges friction in them it is possible to take into account by the eccentric appendix of loading or appendix of moment. However at such approach it is difficult enough to define the size of attached force or moment. Purpose. To set influencing of friction in the hinge of bar fastening on of his critical force size in sense of Euler, and also build dependences for determination of bar critical force taking into account mechanical descriptions of hinges materials. Conclusion. For the task of determination the size of bar critical force with the joint fastening on ends are got the dependences which take into account mechanical descriptions of material hinge. The received dependences allow to define more exact meaning of critical force for bars. The examples of calculation of whole bar and bar with undercuting in the middle are resulted that values of critical force, certain on a traditional method are overpriced.

  11. Impact of health care reform on the cancer patient: a view from cancer executives.

    Science.gov (United States)

    Ferris, Linda W; Farber, Matthew; Guidi, Teri Ursin; Laffey, William J

    2010-01-01

    Cancer leaders assess the impact on the cancer patient of the historic passage of Patient Protection and Affordable Care Act (HR 3590) (PPACA). The Association of Cancer Executives, a national organization for leadership development of oncology executives and improvements in patient care delivery, and the Association of Community Cancer Centers, a leading education and advocacy organization for the cancer team, weigh in on the impact of PPACA. Oncology leaders assess the impact of PPACA on cancer patients and families, cancer programs in the United States, and provider relations. The provisions of PPACA most impacting cancer patients are reviewed, including reimbursement changes, expansion of prevention and screening services, the development of accountable care organizations, physician relations, and the implementation of integrated electronic health records. Cancer executives prepare their programs for PPACA by changing the care delivery model to ensure the economic survival of private practices and hospital-based programs.

  12. ["Meet the AIX-PERTs." Emergency medical care at the beginning of the medical reform curriculum in Aachen].

    Science.gov (United States)

    Beckers, S; Bickenbach, J; Fries, M; Hoffmann, N; Classen-Linke, I; Killersreiter, B; Wainwright, U; Kuhlen, R; Rossaint, R

    2004-06-01

    Extensive knowledge and skills in the basics of emergency medical care are of paramount importance for every physician and should therefore be an integral part of medical education. Regulations for medical licensure in Germany were revised by the administrative authorities in 2002 and as a consequence the Medical Faculty of the University of Aachen (Germany) decided to start the Medical Reform Curriculum Aachen. A multidisciplinary, problem-oriented and organ-related approach to medical education replaces the classical discrimination between basic and clinical sciences. With AIX-PERT (AIX-la-Chapelle Program for Emergency medical care and Resuscitation Training), a program consisting of problem-based learning sessions was developed for introduction to the first year students. Defined teaching objectives in emergency medicine are now incorporated in undergraduate medical education. The extremely positive evaluation of the new approach encouraged us to promote AIX-PERT further. In the future the effects of success of this approach will be assessed by longitudinal studies of skills and knowledge during the continuing curriculum.

  13. [Economic aspects of anesthesia. I. Health care reform in the German Republic].

    Science.gov (United States)

    Bach, A; Bauer, M

    1998-03-01

    Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

  14. Adjustable hinge permits movement of knee in plaster cast

    Science.gov (United States)

    Maley, W. E.

    1967-01-01

    Metal knee hinge with an adjustable sleeve worn on the outside of a leg cast facilitates movement of the knee joint. This helps eliminate stiffness of the knee and eliminates bulkiness and adjustment difficulty.

  15. Socialist government health policy reforms in Bolivia and Ecuador: The underrated potential of integrated care to tackle the social determinants of health

    Directory of Open Access Journals (Sweden)

    Herland Tejerina

    2009-12-01

    Full Text Available Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries’ health system’s features after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods Qualitative document analysis. Findings Earlier reform left Bolivia’s and Ecuador’s population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming and targeting are largely left unattended. Neglecting care is understandable in the light of particular interpretations of social medicine and social determinants, international policy pressures, reliance on external funding and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification. It might not improve health and worsen poverty. Interpretation Care can be considered as a social determinant on its own. Key to the accomplishment of primary care is an integrated application of family medicine, taking advantage of individual care as one of the ways to act on social determinants. It deserves a central place on the policy-makers’ priority list, in Bolivia and Ecuador as elsewhere.

  16. Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands.

    Science.gov (United States)

    Janssen, David; Jongen, Wesley; Schröder-Bäck, Peter

    2016-08-01

    In this case study, European quality benchmarks were used to explore the contemporary quality of the long-term care provision for older people in the Belgian region of Flanders and the Netherlands following recent policy reforms. Semi-structured qualitative interviews were conducted with various experts on the long-term care provision. The results show that in the wake of the economic crisis and the reforms that followed, certain vulnerable groups of older people in Belgium and the Netherlands are at risk of being deprived of long-term care that is available, affordable and person-centred. Various suggestions were provided on how to improve the quality of the long-term care provision. The main conclusion drawn in this study is that while national and regional governments set the stage through regulatory frameworks and financing mechanisms, it is subsequently up to long-term care organisations, local social networks and informal caregivers to give substance to a high quality long-term care provision. An increased reliance on social networks and informal caregivers is seen as vital to ensure the sustainability of the long-term care systems in Belgium and in the Netherlands, although this simultaneously introduces new predicaments and difficulties. Structural governmental measures have to be introduced to support and protect informal caregivers and informal care networks.

  17. The Affordable Care Act's pre-existing condition insurance plan: enrollment, costs, and lessons for reform.

    Science.gov (United States)

    Hall, Jean P; Moore, Janice M

    2012-09-01

    The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool created under the Affordable Care Act to provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes avail­able to them. Nearly 78,000 people have enrolled since the program was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the Affordable Care Act and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.

  18. Foundational ethics of the health care system: the moral and practical superiority of free market reforms.

    Science.gov (United States)

    Sade, Robert M

    2008-10-01

    Proposed solutions to the problems of this country's health care system range along a spectrum from central planning to free market. Central planners and free market advocates provide various ethical justifications for the policies they propose. The crucial flaw in the philosophical rationale of central planning is failure to distinguish between normative and metanormative principles, which leads to mistaken understanding of the nature of rights. Natural rights, based on the principle of noninterference, provide the link between individual morality and social order. Free markets, the practical expression of natural rights, are uniquely capable of achieving the goals that central planners seek but find beyond their grasp. The history of this country's health care system and the experiences of other nations provide evidence of the superiority of free markets in reaching for the goals of universal access, control of costs, and sustaining the quality of health care.

  19. Principle of bio-inspired insect wing rotational hinge design

    Science.gov (United States)

    Fei, Fan

    A principle for designing and fabricating bio-inspired miniature artificial insect flapping wing using flexure rotational hinge design is presented. A systematic approach of selecting rotational hinge stiffness value is proposed. Based on the understanding of flapping wing aerodynamics, a dynamic simulation is constructed using the established quasi-steady model and the wing design. Simulations were performed to gain insight on how different parameters affect the wing rotational response. Based on system resonance a model to predict the optimal rotational hinge stiffness based on given wing parameter and flapping wing kinematic is proposed. By varying different wing parameters, the proposed method is shown to be applicable to a wide range of wing designs with different sizes and shapes. With the selected hinge stiffness value, aspects of the rotational joint design is discussed and an integrated wing-hinge structure design using laminated carbon fiber and polymer film is presented. Manufacturing process of such composite structure is developed to achieve high accuracy and repeatability. The yielded hinge stiffness is verified by measurements. To validate the proposed model, flapping wing experiments were conducted. A flapping actuation set up is built using DC motor and a controller is implemented on a microcontroller to track desired wing stroke kinematic. Wing stroke and rotation kinematic were extracted using a high speed camera and the lift generation is evaluated. A total of 49 flapping experiments were presented, experimental data shows good correlation with the model's prediction. With the wing rotational hinge stiffness designed so that the rotational resonant frequency is twice as the stroke frequency, the resulting wing rotation generates near optimal lift. With further simulation, the proposed model shows low sensitivity to wing parameter variation. As a result, giving a design parameter of a flapping wing robot platform, the proposed principle can

  20. The human perspective on health care reform: coping with diabetes in Kyrgyzstan.

    Science.gov (United States)

    Hopkinson, Botagoz; Balabanova, Dina; McKee, Martin; Kutzin, Joseph

    2004-01-01

    Health systems world wide are confronted by the challenge of rising levels of chronic diseases. Yet existing approaches to health system analysis often fail to capture the complexity of the responses required to address this challenge. In this paper we describe the results of a pilot study using a rapid appraisal technique to assess the performance of the health care system in Kyrgyzstan, a former Soviet central Asian republic. The study focuses on diabetes, a condition whose effective management requires a coordinated response involving many components of the health care system. The study sets out a conceptual framework in which the system is seen from the perspectives of users, health professionals and policy-makers. It sees the effective delivery of health care as dependent on appropriate investment in human, physical, intellectual and social resources. The study reveals important weaknesses in all of these areas, although it also notes that current policies, while constrained by the legacy of the past and by limited resources, are beginning to tackle them. This pilot study indicates that rapid appraisal, using a condition such as diabetes, where those affected can be easily identified, offers a means of gaining important insights into a health care system.

  1. [Strengthening of the steering role of health++ authorities in health care reforms].

    Science.gov (United States)

    Marín, J M

    2000-01-01

    Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

  2. Inpatient psychiatric care in the 21st century: the need for reform.

    Science.gov (United States)

    Glick, Ira D; Sharfstein, Steven S; Schwartz, Harold I

    2011-02-01

    Driven by financial pressures, the sole focus of psychiatric inpatient treatment has become safety and crisis stabilization. Data are lacking on outcomes of ultrashort-stay hospitalizations; however, such stays may diminish opportunities for a sustained recovery. In the absence of an evidence base to guide clinicians and policy makers, mental health professionals have an ethical obligation to promote what they consider to be best practice. This Open Forum focuses on the need to reconsider the current model of inpatient hospitalization in order to maximize positive outcomes and emphasize appropriate transition to the community and less intensive levels of care. A model of care is presented based on rapid formulation of diagnosis, goals, and treatment modalities before treatment begins. Three phases are described--assessment, implementation, and resolution--with specific principles to guide length-of-stay decisions and requirements for staffing.

  3. Of honey and health policy: the limits of sweet, sticky substances in reforming primary care.

    Science.gov (United States)

    Martin, Danielle

    2012-01-01

    It is a well-known axiom that one attracts more flies with honey than vinegar. Nowhere has this approach been taken more to heart than in the past decade of primary care policy in Canada. Governments, physician and nursing organizations and regional health authorities have invested in a lot of "honey" to draw healthcare providers onto a path from single-physician offices to team-based care with flexible hours and a population-based approach. In the lead essay for this edition of Healthcare Papers, Kates and colleagues have outlined a framework that embraces this paradigm. Their articulation of a framework is a place to start, but it can only be a start. To make that framework come alive, a wider variety of policy tools will be needed than have been used thus far, and by a wider variety of actors. Within the healthcare workforce itself, leadership, vision and the courage to hold ourselves to account for changes to primary care are needed.

  4. Availability of Mental Health Services Prior to Health Care Reform Insurance Expansions.

    Science.gov (United States)

    West, Joyce C; Clarke, Diana E; Duffy, Farifteh Firoozmand; Barber, Keila D; Mojtabai, Ramin; Mościcki, Eve K; Kroeger Ptakowski, Kristin; Levin, Saul

    2016-09-01

    This study sought to examine psychiatrists' perceptions of gaps in the availability of mental health and substance use services and their ability to spend sufficient time and provide enough visits to meet patients' clinical needs. A cross-sectional probability survey of U.S. psychiatrists was fielded during September through December 2013 by using practice-based research methods, including distribution by priority mail. Psychiatrists (N=2,800) were randomly selected from the American Medical Association Physician Masterfile, and 1,188 of the 2,615 (45%) with deliverable addresses responded. Of those, 93% (N=1,099) reported currently treating psychiatric patients, forming the sample for this study. Thirty percent or more of psychiatrists reported being unable to provide or find a source for each of the following services in the past 30 days: psychotherapy, housing, supported employment, case management or assertive community treatment, and substance use treatment. Approximately 20% reported being unable to provide or find a source for inpatient treatment, psychosocial rehabilitation, general medical care, pharmacologic treatment, and child and adolescent treatment. Approximately half (52%) of psychiatrists reported not having enough time during patient visits, affecting 28% of patients. More than one-third (37%) reported being unable to provide enough visits to meet patients' clinical needs, affecting 24% of patients. Psychiatrists reported constrained availability of a range of mental health, substance use, and general medical services. In order for the Affordable Care Act to realize the promise of increased access to care, the infrastructure for mental health and substance use treatment, workforce, and services delivery may require significant enhancement.

  5. 浅谈新课改下“案例教学法”在中职德育课教学中的运用%A Brief Discussion on the Application of Case-based Teac-hing Approach in the Teaching of Secondary Vocational Moral Education Course under the New Curriculum Re-form

    Institute of Scientific and Technical Information of China (English)

    梁胜荣

    2014-01-01

    Impelled by a new round of curriculum reform, the textbooks for secondary vocational moral education course is transforming from the traditional "chalk and talk" pattern to case-based, problem-based and activity-based pattern. The new curriculum reform requires that secondary vocational moral edu-cation teachers should transform their old teaching ideas and styles and use advanced teaching methods. This paper elaborated from the connotation of case-based teaching approach, case se-lection, and problems that should be noticed in case-based teaching, emphasized that the application of case-based teaching approach in secondary vocational moral education course is con-ducive to the motivation of students' enthusiasm, the stimulation of their learning interest, the cultivation of their comprehensive ability, and the improvement of teaching effect.%在新一轮课程改革的推动下,中职学校德育课教材由传统的说教性、灌输性向案例性、问题性和活动性转变。新课改要求中职德育教师转变旧的教学理念和方式,使用先进的教学方法。本文从“案例教学法”的含义、案例的编选以及案例教学中需注意的问题等几方面来阐述,强调中职德育课采用“案例教学法”有利于调动学生的积极性,激发学生的学习兴趣,培养学生的综合能力,并提高教学效果。

  6. Going for the gold: the redistributive agenda behind market-based health care reform.

    Science.gov (United States)

    Evans, R G

    1997-04-01

    Political conflict over the respective roles of the state and the market in health care has a long history. Current interest in market approaches represents the resurgence of ideas and arguments that have been promoted with varying intensity throughout this century. (In practice, advocates have never wanted a truly competitive market, but rather one managed by and for particular private interests). Yet international experience over the last forty years has demonstrated that greater reliance on the market is associated with inferior system performance--inequity, inefficiency, high cost, and public dissatisfaction. The United States is the leading example. So why is this issue back again? Because market mechanisms yield distributional advantages for particular influential groups. (1) A more costly health care system yields higher prices and incomes for suppliers--physicians, drug companies, and private insurers. (2) Private payment distributes overall system costs according to use (or expected use) of services, costing wealthier and healthier people less than finance from (income-related) taxation. (3) Wealthy and unhealthy people can purchase (real or perceived) better access or quality for themselves, without having to support a similar standard for others. Thus there is, and always has been, a natural alliance of economic interest between service providers and upper-income citizens to support shifting health financing from public to private sources. Analytic arguments for the potential superiority of hypothetical competitive markets are simply one of the rhetorical forms through which this permanent conflict of economic interest is expressed in political debate.

  7. The impact of welfare reform on parents' ability to care for their children's health.

    Science.gov (United States)

    Heymann, S J; Earle, A

    1999-04-01

    Most of the national policy debate regarding welfare assumed that if middle-income mothers could balance work while caring for their children's health and development, mothers leaving welfare for work should be able to do so as well. Yet, previous research has not examined the conditions faced by mothers leaving welfare for work. Using data from the National Longitudinal Survey of Youth, this study examined the availability of benefits that working parents commonly use to meet the health and developmental needs of their children; paid sick leave, vacation leave, and flexible hours. In comparison with mothers who had never received welfare, mothers who had been on Aid to Families with Dependent Children were more likely to be caring for at least 1 child with a chronic condition (37% vs 21%, respectively). Yet, they were more likely to lack sick leave for the entire time they worked (36% vs 20%) and less likely to receive other paid leave or flexibility. If current welfare recipients face similar conditions when they return to work, many will face working conditions that make it difficult or impossible to succeed in the labor force at the same time as meeting their children's health and developmental needs.

  8. Does the Accountable Care Act Aim to Promote Quality, Health, and Control Costs or Has It Missed the Mark? ;Comment on “Health System Reform in the United States”

    Directory of Open Access Journals (Sweden)

    Carol Molinari

    2014-02-01

    Full Text Available McDonough’s perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consumer.

  9. Price elasticities in the German Statutory Health Insurance market before and after the health care reform of 2009.

    Science.gov (United States)

    Pendzialek, Jonas B; Danner, Marion; Simic, Dusan; Stock, Stephanie

    2015-05-01

    This paper investigates the change in price elasticity of health insurance choice in Germany after a reform of health insurance contributions. Using a comprehensive data set of all sickness funds between 2004 and 2013, price elasticities are calculated both before and after the reform for the entire market. The general price elasticity is found to be increased more than 4-fold from -0.81 prior to the reform to -3.53 after the reform. By introducing a new kind of health insurance contribution the reform seemingly increased the price elasticity of insured individuals to a more appropriate level under the given market parameters. However, further unintended consequences of the new contribution scheme were massive losses of market share for the more expensive sickness funds and therefore an undivided focus on pricing as the primary competitive element to the detriment of quality.

  10. Optimal design of an extrusion process for a hinge bracket

    Energy Technology Data Exchange (ETDEWEB)

    Na, Geum Ju; Jang, Myung Geun; Kim, Jong Bong [Seoul National University, Seoul (Korea, Republic of)

    2016-05-15

    This study considers process design in forming a hinge bracket. A thin hinge bracket is typically produced by bending a sheet panel or welding a hollow bar into a sheet panel. However, the hinge bracket made by bending or welding does not have sufficient durability in severe operating conditions because of the stress concentration in the bended region or the low corrosion resistance of the welded region. Therefore, this study uses forming to produce the hinge bracket part of a foldable container and to ensure durability in difficult operating conditions. An extrusion process for a T-shaped hinge bracket is studied using finite element analysis. Preliminary analysis shows that a very high forging load is required to form the bracket by forging. Therefore, extrusion is considered as a candidate process. Producing the part through the extrusion process enables many brackets to be made in a single extrusion and through successive cutting of the extruded part, thereby reducing the manufacturing cost. The design focuses on reducing the extrusion load and on ensuring shape accuracy. An initial billet is designed to reduce the extrusion load and to obtain a geometrically accurate part. The extruded part is bent frequently because of uneven material flow. Thus, extrusion die geometries are designed to obtain straight parts.

  11. The modernization of American public law: health care reform and popular constitutionalism.

    Science.gov (United States)

    Super, David A

    2014-04-01

    The Patient Protection and Affordable Care Act (ACA) transformed U.S. public law in crucial ways extending far beyond health care. As important as were the doctrinal shifts wrought by National Federation of Independent Business v. Sebelius, the ACA's structural changes to public law likely will prove far more important should they become entrenched. The struggle over the ACA has triggered the kind of "constitutional moment" that has largely replaced Article V's formal amendment procedure since the Prohibition fiasco. The Court participates in this process, but the definitive and enduring character of these constitutional moments' outcomes springs from broad popular engagement. Despite the Court's ruling and the outcome of the 2012 elections, the battle over whether to implement or shelve the ACA will continue unabated, both federally and in the states, until We the People render a clear decision. Whether the ACA survives or fails will determine the basic principles that guide the development of federalism, social insurance, tax policy, and privatization for decades to come. In each of these areas, the New Deal bequeathed us a delicate accommodation between traditionalist social values and modernizing norms of economic efficiency and interest group liberalism. This balance has come under increasing stress, with individual laws rejecting tradition far more emphatically than the New Deal did. But absent broad popular engagement, no definitive new principles could be established. The ACA's entrenchment would elevate technocratic norms across public law, the first change of our fundamental law since the civil rights revolution. The ACA's failure would rejuvenate individualistic, moralistic, pre-New Deal norms and allow opponents to attempt a counterrevolution against technocracy.

  12. A comparison of job satisfaction of community health workers before and after local comprehensive medical care reform: a typical field investigation in Central China.

    Directory of Open Access Journals (Sweden)

    Hong Ding

    Full Text Available BACKGROUND: The government of China promulgated new medical care reform policies in March 2009. After that, provincial-level governments launched new medical care reform which focusing on local comprehensive medical care reform (LCMR. Anhui Province is an example of an area affected by LCMR, in which the LCMR was started in October 2009 and implemented in June 2010. The objective of this study was to compare the job satisfaction (JS of community health workers (CHWs before and after the reform in Anhui Province. METHODS: A baseline survey was carried out among 813 community health workers (CHWs of 57 community health centers (CHCs (response rate: 94.1% and an effect evaluation survey among 536 CHWs of 30 CHCs (response rate: 92.3% in 2009 and 2012 respectively. A self-completion questionnaire was used to assess the JS of the CHWs (by the job satisfaction scale, JSS. RESULTS: The average scores of total JS and satisfaction with pay, contingent rewards, operating procedures and communication in the effect evaluation survey were statistically significantly higher than those of the baseline survey (P<0.05. The average score of satisfaction with promotion (2.55 ± 1.008 in the effect evaluation survey was statistically significantly lower than that in the baseline survey (2.71 ± 0.730 (P=0.002. In both surveys, the average scores of satisfaction with pay, benefits and promotion were statistically significantly lower than the others (all P<0.05. CONCLUSIONS: After two years' implementation of the LCMR, CHWs' total JS have a small improvement. However, CHWs have lower satisfaction in the dimensions of pay, promotion and benefits dimensions before and after the LCMR. Therefore, policy-makers should take corresponding measures to raise work reward of CHWs and pay more attention to CHWs' professional development to further increase their JS.

  13. Gas turbine combustor exit piece with hinged connections

    Energy Technology Data Exchange (ETDEWEB)

    Charron, Richard C.; Pankey, William W.

    2016-04-26

    An exit piece (66) with an inlet throat (67) that conducts a combustion gas flow (36A) in a path (82) from a combustor (63) to an annular chamber (68) that feeds the first blade section (37) of a gas turbine (26). The exit piece further includes an outlet portion (69) that forms a circumferential segment of the annular chamber. The outlet portion interconnects with adjacent outlet portions by hinges (78A, 78B, 80A, 80B). Each hinge may have a hinge axis (82A, 82B) parallel to a centerline (21) of the turbine. Respective gas flows (36A) are configured by an assembly (60) of the exit pieces to converge on the feed chamber (68) into a uniform helical flow that drives the first blade section with minimal circumferential variations in force.

  14. Adaptive fiber optics collimator based on flexible hinges.

    Science.gov (United States)

    Zhi, Dong; Ma, Yanxing; Ma, Pengfei; Si, Lei; Wang, Xiaolin; Zhou, Pu

    2014-08-20

    In this manuscript, we present a new design for an adaptive fiber optics collimator (AFOC) based on flexible hinges by using piezoelectric stacks actuators for X-Y displacement. Different from traditional AFOC, the new structure is based on flexible hinges to drive the fiber end cap instead of naked fiber. We fabricated a real AFOC based on flexible hinges, and the end cap's deviation and resonance frequency of the device were measured. Experimental results show that this new AFOC can provide fast control of tip-tilt deviation of the laser beam emitting from the end cap. As a result, the fiber end cap can support much higher power than naked fiber, which makes the new structure ideal for tip-tilt controlling in a high-power fiber laser system.

  15. Scaffold mining of kinase hinge binders in crystal structure database

    Science.gov (United States)

    Xing, Li; Rai, Brajesh; Lunney, Elizabeth A.

    2014-01-01

    Protein kinases are the second most prominent group of drug targets, after G-protein-coupled receptors. Despite their distinct inhibition mechanisms, the majority of kinase inhibitors engage the conserved hydrogen bond interactions with the backbone of hinge residues. We mined Pfizer internal crystal structure database (CSDb) comprising of several thousand of public as well as internal X-ray binary complexes to compile an inclusive list of hinge binding scaffolds. The minimum ring scaffolds with directly attached hetero-atoms and functional groups were extracted from the full compounds by applying a rule-based filtering procedure employing a comprehensive annotation of ATP-binding site of the human kinase complements. The results indicated large number of kinase inhibitors of diverse chemical structures are derived from a relatively small number of common scaffolds, which serve as the critical recognition elements for protein kinase interaction. Out of the nearly 4,000 kinase-inhibitor complexes in the CSDb we identified approximately 600 unique scaffolds. Hinge scaffolds are overwhelmingly flat with very little sp3 characteristics, and are less lipophilic than their corresponding parent compounds. Examples of the most common as well as the uncommon hinge scaffolds are presented. Although the most common scaffolds are found in complex with multiple kinase targets, a large number of them are uniquely bound to a specific kinase, suggesting certain scaffolds could be more promiscuous than the others. The compiled collection of hinge scaffolds along with their three-dimensional binding coordinates could serve as basis set for hinge hopping, a practice frequently employed to generate novel invention as well as to optimize existing leads in medicinal chemistry.

  16. A large workspace flexure hinge-based parallel manipulator system

    Institute of Scientific and Technical Information of China (English)

    Dong Wei; Du Zhijiang; Sun Lining

    2005-01-01

    Parallel manipulator systems as promising precision devices are used widely in current researches. A novel large workspace flexure parallel manipulator system utilizing wide-range flexure hinges as passive joints is proposed in this paper, which can attain sub-micron-scale precision over the cubic centimeter motion range. This paper introduces the mechanical system architecture based on the wide-range flexure hinges, analyzes the kinematics via stiffness matrices, presents the control system configuration and control strategy, and finally gives the system performance test results.

  17. Beyond welfare reform: reframing undocumented immigrants' entitlement to health care in the United States, a critical review.

    Science.gov (United States)

    Viladrich, Anahí

    2012-03-01

    This article addresses the main scholarly frames that supported the deservingness of unauthorized immigrants to health benefits in the United States (U.S.) following the passage of the Personal Responsibility Work Opportunity Reconciliation Act (PRWORA), known as the Welfare Reform bill, in 1996. Based on a critical literature review, conducted between January 1997 and March 2011, this article begins with an analysis of the public health rhetorics that endorsed immigrants' inclusion into the U.S. health safety net. In this vein, the "cost-saving" and "the effortful immigrant" frames underscore immigrants' contributions to society vis-à-vis their low utilization of health services. These are complemented by a "surveillance" account that claims to protect the American public from communicable diseases. A "maternalistic" frame is also discussed as a tool to safeguard families, and particularly immigrant mothers, in their roles as bearers and caretakers of their American-born children. The analyses of the "chilling" and the "injustice" frames are then introduced to underscore major anthropological contributions to the formulation of counter-mainstream discourses on immigrants' selective inclusion into the U.S. health care system. First, the "chilling effect," defined as the voluntary withdrawal from health benefits, is examined in light of unauthorized immigrants' internalized feelings of undeservingness. Second, an "injustice" narrative highlights both the contributions and the limitations of a social justice paradigm, which advocated for the restoration of government benefits to elderly immigrants and refugees after the passage of PRWORA. By analyzing the contradictions among all these diverse frames, this paper finally reflects on the conceptual challenges faced by medical anthropology, and the social sciences at large, in advancing health equity and human rights paradigms. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Reforma, responsabilidades e redes: sobre o cuidado em saúde mental Reform, responsibilities and networks: about mental health care

    Directory of Open Access Journals (Sweden)

    Martinho Braga Batista e Silva

    2009-02-01

    Full Text Available Tendo em vista o processo paulatino de responsabilização de atores e instâncias sociais pelo cuidado no contexto da Reforma Psiquiátrica brasileira, percebe-se que familiares e vizinhos de pacientes psiquiátricos têm sido instigados a " participar" da política pública, principalmente no lugar de " suporte social" , embora oficialmente considerados " parceiros" . Essa reconfiguração da relação entre Estado e sociedade civil é consagrada pela diretriz governamental de tomada de responsabilidade dos serviços pelo território, uma mudança da lógica de demanda e oferta de atendimento no sentido de estimular serviços extra-hospitalares - como os Centros de Atenção Psicossocial, campo desse estudo - a se encarregarem pela população adscrita a uma área geográfica. O objetivo desse texto é investigar as tecnologias psicossociais produzidas nesse contexto político, institucional e histórico específico, tais como a mediação de trocas sociais e a arbitragem de conflitos. Um dos materiais analisados são os registros em prontuário, que podem constituir os atores e instâncias sociais citados como envolvidos no campo da saúde mental, enredando-os na malha administrativa construída como rede de suporte social.In the context of the Brazilian Psychiatric Reform family members and neighbors of psychiatric patients have been urged to " participate" in the public policies, mainly as " social support" although officially considered " partners" . This reconfiguration of the relationship between State and civil society is reflected in the directive that the services have to take over the responsibility for territories, a change in the logic of supply and demand aimed at stimulating extra-hospital services such as Psychosocial Care Centers, the object of this study, to provide care to the population of a certain geographical area. The purpose of this article is to investigate the psychosocial technologies produced in this specific

  19. Size effects in plastic hinges of reinforced concrete members

    NARCIS (Netherlands)

    Bigaj-van Vliet, A.J.; Walraven, J.C.

    2002-01-01

    Reasons for size dependence of rotation capacity of plastic hinges are discussed. The increase of ductility with decreasing member size is interpreted from the viewpoint of fracture mechanics of concrete. The results of the introductory test series on simply supported slender beams loaded in three-p

  20. Size Effects in Plastic Hinges of Reinforced Concrete Members

    NARCIS (Netherlands)

    Bigaj, A.; Walraven, J.C.

    2002-01-01

    Reasons for size dependence of rotation capacity of plastic hinges are discussed. The increase of ductility with decreasing member size is interpreted from the viewpoint of fracture mechanics of concrete. The results of the introductory test series on simply supported slender beams loaded in three-p

  1. Tartus taas kunstiühing "Pallas" / Enn Lillemets

    Index Scriptorium Estoniae

    Lillemets, Enn, 1958-

    1999-01-01

    5. jaan. kanti Tartu Linnakohtus mittetulundusühingute ja sihtasutuste registrisse kunstiühing "Pallas", mis on 1998. a. asutatud Tartu Kunstiühingu uus nimi. "Pallase" kui huviühenduse eesmärgist, kõrgemas kunstikoolis "Pallas" õppinud ühingu liikmeid.

  2. Influence of the cardiac myosin hinge region on contractile activity.

    Science.gov (United States)

    Margossian, S S; Krueger, J W; Sellers, J R; Cuda, G; Caulfield, J B; Norton, P; Slayter, H S

    1991-06-01

    The participation of cardiac myosin hinge in contractility was investigated by in vitro motility and ATPase assays and by measurements of sarcomere shortening. The effect on contractile activity was analyzed using an antibody directed against a 20-amino acid peptide within the hinge region of myosin. This antibody bound specifically at the hinge at a distance of 55 nm from the S1/S2 junction, was specific to human, dog, and rat cardiac myosins, did not crossreact with gizzard or skeletal myosin, and had no effect on ATPase activity of purified S1 and myofibrils. However, it completely suppressed the movement of actin filaments in in vitro motility assays and reduced active shortening of sarcomeres of skinned cardiac myocytes by half. Suppression of motion by the anti-hinge antibody may reflect a mechanical constraint imposed by the antibody upon the mobility of the S2 region of myosin. The results suggest that the steps in the mechanochemical energy transduction can be separately influenced through S2.

  3. Thermal distortion testing of a 90-degree deployment hinge

    Science.gov (United States)

    Lininger, Lance

    2003-09-01

    Virtually all modern spacecraft have at least one (if not many) deployable items, some of which require a high degree of positional accuracy and repeatability. There are many variables that affect the deployment performance, and often the most critical and difficult variable to quantify is the affect of the thermal environment on the deployment mechanisms. Temperature changes before and after deployment can greatly affect the final deployment position and the subsequent thermal distortion of the mechanism, and it is critical to properly quantify these factors. Historically the affects of temperature change on deployment mechanisms have been evaluated via analysis due to the relative cost and difficulty in performing a test. However, during the design process of a recent Lockheed Martin deployment hinge, the engineers wanted to provide their customer with a more reliable empirical assessment. Thus, it was decided to conduct a thermal distortion and repeatability test on the hinge during the qualification phase. Testing of this nature is very rare for relatively inexpensive deployment hinges and is usually reserved for high precision, actively-latched optical hinges. Results of this testing are presented, along with lessons learned when performing the test.

  4. Hinged Polysilicon Structures with Integrated CMOS Thin Film Transistors

    Science.gov (United States)

    Pister, Kristofer Stefan Josef

    Micro electromechanical systems (MEMS) have the potential to have a profound impact on both scientific research and commercial products. MEMS have proven to be a commercial success, finding application in such diverse environments as hospital operating rooms and automobile engines. One of the open research problems in MEMS is the fabrication of three dimensional structures using what is essentially a planar process. Several methods exist for making large vertical steps in silicon, but they offer only specific geometries and have limited resolution. The process described here is based on polysilicon surface micromachining, with the addition that micro hinges are built along with other structures. In this approach, polycrystalline silicon structural elements are fabricated in the plane of the wafer, and then rotated out of the plane of the wafer using hinged joints. Individual elements are then assembled together to form more complicated three dimensional structures with high detail in all dimensions. The assembly process has been automated to some degree by the inclusion of spring loaded locks which snap into place once a hinge has reached a critical angle. With these hinged structures and spring locks, thousands of structures can be rotated and locked into place simultaneously in the final step of fabrication. Several examples of hinged three dimensional structures are presented, including a hot wire anemometer, a frog-embryo dynamometer, and a parallel jaw gripper, all of which fit inside a 1 millimeter cube. In addition to the structural elements provided in the process, several electronic elements have been integrated as well. These elements include CMOS thin film transistors integrated directly in the polysilicon structural thin film, piezoresistive strain sensors for measuring force and deflection, and flexible micro ribbon cable which allows electrical wiring to be run between the substrate and the rotated structures.

  5. Religious Groups as Interest Groups: The United States Catholic Bishops in the Welfare Reform Debate of 1995–1996 and the Health Care Reform Debate of 2009–20101

    Directory of Open Access Journals (Sweden)

    Anne Marie Cammisa

    2016-02-01

    Full Text Available The United States has a long history of religious influence on public policy: the anti-slavery movement, progressivism, prohibition, civil rights, abortion, school vouchers, school prayer and nuclear disarmament are all issues that have involved religion and religious groups in policymaking. In recent decades, the number of religious interest groups (as well as interest groups in general has greatly expanded, but the role that the religious organizations play as interest groups in the policy arena has received relatively little attention. How are they similar to and different from other interest groups? What tactics do they use? How successful are they? Under what conditions is success or failure more likely? This article examines Roman Catholic religious groups as interest groups in the congressional policymaking process. First, it places Catholic interest groups in the context of the interest group literature, and second, it examines Catholic interest groups’ activity in the passage of welfare reform in 1996 and in the passage of health care reform in 2010. In both cases, they played a greater role in context-setting than in actually changing provisions.

  6. Prokurör nägi inimliku jõhkruse piiritust / Hinge Brand ; interv. Tiiu Põld

    Index Scriptorium Estoniae

    Brand, Hinge, 1940-2007

    2006-01-01

    Intervjuu ametist lahkuva prokurör Hinge Brandiga. Lisatud: Hinge Brandi CV; Hinge Brandi osavõtul peetud kõmulisemad mõrvaprotsessid. Kommenteerivad Aivar Pilv, Elmar Vaher, Alar Kirs, Eda Murak, Dilaila Nahkur-Tammiksaar

  7. Prokurör nägi inimliku jõhkruse piiritust / Hinge Brand ; interv. Tiiu Põld

    Index Scriptorium Estoniae

    Brand, Hinge, 1940-2007

    2006-01-01

    Intervjuu ametist lahkuva prokurör Hinge Brandiga. Lisatud: Hinge Brandi CV; Hinge Brandi osavõtul peetud kõmulisemad mõrvaprotsessid. Kommenteerivad Aivar Pilv, Elmar Vaher, Alar Kirs, Eda Murak, Dilaila Nahkur-Tammiksaar

  8. Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform Law

    Science.gov (United States)

    Dworsky, Amy; Ahrens, Kym; Courtney, Mark

    2013-01-01

    This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

  9. The long shadow of the past: risk pooling and the political development of health care reform in the States.

    Science.gov (United States)

    Chen, Anthony S; Weir, Margaret

    2009-10-01

    Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.

  10. Linux领域新宠Hinge BI 8.0

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    近日,和勤软件有限公司宣布推出Hinge BI 8.0版本。和勤商业智能(Hinge BI)是一个功能完善、性能成熟的企业信息门户及商业智能软件平台,提供安全的信息访问、实时的数据和商业信息分析,并帮助企业充分利用其内外部数据、提高企业的决策能力,最终提高企业的竞争力并降低企业的营运成本。

  11. "If I ever did have a daughter, I wouldn't raise her in New Brunswick:" exploring women's experiences obtaining abortion care before and after policy reform.

    Science.gov (United States)

    Foster, Angel M; LaRoche, Kathryn J; El-Haddad, Julie; DeGroot, Lauren; El-Mowafi, Ieman M

    2017-05-01

    New Brunswick (NB)'s Regulation 84-20 has historically restricted funded abortion care to procedures deemed medically necessary by two physicians and performed in a hospital by an obstetrician-gynecologist. However, on January 1, 2015, the provincial government amended the regulation and abolished the "two physician rule." We aimed to document women's experiences obtaining abortion care in NB before and after the Regulation 84-20 amendment; identify the economic and personal costs associated with obtaining abortion care; and examine the ways in which geography, age and language-minority status condition access to care. We conducted 33 semistructured telephone interviews with NB residents who had abortions between 2009 and 2014 (n=27) and after January 1, 2015 (n=6), in English and French. We audiorecorded and transcribed all interviews and conducted content and thematic analyses using ATLAS.ti software to manage our data. The cost of travel is significant for NB residents trying to access abortion services. Women reported significant wait times which impacted the disclosure of their pregnancy and the gestational age at the time of the abortion. Further, many women reported that physicians refused to provide referrals for abortion care. Even after the amendment to 84-20, all participants reported that they were required to have two physicians approve their procedure. The funding restrictions for abortion care in NB represent a profound inequity. Amending Regulation 84-20 was an important step but failed to address the fundamental issue that clinic-based abortion care is not funded and significant barriers to access persist. NB's policies create unnecessary barriers to accessing timely and affordable abortion care and produce a significant health inequity for women in the province. Further policy reforms are required to ensure that women are able to get the abortion care to which they are entitled. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Hinge Dimension: An Exploration of Enaction in Architecture

    DEFF Research Database (Denmark)

    Franinovic, Karmen; Wilson, Alexander

    2007-01-01

    In this paper, we address issues of technologically mediated enactive experience with and within architectural contexts, and the ways in which it may affect our relationships to constructed surroundings. We present the conceptual ideas and design development of the Hinge Dimension project......, an interactive architecture which is activated and transformed though the actions of its inhabitants. Changing structural, sonic and luminous arrangements continuously produce different spatial experiences as visitors move though the architecture. We summarize the results that we gathered during the public...

  13. Biomechanical Analysis of the Effects of Bilateral Hinged Knee Bracing

    Science.gov (United States)

    Lee, Hangil; Ha, Dokyeong; Kang, Yeoun-Seung; Park, Hyung-Soon

    2016-01-01

    This research analyzed the effect of bilateral hinged knee braces on a healthy knee from a biomechanical frame in vivo. This was accomplished by fitting a knee brace with two customized wireless force/torque (F/T) sensors that could readily record force and torque during live motion, while the kinetics at the knee were computed using the inverse dynamics of the motion capture and force plate data. Four tasks to test the brace’s effects were drop vertical jumping, pivoting, stop vertical jumping, and cutting. The results showed that the hinges in the knee brace can absorb up to 18% of the force and 2.7% of the torque at the knee during various athletic motions. Thus, the hinges demonstrated minimal effect in reducing the mechanical load on the knee. There were limitations concerning the consistency of the motions performed by the subjects during the trials and the influence of the other portions of the brace to evaluate the overall effectiveness of the brace as a whole. Future works may incorporate a fatigue protocol and injured subjects to better determine the effects of the brace. There is still a need for more research on the biomechanical influence of knee braces to develop safer and more effective products. PMID:27379233

  14. Biomechanical Analysis of the Effects of Bilateral Hinged Knee Bracing.

    Science.gov (United States)

    Lee, Hangil; Ha, Dokyeong; Kang, Yeoun-Seung; Park, Hyung-Soon

    2016-01-01

    This research analyzed the effect of bilateral hinged knee braces on a healthy knee from a biomechanical frame in vivo. This was accomplished by fitting a knee brace with two customized wireless force/torque (F/T) sensors that could readily record force and torque during live motion, while the kinetics at the knee were computed using the inverse dynamics of the motion capture and force plate data. Four tasks to test the brace's effects were drop vertical jumping, pivoting, stop vertical jumping, and cutting. The results showed that the hinges in the knee brace can absorb up to 18% of the force and 2.7% of the torque at the knee during various athletic motions. Thus, the hinges demonstrated minimal effect in reducing the mechanical load on the knee. There were limitations concerning the consistency of the motions performed by the subjects during the trials and the influence of the other portions of the brace to evaluate the overall effectiveness of the brace as a whole. Future works may incorporate a fatigue protocol and injured subjects to better determine the effects of the brace. There is still a need for more research on the biomechanical influence of knee braces to develop safer and more effective products.

  15. Pseudo random interpretation of double hinged ALP under aerodynamic loading

    Directory of Open Access Journals (Sweden)

    Moazzam Aslam

    2016-09-01

    Full Text Available Wind produces three different types of effects on structure: static, dynamic and aerodynamic. When the structure deflects in response to wind load then the dynamic and aerodynamic effects should be analysed. The basic mode of an articulated tower is the motion characterized by rigid body sway compliant with a relatively high natural period. The higher modes of oscillation have smaller periods, and their influence is rather insignificant in the overall platform motion. Since the wind velocity spectrum of the fluctuating component has lower frequency energy content, the wind induced vibration of an articulated tower may be significant. The wind induced overturning moment increases linearly with the height of the structure, and thus, as these structures are built in deep and deeper water, the effects of wind drag then become increasingly significant in design. To approach towards the realistic environment, the dynamic analysis of double-hinged articulated tower under the action of wind, waves and current has been carried out. The wave forces with the interaction of current have been computed by the application of Stokes’ fifth order nonlinear wave theory. The sea state with respect to wind speed of 25 m/s (Hs = 18.03 m, Tz = 13.59 s has been considered and standard wind velocity spectrum Ahsan Kareem has been used for the dynamic analysis. The Pierson Moskowitz sea surface elevation spectrum has been used to model the random wave loads. The responses have been obtained under multi-point wind field. The study shows that energy content under combined action of wave and wind forces is more than energy derived under wave alone forces. Results also show that upper hinge is more dynamically active than lower hinge due to wind forces. PSDF shows that wind forces do not practically affect the bending moment, which is predominantly governed by the second mode of frequency; however, the other response parameters like deck displacement, hinge

  16. Health reform redux: learning from experience and politics.

    Science.gov (United States)

    Ross, Johnathon S

    2009-05-01

    The 2008 presidential campaign season featured health care reform proposals. I discuss 3 approaches to health care reform and the tools for bringing about reform, such as insurance market reforms, tax credits, subsidies, individual and employer mandates, and public program expansions. I also discuss the politics of past and current health care reform efforts. Market-based reforms and mandates have been less successful than public program expansions at expanding coverage and controlling costs. New divisions among special interest groups increase the likelihood that reform efforts will succeed. Federal support for state efforts may be necessary to achieve national health care reform. History suggests that state-level success precedes national reform. History also suggests that an organized social movement for reform is necessary to overcome opposition from special interest groups.

  17. Practice budgets and the patient mix of physicians - the effect of a remuneration system reform on health care utilisation.

    Science.gov (United States)

    Schmitz, Hendrik

    2013-12-01

    This study analyses the effect of a change in the remuneration system for physicians on the treatment lengths as measured by the number of doctor visits using data from the German Socio-Economic Panel over the period 1995-2002. Specifically, I analyse the introduction of a remuneration cap (so called practice budgets) for physicians who treat publicly insured patients in 1997. I find evidence that the reform of 1997 did not change the extensive margin of doctor visits but strongly affected the intensive margin. The conditional number of doctor visits among publicly insured decreased while it increased among privately insured. This can be seen as evidence that physicians respond to the change in incentives induced by the reform by altering their patient mix.

  18. The Main Points of Obam’s Health Care Reform%奥巴马医疗保健制度改革的主要内容

    Institute of Scientific and Technical Information of China (English)

    颜清辉

    2013-01-01

      经过多方协商和博弈,美国终于2010年3月21日通过医疗保健制度改革议案,为美国实现全民医保迈出关键的一步。医改法案着眼全民医保,在强制参保以扩大医疗保险覆盖面、增收节支以维持基金平衡、加强管理以遏制医疗费用过快增长等方面提出明确具体措施。美国医改在厘清政府责任边界、完善利益表达体系、合理定位政策目标、重视政策可操作性等方面给人启迪。%The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare, was signed into law by President Barack Obama on March 23, 2010. The PPACA is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care. It provides a number of mechanisms for employers and individuals to increase the coverage rate. Additional reforms aim to increase revenue and reduce expenses in order to mountain fund balance. Health care reform in America is enlightening in many aspects, such as clarifing the boundaries of government responsibility, improving the system of interest expression, positioning policy objectives reasonably, attaching importance to operability of policies.

  19. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    OpenAIRE

    Daniel Alyeshmerni; Froehlich, James B; Jack Lewin; Kim A Eagle

    2014-01-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how h...

  20. Characterization of flexure hinges for the French watt balance experiment

    Directory of Open Access Journals (Sweden)

    Pinot Patrick

    2014-01-01

    Full Text Available In the French watt balance experiment, the translation and rotation functions must have no backlash, no friction, nor the need for lubricants. In addition errors in position and movement must be below 100 nm. Flexure hinges can meet all of these criteria. Different materials, profile shapes and machining techniques have been studied. The flexure pivots have been characterized using three techniques: 1 an optical microscope and, if necessary, a SEM to observe the surface inhomogeneities; 2 a mass comparator to determine the bending stiffness of unloaded pivots; 3 a loaded beam oscillating freely under vacuum to study the dynamic behavior of loaded pivots.

  1. Instability of modes in a partially hinged rectangular plate

    Science.gov (United States)

    Ferreira, Vanderley; Gazzola, Filippo; Moreira dos Santos, Ederson

    2016-12-01

    We consider a thin and narrow rectangular plate where the two short edges are hinged whereas the two long edges are free. This plate aims to represent the deck of a bridge, either a footbridge or a suspension bridge. We study a nonlocal evolution equation modeling the deformation of the plate and we prove existence, uniqueness and asymptotic behavior for the solutions for all initial data in suitable functional spaces. Then we prove results on the stability/instability of simple modes motivated by a phenomenon which is visible in actual bridges and we complement these theorems with some numerical experiments.

  2. Characterization of flexure hinges for the French watt balance experiment

    Science.gov (United States)

    Pinot, Patrick; Genevès, Gérard

    2014-08-01

    In the French watt balance experiment, the translation and rotation functions must have no backlash, no friction, nor the need for lubricants. In addition errors in position and movement must be below 100 nm. Flexure hinges can meet all of these criteria. Different materials, profile shapes and machining techniques have been studied. The flexure pivots have been characterized using three techniques: 1) an optical microscope and, if necessary, a SEM to observe the surface inhomogeneities; 2) a mass comparator to determine the bending stiffness of unloaded pivots; 3) a loaded beam oscillating freely under vacuum to study the dynamic behavior of loaded pivots.

  3. A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review.

    Science.gov (United States)

    Nicholson, Caroline; Jackson, Claire; Marley, John

    2013-12-20

    Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. All examples of successful primary/secondary care integration reported in the literature have focused on a combination

  4. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review

    Science.gov (United States)

    2013-01-01

    Background Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. Methods A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Results Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. Conclusions All examples of successful primary/secondary care integration reported in

  5. [The Need of a New Integral Approach to the Care of Patient with Severe Mental Disorder Thirty Years after the Psychiatric Reform].

    Science.gov (United States)

    Madoz-Gúrpide, Agustín; Ballesteros Martín, Juan Carlos; Leira Sanmartín, Mónica; García Yagüe, Ernesto

    2017-01-18

    More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.

  6. Study on Tax Policies That Promote China's Health Care Reform%促进医药卫生改革的税收政策研究

    Institute of Scientific and Technical Information of China (English)

    张仲芳

    2012-01-01

    我国医药卫生领域现行税收政策与新一轮医药卫生体制改革目标存在一定冲突。现行税收政策不利于医疗行业公益性目标的实现,不利于吸引民营资本进入,不利于营利性民营医疗机构的发展,不利于鼓励商业健康保险的发展。我国应建立和完善能够与医药卫生体制改革目标相适应的税收政策体系,包括医疗服务营业税及税收优惠制度、医疗机构所得税税收优惠制度、药品增值税及税收优惠制度、商业健康保险税收优惠制度等。%There exist some conflicts between the present tax policies and the objectives of the health care system reform, The current tax policies hamper the realization of public welfare goals of the medical industry, fail to attract the private capital, hinder the development of the profit-making private medical institutions and that of commercial health insurance. A new tax system should be established and improved to comply with the goals of the health care reform, including sales tax policies for medical services, value-added tax policies for medicines, income tax policies for medical institutions, and tax incentives for private health insurance.

  7. Reform of the Buy-and-Bill System for Outpatient Chemotherapy Care Is Inevitable: Perspectives from an Economist, a Realpolitik, and an Oncologist.

    Science.gov (United States)

    Polite, Blase; Conti, Rena M; Ward, Jeffery C

    2015-01-01

    Treating patients with cancer with infused or injected oncolytics is a core component of outpatient oncology practice. Currently, practices purchase drugs and then bill insurers, colloquially called "buy and bill." Reimbursement for these drugs is the largest source of gross revenue for oncology practices, and as the prices of cancer drugs have grown over time, these purchases have had significant impact on the financial health of practices and pose a risk that jeopardizes the ability of many practices to operate and provide patient care. Medicare Part B spending on drugs is under political scrutiny because of federal spending pressures, and the margin between buy and bill, lowered to 6% by the Medicare Modernization Act and further decreased to 4.3% by sequestration, is a convenient and popular target of budgetary discussions and proposals, scored to save billions of dollars over 10-year budget windows for each percentage-point reduction. Alternatives to the buy-and-bill system have been proposed to include invoice pricing, least costly alternative reimbursement, bundling of drugs into episode-of-care payments, shifting Part B drugs to the Medicare Part D benefit, and revision of the failed Competitive Acquisition Program. This article brings the perspectives of policy makers, health care economists, and providers together to discuss this major challenge in oncology payment reform.

  8. Expanding Pharmacist Services in Québec: A Health Reform Analysis of Bill 41 and its Implications for Equity in Financing Care

    Directory of Open Access Journals (Sweden)

    Renée Carter

    2014-12-01

    Full Text Available On 8 December 2011, Québec’s Minister of Health and Social Services amended the province’s Pharmacy Act by introducing Bill 41 to expand pharmacists’ role in patient care. Québec is the only Canadian province with a legal mandate for prescription drug insurance coverage for all residents, with public coverage offered only to those who do not have access to private health insurance through their employer. Bill 41 aims to increase access to health care and reduce physician wait times by extending the scope of pharmacist services to mirror that of physicians (e.g., modify the form of the medication and its dosage. The reform is currently pending due to disputes between the Ministry of Health and Social Services and the Quebec Association of Pharmacy Owners over remuneration for pharmacists. Should Bill 41 come into force, it is unclear whether the expansion of pharmacists’ roles, which in principle would duplicate physician services, should be considered part of the public basket of medically necessary care. Current negotiations suggest that only those with public coverage will also be covered for expanded services thereby placing equity of finance for those with private insurance in question.

  9. Expanding Pharmacist Services in Québec: A Health Reform Analysis of Bill 41 and its Implications for Equity in Financing Care

    Directory of Open Access Journals (Sweden)

    Renée Carter

    2014-12-01

    Full Text Available On 8 December 2011, Québec’s Minister of Health and Social Services amended the province’s Pharmacy Act by introducing Bill 41 to expand pharmacists’ role in patient care. Québec is the only Canadian province with a legal mandate for prescription drug insurance coverage for all residents, with public coverage offered only to those who do not have access to private health insurance through their employer. Bill 41 aims to increase access to health care and reduce physician wait times by extending the scope of pharmacist services to mirror that of physicians (e.g., modify the form of the medication and its dosage. The reform is currently pending due to disputes between the Ministry of Health and Social Services and the Quebec Association of Pharmacy Owners over remuneration for pharmacists. Should Bill 41 come into force, it is unclear whether the expansion of pharmacists’ roles, which in principle would duplicate physician services, should be considered part of the public basket of medically necessary care. Current negotiations suggest that only those with public coverage will also be covered for expanded services thereby placing equity of finance for those with private insurance in question.

  10. Addressing health care market reform through an insurance exchange: essential policy components, the public plan option, and other issues to consider.

    Science.gov (United States)

    Fronstin, Paul; Ross, Murray N

    2009-06-01

    HEALTH INSURANCE EXCHANGE: This Issue Brief examines issues related to managed competition and the use of a health insurance exchange for the purpose of addressing cost, quality, and access to health care services. It discusses issues that must be addressed when designing an exchange in order to reform the health insurance market and also examines state efforts at health reform that use an exchange. RISK VS. PRICE COMPETITION: The basic component of managed competition is the creation an organized marketplace that brings together health insurers and consumers (either as individuals or through their employers). The sponsor of the exchange would set "rules of engagement" for participating insurers and offer consumers a menu of choices among different plans. Ultimately, the goal of a health insurance exchange is to shift the market from competition based on risk to competition based on price and quality. ADVERSE SELECTION AND AFFORDABILITY: Among the issues that need to be addressed if an exchange that uses managed competition has a realistic chance of reducing costs, improving quality, and expanding coverage: Everyone needs to be in the risk pool, with individuals required to purchase insurance or face significant financial consequences; effective risk adjustment is essential to eliminate risk selection as an insurance business model--forcing competition on costs and quality; the insurance benefit must be specific and clear--without standards governing cost sharing, covered services, and network coverage there is no way to assess whether a requirement to purchase or issue coverage has been met; and subsidies would be necessary for low-income individuals to purchase insurance. THE PUBLIC PLAN OPTION: The public plan option is shaping up to be one of the most contentious issues in the health reform debate. Proponents also believe of a public plan is necessary to drive private insurers toward true competition. Opponents view it as a step toward government-run health

  11. Putting matters on the triangle-hinge models

    CERN Document Server

    Fukuma, Masafumi; Umeda, Naoya

    2015-01-01

    In a recent paper [arXiv:1503.08812] a new class of models generating three-dimensional random volumes are introduced, where the Boltzmann weight of each configuration is given by the product of values assigned to the triangles and the hinges. These triangle-hinge models are characterized by semisimple associative algebras, and the set of possible diagrams can be reduced such that only and all of the three-dimensional manifolds with tetrahedral decompositions are generated. In this letter, we give a general prescription to put matters on the models. We show that the degrees of freedom representing matter fields can be assigned to simplices of any dimensions (tetrahedra, triangles, edges and vertices) in such a way that they have local interactions. Simple examples include the Ising model, the q-state Potts models and the RSOS models coupled to three-dimensional quantum gravity. We also show that the three-dimensional colored tensor models can be obtained by putting specific matters on both tetrahedra and tria...

  12. Roadblocks to Reform: Beyond the Usual Suspects

    OpenAIRE

    Grignon Michel

    2012-01-01

    Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered for why such reforms are so difficult: institutional gridlock, path dependency and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that, as a result, public resistance to real reform may more accurately reflect citizensÕ personal convictions, self...

  13. Measuring intensive care unit performance after sustainable growth rate reform: An example with the National Quality Forum metrics.

    Science.gov (United States)

    Nguyen, Albert P; Hyder, Joseph A; Wanta, Brendan T; Stelfox, Henry T; Schmidt, Ulrich

    2016-12-01

    Performance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States. We reviewed the National Quality Forum library of performance measures to highlight measures that are relevant to critical care medicine, and we describe gaps and opportunities for the future of performance measurement in critical care medicine. Crafting performance measures that address core aspects of critical care will be challenging, as current outcome and performance measures have problems with validity. Future quality measures will likely focus on interdisciplinary measures across the continuum of patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Alternative S2 Hinge Regions of the Myosin Rod Affect Myofibrillar Structure and Myosin Kinetics

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Mark S.; Dambacher, Corey M.; Knowles, Aileen F.; Braddock, Joan M.; Farman, Gerrie P.; Irving, Thomas C.; Swank, Douglas M.; Bernstein, Sanford I.; Maughan, David W.; (RPI); (IIT); (SDSU); (Vermont)

    2009-07-01

    The subfragment 2/light meromyosin 'hinge' region has been proposed to significantly contribute to muscle contraction force and/or speed. Transgenic replacement of the endogenous fast muscle isovariant hinge A (exon 15a) in Drosophila melanogaster indirect flight muscle with the slow muscle hinge B (exon 15b) allows examination of the structural and functional changes when only this region of the myosin molecule is different. Hinge B was previously shown to increase myosin rod length, increase A-band and sarcomere length, and decrease flight performance compared to hinge A. We applied additional measures to these transgenic lines to further evaluate the consequences of modifying this hinge region. Structurally, the longer A-band and sarcomere lengths found in the hinge B myofibrils appear to be due to the longitudinal addition of myosin heads. Functionally, hinge B, although a significant distance from the myosin catalytic domain, alters myosin kinetics in a manner consistent with this region increasing myosin rod length. These structural and functional changes combine to decrease whole fly wing-beat frequency and flight performance. Our results indicate that this hinge region plays an important role in determining myosin kinetics and in regulating thick and thin filament lengths as well as sarcomere length.

  15. Static deformation modeling and analysis of flexure hinges made of a shape memory alloy

    Science.gov (United States)

    Du, Zhijiang; Yang, Miao; Dong, Wei; Zhang, Dan

    2016-11-01

    The flexure hinge is a key element in compliant mechanisms to achieve continuous motion; however the motion range of a flexure hinge is severely restricted by the material’s allowable strain. Due to the superelasticity effect, shape memory alloys (SMAs) can undergo much larger strain than other metals; this means that they are excellent candidates for the fabrication of flexure hinges with a large motion range. In this paper, a simple static deformation modeling approach is proposed for a flexure hinge made of a SMA. The superelastic behavior of the SMA is described by Brinson’s constitutive model. The flexure hinge is considered as a non-prismatic cantilever beam associated with geometrical and material nonlinearities. Govern equations of the flexure hinge are derived and solved numerically by applying the nonlinear bending theory of the Euler-Bernoulli beam. Experimental tests show that the proposed modeling approach can predict the deformation of the flexure hinge precisely; the maximum relative error is less than 6.5%. Based on the static deformation model, the motion capacity, the stiffness characteristic and the rotational error of the flexure hinge are also investigated. The results reveal that the flexure hinge made of a SMA has great potential to construct compliant mechanisms with a large motion range.

  16. Impact of Plastic Hinge Properties on Capacity Curve of Reinforced Concrete Bridges

    Directory of Open Access Journals (Sweden)

    Nasim Shatarat

    2017-01-01

    Full Text Available Pushover analysis is becoming recently the most practical tool for nonlinear analysis of regular and irregular highway bridges. The nonlinear behaviour of structural elements in this type of analysis can be modeled through automated-hinge or user-defined hinge models. The nonlinear properties of the user-defined hinge model for existing highway bridges can be determined in accordance with the recommendations of the Seismic Retrofit Manual by the Federal Highway Administration (FHWA-SRM. Finite element software such as the software SAP2000 offers a simpler and easier approach to determine the nonlinear hinge properties through the automated-hinge model which are determined automatically from the member material and cross section properties. However, the uncertainties in using the automated-hinge model in place of user-defined hinge model have never been addressed, especially for existing and widened bridges. In response to this need, pushover analysis was carried out for four old highway bridges, of which two were widened using the same superstructure but with more attention to seismic detailing requirements. The results of the analyses showed noticeable differences in the capacity curves obtained utilizing the user-defined and automated-hinge models. The study recommends that bridge design manuals clearly ask bridge designers to evaluate the deformation capacities of existing bridges and widened bridges using user-defined hinge model that is determined in accordance with the provisions of the FHWA-SRM.

  17. Medical Education and Curriculum Reform: Putting Reform Proposals in Context

    Directory of Open Access Journals (Sweden)

    Daniel Kam Yin Chan, MD, MB.BS, MHA

    2004-01-01

    Full Text Available The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.

  18. Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs.

    Science.gov (United States)

    Hume, S K

    1993-06-01

    Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.

  19. Expected Impact of Health Care Reform on the Organization and Service Delivery of Publicly Funded Addiction Health Services.

    Science.gov (United States)

    Guerrero, Erick G; Harris, Lesley; Padwa, Howard; Vega, William A; Palinkas, Lawrence

    2017-07-01

    Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs' strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities.

  20. Health promotion interventions and policies addressing excessive alcohol use: A systematic review of national and global evidence as a guide to health-care reform in China

    Science.gov (United States)

    Li, Qing; Babor, Thomas F.; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F.; Nelson, Toben F.; Shen, Weixing; Li, Bing

    2014-01-01

    Aims Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiologic transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. Methods We searched in Chinese and English language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the WHO Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. Results In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of ten in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, workplaces, the health sector, and taxation. Conclusions China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy, and health reform experience in Russia, Australia, Mexico, and the USA, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems, and the implementation of effective alcohol control strategies. PMID:25533866

  1. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    Science.gov (United States)

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice.

  2. An alternative RNA polymerase I structure reveals a dimer hinge.

    Science.gov (United States)

    Kostrewa, Dirk; Kuhn, Claus-D; Engel, Christoph; Cramer, Patrick

    2015-09-01

    RNA polymerase I (Pol I) is the central, 14-subunit enzyme that synthesizes the ribosomal RNA (rRNA) precursor in eukaryotic cells. The recent crystal structure of Pol I at 2.8 Å resolution revealed two novel elements: the `expander' in the active-centre cleft and the `connector' that mediates Pol I dimerization [Engel et al. (2013), Nature (London), 502, 650-655]. Here, a Pol I structure in an alternative crystal form that was solved by molecular replacement using the original atomic Pol I structure is reported. The resulting alternative structure lacks the expander but still shows an expanded active-centre cleft. The neighbouring Pol I monomers form a homodimer with a relative orientation distinct from that observed previously, establishing the connector as a hinge between Pol I monomers.

  3. A structurally variable hinged tetrahedron framework from DNA origami.

    Science.gov (United States)

    Smith, David M; Schüller, Verena; Forthmann, Carsten; Schreiber, Robert; Tinnefeld, Philip; Liedl, Tim

    2011-01-01

    Nanometer-sized polyhedral wire-frame objects hold a wide range of potential applications both as structural scaffolds as well as a basis for synthetic nanocontainers. The utilization of DNA as basic building blocks for such structures allows the exploitation of bottom-up self-assembly in order to achieve molecular programmability through the pairing of complementary bases. In this work, we report on a hollow but rigid tetrahedron framework of 75 nm strut length constructed with the DNA origami method. Flexible hinges at each of their four joints provide a means for structural variability of the object. Through the opening of gaps along the struts, four variants can be created as confirmed by both gel electrophoresis and direct imaging techniques. The intrinsic site addressability provided by this technique allows the unique targeted attachment of dye and/or linker molecules at any point on the structure's surface, which we prove through the superresolution fluorescence microscopy technique DNA PAINT.

  4. Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014

    Science.gov (United States)

    Gebrehiwot, Yirgu; Fetters, Tamara; Gebreselassie, Hailemichael; Moore, Ann; Hailemariam, Mengistu; Dibaba, Yohannes; Bankole, Akinrinola; Getachew, Yonas

    2017-01-01

    CONTEXT In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care—i.e., legal abortion and treatment of abortion complications—changed over time. METHODS Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities—some of which provide abortion care—to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014. RESULTS The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception. CONCLUSIONS Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved. PMID:28825903

  5. Experimental Research on Fatigue Performance of Hinge Joints of Hinged Slab Bridge%铰接板桥铰缝疲劳性能试验研究

    Institute of Scientific and Technical Information of China (English)

    唐先习; 尹月酉; 国伟; 徐岳

    2015-01-01

    For the research on fatigue performance of hinge joints with different structures ,two hinged slab bridges with deep hinge joints and shallow hinge joints were adopted in the experiments .Based on the results of the transverse strains regularity of hinge joints at the middle span of hinged slab ,the researches on the fatigue performance of the hinge joints were carried out .The transverse strains of hinge joints include the concrete transverse strain at the bottom and the top of hinge joints ,and the transverse strain of the connection steels in hinge joints .The experimental results suggest that , within 2 × 106 times of fatigue load ,due to the relatively small fatigue amplitudes ,the concrete and reinforcement strain values of hinge joints decrease as static load applied after the fatigue cycle of certain numbers ,with the increasing of fa-tigue cycle number ,the changes of the strain values tend to be more stable .When the fatigue cycle number is more than 2 × 106 times ,as the fatigue amplitudes increase ,the influence on the damage of shallow hinge joints by fatigue load is great ,but no obvious influence on deep hinge joints .Therefore ,the fatigue load with certain fatigue amplitude is a major factor which causes the destruction of shallow hinge joints ,and the fatigue damage resistance performance of deep hinge joints is much better than shallow hinge joints .%为研究不同构造的铰接板桥铰缝的疲劳性能,采用深铰缝和浅铰缝两种形式的铰接板桥进行试验研究,通过对跨中铰缝顶底部混凝土的横向应变规律及铰缝内部横向连接钢筋的应变规律进行对比分析,对铰缝的疲劳性能进行研究。试验结果表明,在200万次疲劳荷载以前,由于疲劳幅值相对较小,随着疲劳次数的增加,完成一定疲劳循环后施加静载时铰缝混凝土及钢筋的应变值逐渐减小,应变值的变化趋于更加稳定。当疲劳次数超过200万次后,由于疲劳幅

  6. Administrative Reform

    DEFF Research Database (Denmark)

    Plum, Maja

    Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...

  7. Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?

    Science.gov (United States)

    Grit, K; de Bont, A

    2010-02-01

    Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of 'need' is transformed into the principle of 'economic demand'. Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

  8. [Psychiatric reform and substitutive mental health practices: an institutional reading of an experience at a psychosocial care center].

    Science.gov (United States)

    Koda, Mirna Yamazato; Fernandes, Maria Inês Assumpção

    2007-06-01

    This article discusses the development of mental health care services based on the Anti-Asylum Movement. Drawing on contributions from psychoanalysis and social psychology, the study analyzes the conflicts and dilemmas arising in a Psychosocial Care Center (NAPS) in Santos, São Paulo, Brazil. This study is part of Master's degree research at the Social and Occupational Psychology Department, Institute of Psychology, University of São Paulo. Semi-structured interviews were used with workers at the NAPS. According to the interviews, the transformation of the mental health care model mobilizes psychological issues among the workers. Various conflicts and anxieties were observed in relation to changes in the institutional support provided by the NAPS over time. The article analyzes difficulties in dealing with differences in the team or feelings of abandonment resulting from changes in the local administration in the interface between subjects and the institution.

  9. California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

    Directory of Open Access Journals (Sweden)

    Patrick T Hazelton

    Full Text Available In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved.30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses.Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients.California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people

  10. 用于微机电系统的叉形微铰链%Micro Fork Hinge for MEMS Devices

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Flexible beams are often used for rotation in MEMS (Micro Electro Mechanical Systems) devices to avoid the friction problems associated with hinge. However, the rotation angle of flexible beam is very limited and not enough for many applications. In this paper, we introduce a quasi hinge structure named as Fork Hinge, which has a larger equivalent rotation angle (e.g.10 times lager) and is more stable than the flexible hinge, while keeping its interesting properties. We develop an analytical model and simulate the Fork hinge behavior with FEM analysis. We find a good correlation with Fork Hinges fabricated using a SOI (Silicon on Insulator) wafer and DRIE (Deep Reactive Ion Etching).

  11. SISTEMAS SANITARIOS Y REFORMA AUGE EN CHILE SISTEMAS SANITÁRIOS E REFORMA AUGE NO CHILE HEALTH CARE SYSTEMS AND "AUGE" REFORM IN CHILE

    Directory of Open Access Journals (Sweden)

    Alejandra Zúñiga Fajuri

    2007-11-01

    Full Text Available A partir de la clasificación de los sistemas sanitarios en términos de su financiamiento, número de actores y consecuencias en equidad, este ensayo pretende analizar algunas de las transformaciones producidas en Chile con la reforma del sistema de salud llamada "Plan AUGE" (Acceso Universal de Garantías Explícitas. Se examinan las tareas pendientes para la conversión de un sistema que, manteniendo su carácter mixto, sea capaz de superar sus actuales consecuencias fuertemente regresivasA partir da classificação de dois sistemas sanitários em termos de seu financiamento, número de atores e conseqüências em termos de equidade, este ensaio pretende analisar algumas das transformações produzidas no Chile com a reforma do sistema de saúde chamado "Plano AUGE" (Acesso Universal de Garantias Explícitas. São examinados as tarefas pendentes para a conversão de um sistema que, mantendo seu caráter misto, seja capaz de superar suas conseqüências fortemente regressivasThrough the classification of health care systems in terms of their financing, number of stakeholders and consequences for health care equity, this essay pretends to analyze some of the changes that have taken place in Chile due to the health care reform system "AUGE" (Universal Access to Explicit Guarantees. Pending tasks are examined for conversion to the system that, while maintaining its mixed character, may be able to overcome its present strongly regressive consequences

  12. Design of Hierarchically Cut Hinges for Highly Stretchable and Reconfigurable Metamaterials with Enhanced Strength.

    Science.gov (United States)

    Tang, Yichao; Lin, Gaojian; Han, Lin; Qiu, Songgang; Yang, Shu; Yin, Jie

    2015-11-25

    Applying hierarchical cuts to thin sheets of elastomer generates super-stretchable and reconfigurable metamaterials, exhibiting highly nonlinear stress-strain behaviors and tunable phononic bandgaps. The cut concept fails on brittle thin sheets due to severe stress concentration in the rotating hinges. By engineering the local hinge shapes and global hierarchical structure, cut-based reconfigurable metamaterials with largely enhanced strength are realized.

  13. Use of quality measures for Medicaid behavioral health services by state agencies: implications for health care reform.

    Science.gov (United States)

    Seibert, Julie; Fields, Suzanne; Fullerton, Catherine Anne; Mark, Tami L; Malkani, Sabrina; Walsh, Christine; Ehrlich, Emily; Imshaug, Melina; Tabrizi, Maryam

    2015-06-01

    The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. Data were collected by reviewing online documents related to Medicaid managed care contracts for behavioral health, quality strategies, quality improvement plans, quality and performance indicators data, annual outcomes reports, performance measure specification manuals, legislative reports, and Medicaid waiver requests for proposals. Information was publicly available for 29 states. Most states relied on process measures, along with some structure and outcome measures. Although all states reported on at least one process measure of behavioral health quality, 52% of states did not use any outcomes measures and 48% of states had no structure measures. A majority of the states (69%) used behavioral health measures from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set, and all but one state in the sample (97%) used consumer experience-of-care surveys. Many states supplemented these data with locally developed behavioral health indicators that rely on administrative and nonadministrative data. State Medicaid agencies are using nationally recognized as well as local measures to assess quality of behavioral health care. Findings indicate a need for additional nationally endorsed measures in the area of substance use disorders and treatment outcomes.

  14. 77 FR 43773 - Wireline Competition Bureau Seeks Further Comment on Issues in the Rural Health Care Reform...

    Science.gov (United States)

    2012-07-26

    ... DA 12-1166 and may be filed using the Commission's Electronic Comment Filing System (ECFS). See... providers on their networks, using telemedicine and other telehealth applications to improve the quality and... rural health care, telemedicine, and Health IT. Based on what we have learned from the Pilot...

  15. From Universalism to Selectivity? The Background, Discourses and Ideas of Recent Early Childhood Education and Care Reforms in Finland

    Science.gov (United States)

    Lundkvist, Marina; Nyby, Josefine; Autto, Janne; Nygård, Mikael

    2017-01-01

    Universal public childcare for children under seven has been central in Finland since the mid-1990s, capacitating both gender equality and children's human capital and wellbeing. In 2015, as a further step in the development of this system, early learning and childhood pedagogy was strengthened through the early childhood education and care (ECEC)…

  16. Responding to health care reform by addressing the institute of medicine report on the future of nursing.

    Science.gov (United States)

    Ellerbe, Suellyn; Regen, Debra

    2012-01-01

    The current health care environment has heightened the importance of achieving positive patient outcomes and excellent customer satisfaction. To remain competitive, health care organizations must adapt quickly to changing regulatory requirements, quality improvement initiatives, and customer expectations. To ensure nursing practice at the Saint Clare's Health System in Northwest New Jersey is at the forefront of leading change, the nursing staff has embraced the Institute of Medicine report The Future of Nursing: Leading Change. The empowered nursing team has applied Benner's Novice to Expert model and McCauley's Careful Nursing Theory as the foundation for nursing practice. The ability to apply evidence-based nursing research and cultivate professional development at the bedside has resulted in retention of expert nurses at the bedside. Engaging the nursing team has resulted in increased patient satisfaction and improved clinical outcomes. Advanced practice nurses play an important role to mentor the nursing staff and promote an interdisciplinary, collaborative relationship between all health care disciplines and community support programs. Nurses are recognized for their accomplishments and encouraged to obtain specialty certification, advanced degrees, and earn state and national recognition through professional organizations. The professional nurses at the Saint Clare's Health System are prepared to work in whatever environment the new normal creates.

  17. Parametric analysis and temperature effect of deployable hinged shells using shape memory polymers

    Science.gov (United States)

    Tao, Ran; Yang, Qing-Sheng; He, Xiao-Qiao; Liew, Kim-Meow

    2016-11-01

    Shape memory polymers (SMPs) are a class of intelligent materials, which are defined by their capacity to store a temporary shape and recover an original shape. In this work, the shape memory effect of SMP deployable hinged shell is simulated by using compiled user defined material subroutine (UMAT) subroutine of ABAQUS. Variations of bending moment and strain energy of the hinged shells with different temperatures and structural parameters in the loading process are given. The effects of the parameters and temperature on the nonlinear deformation process are emphasized. The entire thermodynamic cycle of SMP deployable hinged shell includes loading at high temperature, load carrying with cooling, unloading at low temperature and recovering the original shape with heating. The results show that the complicated thermo-mechanical deformation and shape memory effect of SMP deployable hinge are influenced by the structural parameters and temperature. The design ability of SMP smart hinged structures in practical application is prospected.

  18. Experience from UK integrated care and the implications for health care reform in China%英国整合型保健发展经验及启示

    Institute of Scientific and Technical Information of China (English)

    谢春艳; 金春林; 王贤吉

    2015-01-01

    This paper summarized the practice and experience about integrated care carried out in UK through qualitative research methods including on-site observation and deep interview,especially the integration and coordination of health service and social service systems in recent years. And then some relevant policy recommendations were put forward on health care reform according to the problems of fragmented health care system in China,including developing primary health care and community health services,strengthening multidisciplinary team,building a gate keeping health care system in which GPs were the core,establishing mechanisms for communication and collaboration between the relevant government departments,and integrating multi-social service resources at the community level.%通过现场观察与深度访谈的定性研究方法,总结了英格兰NHS整合型保健的做法和经验,并针对我国卫生服务体系存在的碎片化问题,提出了相关的政策建议:大力发展初级卫生保健和社区卫生服务,加强以全科医生为核心的多学科服务团队建设,建立全科医生“守门人”制度,建立相关政府部门间的沟通协作机制,在社区层面横向整合多方社会服务资源等。

  19. Defense Health Care Reform: DOD Needs Further Analysis of the Size, Readiness, and Efficiency of the Medical Force

    Science.gov (United States)

    2016-09-01

    and execution. While the Study’s recommendations position DOD, over time , to take actions to improve the effectiveness and efficiency of the...from the standards that, among other things, state that it is good practice for a study to describe how researchers determined the data used were...network of private providers, and on the battlefield in support of contingency operations. Responsibility for the delivery of care is shared among the

  20. Let's make a deal: trading malpractice reform for health reform.

    Science.gov (United States)

    Sage, William M; Hyman, David A

    2014-01-01

    Physician leadership is required to improve the efficiency and reliability of the US health care system, but many physicians remain lukewarm about the changes needed to attain these goals. Malpractice liability-a sore spot for decades-may exacerbate physician resistance. The politics of malpractice have become so lawyer-centric that recognizing the availability of broader gains from trade in tort reform is an important insight for health policy makers. To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals. There are also reasons to believe that tort reform can make ongoing health care delivery reforms work better, in addition to buttressing health reform efforts that might otherwise fail politically.

  1. Public Administration reforms and results

    Directory of Open Access Journals (Sweden)

    Gunnar Helgi Kristinsson

    2014-12-01

    Full Text Available Research on administrative reforms during the past thirty years indicates that reform efforts of countries differ. The Anglo Saxon states were at the forefront of the New Public Management movement while countries on mainland Europe were more hesitant and moved further towards the Neo-Weberian state. Academics have tried to explain different reform efforts within countries by looking at political, historical and cultural issues, values and economic factors to name just a few. Three hypotheses are put forward to explain reform efforts in different states. This research involves analysing the implementation of two different reform trends, New Public Management and the Neo-Weberian tradition. The analysis indicates that countries vary in their commitment to reform rather than in the emphasis on either New Public Management or the Neo-Weberian State. Decentralization, clear objectives and consultation with communities and experts are closely related to national reform efforts. However, Iceland does distinguish itself from Europe and the Nordic countries. The analysis reveals that although decentralization is high in the Icelandic system, autonomy of agencies does not have a strong relation to a varied use of administrative instruments. The second part of the article focuses on the results and achievements of reform programmes. The achievement of reform programmes are examined in relation to theories of bounded rationality, street level bureaucracy (bottom up and consensus decision making. Three hypotheses are presented and tested to explain what causes reforms programmes to be successful in some countries and not in others. The analysis reveals that countries are more likely to succeed if bounded rationality is applied with careful preparation and when stakeholders are consulted.

  2. Looking to Hume for justice: on the utility of Hume's view of justice for American health care reform.

    Science.gov (United States)

    Churchill, L R

    1999-08-01

    This essay argues that Hume's theory of justice can be useful in framing a more persuasive case for universal access in health care. Theories of justice derived from a Rawlsian social contract tradition tend to make the conditions for deliberation on justice remote from the lives of most persons, while religiously-inspired views require superhuman levels of benevolence. By contrast, Hume's theory derives justice from the prudent reflections of socially-encumbered selves. This provides a more accessible moral theory and a more realistic path to the establishment of universal access.

  3. Chile's health sector reform: lessons from four reform periods.

    Science.gov (United States)

    de la Jara, J J; Bossert, T

    1995-01-01

    This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.

  4. Air curtain development: an energy harvesting solution for hinged doors

    Science.gov (United States)

    Dayal, Vineed; Lee, Soobum

    2017-04-01

    The paper proposes a fully mechanical air curtain system that will be powered solely by harvested energy from common hinged doors. The average person uses this type of door several times a day with an almost unconscious amount of applied force and effort. This leads to a high potential of energy to be harvested in doorways that see high traffic and frequent operation7 . Frequently opened door entry ways have always been regarded as a major element that causes significant energy loss and contaminated air conditions in buildings6 . Private companies, particularly those with warehouses, have introduced commercial electrical air curtains to block the open entrances from invading cold air11. This project intends to introduce an original design of air curtain which operates fans only when the door opens and closes, by directly converting door motion to fan rotation without any electronic motor or power cable. The air stream created by this device will prevent the transfer of outside air and contaminants. Research will be conducted to determine the most efficient method of harvesting energy from door use, and the prototyping process will be conducted to meet the required performance of current air curtain models.

  5. A Structurally Variable Hinged Tetrahedron Framework from DNA Origami

    Science.gov (United States)

    Smith, David M.; Schüller, Verena; Forthmann, Carsten; Schreiber, Robert; Tinnefeld, Philip; Liedl, Tim

    2011-01-01

    Nanometer-sized polyhedral wire-frame objects hold a wide range of potential applications both as structural scaffolds as well as a basis for synthetic nanocontainers. The utilization of DNA as basic building blocks for such structures allows the exploitation of bottom-up self-assembly in order to achieve molecular programmability through the pairing of complementary bases. In this work, we report on a hollow but rigid tetrahedron framework of 75 nm strut length constructed with the DNA origami method. Flexible hinges at each of their four joints provide a means for structural variability of the object. Through the opening of gaps along the struts, four variants can be created as confirmed by both gel electrophoresis and direct imaging techniques. The intrinsic site addressability provided by this technique allows the unique targeted attachment of dye and/or linker molecules at any point on the structure's surface, which we prove through the superresolution fluorescence microscopy technique DNA PAINT. PMID:21941629

  6. A Structurally Variable Hinged Tetrahedron Framework from DNA Origami

    Directory of Open Access Journals (Sweden)

    David M. Smith

    2011-01-01

    Full Text Available Nanometer-sized polyhedral wire-frame objects hold a wide range of potential applications both as structural scaffolds as well as a basis for synthetic nanocontainers. The utilization of DNA as basic building blocks for such structures allows the exploitation of bottom-up self-assembly in order to achieve molecular programmability through the pairing of complementary bases. In this work, we report on a hollow but rigid tetrahedron framework of 75 nm strut length constructed with the DNA origami method. Flexible hinges at each of their four joints provide a means for structural variability of the object. Through the opening of gaps along the struts, four variants can be created as confirmed by both gel electrophoresis and direct imaging techniques. The intrinsic site addressability provided by this technique allows the unique targeted attachment of dye and/or linker molecules at any point on the structure's surface, which we prove through the superresolution fluorescence microscopy technique DNA PAINT.

  7. Identification of Mitral Annulus Hinge Point Based on Local Context Feature and Additive SVM Classifier

    Directory of Open Access Journals (Sweden)

    Jianming Zhang

    2015-01-01

    Full Text Available The position of the hinge point of mitral annulus (MA is important for segmentation, modeling and multimodalities registration of cardiac structures. The main difficulties in identifying the hinge point of MA are the inherent noisy, low resolution of echocardiography, and so on. This work aims to automatically detect the hinge point of MA by combining local context feature with additive support vector machines (SVM classifier. The innovations are as follows: (1 designing a local context feature for MA in cardiac ultrasound image; (2 applying the additive kernel SVM classifier to identify the candidates of the hinge point of MA; (3 designing a weighted density field of candidates which represents the blocks of candidates; and (4 estimating an adaptive threshold on the weighted density field to get the position of the hinge point of MA and exclude the error from SVM classifier. The proposed algorithm is tested on echocardiographic four-chamber image sequence of 10 pediatric patients. Compared with the manual selected hinge points of MA which are selected by professional doctors, the mean error is in 0.96 ± 1.04 mm. Additive SVM classifier can fast and accurately identify the MA hinge point.

  8. Reassessing the Plastic Hinge Model for Energy Dissipation of Axially Loaded Columns

    Directory of Open Access Journals (Sweden)

    R. M. Korol

    2014-01-01

    Full Text Available This paper investigates the energy dissipation potential of axially loaded columns and evaluates the use of a plastic hinge model for analysis of hi-rise building column collapse under extreme loading conditions. The experimental program considered seven axially loaded H-shaped extruded aluminum structural section columns having slenderness ratios that would be typical of floor-to-ceiling heights in buildings. All seven test specimens initially experienced minor-axis overall buckling followed by formation of a plastic hinge at the mid-height region, leading to local buckling of the flanges on the compression side of the plastic hinge, and eventual folding of the compression flanges. The experimental energy absorption, based on load-displacement relations, was compared to the energy estimates based on section plastic moment resistance based on measured yield stress and based on measured hinge rotations. It was found that the theoretical plastic hinge model underestimates a column’s actual ability to absorb energy by a factor in the range of 3 to 4 below that obtained from tests. It was also noted that the realizable hinge rotation is less than 180°. The above observations are based, of course, on actual columns being able to sustain high tensile strains at hinge locations without fracturing.

  9. Identification of Mitral Annulus Hinge Point Based on Local Context Feature and Additive SVM Classifier.

    Science.gov (United States)

    Zhang, Jianming; Liu, Yangchun; Xu, Wei

    2015-01-01

    The position of the hinge point of mitral annulus (MA) is important for segmentation, modeling and multimodalities registration of cardiac structures. The main difficulties in identifying the hinge point of MA are the inherent noisy, low resolution of echocardiography, and so on. This work aims to automatically detect the hinge point of MA by combining local context feature with additive support vector machines (SVM) classifier. The innovations are as follows: (1) designing a local context feature for MA in cardiac ultrasound image; (2) applying the additive kernel SVM classifier to identify the candidates of the hinge point of MA; (3) designing a weighted density field of candidates which represents the blocks of candidates; and (4) estimating an adaptive threshold on the weighted density field to get the position of the hinge point of MA and exclude the error from SVM classifier. The proposed algorithm is tested on echocardiographic four-chamber image sequence of 10 pediatric patients. Compared with the manual selected hinge points of MA which are selected by professional doctors, the mean error is in 0.96 ± 1.04 mm. Additive SVM classifier can fast and accurately identify the MA hinge point.

  10. The polyproline site in hinge 2 influences the functional capacity of truncated dystrophins.

    Directory of Open Access Journals (Sweden)

    Glen B Banks

    2010-05-01

    Full Text Available Mutations in dystrophin can lead to Duchenne muscular dystrophy or the more mild form of the disease, Becker muscular dystrophy. The hinge 3 region in the rod domain of dystrophin is particularly prone to deletion mutations. In-frame deletions of hinge 3 are predicted to lead to BMD, however the severity of disease can vary considerably. Here we performed extensive structure-function analyses of truncated dystrophins with modified hinges and spectrin-like repeats in mdx mice. We found that the polyproline site in hinge 2 profoundly influences the functional capacity of a microdystrophin(DeltaR4-R23/DeltaCT with a large deletion in the hinge 3 region. Inclusion of polyproline in microdystrophin(DeltaR4-R23/DeltaCT led to small myofibers (12% smaller than wild-type, Achilles myotendinous disruption, ringed fibers, and aberrant neuromuscular junctions in the mdx gastrocnemius muscles. Replacing hinge 2 of microdystrophin(DeltaR4-R23/DeltaCT with hinge 3 significantly improved the functional capacity to prevent muscle degeneration, increase muscle fiber area, and maintain the junctions. We conclude that the rigid alpha-helical structure of the polyproline site significantly impairs the functional capacity of truncated dystrophins to maintain appropriate connections between the cytoskeleton and extracellular matrix.

  11. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

    Science.gov (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

    2011-01-01

    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  12. Methodological issues of optimization the sanitary-educational assistance for children with asthma during the health care reform of Ukraine

    Directory of Open Access Journals (Sweden)

    S. N. Nedelskaya

    2013-08-01

    Full Text Available Entry. Asthma remains the medical, social, economic issue of the day of modern society and industry of health protection. Research works on questions asthma are sanctified to mainly the improvement of diagnostics and treatment of asthma and a sanitary-educational help is underestimated. In the modern terms of structural alteration of network of establishments of health care in Ukraine a sanitary-educational help must be an effective complex in strategy of therapy of patients with asthma. Research aim. To ground importance, modern forms and methods of sanitary -educational help in providing of control above asthma on the stage of structural reorganization of establishments of health care in Ukraine. Materials and research methods. Scientifically-methodical literature was analyzed on general questions of organization and realization of sanitary-educational work in asthma. Long-term of own experience of realization of this work is generalized in the conditions of stationary treatment of patients with asthma. Research results. Sanitary-educational work in a form of education in the program "Asthma school". General practitioner, as a key figure of establishments of primary medical and sanitary help, must own the psychological methods including medical-psychology programs of before- and after graduation medical education. Conclusions. In providing of effective control above bronchial asthma in children a sanitary-educational help must be logical continuation and addition of curative help. Application of the educational programs and volume of work of doctors at their implementation must be legislatively lighted up in "Protocols of diagnostics and treatment of bronchial asthma for children".

  13. Telecom Reform

    DEFF Research Database (Denmark)

    and information infrastructure issues - for people in government, academia, industry and the consulting community. This book addresses the process of policy and regulatory reform in telecom that is now in its formative stage. It draws on detailed knowledge of industry development and regulatory experience...

  14. Reforming health care in Canada: current issues La reforma del sistema de atención a la salud en Canadá: situación actual

    Directory of Open Access Journals (Sweden)

    Enis Baris

    1998-05-01

    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government’s clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada’s health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.Este artículo examina los temas más recientes en las reformas del sistema de atención a la salud en Canadá. Los planes de seguridad en el sector salud durante los años sesenta y setenta tuvieron efectos inapropiados en cuanto a que limitaron el poder del gobierno federal para controlar costos y promover un sistema centrado en la atención médico-hospitalaria. Recientemente, varias comisiones provinciales reportaron que las actuales estructuras de gobierno y gestión de los procesos no están actualizadas en términos del nuevo conocimiento, las nuevas realidades fiscales y la evolución en las formas de poder entre los grupos de interés. Sus recomendaciones incluyen formas descentralizadas de gobierno y mayor participación ciudadana. A pesar de que el sistema de atención a la salud en Canadá permanece comprometido a garantizar sus principios centrales, el balance de poder estaría cambiando de los

  15. Health Care System and Reform in Austria: Implications for China%奥地利的卫生制度与改革及对中国的启示

    Institute of Scientific and Technical Information of China (English)

    李红文

    2011-01-01

    简要介绍了奥地利卫生制度的一些基本特征,以及近30年来在卫生制度领域进行的改革,着力分析了它们对于中国医疗改革的启示性意义.有四个方面的启示值得中国学习:权力制约与监督,公私结合、以公为主,卫生服务的普遍可及以及卫生服务的公平性.%This paper first makes an introduction of health care system in Austria, and health care reform in the past thirty years there. Then it analyzes the implications to China' health care reform. There are four aspects from which China should learn; decentralization of health authority, public owned system with part of privatization, universal health care, and equity in access to health care.

  16. Tactile efficiency of insect antennae with two hinge joints.

    Science.gov (United States)

    Krause, Andre F; Dürr, Volker

    2004-09-01

    Antennae are the main organs of the arthropod tactile sense. In contrast to other senses that are capable of retrieving spatial information, e.g. vision, spatial sampling of tactile information requires active movement of the sense organ. For a quantitative analysis of basic principles of active tactile sensing, we use a generic model of arbitrary antennae with two hinge joints (revolute joints). This kind of antenna is typical for Orthoptera and Phasmatodea, i.e. insect orders that contain model species for the study of antennal movements, including cricket, locust and stick insect. First, we analyse the significance of morphological properties on workspace and sampling acuity. It is shown how joint axis orientation determines areas out of reach while affecting acuity in the areas within reach. Second, we assume a parametric set of movement strategies, based on empirical data on the stick insect Carausius morosus, and investigate the role of each strategy parameter on tactile sampling performance. A stochastic environment is used to measure sampling density, and a viscous friction model is assumed to introduce energy consumption and, thus, a measure of tactile efficiency. Up to a saturation level, sampling density is proportional to the range or frequency of joint angle modulation. The effect of phase shift is strong if joint angle modulation frequencies are equal, but diminishes for other frequency ratios. Speed of forward progression influences the optimal choice of movement strategy. Finally, for an analysis of environmental effects on tactile performance, we show how efficiency depends on predominant edge direction. For example, with slanted and non-orthogonal joint axis orientations, as present in the stick insect, the optimal sampling strategy is less sensitive to a change from horizontal to vertical edge predominance than with orthogonal and non-slanted joint axes, as present in a cricket.

  17. The Medical Insurance and Medical Care Price Reform%医疗保险与医药价格改革

    Institute of Scientific and Technical Information of China (English)

    王震

    2015-01-01

    在全民医保背景下,医保不仅是风险分散的手段,而且作为医疗服务的主要付费方和需方代理人,应在医药价格形成中充分利用市场机制,通过参与价格形成发挥医疗资源配置者的功能.当前的主要障碍:一是医药的行政定价;二是供方事实上的行政垄断.政策突破口是建立医保医师制度,打破公立医院垄断,充分利用市场机制形成合理的医药定价机制.%Under the background of universal health care, medical insurance should play role in allocating medical resources amongst different parties in medical industries by involving in price forming system, since medical insurance is not only a way of risk diversifying, but also the main payers and the agents of the insured. However, the basic medical insurance in China is excluded from the medical price forming system, because of the monopolistic position of public hospitals in medical services and governmental price forming. The ways to solve this problem is to build a direct physician contracting system, break the monopoly of public hospitals, and construct a reasonable medical pricing system based on market mechanism.

  18. Reform and Backlash to Reform

    DEFF Research Database (Denmark)

    Hougaard Jensen, Svend E.; Hagen Jørgensen, Ole

    Using a stochastic general equilibrium model with overlapping generations, this paper studies (i) the effects on both extensive and intensive labor supply responses to changes in fertility rates, and (ii) the potential of a retirement reform to mitigate the effects of fertility changes on labor...

  19. Covalent protein modification with ISG15 via a conserved cysteine in the hinge region.

    Directory of Open Access Journals (Sweden)

    Veronika N Bade

    Full Text Available The ubiquitin-like protein ISG15 (interferon-stimulated gene of 15 kDa is strongly induced by type I interferons and displays antiviral activity. As other ubiquitin-like proteins (Ubls, ISG15 is post-translationally conjugated to substrate proteins by an isopeptide bond between the C-terminal glycine of ISG15 and the side chains of lysine residues in the substrates (ISGylation. ISG15 consists of two ubiquitin-like domains that are separated by a hinge region. In many orthologs, this region contains a single highly reactive cysteine residue. Several hundred potential substrates for ISGylation have been identified but only a few of them have been rigorously verified. In order to investigate the modification of several ISG15 substrates, we have purified ISG15 conjugates from cell extracts by metal-chelate affinity purification and immunoprecipitations. We found that the levels of proteins modified by human ISG15 can be decreased by the addition of reducing agents. With the help of thiol blocking reagents, a mutational analysis and miRNA mediated knock-down of ISG15 expression, we revealed that this modification occurs in living cells via a disulphide bridge between the substrates and Cys78 in the hinge region of ISG15. While the ISG15 activating enzyme UBE1L is conjugated by ISG15 in the classical way, we show that the ubiquitin conjugating enzyme Ubc13 can either be classically conjugated by ISG15 or can form a disulphide bridge with ISG15 at the active site cysteine 87. The latter modification would interfere with its function as ubiquitin conjugating enzyme. However, we found no evidence for an ISG15 modification of the dynamin-like GTPases MxA and hGBP1. These findings indicate that the analysis of potential substrates for ISG15 conjugation must be performed with great care to distinguish between the two types of modification since many assays such as immunoprecipitation or metal-chelate affinity purification are performed with little or no

  20. Covalent protein modification with ISG15 via a conserved cysteine in the hinge region.

    Science.gov (United States)

    Bade, Veronika N; Nickels, Jochen; Keusekotten, Kirstin; Praefcke, Gerrit J K

    2012-01-01

    The ubiquitin-like protein ISG15 (interferon-stimulated gene of 15 kDa) is strongly induced by type I interferons and displays antiviral activity. As other ubiquitin-like proteins (Ubls), ISG15 is post-translationally conjugated to substrate proteins by an isopeptide bond between the C-terminal glycine of ISG15 and the side chains of lysine residues in the substrates (ISGylation). ISG15 consists of two ubiquitin-like domains that are separated by a hinge region. In many orthologs, this region contains a single highly reactive cysteine residue. Several hundred potential substrates for ISGylation have been identified but only a few of them have been rigorously verified. In order to investigate the modification of several ISG15 substrates, we have purified ISG15 conjugates from cell extracts by metal-chelate affinity purification and immunoprecipitations. We found that the levels of proteins modified by human ISG15 can be decreased by the addition of reducing agents. With the help of thiol blocking reagents, a mutational analysis and miRNA mediated knock-down of ISG15 expression, we revealed that this modification occurs in living cells via a disulphide bridge between the substrates and Cys78 in the hinge region of ISG15. While the ISG15 activating enzyme UBE1L is conjugated by ISG15 in the classical way, we show that the ubiquitin conjugating enzyme Ubc13 can either be classically conjugated by ISG15 or can form a disulphide bridge with ISG15 at the active site cysteine 87. The latter modification would interfere with its function as ubiquitin conjugating enzyme. However, we found no evidence for an ISG15 modification of the dynamin-like GTPases MxA and hGBP1. These findings indicate that the analysis of potential substrates for ISG15 conjugation must be performed with great care to distinguish between the two types of modification since many assays such as immunoprecipitation or metal-chelate affinity purification are performed with little or no reducing agent

  1. 健康守门人制度与中国医药卫生改革(待续)%Health Gatekeeper System and China's Health Care Reform

    Institute of Scientific and Technical Information of China (English)

    鲍勇; 诸培红; 王金柱; 杜学礼

    2013-01-01

    大力发展社区卫生服务,已成为提高居民的健康水平、控制医疗费用过快增长的普遍共识.国外的基层医疗卫生服务体系经过多年的发展,已基本形成比较完备的体系,特别是其所建立的家庭医生制度以及家庭医生首诊制度,使得健康守门人制度在提高居民健康水平、分级就诊等方面起到了巨大作用.本文在回顾国内外关于健康守门人制度的特点及实践基础上,阐述了建立健康守门人制度的意义.同时在中国医疗卫生改革中,就如何加强社区卫生服务的发展,构建具有中国特色的健康守门人制度提出了政策建议,如规范社区卫生服务功能,推进社区卫生服务模式改革;加强人才队伍建设;加强政策支持和财政补助;加强社区信息化网络建设等.%It is a general consensus about to improving the health of residents and reducing the excessive growth of medical costs by developing community health services. After years of development, the foreign primary medical care and health service system has basically formed a relatively complete system. Especially their family doctor system, and the first diagnosis of the family doctor system,health gatekeeper system has played a huge role in improving the health of residents,in the level of classification treatment and so on. On the basis of reviewing the characteristics and practical health gatekeeper system to the domestic and foreign , the authors expound the significance of the healthy gatekeeper system. And at the same, the authors also give some advice on how to strengthen the development of community health services so as to building health-gatekeeper system with Chinese characteristics at the China' s health care reform,such as formulating the norms of the community health service,promoting the reform of the Community Health Service; strengthening the development of qualified personnel; strengthening policy support and financial assistance

  2. The Stress Analysis and Tests on the Hinge Beam of the Diamond Synthesis Cubic Press

    Directory of Open Access Journals (Sweden)

    Ma Liang

    2016-01-01

    Full Text Available To deal with the problem of the lug fractures of hinge beam caused by the fatigue and overload during the operation of the cubic press, the analysis methods of finite element are applied to the analysis of the internal stress distributions of the hinge beam. The simulation results show that the internal stress of the hinge beam mainly concentrates on the upper surface of the lug roots connecting the outer cylinder with the both lugs. According to the data of simulation and analysis as well as the actual fracture situations, considering the strain-test methods we have designed the schemes of testing the strain on the lugs of hinge beam. And the strain measurements of the lugs are completed by the repeated loading experiments. Comparing the data of simulation and analysis with the measured data has verified their consistency. It also confirms the model established by the simulation and analysis is reasonable and accurate at the same time.

  3. Meie hõimlased ja naabrid usuvad puusse kui hinge asupaika

    Index Scriptorium Estoniae

    2009-01-01

    Tallinna Ülikooli Eesti Humanitaarinstituudi maastiku ja kultuuri keskuse etnokultuuri vanemteadur Marju Kõivupuu esitles oma monograafiat "Hinged puhkavad puudes", mis on ülevaatlik käsitlus puudega seotud hingeuskumustest lõunaeestlaste matmiskombestikus. Marju Kõivupuu peamistest uurimissuundadest

  4. CALCULATION OF CONTACT TENSIONS IN CONJUGATE SURFACES IN SPHERE GLOBOIDAL RUSK SYNCHRONOUS CARDAN HINGE

    Directory of Open Access Journals (Sweden)

    A. M. Saniotsky

    2015-01-01

    Full Text Available The paper presents  a calculation of contact tensions between conjugate surfaces in sphere globoidal rusk synchronous cardan hinge on the condition that there is power balance at the constant torque on the output shaft. The required torque effect on the intake shaft at the constant angular velocity  has been calculated with the help of the Hertz’s theory of contact deformations . The maximum contact pressure has been ascertained through the torque which determines strength of the cardan hinge, its durability, wear rate in  the conjugate friction pair. The paper investigates transmission dependence of the maximum torque while changing  material quality and according to various typical sizes of the cardan hinge. Dependences of the calculated maximum torque value on material strength have been demonstrated graphically  in the logarithmic coordinate system.  A formula for maximum contact pressure value has been derived and it determines  strength of the hinge mechanism, its durability and wear rate  in the conjugate friction pair.The effect of geometrical relationship between a spherical cam radius and a globoidal  surface radius of a hinge contact has been determined with the purpose to analyze optimal design parameters of the sphere globoidal rusk synchronous cardan hinge. It has been established that permissible torque in the hinge mechanism grows with a quadratic dependence while increasing a cam radius and  the torque is proportionally growing while increasing an axis radius of globoidal rusk surface on which spherical cams are set. The maximum permissible torque value grows with a cubic dependence while using qualitative material with thermally treated surface and application of lubrication materials which tolerates significant (up to [σ] = 1000 MPa contact loads.  Two-fold increase of typical size of the sphere globoidal rusk synchronous cardan hinge leads to an 8-fold increase of the permissible transmitted torque.

  5. Nonlinear seismic analysis of concrete buildings considering different models of plastic hinges

    OpenAIRE

    López‐López, Andrés; Tomás, Antonio

    2015-01-01

    Congreso celebrado en la Escuela de Arquitectura de la Universidad de Sevilla desde el 24 hasta el 26 de junio de 2015. Pushover analysis is one of the most frequently used methods for the seismic analysis of structures. The accurate modelling of the plastic hinges generated during the pushover analysis is crucial. The response curve of plastic hinges can be defined with empirical expressions that obtain the yielding and ultimate states of the cross‐sections. The main objective of this wor...

  6. Identification of Fold Hinge Migration in Natural Deformation: A New Technique Using Grain Shape Fabric Analysis

    OpenAIRE

    Rose, Kelly Kathleen

    1999-01-01

    Partitioning of finite strains in different domains within the limb and hinge regions of a fold can be used to understand the deformation processes operative during fold formation. Samples taken from the limb and hinge regions of a gently plunging, asymmetric, tight, mesoscale fold in the Erwin formation of the Blue Ridge in North Carolina were analyzed to determine the deformation mechanisms and strains associated with the folding event. Rf/phi grain shape fabric analysis was conducted for...

  7. Milleks inimesele on antud hing? : [luuletused] / Omel Ladi ; tlk. Arvo Valton

    Index Scriptorium Estoniae

    Ladi, Omel

    2006-01-01

    Sisu: Milleks inimesele on antud hing? ; "Tuli Jõhkur..." ; Versdorfi märkmikust ; "Mu sõber on mu hing..." ; "Sõber Armin..." ; "Kas taevas sünnib ilus muusika..." ; "Kui orel mängu alustab..." ; "Dirigent seal toksib sagris rähnina..." ; "Ma kõike, kõike seda oleks nagu näind...". Luuletused paralleelselt udmurdi ja eesti keeles

  8. Functionalisation of the hinge region in receptor molecules for explosive detection

    DEFF Research Database (Denmark)

    Krebs, Frederik C

    2003-01-01

    The functionalisation of the hinge region in a molecular tweezer molecule showing a strong binding to explosives is presented. Two versatile functional groups are introduced, a carboxylic acid and a bromine atom. (C) 2003 Elsevier Ltd. All rights reserved.......The functionalisation of the hinge region in a molecular tweezer molecule showing a strong binding to explosives is presented. Two versatile functional groups are introduced, a carboxylic acid and a bromine atom. (C) 2003 Elsevier Ltd. All rights reserved....

  9. Activation of complement by an IgG molecule without a genetic hinge.

    Science.gov (United States)

    Brekke, O H; Michaelsen, T E; Sandin, R; Sandlie, I

    1993-06-17

    The hinge region links the two Fab arms to the Fc portion of the IgG molecule. It mediates flexibility to the molecule and serves as a connecting structure between the two heavy chains. In addition it provides space between the Fab and Fc parts. All three properties have been proposed to be important for the ability of IgG to initiate complement activation leading to complement-mediated cell lysis (CML). Here we report the construction of a hinge-deleted mouse-human chimaeric IgG3 molecule with specificity for the hapten NIP (3-iodo-4-hydroxy-5-nitrophenacetyl), HM-1. HM-1 lacks the genetic hinge, but has an introduced cysteine between Ala 231 (EU numbering) and Pro 232 in the lower hinge encoded by the CH2 exon. The introduced cysteine forms a disulphide bond between the two heavy chains of the molecule. In CML, HM-1 shows a greater activity than IgG3 wild type. This is the first time an IgG molecule without a genetic hinge has been found to be active in CML. We conclude that the hinge functioning as a spacer is not a prerequisite for complement activation. Rather, its major role seems to be to connect the heavy chains to each other in the amino-terminal part of CH2. Because HM-1 is expected to have low Fab-Fc flexibility, this molecular feature is probably of no importance for complement activation.

  10. Extracellular-regulated kinase 2 is activated by the enhancement of hinge flexibility.

    Science.gov (United States)

    Sours, Kevin M; Xiao, Yao; Ahn, Natalie G

    2014-05-01

    Protein motions underlie conformational and entropic contributions to enzyme catalysis; however, relatively little is known about the ways in which this occurs. Studies of the mitogen-activated protein kinase ERK2 (extracellular-regulated protein kinase 2) by hydrogen-exchange mass spectrometry suggest that activation enhances backbone flexibility at the linker between N- and C-terminal domains while altering nucleotide binding mode. Here, we address the hypothesis that enhanced backbone flexibility within the hinge region facilitates kinase activation. We show that hinge mutations enhancing flexibility promote changes in the nucleotide binding mode consistent with domain movement, without requiring phosphorylation. They also lead to the activation of monophosphorylated ERK2, a form that is normally inactive. The hinge mutations bypass the need for pTyr but not pThr, suggesting that Tyr phosphorylation controls hinge motions. In agreement, monophosphorylation of pTyr enhances both hinge flexibility and nucleotide binding mode, measured by hydrogen-exchange mass spectrometry. Our findings demonstrate that regulated protein motions underlie kinase activation. Our working model is that constraints to domain movement in ERK2 are overcome by phosphorylation at pTyr, which increases hinge dynamics to promote the active conformation of the catalytic site.

  11. A connecting hinge represses the activity of endothelial nitric oxide synthase.

    Science.gov (United States)

    Haque, Mohammad Mahfuzul; Panda, Koustubh; Tejero, Jesús; Aulak, Kulwant S; Fadlalla, Mohammed Adam; Mustovich, Anthony T; Stuehr, Dennis J

    2007-05-29

    In mammals, endothelial nitric oxide synthase (eNOS) has the weakest activity, being one-tenth and one-sixth as active as the inducible NOS (iNOS) and the neuronal NOS (nNOS), respectively. The basis for this weak activity is unclear. We hypothesized that a hinge element that connects the FMN module in the reductase domain but is shorter and of unique composition in eNOS may be involved. To test this hypothesis, we generated an eNOS chimera that contained the nNOS hinge and two mutants that either eliminated (P728IeNOS) or incorporated (I958PnNOS) a proline residue unique to the eNOS hinge. Incorporating the nNOS hinge into eNOS increased NO synthesis activity 4-fold, to an activity two-thirds that of nNOS. It also decreased uncoupled NADPH oxidation, increased the apparent K(m)O(2) for NO synthesis, and caused a faster heme reduction. Eliminating the hinge proline had similar, but lesser, effects. Our findings reveal that the hinge is an important regulator and show that differences in its composition restrict the activity of eNOS relative to other NOS enzymes.

  12. Engineering upper hinge improves stability and effector function of a human IgG1.

    Science.gov (United States)

    Yan, Boxu; Boyd, Daniel; Kaschak, Timothy; Tsukuda, Joni; Shen, Amy; Lin, Yuwen; Chung, Shan; Gupta, Priyanka; Kamath, Amrita; Wong, Anne; Vernes, Jean-Michel; Meng, Gloria Y; Totpal, Klara; Schaefer, Gabriele; Jiang, Guoying; Nogal, Bartek; Emery, Craig; Vanderlaan, Martin; Carter, Paul; Harris, Reed; Amanullah, Ashraf

    2012-02-17

    Upper hinge is vulnerable to radical attacks that result in breakage of the heavy-light chain linkage and cleavage of the hinge of an IgG1. To further explore mechanisms responsible for the radical induced hinge degradation, nine mutants were designed to determine the roles that the upper hinge Asp and His play in the radical reactions. The observation that none of these substitutions could inhibit the breakage of the heavy-light chain linkage suggests that the breakage may result from electron transfer from Cys(231) directly to the heavy-light chain linkage upon radical attacks, and implies a pathway separate from His(229)-mediated hinge cleavage. On the other hand, the substitution of His(229) with Tyr showed promising advantages over the native antibody and other substitutions in improving the stability and function of the IgG1. This substitution inhibited the hinge cleavage by 98% and suggests that the redox active nature of Tyr did not enable it to replicate the ability of His to facilitate radical induced degradation. We propose that the lower redox potential of Tyr, a residue that may be the ultimate sink for oxidizing equivalents in proteins, is responsible for the inhibition. More importantly, the substitution increased the antibody's binding to FcγRIII receptors by 2-3-fold, and improved ADCC activity by 2-fold, while maintaining a similar pharmacokinetic profile with respect to the wild type. Implications of these observations for antibody engineering and development are discussed.

  13. Dimensions of health system reform.

    Science.gov (United States)

    Frenk, J

    1994-01-31

    During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross

  14. [Reform of psychiatry in Spain].

    Science.gov (United States)

    Pedrosa Gil, F; Luderer, H J

    2000-11-01

    Since the 1980's psychiatric care in Spain changed considerably (Reforma psiquiátrica española). In the course of this reform, many positive results were achieved. An extensive community network of mental health centres was build up which resulted in the majority of psychiatric patients being integrated in the Spanish general health care system and making a better organized mental health care structure possible. New legislation also improved the care and civil rights of patients. An analysis of the experiences of the Spanish psychiatric reform shows that the tendency to retain the old mental hospitals, alongside the other institutions still exists. The process of deinstitutionalization and the original aims of the psychiatric reform cannot only be satisfied by the closure of large psychiatric hospitals as during the reform new aspects and problems as well the great complexity of the task have become apparent. This article together with the details of the Spanish sources gives the German public a good overview of the developments in Spanish psychiatry.

  15. Capacity building for primary health care reform and its effectiveness in Feixi county, Anhui province%安徽省肥西县基层卫生服务能力提升改革及其成效

    Institute of Scientific and Technical Information of China (English)

    金音子; 何莉; 岳大海; 朱炜明; 张鲁豫; 马慧芬; 孟庆跃

    2015-01-01

    目的::分析安徽省肥西县基层卫生服务能力提升改革措施及成效,为深化基层医疗卫生服务体系改革提供参考。方法:采用关键知情人访谈、政策文件和档案资料分析以及机构问卷调查等方法收集资料,定性和定量研究结合,通过交叉分析和解释得出研究发现。结果:2010—2014年,肥西县从基层卫生人员能力、卫生服务体系网络建设、工作条件改善、机构管理制度建设四方面进行改革后,基层卫生人员能力提升、工作积极性增加、收入提高,基层卫生条件改善,纵向和横向医疗服务协作机制建立,县内就诊率和基层卫生服务利用提高。结论:肥西县“自下而上”的探索路径和“以点带面”的试点推行,不仅是基层卫生体系综合改革的核心内容,也有效撬动了其它方面的改革,触动了医疗卫生体系体制机制。%Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate

  16. 提升医保质量亟需“三改并举”%Enhance the Quality of Care to Three Medical Reform to Develop Simultaneously

    Institute of Scientific and Technical Information of China (English)

    张学顺; 尹春燕

    2012-01-01

      “三改并举”是深化医改和建设“质量医保”的重大方略和重大步骤。“十二五”医改规划强调要充分发挥全民医保的基础性作用,这不仅是对医保部门提出的要求,也是卫生、药监等部门的共同责任。公立医院在建设“质量医保”的进程中要成为医疗体系的模范。%  The "three reform (medical and health system reform, purchase and sale of medicine circulation system reform, medical insurance for urban workers) simultaneously " is the deepening medical reform and construction of"quality health insurance"major strategy and major steps."12.5"medical reform program emphasized the need to give full play to the basic role of the national medical insurance, this is not only for medical insurance department 's request, is also the health, medical and other departments of the joint liability. Public hospitals in the construction of"quality health insurance"in the process to become a medical insurance system model.

  17. 妥善处理医药卫生体制改革中的五对关系%Dealing With Five Pairs of Relationships in Health Care System Reform

    Institute of Scientific and Technical Information of China (English)

    陈诚诚

    2014-01-01

    本文通过深入辨析医疗卫生体制改革中的五对关系:医疗机构与卫生部门、医疗机构与医药企业、医疗机构与医保机构、医患之间、公立医院与私立医院之间的关系,得出医改过程中的难点和重点在于平衡各方的利益,给需方以利益表达渠道,给供方以合理的利益补偿。同时提出,改革应遵循建立公平的竞争机制、有效分配医疗资源等原则。妥善处理这五对关系是中国医改的核心内容。%The article intensively analyzed five pairs of relationship in health care system, which included the relationship between medical institutions and departments of health, between medical institutions and pharmaceutical enterprises, between medical institutions and health insurance, between physicians and patients, between public hospitals and private hospitals. It can be concluded that the most crucial and dififcult part is to balance the interests of all parties in the process of health care reform. The demanders should be provided interest expression channels. Meanwhile, it is also necessary to offer reasonable beneift compensation to suppliers. The aims of the reform are to formulate fair competition mechanism and distribute medical resources effectively. In brief, the core of health care system reform is to handle these ifve pairs of relationship appropriately.

  18. 新医改背景下公立医院整形医师培养探索%Based on the new medical and health care system reform views in China of plastic surgeons training in public hospitals

    Institute of Scientific and Technical Information of China (English)

    刘翔宇; 舒茂国; 刘宗辉

    2016-01-01

    Objective:Under the ‘on deepening the medical and health care system reform views’ issued, ifrst time, it articulated clearly the basic medical and health care system as a public product to national peoples as the basic principles, establish aim of equal basic public health services, public hospitals as the center of the reform, promoting the transformation of government public service function and integration, and public medical and health care must adhere to the public-welfare nature. But plastic surgery is unconventional medicals. How to combine the health reform and the current training system to cultivate excellent plastic surgeon is a problem worthy of exploring.%《关于深化医药卫生体制改革的意见》的新医改文件,首次明确提出把基本医疗卫生制度作为公共产品向全民提供的基本改革原则,确立基本公共卫生服务均等化目标,并以公立医院改革为重心,促进政府服务性职能的进一步转变和整合,改革必须坚持公共医疗卫生的公益性质。但是整形外科非传统意义的医学,如何更好地结合医改政策及目前的培训体制来培养优秀的整形医师是目前值得探讨的问题。

  19. Health care in the Netherlands.

    NARCIS (Netherlands)

    Weel, C. van; Schers, H.J.; Timmermans, A.

    2012-01-01

    This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

  20. National Health-Care Reform

    Science.gov (United States)

    2009-03-24

    that is due primarily to lifestyle choices.79 If public willingness to subsidize poor lifestyle choices declines, then it will be time to tie personal...making healthy lifestyle choices and penalizes those making poor choices. America currently levies heavy sales taxes on tobacco, perhaps taxes on...fattening foods or similar disincentives would modify America’s lifestyle choices. If not, they would at least ensure that those making poor choices are

  1. The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed?

    Science.gov (United States)

    Polyzos, Nikos; Karakolias, Stefanos; Dikeos, Costas; Theodorou, Mamas; Kastanioti, Catherine; Mama, Kalomira; Polizoidis, Periklis; Skamnakis, Christoforos; Tsairidis, Charalampos; Thireos, Eleutherios

    2014-11-25

    The National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC). Health funding (public/private) mix is examined, alongside the role of pre-existing health insurance funds. The main pursuit of this paper is to evaluate whether EOPYY has met its goals. The article surveys for best practices in advanced health systems and similar sickness funds. The main benchmarks focus on PHC provision and providers' reimbursement. It then turns to an analysis of EOPYY, focusing on specific questions and searching the relevant databases. It compares the best practice examples to the EOPYY (alongside further developments set by new legislation in L 4238/14), revealing weaknesses relevant to non-integrated PHC network, unbalanced manpower, non-gatekeeping, under-financing and other funding problems caused by the current crisis. Finally, a new model of medical procedures cost accounting was tested in health centers. An alternative operation of EOPYY functioning primarily as an insurer whereas its proprietary units are integrated with these of the NHS is proposed. The paper claims it is critical to revise the current induced demand favorable reimbursement system, via per capita payments for physicians combined with extra pay-for-performance payments, while cost accounting corroborates a prospective system for NHS's and EOPYY's units, under a combination of global budgets and Ambulatory Patient Groups (APGs) Self-critical points on the limitations of results due to lack of adequate data (not) given by EOPYY are initially raised. Then the issue concerning the debate between 'copying' benchmarks and 'a la cart' selectively adopting and adapting best practices from wider experience is discussed, with preference to the latter. The idea of an 'a la cart' choice of international examples is proposed

  2. How Health Reform is Recasting Public Psychiatry.

    Science.gov (United States)

    Shaner, Roderick; Thompson, Kenneth S; Braslow, Joel; Ragins, Mark; Parks, Joseph John; Vaccaro, Jerome V

    2015-09-01

    This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.

  3. Survey on Awareness on Recent Health Care Reform in Medical Staff and Patients of Shaanxi%陕西医患双方对新医改认知的调查

    Institute of Scientific and Technical Information of China (English)

    李全义; 师社会; 王明旭

    2012-01-01

    目的 了解医患双方对新医改的感受和认知,分析其影响因素.方法采用问卷调查的方法.结果 医患双方在学历和职称两方面存在显著性差异(x2=25.74,P<0.01)、(x=104.74,P<0.01),但在收入上无差异(x2=8.60,P>0.05).医患双方分别有8.12%和27.61%的人不知道我国目前已稚行新医改,医务人员对新医改的认识主要来自于工作经历(89.68%),公众的认知主要来自于亲身感受(81.40%)和家人、亲戚朋友口口相传(14.65%).医务人员关心的是个人收入变化(48.56%)和医疗环境改善(40.61%),公众更在意医保报销比例(37.20%)和医药费用降低(25.08%).与医改前相比,医患双方均认为“看病难、看病责”问题有所缓解,但问题依然存在.个人收入变化是形成医方对医改认知的最主要因素(P<0.01),而医保参加情况则是影响公众对医改认知的重要原因(P<0.01).结论 陕西医患双方对新医改认识不同;个人收入变化、医保参加情况是影响医患双方对新医改认知的因素.%Objective; To survey the awareness and feeling about the recent health care reform in medical staff and patients, and analyze the influencing factors. Methods: Questionnaires method was used in this study. Re-SliltS; There was significant difference between medical staff and patients in educational background and technical title(x2 =25.74,P 0. 05 ). 8. 12% of medical staff and 27. 61% of patients did not know the new health care reform. The cognition of medical staff on new health care reform mainly came work experience (89. 68% ). For the patients, it mainly came from personal feeling ( 81. 40% ) and hearing from families and friends (14. 65% ). Most of medical staff concerned about personal incomes (48. 56% ) and the improvement of medical environment (40. 61% ). The public concerned about the proportion of medical compensation(37. 20% ) and reduction of medical costs(25.08% ). Comparing with before

  4. Arbitration Reform

    Directory of Open Access Journals (Sweden)

    Svetlana Stepurina

    2017-01-01

    Full Text Available УДК 347.73:341.63Subject. This informational article highlights recent changes to the Russian legislation on arbitration.Purpose. To highlight the most important aspects of arbitration law reform, and examines the effects they will have on the development of arbitration in RussiaMethodology. The author uses a formal-legal method.Results, scope of application. The author distinguishes the difference between constantly acting arbitration courts and arbitration courts ad hoc. The special status of a number of arbitration institutions (the ICAC and MAC at the Russian Chamber of Commerce and Industry, is contrary to the constitutional principle of equality under the law. A major achievement of the new legislation on arbitration courts is expanding the range arbitrarily disputes.Conclusions. The new legislation more clearly prescribed the interaction of arbitration and state courts, including requiring the latter to promote the arbitrators, acting under the regulations of the permanent arbitration institutions in obtaining evidence.In addition, the reform of the arbitration law have left aside the problem of improving the quality of judicial control over arbitration decisions.The arbitration law will still be able to improve the arbitration, to enhance its credibility and attractiveness for the participants of civil turnover.

  5. Understanding protein lids: kinetic analysis of active hinge mutants in triosephosphate isomerase.

    Science.gov (United States)

    Sun, J; Sampson, N S

    1999-08-31

    In previous work we tested what three amino acid sequences could serve as a protein hinge in triosephosphate isomerase [Sun, J., and Sampson, N. S. (1998) Protein Sci. 7, 1495-1505]. We generated a genetic library encoding all 8000 possible 3 amino acid combinations at the C-terminal hinge and selected for those combinations of amino acids that formed active mutants. These mutants were classified into six phylogenetic families. Two families resembled wild-type hinges, and four families represented new types of hinges. In this work, the kinetic characteristics and thermal stabilities of mutants representing each of these families were determined in order to understand what properties make an efficient protein hinge, and why all of the families are not observed in nature. From a steady-state kinetic analysis of our mutants, it is clear that the partitioning between protonation of intermediate to form product and intermediate release from the enzyme surface to form methylglyoxal (a decomposition product) is not affected. The two most impaired mutants undergo a change in rate-limiting step from enediol formation to dihydroxyacetone phosphate binding. Thus, it appears that k(cat)/K(m)'s are reduced relative to wild type as a result of slower Michaelis complex formation and dissociation, rather than increased loop opening speed.

  6. Federal official discusses reform. Interview by Debra Mamorsky.

    Science.gov (United States)

    Vladeck, B C

    1993-01-01

    The administrator of the Health Care Financing Administration discusses managed competition, the cost concerns of small and large employers under such a program, and what benefits managers must do in response to health care reform.

  7. Fabrication of Hinged Mirrors Using a Strain-Driven Self-Assembly Method on a GaAs Substrate

    Institute of Scientific and Technical Information of China (English)

    ZHOU yan; WANG Hai-Long; MA Chuan-He; GONG Qian; FENG Song-Lin

    2011-01-01

    Hinged mirror arrays are widely utilized for display applications and optical communication. They can be fabricated by an self-assembly technique using the strain in lattice-mismatched epitaxial layers. A multilayer structure including a strain-compensated layer,a digital alloy sacrificial layer and a strain bilayer,is grown by molecular-beam epitaxy.Self-assembly hinged mirrors on a GaAs substrate have been successfully fabricated by photolithography and selective etching.The hinge fabrication method with a strain bilayer is simple and flexible.Structures formed by multiple hinged plates will enable the self-assembly of more complex three-dimensional microstructures.

  8. ATPase-dependent auto-phosphorylation of the open condensin hinge diminishes DNA binding.

    Science.gov (United States)

    Akai, Yuko; Kanai, Ryuta; Nakazawa, Norihiko; Ebe, Masahiro; Toyoshima, Chikashi; Yanagida, Mitsuhiro

    2014-12-01

    Condensin, which contains two structural maintenance of chromosome (SMC) subunits and three regulatory non-SMC subunits, is essential for many chromosomal functions, including mitotic chromosome condensation and segregation. The ATPase domain of the SMC subunit comprises two termini connected by a long helical domain that is interrupted by a central hinge. The role of the ATPase domain has remained elusive. Here we report that the condensin SMC subunit of the fission yeast Schizosaccharomyces pombe is phosphorylated in a manner that requires the presence of the intact SMC ATPase Walker motif. Principal phosphorylation sites reside in the conserved, glycine-rich stretch at the hinge interface surrounded by the highly basic DNA-binding patch. Phosphorylation reduces affinity for DNA. Consistently, phosphomimetic mutants produce severe mitotic phenotypes. Structural evidence suggests that prior opening (though slight) of the hinge is necessary for phosphorylation, which is implicated in condensin's dissociation from and its progression along DNA.

  9. Intensive mutagenesis of the nisin hinge leads to the rational design of enhanced derivatives.

    Directory of Open Access Journals (Sweden)

    Brian Healy

    Full Text Available Nisin A is the most extensively studied lantibiotic and has been used as a preservative by the food industry since 1953. This 34 amino acid peptide contains three dehydrated amino acids and five thioether rings. These rings, resulting from one lanthionine and four methyllanthionine bridges, confer the peptide with its unique structure. Nisin A has two mechanisms of action, with the N-terminal domain of the peptide inhibiting cell wall synthesis through lipid II binding and the C-terminal domain responsible for pore-formation. The focus of this study is the three amino acid 'hinge' region (N 20, M 21 and K 22 which separates these two domains and allows for conformational flexibility. As all lantibiotics are gene encoded, novel variants can be generated through manipulation of the corresponding gene. A number of derivatives in which the hinge region was altered have previously been shown to possess enhanced antimicrobial activity. Here we take this approach further by employing simultaneous, indiscriminate site-saturation mutagenesis of all three hinge residues to create a novel bank of nisin derivative producers. Screening of this bank revealed that producers of peptides with hinge regions consisting of AAK, NAI and SLS displayed enhanced bioactivity against a variety of targets. These and other results suggested a preference for small, chiral amino acids within the hinge region, leading to the design and creation of producers of peptides with hinges consisting of AAA and SAA. These producers, and the corresponding peptides, exhibited enhanced bioactivity against Lactococcus lactis HP, Streptococcus agalactiae ATCC 13813, Mycobacterium smegmatis MC2155 and Staphylococcus aureus RF122 and thus represent the first example of nisin derivatives that possess enhanced activity as a consequence of rational design.

  10. Transition of arrestin into the active receptor-binding state requires an extended interdomain hinge.

    Science.gov (United States)

    Vishnivetskiy, Sergey A; Hirsch, Joel A; Velez, Maria-Gabriela; Gurevich, Yulia V; Gurevich, Vsevolod V

    2002-11-15

    Arrestins selectively bind to the phosphorylated activated form of G protein-coupled receptors, thereby blocking further G protein activation. Structurally, arrestins consist of two domains topologically connected by a 12-residue long loop, which we term the "hinge" region. Both domains contain receptor-binding elements. The relative size and shape of arrestin and rhodopsin suggest that dramatic changes in arrestin conformation are required to bring all of its receptor-binding elements in contact with the cytoplasmic surface of the receptor. Here we use the visual arrestin/rhodopsin system to test the hypothesis that the transition of arrestin into its active receptor-binding state involves a movement of the two domains relative to each other that might be limited by the length of the hinge. We have introduced three insertions and 24 deletions in the hinge region and measured the binding of all of these mutants to light-activated phosphorylated (P-Rh*), dark phosphorylated (P-Rh), dark unphosphorylated (Rh), and light-activated unphosphorylated rhodopsin (Rh*). The addition of 1-3 extra residues to the hinge has no effect on arrestin function. In contrast, sequential elimination of 1-8 residues results in a progressive decrease in P-Rh* binding without changing arrestin selectivity for P-Rh*. These results suggest that there is a minimum length of the hinge region necessary for high affinity binding, consistent with the idea that the two domains move relative to each other in the process of arrestin transition into its active receptor-binding state. The same length of the hinge is also necessary for the binding of "constitutively active" arrestin mutants to P-Rh*, dark P-Rh, and Rh*, suggesting that the active (receptor-bound) arrestin conformation is essentially the same in both wild type and mutant forms.

  11. 全民免费医疗:凝聚民心的医改目标%National Health Care System:object of Chinese health reform to condensate popular sentiment

    Institute of Scientific and Technical Information of China (English)

    王颖; 吕军; 孙梅; 励晓红; 李程跃; 苌凤水; 郝模

    2015-01-01

    本轮医改旨在建立“基本医疗卫生制度”。然而,这一组织者的改革目标,过于遥远、抽象。百姓无法明确该目标与自身期望的关系;服务于百姓的地方政府难以实现承诺于民,服务于民的现代政府宗旨。基于30余年的医改专题研究结晶,健康风险预警治理协同创新中心认为:我国医改亟需一个凝聚各阶层民心的社会目标!“病有所医”、“看病不会倾家荡产”是百姓心中最大的期望,至少85%的公众向往免费医疗。全民免费医疗制度的构建,我国现有筹资足以支撑,理论和技术都很成熟,关键要看决策者的决心。%The health care reform was to build the basic health care system in China. As a health care organizers’ goal,this target is too remote and abstract. People couldn’t understand the relation between it and their life and what it was going to bring about to them. For the governments at different levels in local areas,they couldn’t be aware of grasping what they should do with commitment and service to the people during the reform. Based on the research results over the past 30 years from Collaborative Innovation Center for Social Risks Governance in Health,the paper discovered that China needs the social target for the public during health care reform to get the people cohere and local government perform their function.“Basic health protection for all”and“defending high expense disease”is the dream for so many people. More than 85%of the people have been dreaming of the National Health Care System,which protects Chinese from high medical expenditure and somewhat basic risks. China has enough resources to develop this system under the scientific design. The key to develop the system is the government’s decision under the scientific and mature technology.

  12. THE GROUNDING OF THE STRUCTURAL PARAMETERS OF THE AREAHLOBOYID RUSK SYNCHRONOUS CARDAN HINGE

    Directory of Open Access Journals (Sweden)

    A. Saniotskyi

    2015-02-01

    Full Text Available The method of calculation of structural parameters of the areahloboyid rusk synchronous cardan hinge with consideration of contact tensions in the mating surfaces is determined, the required torque in the input wave with a contact by using the Hertz’s theory of contact deformations is determined. The dependence of the maximum torque for different hyposizes of the cardan hinge is investigated. The dependences of the calculated maximum torque to the resistance of the material are demonstrated graphically in the logarithmic coordinate system.

  13. A connecting hinge represses the activity of endothelial nitric oxide synthase

    OpenAIRE

    Haque, Mohammad Mahfuzul; Panda, Koustubh; Tejero, Jesús; Aulak, Kulwant S.; Fadlalla, Mohammed Adam; Mustovich, Anthony T.; Stuehr, Dennis J

    2007-01-01

    In mammals, endothelial nitric oxide synthase (eNOS) has the weakest activity, being one-tenth and one-sixth as active as the inducible NOS (iNOS) and the neuronal NOS (nNOS), respectively. The basis for this weak activity is unclear. We hypothesized that a hinge element that connects the FMN module in the reductase domain but is shorter and of unique composition in eNOS may be involved. To test this hypothesis, we generated an eNOS chimera that contained the nNOS hinge and two mutants that e...

  14. Determination of the amino acid requirements for a protein hinge in triosephosphate isomerase.

    OpenAIRE

    Sun, J.; Sampson, N. S.

    1998-01-01

    We have determined the sequence requirements for a protein hinge in triosephosphate isomerase. The codons encoding the hinge at the C-terminus of the active-site lid of triosephosphate isomerase were replaced with a genetic library of all possible 8,000 amino acid combinations. The most active of these 8,000 mutants were selected using in vivo complementation of a triosephosphate isomerase deficient strain of E. coli, DF502. Approximately 3% of the mutants complement DF502 with an activity th...

  15. Proline-induced hinges in transmembrane helices: possible roles in ion channel gating.

    Science.gov (United States)

    Tieleman, D P; Shrivastava, I H; Ulmschneider, M R; Sansom, M S

    2001-08-01

    A number of ion channels contain transmembrane (TM) alpha-helices that contain proline-induced molecular hinges. These TM helices include the channel-forming peptide alamethicin (Alm), the S6 helix from voltage-gated potassium (Kv) channels, and the D5 helix from voltage-gated chloride (CLC) channels. For both Alm and KvS6, experimental data implicate hinge-bending motions of the helix in an aspect of channel gating. We have compared the hinge-bending motions of these TM helices in bilayer-like environments by multi-nanosecond MD simulations in an attempt to describe motions of these helices that may underlie possible modes of channel gating. Alm is an alpha-helical channel-forming peptide, which contains a central kink associated with a Gly-x-x-Pro motif in its sequence. Simulations of Alm in a TM orientation for 10 ns in an octane slab indicate that the Gly-x-x-Pro motif acts as a molecular hinge. The S6 helix from Shaker Kv channels contains a Pro-Val-Pro motif. Modeling studies and recent experimental data suggest that the KvS6 helix may be kinked in the vicinity of this motif. Simulations (10 ns) of an isolated KvS6 helix in an octane slab and in a POPC bilayer reveal hinge-bending motions. A pattern-matching approach was used to search for possible hinge-bending motifs in the TM helices of other ion channel proteins. This uncovered a conserved Gly-x-Pro motif in TM helix D5 of CLC channels. MD simulations of a model of hCLC1-D5 spanning an octane slab suggest that this channel also contains a TM helix that undergoes hinge-bending motion. In conclusion, our simulations suggest a model in which hinge-bending motions of TM helices may play a functional role in the gating mechanisms of several different families of ion channels.

  16. Hinge-free topology optimization with embedded translation-invariant differentiable wavelet shrinkage

    DEFF Research Database (Denmark)

    Yoon, G. H.; Kim, Y. Y.; Bendsøe, Martin P.;

    2004-01-01

    In topology optimization applications for the design of compliant mechanisms, the formation of hinges is typically encountered. Often such hinges are unphysical artifacts that appear due to the choice of discretization spaces for design and analysis. The objective of this work is to present a new...... in the multiscale design space. To imbed the shrinkage method implicitly in the optimization formulation and thus facilitate sensitivity analysis, the shrinkage method is made differentiable by means of differentiable versions of logical operators. The validity of the present method is confirmed by solving typical...... two-dimensional compliant mechanism design problems....

  17. The Analysis of Reformation and Innovation of Out-patient Pharmaceutical Care%门诊药房药学服务改革与创新的探讨

    Institute of Scientific and Technical Information of China (English)

    刘夏; 郭澄

    2013-01-01

    Out-patient pharmaceutical care is one of the important departments of hospital pharmaceutical care,which offers direct medical services to patients.The reformation and innovation of out-patient pharmaceutical care has significant meaning in improving the quality of medical service,ensuring the safety of medication use,and enhancing hospital service in a whole.By analyzing the importance of out-patient pharmaceutical care and summarizing the problem it encounters now,this article offers suggestion for reformation,such as increasing professional trainings for employees;reducing disputes by flexibly putting regulations in to action;improving medication consulting service;regularly researching patient’s satisfaction rate and improving hospital information network system.%  门诊药房药学服务是医院药学的重要分支,是直接面向患者提供医疗服务的重要窗口。门诊药房药学服务的改革与创新在提高医疗服务质量,保证患者用药安全,提高医院整体服务水平方面有重要意义。本文通过分析门诊药房药学服务改革与创新的必要性,总结当前药学服务所存在的问题,提出加强窗口人员的业务能力培训,强化窗口人员的职业道德培养,特事特办,减少药事纠纷,积极开展药物咨询工作,按时进行患者满意度调查,完善医院信息系统的改革建议。

  18. Long-term Care Insurance of Germany:Recent Reform and Lessons%德国长期护理保险最新改革动态及启示

    Institute of Scientific and Technical Information of China (English)

    华颖

    2016-01-01

    After the New Grand Coalition Government of Germany took offce, it has initiated a new round of reforms in the statutory long-term care insurance. The First and Second Bill of “Strengthen Long-Term Care”have come into operation in 2015 and 2016, aiming to implement reform by two steps, with the main contents of new deifnition of long-term care needs, further classifying the care grades to ifve levels, increasing fund contribution while gradually expanding beneifts, and more supporting for home care. The system has achieved the goal of meeting the long-term care needs of disabled, sustaining home care, stimulating private investment and reducing costs of health insurance and social assistance. While it adapting to the changing society by adjusting itself to be a precise system design, it remains and intensiifes its original features such as partial co-payment, sharing responsibilities and home care ifrst.%本届德国大联合政府上台后,法定长期护理保险迎来了新一轮改革和调整。《护理加强法案》第一部、第二部于2015年、2016年先后生效,旨在通过两个阶段实现改革计划,主要内容包括对长期护理需求重新界定、进一步细分护理等级、提高缴费率的同时提高待遇、为居家护理提供更多支持等。德国长期护理保险制度实现了解决失能护理问题、维系家庭护理、鼓励民间资本投入、减少医疗保险和社会救助支出等多重功能。在因应时代背景变化不断进行调整,走向制度设计精细化的同时,保持并强化着初建时的部分险(需自负一部分)、责任共担、居家护理优先等特色。

  19. Educational Reform in an Era of Disinformation

    Directory of Open Access Journals (Sweden)

    David C. Berliner

    1993-02-01

    Full Text Available Data which suggest the failure of America's schools to educate its youth well do not survive careful scrutiny. School reforms based on these questionable data are wrongheaded and potentially distructive of quality education. Reforms of the kind proposed by those who have started from an assumption that America's schools have failed will exacerbate the differences between the "have" and the "have-not" school districts.

  20. Visualizing Key Hinges and a Potential Major Source of Compliance in the Lever Arm of Myosin

    Energy Technology Data Exchange (ETDEWEB)

    J Brown; V Senthil Kumar; E ONeall-Hennessey; L Reshetnikova; H Robinson; M Nguyen-McCarty; A Szent-Gyorgyi; C Cohen

    2011-12-31

    We have determined the 2.3-{angstrom}-resolution crystal structure of a myosin light chain domain, corresponding to one type found in sea scallop catch ('smooth') muscle. This structure reveals hinges that may function in the 'on' and 'off' states of myosin. The molecule adopts two different conformations about the heavy chain 'hook' and regulatory light chain (RLC) helix D. This conformational change results in extended and compressed forms of the lever arm whose lengths differ by 10 {angstrom}. The heavy chain hook and RLC helix D hinges could thus serve as a potential major and localized source of cross-bridge compliance during the contractile cycle. In addition, in one of the molecules of the crystal, part of the RLC N-terminal extension is seen in atomic detail and forms a one-turn alpha-helix that interacts with RLC helix D. This extension, whose sequence is highly variable in different myosins, may thus modulate the flexibility of the lever arm. Moreover, the relative proximity of the phosphorylation site to the helix D hinge suggests a potential role for conformational changes about this hinge in the transition between the on and off states of regulated myosins.

  1. Delta-n Hinge: rotation-invariant features for writer identification

    NARCIS (Netherlands)

    He, Sheng; Schomaker, Lambertus

    2014-01-01

    This paper presents a method for extracting rotation-invariant features from images of handwriting samples that can be used to perform writer identification. The proposed features are based on the Hinge feature [1], but incorporating the derivative between several points along the ink contours. Fina

  2. Except the negative reverse effect and automatically compensate for wear in the hinge manipulators

    Directory of Open Access Journals (Sweden)

    Aleksei Serebryanskii

    2014-04-01

    Full Text Available Article is dedicated to increasing the wear resistance joints manipulator process equipment by constructive exclusion reversibility friction and applying mechanisms automatic wear compensation. Such changes can significantly increase the service life of hinges and are recommended for use in the design of process equipment attachments.

  3. Performance optimization of large stroke flexure hinges for high stiffness and eigenfrequency

    NARCIS (Netherlands)

    Gunnink, K.; Aarts, R.G.K.M.; Brouwer, D.M.

    2013-01-01

    Two flexure hinge types are optimized for high support stiffness and high first unwanted eigenfrequency for two different working ranges, ±5.7° and ±20°. We show how multiple performance specifications lead to different designs with different performance. The optimization uses efficient parameterize

  4. Capillary origami of micro-machined micro-objects: Bi-layer conductive hinges

    NARCIS (Netherlands)

    Legrain, A.; Berenschot, J.W.; Tas, N.R.; Abelmann, L.

    2015-01-01

    Recently, we demonstrated controllable 3D self-folding by means of capillary forces of silicon-nitride micro-objects made of rigid plates connected to each other by flexible hinges (Legrain et al., 2014). In this paper, we introduce platinum electrodes running from the substrate to the plates over t

  5. Visualizing key hinges and a potential major source of compliance in the lever arm of myosin

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.H.; Robinson, H.; Senthil Kumar, V. S.; O' Neall-Hennessey, E.; Reshetnikova, L.; Nguyen-McCarty, M.; Szent-Gyorgyi, A. G.; Cohen, C.

    2011-01-04

    We have determined the 2.3-{angstrom}-resolution crystal structure of a myosin light chain domain, corresponding to one type found in sea scallop catch ('smooth') muscle. This structure reveals hinges that may function in the 'on' and 'off' states of myosin. The molecule adopts two different conformations about the heavy chain 'hook' and regulatory light chain (RLC) helix D. This conformational change results in extended and compressed forms of the lever arm whose lengths differ by 10 {angstrom}. The heavy chain hook and RLC helix D hinges could thus serve as a potential major and localized source of cross-bridge compliance during the contractile cycle. In addition, in one of the molecules of the crystal, part of the RLC N-terminal extension is seen in atomic detail and forms a one-turn alpha-helix that interacts with RLC helix D. This extension, whose sequence is highly variable in different myosins, may thus modulate the flexibility of the lever arm. Moreover, the relative proximity of the phosphorylation site to the helix D hinge suggests a potential role for conformational changes about this hinge in the transition between the on and off states of regulated myosins.

  6. 奥巴马政府面对医疗保健体系的挑战(英文)%Challenge of Health Care Reform under Obama Government

    Institute of Scientific and Technical Information of China (English)

    张鑫; 张枫

    2011-01-01

    The US health care crisis is of great concern to Americans. The United States has the world's most expensive health care system that one-sixth of Americans are uninsured. The paper explored the limitation of American health care insurance system and the basic elements of Obama health reform plan .The key point to carry out health reform successfully is to overcome the difficulties coming from government finance, relative interest groups, political conflict and the general public doubt.%美国的医疗保健危机引起了广大美国人民的关注。美国的医疗保健系统是全世界最为昂贵的,六分之一的美国人因此而不能享有医疗保健。为了能有一个广泛的,高质量的,可以为广大民众能够负担的医疗保健系统,美国人民试着发现和改变一系列现存的问题。该文章浅析了美国医疗保障体系中的种种弊端和奥巴马政府在医疗改革中的基本原则。医疗改革能否成功的关键在于是否能够克服财政,特殊利益集团和政党斗争以及民众的质疑等问题。

  7. Characterization of transcriptional activation and DNA-binding functions in the hinge region of the vitamin D receptor.

    Science.gov (United States)

    Shaffer, Paul L; McDonnell, Donald P; Gewirth, Daniel T

    2005-02-22

    The vitamin D receptor (VDR) is a ligand-responsive transcription factor that forms active, heterodimeric complexes with the 9-cis retinoic acid receptor (RXR) on vitamin D response elements (VDREs). Both proteins consist of an N-terminal DNA-binding domain, a C-terminal ligand-binding domain, and an intervening hinge region. The length requirements of the hinge for both transcriptional regulation and DNA binding have not been studied to date for any member of the steroid hormone superfamily. We have generated a series of internal deletion mutants of the VDR hinge and found that deletion of as few as five amino acids from the C-terminus of the hinge significantly reduces transcriptional activation in vivo. Replacing deleted residues in the C-terminus of the hinge with alanines restored activity, indicating that this section of the hinge acts as a sequence-independent spacer. The hinge region of VDR forms a long helix, and the geometric consequences of this structure may explain the requirement of the hinge region for transcriptional activity. Interestingly, all of the deletion mutants, even those that do not activate transcription, bind VDREs with equal and high affinity, indicating that the defect in these mutants is not their ability to bind VDREs. In contrast to VDR, constructs of RXR containing deletions of up to 14 amino acids in the hinge region exhibit near wild-type transcriptional activity. The ability to delete more of the RXR hinge may be related to the additional plasticity required by its role as the common heterodimer partner for nuclear receptors on differing DNA elements.

  8. 加大改革力度促进城乡基本医保服务均等化%Promote Equal Access to Basic Health Care Services in Urban and Rural Areas through the Way of Deepening Reform

    Institute of Scientific and Technical Information of China (English)

    邓微

    2014-01-01

    The prominent obstacle to achieve equal basic medical insurance system between urban and rural areas in China is the segmentation of basic medical insurance system and the imbalance health care service. Under the background of comprehensively deepening health insurance reform in China, promoting the equalization in basic health care services for urban and rural residents should be conducted mainly from the reform and construction of three aspects, namely, providers of public products, receivers of basic health insurance and carriers of basic medical insurance. First of all, it should reform the administrative system of basic medical insurance, straighten out the relations of service providers, and reduce the internal friction of government departments so as to reduce administrative costs, and promote the equalization of basic medical insurance services. Secondly, it need to optimize the framework of the basic health care system, integrate the urban basic medical insurance system and new rural cooperative medical care system, and establish basic medical insurance system for residents. Third, change basic medical insurance for urban employees into basic medical insurance for employees, expand the coverage and improve the basic medical insurance level. Last, strengthen medical treatment system reform, optimize the resource allocation in basic medical insurance carriers, strengthen the construction of rural medical and health care network, and relieve the contradictions in medical manpower distribution between urban and rural.%在我国推进城乡基本医保服务均等化,主要应从公共产品供给主体、基本医保受众和基本医保实现载体三个方面着力。改革基本医疗保险行政管理体制,理顺基本医保供给主体,减少政府部门的摩擦和内耗,降低行政管理成本,保证基本医保服务均等化;优化基本医保制度体系,整合城镇居民医保与新农合,建立居民基本医疗保险制度;

  9. Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

    Science.gov (United States)

    Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

    2015-01-01

    To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

  10. Health policy reform in China: lessons from Asia.

    Science.gov (United States)

    Ramesh, M; Wu, Xun

    2009-06-01

    Declining access to health care and rapidly rising health expenditures are a matter of grave public concern in China. After decades of efforts to reduce its involvement, the Chinese government is currently in the process of reforming the sector through increase in public expenditures and expansion of health insurance. The objective of this paper is to assess the potential of the reform direction in light of international experiences with similar reforms. It argues--on the basis of examination of reform experiences in Korea, Singapore and Thailand--that financing reforms without parallel measures to improve the provision system, especially how providers are paid, are unlikely to address the problems and may actually aggravate them. If the financing reforms are to succeed, it is vital for China to reform the incentives that guide the providers' behaviour.

  11. nigeria's banking sector reforms

    African Journals Online (AJOL)

    NESG PUBLICATIONS

    sector reforms to enthrone sound financial practices and good corporate governance ... April - June 2009 . 9. NIGERIA'S BANKING SECTOR REFORMS: THE JOURNEY SO FAR ..... implementation of a code of sound corporate governance in ...

  12. 桥梁转体施工中平面铰与球铰的对比分析%Comparison of Plane Hinge and Spherical Hinge Used in Bridge Rotation Construction

    Institute of Scientific and Technical Information of China (English)

    傅贤超; 唐英; 曹文

    2016-01-01

    Bridge rotation construction is commonly used to date. Hinge is the key structure. Currently,plane hinge and spherical hinge are both used. The latter is more widely applied while the former is mainly used in light bridge. In this paper,these two hinges were compared in terms of hinge structure design,fabrication,installation,and rotation construction. In this case,plane hinge outweighs spherical hinge in terms of mechanic characteristics and operation properties.%我国采用转体施工工艺的桥梁日益增多,转铰是实现其转体功能的关键结构.目前桥梁平转法施工中转铰一般采用球铰和平面铰,球铰运用比较广泛,而平面铰主要运用于轻型桥梁.本文从转铰结构设计、制作安装、转体施工等方面对两种转铰进行对比分析,论证了平面铰的受力特性和使用性能更加合理.

  13. [The fiberglass dressing with a hinge and its value in the care of ski injuries].

    Science.gov (United States)

    Schnitzler, M; Hipp, R

    1976-01-22

    Casts for immobilisation of a limb with an artificial external joint can be made light and stable using fiberglass material, because the application of a joint is possible with less material as it is possible using a conventional cast.

  14. La atención gerenciada en América Latina. Transnacionalización del sector salud en el contexto de la reforma Managed care in Latin America: transnationalization of the health sector in a context of reform

    Directory of Open Access Journals (Sweden)

    Celia Iriart

    2000-01-01

    Full Text Available Este artículo presenta resultados de la investigación comparativa "Atención Gerenciada en América Latina: Su Papel en la Reforma de los Sistemas de Salud", realizada por equipos de Argentina, Brasil, Chile, Ecuador y Estados Unidos. El objetivo del estudio fue analizar el proceso de exportación de la atención gerenciada, especialmente desde Estado Unidos, y su incorporación en los países latinoamericanos. Los métodos utilizados incluyeron técnicas cualitativas y cuantitativas. La adopción de la atención gerenciada muestra el proceso de transnacionalización del sector salud. Nuestros hallazgos demuestran el ingreso de los principales capitales financieros multinacionales en el sector privado de seguros y de prestadores de salud, y su intencionalidad de participar en la administración de las instituciones estatales y de los fondos de la seguridad social médica. Concluimos que este proceso de cambio sustancial, que implica la paulatina adopción de la atención gerenciada, es facilitado por las transformaciones operadas a nivel ideológico.This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by

  15. Reforming Organizational Structures

    OpenAIRE

    Van de Walle, Steven

    2016-01-01

    textabstractPublic sectors have undergone major transformations. Public sector reform touches upon the core building blocks of the public sector: organizational structures, people and finances. These are objects of reform. This chapter presents and discusses a set of major transformations with regard to organizational structures. It provides readers a fairly comprehensive overview of the key reforms that have taken place in Western public sectors. Structural reforms in the public sector show ...

  16. Exploration and Research on How does Medical College and University Libraries Serve New Health Care System Reform%医学院校图书馆服务新医改探究

    Institute of Scientific and Technical Information of China (English)

    黄浩波; 叶青

    2011-01-01

    The paper analyzes the necessity and advantage of medical college and university libraries carrying out services for new health care system reform,discusses approaches like providing public health and medical information service to grass -roots area,integrating electronic health records information,involving in general physician training project and carrying out evidence - based medicine education to grass - roots physicians.%分析医学院校图书馆针对新医改开展信息服务的必要性和优势,探讨医学院校图书馆服务新医改的途径,包括向基层提供公共卫生与医疗信息服务、整合电子健康档案信息、参与全科医生培训、对基层医生进行循证医学教育等方面。

  17. 深化医药卫生体制改革的监督与评估研究%Commentary on study of monitoring and evaluation of deepening health care system reform

    Institute of Scientific and Technical Information of China (English)

    马进

    2011-01-01

    This paper describes the major methods of policy monitoring and evaluation, and then introduces the main modules of health system performance evaluation.Finally, the framework of the study on monitoring and evaluation of the current deepening health care system reform in China is explained.%本文评述了政策措施监督与评估的研究进展与主要方法,并介绍了卫生系统绩效评估的主要流派,最后介绍了本次深化医药卫生体制改革监督与评估的研究思路与框架.

  18. The Effect of an Adjustable Hinged Operating Table on Lumbar Lordosis during Lumbar Surgery.

    Science.gov (United States)

    Sebastian, Arjun; Ahmed, Amin; Vernon, Brian; Nguyen, Emily C; Aleem, Ilyas; Clarke, Michelle J; Currier, Bradford L; Anderson, Paul; Bydon, Mohamad; Nassr, Ahmad

    2017-07-24

    Prospective observational study OBJECTIVES.: Quantify the amount of lumbar lordosis achieved on a hinged operative table in neutral, flexion, and extension. Hinged operative tables may allow surgeons to adjust lumbar spine positioning intraoperatively. The amount of lumbar lordosis in neutral, flexion, and extension positions has not been quantified prospectively using a hinged table. Thirty patients undergoing elective lumbar surgery were enrolled. Standing x-rays taken in neutral, maximal flexion, and maximal extension were obtained. Following prone positioning on a hinged operative table, x-rays in neutral, maximal flexion, and maximal extension were taken. Total lumbar lordosis was calculated for all 6 images by two physicians. Disc degeneration was graded using Pfirrmann grades. Lumbar lordosis on the operative table was 56.5 ± 2.1, 43.6 ± 2.2, 63.2 ± 2.0 compared to 46.9 ± 3.1, 33.2 ± 2.8, 52.3 ± 3.3 on the standing films in neutral, flexion, and extension respectively. Average flexion (12.9 ± 1.1) and extension (6.7 ± 1.2) were significantly different from neutral on the table (p < .001). Lumbar lordosis was significantly higher on the operative table (p < .001). Total range of motion was 19.6 ± 1.9 on the table and 19.1 ± 2.0 with standing (p = 0.42). Average Pfirrmann disc grade was 2.77 ± 0.10 which did not correlate with range of motion (p = 0.40). In this cohort, the hinged operative table allowed for a physiologic arc of motion of nearly 20 from flexion to extension. A considerable amount of lumbar sagittal motion can be obtained on hinged operative tables without decreasing overall lumbar lordosis below physiologic levels. 3.

  19. STUDY OF CARRYING CAPACITY OF A CORRUGATED METAL CONSTRUCTION BY CRITERION OF YIELD HINGE DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Y. Y. Luchko

    2015-10-01

    Full Text Available Purpose. This research is aimed to: 1 calculation of equivalent forces caused by rolling stock in winter and summer seasons at different parameters of the irregularities of railway track; 2 research of bearing capacity of corrugated metal constructions (CMC in terms of development of plastic hinge in the top of the metal pipe due to irreversible residual deformation of the vertical and horizontal diameters of the pipe. Methodology. The calculation of equivalent forces is carried out according to the method of calculating the railway track on strength and stability. Further a mathematical algorithm was developed in the software environment of Mathcad 14, with which the calculations were made about the formation of a plastic hinge at the top of the pipe for different values of the irregularities of the railway track and the degree of compaction of soil backfill. In these studies, the calculations were carried out at the design value of the compaction degree of soil backfill and magnitude of dynamic loading on railway rolling stock. Findings. Analysis of multivariate calculations of testing the condition of occurrence of plastic hinge at the top of the pipe arch has revealed that the first plastic hinge, which occurs in the set of CMC is revealed only when there is a simultaneous unfavorable influence of two factors (causes. These are the factors: the assumption of the development of the track irregularities out of the allowable values without the implementation of measures to eliminate or limit the speed of trains (the first cause; reduction of compaction of soil backfill below the 90 % (the second cause. In case of absence of one of the causes the origin of the plastic hinge will not happen. Originality. It was the first time, when the bearing capacity of corrugated metal construction with large diameter (more than 6 m with account of factors complex: the degree of compaction of soil backfill, the magnitude of the dynamic loads from rolling stock

  20. The importance of hinge sequence for loop function and catalytic activity in the reaction catalyzed by triosephosphate isomerase.

    Science.gov (United States)

    Xiang, J; Sun, J; Sampson, N S

    2001-04-01

    We have determined the sequence requirements for the N-terminal protein hinge of the active-site lid of triosephosphate isomerase. The codons for the hinge (PVW) were replaced with a genetic library of all possible 8000 amino acid combinations. The most active of these 8000 mutants were selected using in vivo complementation of a triosephosphate isomerase-deficient strain of Escherichia coli, DF502. Approximately 0.3 % of the mutants complement DF502 with an activity that is between 10 and 70 % of wild-type activity. They all contain Pro at the first position. Furthermore, the sequences of these hinge mutants reveal that hydrophobic packing is very important for efficient formation of the enediol intermediate. However, the reduced catalytic activities observed are not due to increased rates of loop opening. To explore the relationship between the N-terminal and C-terminal hinges, three semi-active mutants from the N-terminal hinge selection experiment (PLH, PHS and PTF), and six active C-terminal hinge mutants from previous work (NSS, LWA, YSL, KTK, NPN, KVA) were combined to form 18 "double-hinge" mutants. The activities of these mutants suggest that the N-terminal and C-terminal hinge structures affect one another. It appears that specific side-chain interactions are important for forming a catalytically active enzyme, but not for preventing release of the unstable enediol intermediate from the active site of the enzyme. The independence of intermediate release on amino acid sequence is consistent with the absence of a "universal" hinge sequence in structurally related enzymes.

  1. 急危重症护理学实验教学改革的探讨%Reform in the experimental teaching of Emergency and Critical Care Nursing course

    Institute of Scientific and Technical Information of China (English)

    徐建宁; 许虹; 汪国建; 蔡华娟; 叶红芳

    2009-01-01

    目的 培养学生整体急救和监护能力.方法 在护理专业本科生的急危重症护理学实验教学中采用综合训练法教学模式,用场景、角色扮演完成事发现场救护→急诊科救护→ICU救护→普通病房治疗的综合训练教学方法.结果 学生的实践应急、团队合作及沟通交流和自主学习能力均得到了明显提高.取得了满意的教学效果.结论 综合训练法教学模式为学生较好地掌握院前急救、急诊科急救和ICU救护流程.较快地适应临床实习打下了良好的基础.%Objective To cultivate the nursing students' first aid ability and monitoring technique. Methods In the experi-mental teaching of Emergency and Critical Care Nursing for nursing undergraduates,we adopted the comprehensive training teaching model. Students designed and performed role plays and simulation excercises,including pre-hospital first aid,emergency treatment,surveillance and care in ICU and nursing in the ward. Results The students' abilities of emergency reaction,team-work and communication,self study were improved. Conclusions The reform in the experimental teaching is benefit for the students grasping the prehospital care,care procedure of the emergency section and intensive care unit.

  2.  Railway Reforms

    DEFF Research Database (Denmark)

    Asmild, Mette; Holvad, Torben; Hougaard, Jens Leth;

    -directional Efficiency Analysis, which enables investigation of how railway reforms affect the inefficiencies of specific cost drivers. The main findings are that the reform initiatives generally improve operating efficiency but potentially differently for different cost drivers. Specifically, the paper provides clear......This paper considers railway operations in 23 European countries during 1995-2001, where a series of reform initiatives were launched by the European Commission, and analyses whether these reform initiatives improved the operating efficiency of the railways. Efficiency is measured using Multi...... empirical evidence that accounting separation is important for improving operating efficiency for both material and staff costs, whereas other reforms only influenced one of these factors...

  3. Investigation of Motion of Two Hinged Bodies Moored by Mooring Lines in Waves

    Institute of Scientific and Technical Information of China (English)

    纪亨腾; 范菊; 黄祥鹿

    2002-01-01

    In this paper, the motions are studied of a multi-body which is composed of two plates hinged together and mooredby eight mooring lines in regular waves. The experimental results are compared with computational results. The linear po-tential theory and the perturbation method are combined to study this complicated system. The former is used to calculatethe wave forces acting on the plates and the motion responses of them, while the latter is used to describe the dynamiccharacter of the eight mooring lines coupled with the two hinged plates. Some response results of each plate are presentedand comparisons between calculated results and experimental data are given. All the calculations are confined to regularbeam waves.

  4. The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

    LENUS (Irish Health Repository)

    Varley, J

    2011-02-01

    Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

  5. The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

    LENUS (Irish Health Repository)

    Varley, J

    2012-02-01

    Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

  6. Academic Medicine's Choices in an Era of Reform.

    Science.gov (United States)

    Thier, Samuel O.

    1994-01-01

    The economic, social, and educational forces that have led to current health care reform proposals are outlined, the main proposals made to respond to these forces are noted, and ways in which academic medicine can change effectively to meet the reforms are examined. Risks to academic medicine are also considered. (Author/MSE)

  7. Culture clash: aligning payers and providers for real reform.

    Science.gov (United States)

    Bauer, Jeffrey C

    2010-04-01

    Self-imposed cost containment is not part of providers' heritage. The payer business model and its problems are complicated; simplistic reforms won't help. Health reform needs to be refocused on policies that allow providers and payers to align their cultures so that all parties benefit from potential synergies to provide top-quality care as inexpensively as possible.

  8. Strengthening revenue cycle capabilities in an era of reform.

    Science.gov (United States)

    Glaser, John

    2011-05-01

    Strategies that healthcare finance professionals should incorporate to help their organizations respond effectively to payment reforms include: Assessing the organization's ability to capture and share relevant data. Educating themselves, the board of trustees, and the medical staff on pertinent rules as payment reforms are rolled out. Examining inefficiencies related to care processes. Establishing policies and procedures to address "commingled" data.

  9. Influence of hinge position on the effectiveness of opendoor expansive laminoplasty for cervical spondylotic myelopathy

    Directory of Open Access Journals (Sweden)

    WAN Jun

    2011-02-01

    Full Text Available 【Abstract】Objective: To assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP for cervical spondylotic myelopathy (CSM. Methods: A total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically. Results: There were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P=0.003. The incidence of C5 palsy in the wide-open group was higher than that in the narrowopen group (5.3% vs 0, even though the difference did not reach statistical significance (one tailed Fisher's exact test, P=0.17. Conclusions: Proper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C5 palsy and alleviate the severity of axial symptoms. Key words: Cervical vertebrae; Spinal cord diseases; Spondylosis; Surgical procedures, operative

  10. The auto-inhibitory role of the EPAC hinge helix as mapped by NMR.

    Directory of Open Access Journals (Sweden)

    Rajeevan Selvaratnam

    Full Text Available The cyclic-AMP binding domain (CBD is the central regulatory unit of exchange proteins activated by cAMP (EPAC. The CBD maintains EPAC in a state of auto-inhibition in the absence of the allosteric effector, cAMP. When cAMP binds to the CBD such auto-inhibition is released, leading to EPAC activation. It has been shown that a key feature of such cAMP-dependent activation process is the partial destabilization of a structurally conserved hinge helix at the C-terminus of the CBD. However, the role of this helix in auto-inhibition is currently not fully understood. Here we utilize a series of progressive deletion mutants that mimic the hinge helix destabilization caused by cAMP to show that such helix is also a pivotal auto-inhibitory element of apo-EPAC. The effect of the deletion mutations on the auto-inhibitory apo/inactive vs. apo/active equilibrium was evaluated using recently developed NMR chemical shift projection and covariance analysis methods. Our results show that, even in the absence of cAMP, the C-terminal region of the hinge helix is tightly coupled to other conserved allosteric structural elements of the CBD and perturbations that destabilize the hinge helix shift the auto-inhibitory equilibrium toward the apo/active conformations. These findings explain the apparently counterintuitive observation that cAMP binds more tightly to shorter than longer EPAC constructs. These results are relevant for CBDs in general and rationalize why substrates sensitize CBD-containing systems to cAMP. Furthermore, the NMR analyses presented here are expected to be generally useful to quantitatively evaluate how mutations affect conformational equilibria.

  11. Kinematic Research on Hinged Synchronous Universal Joint Applied for Snake-like Manipulator

    Institute of Scientific and Technical Information of China (English)

    WANG Jian-bin; MA Pei-sun; WU Hai-ping; HAO Ying-ming

    2002-01-01

    The structure and motion principle of a hinged synchronous universal joint (HSUJ) is introduced, also whose kinematics is theoretically analyzed. As a result, a few kinematic characters of the HSUJ are obtained,which establish the foundation of its application for snake-like manipulator. Making use of the HSUJ ss actuating mechauism, the developed snake-like manipulator has the merits of small curve radius, fewer actuator, and small volume etc.

  12. Regional septal hinge-point injury contributes to adverse biventricular interactions in pulmonary hypertension.

    Science.gov (United States)

    Nielsen, Eva Amalie; Okumura, Kenichi; Sun, Mei; Hjortdal, Vibeke E; Redington, Andrew N; Friedberg, Mark K

    2017-07-01

    Death and morbidity in pulmonary arterial hypertension (PAH) are often due to right ventricular (RV) failure and associated left ventricular (LV) dysfunction. We investigated regional myocardial remodeling and function as the basis for adverse ventricular-ventricular interactions in experimental chronic RV pressure overload. Two distinct animal models were studied: A rabbit model of increased RV pressure-load through progressive pulmonary artery banding A rat model of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Regional myocardial function was assessed by speckle-tracking strain echocardiography and ventricular pressures measured by catheterization before termination. Regional RV and LV myocardium was analyzed for collagen content, apoptosis and pro-fibrotic signaling gene and protein expression. Although the RV developed more fibrosis than the LV; in both models the LV was substantially affected. In both ventricles, particularly the LV, fibrosis developed predominantly at the septal hinge-point regions in association with decreased regional and global circumferential strain, reduced global RV and LV function and up-regulation of regional transforming growth factor-β1 (TGFβ1) and apoptosis signaling. A group of PAH rats who received the TGFβ blocker SB431542 showed improved RV function and reduced regional hinge-point myocardial fibrosis. RV pressure-loading and PAH lead to biventricular TGFβ1 signaling, fibrosis and apoptosis, predominantly at the septal hinge-point regions, in association with regional myocardial dysfunction. This suggests that altered geometry and wall stress lead to adverse RV-LV interactions through the septal hinge-points to induce LV fibrosis and dysfunction. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  13. A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

    Directory of Open Access Journals (Sweden)

    Verleisdonk Egbert JMM

    2011-06-01

    Full Text Available Abstract Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF, or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36. Discussion The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are

  14. The auto-inhibitory role of the EPAC hinge helix as mapped by NMR.

    Science.gov (United States)

    Selvaratnam, Rajeevan; Mazhab-Jafari, Mohammad T; Das, Rahul; Melacini, Giuseppe

    2012-01-01

    The cyclic-AMP binding domain (CBD) is the central regulatory unit of exchange proteins activated by cAMP (EPAC). The CBD maintains EPAC in a state of auto-inhibition in the absence of the allosteric effector, cAMP. When cAMP binds to the CBD such auto-inhibition is released, leading to EPAC activation. It has been shown that a key feature of such cAMP-dependent activation process is the partial destabilization of a structurally conserved hinge helix at the C-terminus of the CBD. However, the role of this helix in auto-inhibition is currently not fully understood. Here we utilize a series of progressive deletion mutants that mimic the hinge helix destabilization caused by cAMP to show that such helix is also a pivotal auto-inhibitory element of apo-EPAC. The effect of the deletion mutations on the auto-inhibitory apo/inactive vs. apo/active equilibrium was evaluated using recently developed NMR chemical shift projection and covariance analysis methods. Our results show that, even in the absence of cAMP, the C-terminal region of the hinge helix is tightly coupled to other conserved allosteric structural elements of the CBD and perturbations that destabilize the hinge helix shift the auto-inhibitory equilibrium toward the apo/active conformations. These findings explain the apparently counterintuitive observation that cAMP binds more tightly to shorter than longer EPAC constructs. These results are relevant for CBDs in general and rationalize why substrates sensitize CBD-containing systems to cAMP. Furthermore, the NMR analyses presented here are expected to be generally useful to quantitatively evaluate how mutations affect conformational equilibria.

  15. Piezoelectric control of the static behaviour of flextensional actuators with constricted hinges

    Science.gov (United States)

    Przybylski, Jacek

    2014-06-01

    The objective of this paper is to present the mathematical modelling and computational testing of the static operational performance and effectiveness of flextensional actuators comprised of two rectilinear or initially deflected beams placed equidistantly from a centrally located piezoceramic stack in the form of a rod. The beams are mounted by stiff links with an offset to a piezoelectric transformer. A monolithic hinge lever mechanism is applied by cutting constricted hinges at the links to generate and magnify the in-plane displacement created by the application of a voltage to the piezorod. Structures of such a type have been commonly used as passive or active actuators since the manufacturing of the mechanism’s prototypes in the form of Moonie or cymbal actuators. An analytical model of the actuator is developed on the basis of stationary values of the total potential energy principle with the use of the von Kármán non-linear strains theory. During the numerical computations, the deflection and internal axial force generated by both the externally distributed load and the the application of an electric field are determined by changing the actuator properties such as the distance between the beams and the rod, the amplitude of the beam’s initial displacement as well as the stiffness of the constricted hinges. Additionally, the application of structure prestressing is considered to avoid an undesired stretching of the piezo stack. It has been shown that for the flextensional actuator with a very high flexibility of constricted hinges, the generated transverse displacement is limited by the maximum electric field as the characteristic property for each piezoceramic material. A vast number of numerical results exhibit the mechanical responses of the transducer of different geometrical and physical properties to piezoelectric stimulation; this has potential applications in the design process of such actuators.

  16. Identification of ubiquinol cytochrome c reductase hinge (UQCRH) as a potential diagnostic biomarker for lung adenocarcinoma

    OpenAIRE

    Gao, Feng; Liu, Qicai; Li, Guoping; Dong, Feng; Qiu, Minglian; Lv, Xiaoting; Zhang, Sheng; Guo, Zheng

    2016-01-01

    Ubiquinol cytochrome c reductase hinge (UQCRH) is a novel protein that localizes in the mitochondrial membrane and induces mitochondrial reactive oxygen species (ROS) generation. It had a high expression rate of 87.10% (108/124) in lung adenocarcinoma. Moreover, serum UQCRH level in patients with lung adenocarcinoma was significantly increased compared with that of pneumonia patients (p < 0.0001) and normal control subjects (p < 0.0001). Receiver operating characteristic curve analysis using ...

  17. Optimization of the place of the plastic hinges by steel braces at RC buildings

    Science.gov (United States)

    Hatami, Farzad; Ragheb, Mohammad; Namazi, Meysam

    2012-12-01

    Usage of steel braces has become a solution not only for retrofitting of RC structures but as a method in designing of concrete frames in recent years. Although X-braced RC frames have been number of successful studies, but eccentric braced RC frames have not been studied seriously. Maybe it's because of the non ductile behaviour of concrete beams. In this article, a numerical study was conducted to evaluate performance of concrete frames, braced with eccentric steel brace with a vertical steel shear link. Vertical steel shear link eliminated shortcomings of non ductile concrete beam. Therefore 4, 8 and 12 storey concrete frames were designed and subjected to a push over analysis. Life safety level was chose to evaluate the frames and hinges performance. Results were compared with the same frames designed with X braces and moment resisting frame. Results indicated that steel braces shift the place of plastic hinges to be formed on the bracing members instead of columns and beams. Furthermore steel braces delayed the process of formation of first plastic hinge and column failure mechanism.

  18. Biodegradable PLA (polylactic acid) hinged trays keep quality of fresh-cut and cooked spinach.

    Science.gov (United States)

    Botondi, Rinaldo; Bartoloni, Serena; Baccelloni, Simone; Mencarelli, Fabio

    2015-09-01

    This work examines the effects of packaging using two different polymeric trays with hinged lids, polyethylene terephthalate (PET) and polylactic acid (PLA), on fresh-cut and cooked spinach (Spinacia oleracea). Samples were stored in a cold room for 16 days at 4 °C. Chemical (total pigments, total polyphenols, ascorbic acid, antioxidant activity), physical (water activity), technological (colour evaluation), sensorial (aroma, visual appearance and water accumulation) and microbial (total aerobic mesophilic and psychrotrophic counts) parameters were tested. Both polymeric trays maintained the overall quality of fresh spinach for 6 days but spinach stored in PLA trays maintained its flavour longer. A significant increase in total polyphenols, antiradical activity, total carotenoids as well as a decrease in ascorbic acid in fresh spinach was observed in the first 3 days of storage in both samples. Unfortunately, the PLA package accumulated condensed water. The total microbial load of fresh-cut spinach reached about 6.3-7.3 log CFU g(-1) within 8 days. Cooked spinach packed in PLA and PET polymeric hinged trays showed the same behaviour as fresh spinach in terms of quality and shelf life. In conclusion, PLA plastic hinged trays can be used for packaging fresh-cut and cooked cut spinach, but the problem of condensed water must be solved.

  19. Elasto-Capillary Folding Using Stop-Programmable Hinges Fabricated by 3D Micro-Machining.

    Science.gov (United States)

    Legrain, Antoine; Berenschot, Erwin J W; Tas, Niels R; Abelmann, Leon

    2015-01-01

    We show elasto-capillary folding of silicon nitride objects with accurate folding angles between flaps of (70.6 ± 0.1)° and demonstrate the feasibility of such accurate micro-assembly with a final folding angle of 90°. The folding angle is defined by stop-programmable hinges that are fabricated starting from silicon molds employing accurate three-dimensional corner lithography. This nano-patterning method exploits the conformal deposition and the subsequent timed isotropic etching of a thin film in a 3D shaped silicon template. The technique leaves a residue of the thin film in sharp concave corners which can be used as an inversion mask in subsequent steps. Hinges designed to stop the folding at 70.6° were fabricated batchwise by machining the V-grooves obtained by KOH etching in (110) silicon wafers; 90° stop-programmable hinges were obtained starting from silicon molds obtained by dry etching on (100) wafers. The presented technique has potential to achieve any folding angle and opens a new route towards creating structures with increased complexity, which will ultimately lead to a novel method for device fabrication.

  20. Treatment of neglected elbow dislocations with the help of hinged external fixator: Report of two cases

    Directory of Open Access Journals (Sweden)

    Özgür Karakoyun

    2014-06-01

    Full Text Available Elbow dislocations are cases that have to be treated in emergency conditions. Neglected elbow dislocations are seen very rarely and the treatment of such cases are more complicated than acute cases. We present two cases of neglected elbow dislocations treated with open reduction and hinged external fixators. Case 1: 23 year old female patient had a neglected posterior dislocation of left elbow with ipsilateral humeral shaft fracture caused by car accident. The patient was treated after 3 months of initial trauma. We have performed open reduction for the joint. After that we fixed the joint whit a hinged external fixator. The humeral shaft fracture was also fixed with the components of the external fixator. Case 2: 33 year male patient had a large bone and soft tissue defect around the left elbow accompanying with neglected medial elbow dislocation. He presented to our clinic with a delay of 2 months. The patient was treated with open reduction and hinged external fixator after reconstruction of bone defect of distal humerus. Conclusion: The treatment of neglected cases is quite challenging. Open reduction and external fixation has satisfactory results in treatment of late cases of elbow dislocation with the possibility of early rehabilitation. This method can be considered as an option for such cases. J Clin Exp Invest 2014; 5 (2: 443-446

  1. Space deployable domed solar concentrator with foldable panels and hinge therefor

    Science.gov (United States)

    Grayson, Fred G. (Inventor); Miller, Warren H. (Inventor); Sturgis, James D. (Inventor)

    1989-01-01

    A space deployable solar energy concentrator is formed of a dome-shaped arrangement of compactly stowable flat panel segments mounted on a collapsible, space-deployable support structure of interconnected linear components. The support structure is comprised of a plurality of tensioned, curvilinear edge strips which extend in a radial direction from a prescribed vertex of a surrounding umbrella-like framework of radially extending rib members. Between a respective pair of radially-extending, curvilinear edge strips an individual wedge-shaped panel section is formed of a plurality of multi-segment lens panel strips each of which is supported in tension between the pair of edge strips by a pair of circumferentially extending catenary cord members connected to a pair of ribs of the surrounding umbrella-like framework. A respective lens panel strip is comprised of a plurality of flat, generally rectangular-shaped, energy-directing panels arranged side-by-side in the circumferential direction of the dome. Adjacent panels are interconnected by flexible U-shaped hinges which overlap opposing edges of adjacent panels and engage respective cylindrically-shaped, load distribution bars that slide within the flexible hinges. Because each U-shaped hinge is flexible, it is permitted to shift in the circumferential direction of the panel section to facilitate stowage and deployment of the dome.

  2. On the Roles of Substrate Binding and Hinge Unfolding in Conformational Changes of Adenylate Kinase

    Energy Technology Data Exchange (ETDEWEB)

    Brokaw, Jason B.; Chu, Jhih-wei

    2010-11-17

    We characterized the conformational change of adenylate kinase (AK) between open and closed forms by conducting five all-atom molecular-dynamics simulations, each of 100 ns duration. Different initial structures and substrate binding configurations were used to probe the pathways of AK conformational change in explicit solvent, and no bias potential was applied. A complete closed-to-open and a partial open-to-closed transition were observed, demonstrating the direct impact of substrate-mediated interactions on shifting protein conformation. The sampled configurations suggest two possible pathways for connecting the open and closed structures of AK, affirming the prediction made based on available x-ray structures and earlier works of coarse-grained modeling. The trajectories of the all-atom molecular-dynamics simulations revealed the complexity of protein dynamics and the coupling between different domains during conformational change. Calculations of solvent density and density fluctuations surrounding AK did not show prominent variation during the transition between closed and open forms. Finally, we characterized the effects of local unfolding of an important hinge near Pro177 on the closed-to-open transition of AK and identified a novel mechanism by which hinge unfolding modulates protein conformational change. The local unfolding of Pro177 hinge induces alternative tertiary contacts that stabilize the closed structure and prevent the opening transition.

  3. Understanding protein lids: structural analysis of active hinge mutants in triosephosphate isomerase.

    Science.gov (United States)

    Kursula, I; Salin, M; Sun, J; Norledge, B V; Haapalainen, A M; Sampson, N S; Wierenga, R K

    2004-04-01

    The conformational switch from open to closed of the flexible loop 6 of triosephosphate isomerase (TIM) is essential for the catalytic properties of TIM. Using a directed evolution approach, active variants of chicken TIM with a mutated C-terminal hinge tripeptide of loop 6 have been generated (Sun,J. and Sampson,N.S., Biochemistry, 1999, 38, 11474-11481). In chicken TIM, the wild-type C-terminal hinge tripeptide is KTA. Detailed enzymological characterization of six variants showed that some of these (LWA, NPN, YSL, KTK) have decreased catalytic efficiency, whereas others (KVA, NSS) are essentially identical with wild-type. The structural characterization of these six variants is reported. No significant structural differences compared with the wild-type are found for KVA, NSS and LWA, but substantial structural adaptations are seen for NPN, YSL and KTK. These structural differences can be understood from the buried position of the alanine side chain in the C-hinge position 3 in the open conformation of wild-type loop 6. Replacement of this alanine with a bulky side chain causes the closed conformation to be favored, which correlates with the decreased catalytic efficiency of these variants. The structural context of loop 6 and loop 7 and their sequence conservation in 133 wild-type sequences is also discussed.

  4. Engineering allosteric regulation into the hinge region of a circularly permuted TEM-1 beta-lactamase.

    Science.gov (United States)

    Mathieu, Valéry; Fastrez, Jacques; Soumillion, Patrice

    2010-09-01

    In nature, the activity of many enzymes involved in important biochemical pathways is controlled by binding a ligand in a site remote from the active site. The allosteric sites are frequently located in hinge regulatory subunits, in which a conformational change can occur and propagate to the active site. The enzymatic activity is then enhanced or decreased depending on the type of effectors. Many artificial binding sites have been created to engineer an allosteric regulation. Generally, these sites were engineered near the active site in loops or at the surface of contiguous helices or strands but rarely in hinge regions. This work aims at exploring the possibility of regulating a monomeric enzyme whose active site is located at the interface between two domains. We anticipated that binding of a ligand in the hinge region linking the domains would modify their positioning and, consequently, modulate the activity. Here, we describe the design of two mutants in a circularly permuted TEM-1 (cpTEM-1) beta-lactamase. The first one, cpTEM-1-His(3) was created by a rational design. It shows little regulation upon metal ion binding except for a weak activation with Zn(2+). The second one, cpTEM-1-3M-His(2), was selected by a directed evolution strategy. It is allosterically down-regulated by Zn(2+), Ni(2+) and Co(2+) with binding affinities around 300 microM.

  5. Design and Test Analysis of a Solar Array Root Hinge Drive Assembly

    Institute of Scientific and Technical Information of China (English)

    DING Xilun; LI Xin

    2014-01-01

    A root hinge drive assembly is preferred in place of the classical viscous damper in a large solar array system. It has advantages including better deployment control and higher reliability. But the traditional single degree of freedom model should be improved. A multiple degrees of freedom dynamics model is presented for the solar arrays deployment to guide the drive assembly design. The established model includes the functions of the torsion springs, the synchronization mechanism and the lock-up impact. A numerical computation method is proposed to solve the dynamics coupling problem. Then considering the drive torque requirement calculated by the proposed model, a root hinge drive assembly is developed based on the reliability engineering design methods, and dual actuators are used as a redundancy design. Pseudo-efficiency is introduced and the major factors influencing the (pseudo-) efficiency of the gear mechanism designed with high reduction ratio are studied for further test data analysis. A ground prototype deployment test is conducted to verify the capacity of the drive assembly. The test device consists of a large-area solar array system and a root hinge drive assembly. The RHDA development time is about 43 s. The theoretical drive torque is compared with the test values which are obtained according to the current data and the reduction efficiency analysis, and the results show that the presented model and the calibration methods are proper enough.

  6. Design and test analysis of a solar array root hinge drive assembly

    Science.gov (United States)

    Ding, Xilun; Li, Xin

    2014-09-01

    A root hinge drive assembly is preferred in place of the classical viscous damper in a large solar array system. It has advantages including better deployment control and higher reliability. But the traditional single degree of freedom model should be improved. A multiple degrees of freedom dynamics model is presented for the solar arrays deployment to guide the drive assembly design. The established model includes the functions of the torsion springs, the synchronization mechanism and the lock-up impact. A numerical computation method is proposed to solve the dynamics coupling problem. Then considering the drive torque requirement calculated by the proposed model, a root hinge drive assembly is developed based on the reliability engineering design methods, and dual actuators are used as a redundancy design. Pseudo-efficiency is introduced and the major factors influencing the (pseudo-) efficiency of the gear mechanism designed with high reduction ratio are studied for further test data analysis. A ground prototype deployment test is conducted to verify the capacity of the drive assembly. The test device consists of a large-area solar array system and a root hinge drive assembly. The RHDA development time is about 43 s. The theoretical drive torque is compared with the test values which are obtained according to the current data and the reduction efficiency analysis, and the results show that the presented model and the calibration methods are proper enough.

  7. Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

    Institute of Scientific and Technical Information of China (English)

    LI Yong-dong; HAN Xin-wei; WU Gang; LI Ming-hua

    2007-01-01

    Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7(87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple,safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257)[ Key words ] Fistula, pulmonary; Bronchialpleural fistula; Stents and prostheses; Computed tomography

  8. Role of Met93 and Thr96 in the lid hinge region of Rhizopus chinensis lipase.

    Science.gov (United States)

    Zhu, Shan-Shan; Li, Ming; Yu, Xiaowei; Xu, Yan

    2013-05-01

    We engineered Rhizopus chinensis lipase to study its critical amino acid role in catalytic properties. Based on the amino acid sequence and three-dimensional model of the lipase, residues located in its lid hinge region (Met93 and Thr96) were replaced with corresponding amino acid residues (Ile93 and Asn96) found in the lid hinge region of Rhizopus oryzae lipase. The substitutions in the lid hinge region affected not only substrate specificity but also the thermostability of the lipase. Both lipases preferred p-nitrophenyl laurate and glyceryl trilaurate (C12). However, the variant S4-3O showed a slight decline in activity toward long-chain fatty acid (C16-C18). When enzymes activities decreased by half, the temperature of the variant (45 °C) was 22 °C lower than the parent (67 °C), probably substantially destabilized the structure of the lid region. The interfacial kinetic analysis of S4-3O suggested that the lower catalytic efficiency was due to a higher K m* value. According to the lipase structure investigated, Ile93Met played a role of narrowing the size of the hydrophobic patch, which affected the substrate binding affinity, and Asn96Thr destabilized the structure of the lipase by disrupting the H-bond interaction in the lid region.

  9. Health reform: examining the alternatives.

    Science.gov (United States)

    Custer, W

    1994-03-01

    This Issue Brief examines the major issues of the health reform debate. The issues that must be resolved before reform can be enacted include: allocation of health care resources, universal coverage versus universal access, composition of risk pools, employer and individual mandates, and distribution of health care services' costs. This report also contains short descriptions and analyses of the following proposals: McDermott-Wellstone, Clinton administration, Cooper-Breaux, Chafee-Thomas, Michel-Lott, Nickles-Stearns, and Gramm. Proposals without an individual mandate will not achieve universal coverage. An individual mandate raises significant enforcement issues. An employer mandate will not achieve universal coverage by itself. Depending on the number of hours an employee must work to be included in a mandate, an employer mandate could potentially extend health insurance coverage to as many as 85 percent of the currently uninsured. Each individual has a risk of needing health care services. Restructuring the health insurance market is accomplished by changing the way individuals and their risks are pooled. The composition of these risk pools will determine the costs of health insurance and the distribution of these costs. The theory behind medical saving accounts is that the market for health insurance currently leads to health care cost inflation because many events covered under most health insurance plans are not truly insurable. There are two issues involved in medical savings accounts--the impact on low-income individuals and individuals' ability to evaluate the quality of care they receive. The present market does not provide individuals with adequate information for assessing the quality or effectiveness of medical care. Among the critical issues in health reform is how to reduce the rate of health care cost inflation. The effect of proposals that impose explicit budget caps or price controls on health care cost inflation can be more easily estimated than

  10. Production of biologically active IgG hinge-tag soluble epidermal growth factor receptors (ErbB).

    Science.gov (United States)

    Otani, Takayuki; Hashizume, Toshihiro; Nagaoka, Tadahiro; Fukuda, Tomoko; Tang, Careen K; Salomon, David S; Seno, Masaharu

    2010-03-01

    The extracellular domains (ECD) of epidermal growth factor receptors, ErbB1, 2, 3 and 4, were designed as soluble dimeric forms. Each ECD was fused to a short hinge region derived from IgG, such that the stable dimer could be formed with disulfide bridges. This hinge-tagged design minimized the molecular weight to approximately 50% of the conventional Fc-fusion design without an Fc domain of IgG. The refolded dimers could be easily analyzed and characterized by SDS-PAGE. Hinge-tagged soluble ErbBs demonstrated significant affinity for betacellulin and heregulin. The IgG hinge-tag should be a simple method to design soluble dimers that would be useful for high throughput screening of ligands, antagonists or derivatives.

  11. 从新医改中看面向基层医学生的机遇与挑战%The Opportunities and Challenges in the New Health Care Reform for the Medical Students at Basic Level

    Institute of Scientific and Technical Information of China (English)

    张俊义

    2012-01-01

    The new health care reform has advocated strengthening the governments responsibility, strengthening grass - roots, and guiding the general treatment to primary health care sectors. These policies have brought a-bout some good opportunities for the medical students at basic level to develop their careers. At the same time,the target of the new health care reform, that is to relieve and even resolve the difficulty and costliness in medical treatment, has also brought about some large challenges for them. They have to make various efforts to be competent in this era mission. The opportunities come from the pursuit for social justice of people in the condition of the continuous development of the economy and society. The challenges mainly come from the individual moral requirement of the overall career under the technological progress. A good combination of the two forms the ethical basis for the success of the career.%新医改中的“强化政府责任”、“强基层”、“引导一般诊疗下沉基层”等政策为面向基层医学生的事业发展带来良好机遇.同时,新医改的目标,缓解乃至解决“看病难,看病贵”问题,对面向基层医学生也提出了很大挑战.他们需要通过多方面努力才能胜任这一时代使命.机遇来自人们在经济社会不断发展的基础上对社会伦理,即公正的追求,挑战主要源于技术进步前提下整体事业对个体道德,即善的要求.二者契合构成事业成功的伦理基础.

  12. Challenges and reforms in Long-Term Care policy in Spain - See more at: http://www.gigapp.org/index.php/component/jresearch/?view=publication&task=show&id=1808#sthash.QjsbaT7Q.dpuf

    Directory of Open Access Journals (Sweden)

    Moreno-Fuentes, Francisco Javier

    2015-02-01

    Full Text Available The NorSpaR project aims to analyse the main public policy initiatives by which Norway and Spain cope with the new social and economic challenges derived from the so-called New Social Risks (NSR. Although both countries present significant differences in their institutional settings (such as Spanish EU membership, or its belonging to diverse welfare regimes types (Norway is generally included in the Nordic regime, while Spain is part of the Mediterranean one, both countries share a common interest in addressing the aforementioned challenges while maintaining social cohesion. In the last decade, governments in both countries have tried to respond to those challenges by reforming their labour markets, adapting their unemployment schemes, as well as their gender, family and long-term care policies. The analysis covered in this project includes three areas of public policy addressing NSR. First, dependency is one of the most daunting challenges for post-industrial societies experiencing population ageing and with an increasing number of frail people in need of care. This situation is forcing governments to rethink their long-term care policies. Second, family and gender public programs need to respond to the growing difficulties of families in reconciling professional and family life. Third, in the transition to a post-industrial order, and in a context of mass unemployment, social protection systems have a renewed prominence. Along with the so-called passive policies offering financial support to the unemployed, active labour market policies are geared to put people back into work. In our analysis we try to find answers to the following questions: What are the challenges that each of these policies have been trying to address in recent years? How have these policies evolved? What kinds of reforms have been implemented, and which ones have been neglected? Have the policy goals and targets of welfare programs been modified in any significant way

  13. 新医改形势下医院制剂的发展思路%The development of hospital preparation in the new health care reform environ-ment

    Institute of Scientific and Technical Information of China (English)

    陶春; 宋洪涛

    2016-01-01

    目的:探讨医院制剂在新医改形势下的发展思路。方法分析新机遇和挑战,探讨医院制剂的发展思路。结果开发新技术和新剂型,发展中药制剂,深化制剂委托生产并扩大使用范围,是实现医院制剂发展的重要突破口。结论在新医改形势下充分把握机遇,坚持正确的发展思路,医院制剂有望实现可持续发展。%Objective To explore the development of hospital preparation under the domestic health care reform .Meth-ods Research the ideas to further develop hospital preparation by analyzing the opportunities and challenges .Results The de-velopment of hospital preparation can be achieved through new technologies ,new dosage forms ,improved preparation of tradi-tional Chinese medicines ,expanded contract manufacturing ,and broader application of pharmacy compounding .Conclusion In the new health care environment ,the sustainable development of hospital preparation can be realized .Hospital preparation will continue to grow if strategies are in place to recognize and grasp new opportunities .

  14. Influence and Enlightenment of New Healthcare Reform on the Development of Public Hospital in China%我国新医改政策对公立医院发展的影响与启示

    Institute of Scientific and Technical Information of China (English)

    赵晋; 董自西; 颜碧玉; 董晓建; 殷进功

    2016-01-01

    This article describes the policy decision of using both planned economy and market economy in the pro-gress of health care reform in China,the government values the functional duty healthcare,comprehensive measures has been implemented or will be enacted to ensure the public welfare of public hospitals. Finally,several distinguis-hing experimental models are enumerated,which will set an example for the reform of other public hospitals.%阐述了新医改背景下我国医药卫生事业进入综合应用市场经济与计划管理策略的政策新局面,政府重视社会卫生事业责任,实施综合改革措施,解除公立医院逐利意图,实现公立医院公益性回归。最后,列举当前公立医院改革试点的典型模式,启示公立医院未来发展方向。

  15. Urban homelessness and poverty during economic prosperity and welfare reform: changes in self-reported comorbidities, insurance, and sources for usual care, 1995-1997.

    Science.gov (United States)

    O'Toole, Thomas P; Gibbon, Jeanette L; Seltzer, Deborah; Hanusa, Barbara H; Fine, Michael J

    2002-06-01

    Little is known of how homeless and other urban poor populations have fared during the robust economy and within structural changes in health care delivery and entitlement programs of the 1990s. This is important in determining the need for population-specific services during a vigorous economy with low unemployment and increasing Medicaid managed-care penetration. This study compared health insurance status and availability of a source for usual medical care, psychiatric and substance abuse comorbidities, and perceived causes of homelessness in homeless adults surveyed in 1995 and 1997. Cross-sectional, community-based surveys were conducted in 1995 and 1997 at sites frequented by urban homeless adults residing in Pittsburgh, Pennsylvania. Self-reported medical, mental health, and substance abuse comorbidities, health insurance, and source for usual care were measured. Compared to the 388 individuals surveyed in 1995, the 267 homeless adults surveyed in 1997 had more medical comorbidity (56.6% vs. 30.2%, P <.001) and mental health comorbidity (44.9% vs. 36.9%, P =.04) and required more chronic medication (52.1% vs. 30.3%, P <.001). More respondents in 1997 than 1995 reported having no health insurance (41.4% vs. 29.4%, P <.001). While there was no difference in the overall proportion reporting a source for usual care (78.3% in 1997 vs. 80.2% in 1995, P =.55), fewer persons reported use of the emergency department and more persons reported using a shelterbased clinic for usual care in 1997 compared with 1995. These findings suggest more need for medical care among homeless and urban poor persons in 1997 compared with 1995 and support the continued need for outreach and support services despite a vigorous economy.

  16. Comparison of SEC and CE-SDS methods for monitoring hinge fragmentation in IgG1 monoclonal antibodies.

    Science.gov (United States)

    Dada, Oluwatosin O; Rao, Romesh; Jones, Natalie; Jaya, Nomalie; Salas-Solano, Oscar

    2017-10-25

    Fragmentation of monoclonal antibodies is a critical quality attribute routinely monitored to assess the purity and integrity of the product from development to commercialization. Cleavage in the upper hinge region of IgG1 monoclonal antibodies is a common fragmentation pattern widely studied by size exclusion chromatography (SEC). Capillary electrophoresis with sodium dodecylsulfate (CE-SDS) is a well-established technique commonly used for monitoring antibody fragments as well, but its comparability to SEC in monitoring hinge fragments has not been established until now. We report a characterization strategy that establishes the correlation between hinge region fragments analyzed by SEC and CE-SDS. Monoclonal antibodies with elevated hinge fragments were generated under low pH stress conditions and analyzed by SEC and CE-SDS. The masses of the fragments generated were determined by LC-MS. Electrophoretic migration of the hinge fragmentation products in CE-SDS were determined based on their mass values. Comparative assessment of fragments by SEC, and CE-SDS showed similar correlation with incubation time. This study demonstrates that CE-SDS can be employed as a surrogate technique to SEC for monitoring hinge region fragments. Most importantly, combination of these techniques can be used to obtain comprehensive understanding of fragment related characteristics of therapeutic protein products. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Primary Health Care,a Concept to Be Fully Understood and Implemented in Current China's Health Care Reform%Primary Health Care -基础医疗卫生服务应该在中国新医改中得到正确理解和全面实施

    Institute of Scientific and Technical Information of China (English)

    徐国平; 王家骥

    2015-01-01

    's vision of health care and development strategy,in areas such as government policy - making, health care financing,infrastructure planning,and health care workforce training. This article elucidates how PHC has been misconstrued and translated into " entry level health Care" in China and why it is a wrong interpretation of the PHC concept from various angles,including the basic English meaning of " primary" and " health care" ,the concept of comprehensive PHC, the global PHC experience,and the harmful consequences of the misconception in China's PHC development and in society at large. China's current new health care reform towards a PHC - centered health system has made significant early achievements,but also faces huge challenges,including the widespread and ingrained misconception of PHC. It is hoped that academic scholars in the health care field,medical professionals,and officials in the government gain clearer insight into the PHC concept and rectify its harmful effects on PHC development in various sectors,and promote advancement of meaningful health care reform applicable to the masses.

  18. Steepest Ascent Tariff Reforms

    DEFF Research Database (Denmark)

    Raimondos-Møller, Pascalis; Woodland, Alan D.

    2006-01-01

    a theoretical concept where the focus is upon the size of welfare gains accruing from tariff reforms rather than simply with the direction of welfare effects that has been the concern of theliterature.JEL code: F15.Keywords: Steepest ascent tariff reforms; piecemeal tariff policy; welfare; market access; small......This paper introduces the concept of a steepest ascent tariff reform for a small open economy. By construction, it is locally optimal in that it yields the highest gain in utility of any feasible tariff reform vector of the same length. Accordingly, it provides a convenient benchmark...... existing reforms are locally optimal, provide geometric illustrations and compare welfare effectiveness of reforms using numerical examples. Moreover, being a general concept, we apply it to the issue of market access and examine its implications. Overall, the paper's contribution lies in presenting...

  19. Inspiration of Modern View on Health Care Reform in China%现代健康观对我国医改的启示

    Institute of Scientific and Technical Information of China (English)

    杨萍; 赵曼

    2013-01-01

    The modern view of health is overall health, the emphasis of medical have shifted from medical diagnosis and treatment to the prevention. Health is a human capital, the healthy mention relating to civil rights and obligations of States, national health protection capability should use the "Accessibility" and "availability" as a standard. The enlightenment of Modern health concept to medical reform include the combination of prevention and treatment, the medical expenses contain-ment and the allocation of medical resources equilibrium between city and countryside.%现代人的健康观是整体健康,医学重点已从诊断治疗转变为预防保健;健康是一种人力资本,用于医疗方面的开支属于“劳动能力的修理费用”;“健康”已被提到公民福利和国家义务的层面,对国民健康的保障能力要用“可及性”和“可得性”这两个指标作为标准。现代健康观启示我们:对医改应预防与治疗相结合、遏制医疗费用“黑洞”、统筹城乡医疗资源的均衡配置等。

  20. Reforming Ontario Early Learning: A Review

    Science.gov (United States)

    Ryan, Thomas; Date, Gavin

    2014-01-01

    Herein, we address the reformation of Ontario early learning. Over the next 3 years, all 4- and 5-year-olds in Ontario (Canada) will be able to attend full-day early learning with child care, before and after school provided by the Government of Ontario Ministry of Education. The benefits of such a change are both academic and societal and are…

  1. Lesotho - Land Administration Reform

    Data.gov (United States)

    Millennium Challenge Corporation — Michigan State University was assigned to design the impact evaluation (IE) of the Land Administration Reform Project (LARP) funded under the Millennium Challenge...

  2. Evaluating Reforms in the Netherlands' Competitive Health Insurance System

    NARCIS (Netherlands)

    I. Mosca (Ilaria)

    2012-01-01

    textabstractThe 2006 health care reform in the Netherlands attracted widespread international interest in the impact of regulated competition on key factors such as prices, quality, and volume of care. This article reviews evidence on the performance of the health care system six years after the ref

  3. Practice paper of the academy of nutrition and dietetics: principles of productivity in food and nutrition services: applications in the 21st century health care reform era.

    Science.gov (United States)

    Gregoire, Mary B; Theis, Monica L

    2015-07-01

    Food and nutrition services, along with the health care organizations they serve, are becoming increasingly complex. These complexities are driven by sometimes conflicting (if not polarizing) human, department, organization, and environment factors and will require that managers shift how they think about and approach productivity in the context of the greater good of the organization and, perhaps, even society. Traditional, single-factor approaches to productivity measurements, while still valuable in the context of departmental trend analysis, are of limited value when assessing departmental performance in the context of an organization's goals and values. As health care continues to change and new models of care are introduced, food and nutrition services managers will need to consider innovative approaches to improve productivity that are consistent with their individual health care organization's vision and mission. Use of process improvement tools such as Lean and Six Sigma as strategies for evaluating and improving food and nutrition services efficiency should be considered. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  4. Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs.

    Science.gov (United States)

    Bachman, Sara S; Comeau, Meg; Long, Thomas F

    2017-05-01

    There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health. Copyright © 2017 by the American Academy of Pediatrics.

  5. A tribute to Congresswoman Mary Rose Oakar: friend of the elderly, advocate for women, health care reformer, and champion for Cleveland.

    Science.gov (United States)

    Halamandaris, V J

    1992-07-01

    Striking a balance between sensitive caring and political muscle, between aiding her Ohio constituents and mounting national crusades, Congresswoman Mary Rose Oakar is one of the most active members of the House Aging Committee. Her goals for the future are growing every day.

  6. Numerical Modeling on Hydrodynamic Performance of A Bottom-Hinged Flap Wave Energy Converter

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hai-tao; SUN Zhi-lin; HAO Chun-ling; SHEN Jia-fa

    2013-01-01

    The hydrodynamic performance of a bottom-hinged flap wave energy converter (WEC) is investigated through a frequency domain numerical model.The numerical model is verified through a two-dimensional analytic solution,as well as the qualitative analysis on the dynamic response of avibrating system.The concept of "optimum density" of the bottom-hinged flap is proposed,and its analytic expression is derived as well.The frequency interval in which the optimum density exists is also obtained.The analytic expression of the optimum linear damping coefficient is obtained by a bottom-hinged WEC.Some basic dynamic properties involving natural period,excitation moment,pitch amplitude,and optimum damping coefficient are analyzed and discussed in detail.In addition,this paper highlights the analysis of effects on the conversion performance of the device exerted by some important parameters.The results indicate that "the optimum linear damping period of 5.0 s" is the most ideal option in the short wave sea states with the wave period below 6.0 s.Shallow water depth,large flap thickness and low flap density are advised in the practical design of the device in short wave sea states in order to maximize power capture.In the sea state with water depth of 5.0 m and wave period of 5.0 s,the results of parametric optimization suggest a flap with the width of 8.0 m,thickness of 1.6 m,and with the density as little as possible when the optimum power take-off (PTO) damping coefficient is adopted.

  7. Hinge-Region O-Glycosylation of Human Immunoglobulin G3 (IgG3)*

    Science.gov (United States)

    Plomp, Rosina; Dekkers, Gillian; Rombouts, Yoann; Visser, Remco; Koeleman, Carolien A.M.; Kammeijer, Guinevere S.M.; Jansen, Bas C.; Rispens, Theo; Hensbergen, Paul J.; Vidarsson, Gestur; Wuhrer, Manfred

    2015-01-01

    Immunoglobulin G (IgG) is one of the most abundant proteins present in human serum and a fundamental component of the immune system. IgG3 represents ∼8% of the total amount of IgG in human serum and stands out from the other IgG subclasses because of its elongated hinge region and enhanced effector functions. This study reports partial O-glycosylation of the IgG3 hinge region, observed with nanoLC-ESI-IT-MS(/MS) analysis after proteolytic digestion. The repeat regions within the IgG3 hinge were found to be in part O-glycosylated at the threonine in the triple repeat motif. Non-, mono- and disialylated core 1-type O-glycans were detected in various IgG3 samples, both poly- and monoclonal. NanoLC-ESI-IT-MS/MS with electron transfer dissociation fragmentation and CE-MS/MS with CID fragmentation were used to determine the site of IgG3 O-glycosylation. The O-glycosylation site was further confirmed by the recombinant production of mutant IgG3 in which potential O-glycosylation sites had been knocked out. For IgG3 samples from six donors we found similar O-glycan structures and site occupancies, whereas for the same samples the conserved N-glycosylation of the Fc CH2 domain showed considerable interindividual variation. The occupancy of each of the three O-glycosylation sites was found to be ∼10% in six serum-derived IgG3 samples and ∼13% in two monoclonal IgG3 allotypes. PMID:25759508

  8. Direct observation of T4 lysozyme hinge-bending motion by fluorescence correlation spectroscopy.

    Science.gov (United States)

    Yirdaw, Robel B; McHaourab, Hassane S

    2012-10-01

    Bacteriophage T4 Lysozyme (T4L) catalyzes the hydrolysis of the peptidoglycan layer of the bacterial cell wall late in the infection cycle. It has long been postulated that equilibrium dynamics enable substrate access to the active site located at the interface between the N- and C-terminal domains. Crystal structures of WT-T4L and point mutants captured a range of conformations that differ by the hinge-bending angle between the two domains. Evidence of equilibrium between open and closed conformations in solution was gleaned from distance measurements between the two domains but the nature of the equilibrium and the timescale of the underlying motion have not been investigated. Here, we used fluorescence fluctuation spectroscopy to directly detect T4L equilibrium conformational fluctuations in solution. For this purpose, Tetramethylrhodamine probes were introduced at pairs of cysteines in regions of the molecule that undergo relative displacement upon transition from open to closed conformations. Correlation analysis of Tetramethylrhodamine intensity fluctuations reveals hinge-bending motion that changes the relative distance and orientation of the N- and C-terminal domains with ≅ 15 μs relaxation time. That this motion involves interconversion between open and closed conformations was further confirmed by the dampening of its amplitude upon covalent substrate trapping. In contrast to the prevalent two-state model of T4L equilibrium, molecular brightness and number of particles obtained from cumulant analysis suggest that T4L populates multiple intermediate states, consistent with the wide range of hinge-bending angles trapped in the crystal structure of T4L mutants.

  9. A Molecular Brake in the Kinase Hinge Region Regulates the Activity of Receptor Tyrosine Kinases

    Energy Technology Data Exchange (ETDEWEB)

    Chen,H.; Ma, J.; Li, W.; Eliseenkova, A.; Xu, C.; Neubert, T.; Miller, W.; Mohammadi, M.

    2007-01-01

    Activating mutations in the tyrosine kinase domain of receptor tyrosine kinases (RTKs) cause cancer and skeletal disorders. Comparison of the crystal structures of unphosphorylated and phosphorylated wild-type FGFR2 kinase domains with those of seven unphosphorylated pathogenic mutants reveals an autoinhibitory 'molecular brake' mediated by a triad of residues in the kinase hinge region of all FGFRs. Structural analysis shows that many other RTKs, including PDGFRs, VEGFRs, KIT, CSF1R, FLT3, TEK, and TIE, are also subject to regulation by this brake. Pathogenic mutations activate FGFRs and other RTKs by disengaging the brake either directly or indirectly.

  10. Design analysis of the hinge support for the ITER vacuum vessel

    Energy Technology Data Exchange (ETDEWEB)

    Kim, B.Y. [ITER Korea, National Fusion Research Institute, Daejeon 305-333 (Korea, Republic of); Ahn, H.J., E-mail: hjahn@nfri.re.kr [ITER Korea, National Fusion Research Institute, Daejeon 305-333 (Korea, Republic of); Ha, M.S. [DNDE, Busan 612-021 (Korea, Republic of); Kim, Y.K. [Hyundai Heavy Industries Co. Ltd., Ulsan 682-792 (Korea, Republic of); Kim, H.S.; Sa, J.W.; Kim, B.C.; Bak, J.S. [ITER Korea, National Fusion Research Institute, Daejeon 305-333 (Korea, Republic of); Choi, C.H.; Ioki, K.; Wang, X.; Bachmann, C. [ITER Organization, CS 90 046, 13067 St Paul-lez-Durance CEDEX (France)

    2011-10-15

    In order to verify design feasibility and structural integrity of a hinge type support for the ITER VV support system, the design analysis has been performed in detail, which includes heat transfer, elastic stress and limit analyses. The structural analyses were performed to confirm the transfer of forces through the supporting structure and to determine the maximum allowable loads according to the RCC-MR. From the heat transfer analysis for VV baking stage, total heat flow into the support was obtained to confirm the thermal heat flux into the cryostat under baking condition. In addition, the design modification was also discussed to enhance the structural performance of the supporting system.

  11. Paramedian forehead flap combined with hinge flap for nasal tip reconstruction*

    Science.gov (United States)

    Cerci, Felipe Bochnia; Dellatorre, Gerson

    2016-01-01

    The paramedian forehead flap is a great option for restoration of complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. We present a patient with a basal cell carcinoma on the distal nose treated by Mohs micrographic surgery, and a resulting full-thickness defect repaired with paramedian forehead flap combined with a hinge flap. For optimal results with the paramedian forehead flap, adequate surgical planning, patient orientation and meticulous surgical technique are imperative.

  12. Effects of aluminum hinged shoes on the structure of contracted feet in Thoroughbred yearlings.

    Science.gov (United States)

    Tanaka, Kousuke; Hiraga, Atsushi; Takahashi, Toshiyuki; Kuwano, Atsutoshi; Morrison, Scott Edward

    2015-01-01

    We applied aluminum hinged shoes (AHSs) to the club foot-associated contracted feet of 11 Thoroughbred yearlings to examine the effects of the shoes on the shape of the hoof and third phalanx (P III). After 3 months of AHS use, the size of the affected hooves increased significantly, reaching the approximate size of the healthy contralateral hooves with respect to the maximum lateral width of the foot, the mean ratio of the bearing border width to the coronary band width, and the mean ratio of the solar surface width to the articular surface width. These results suggest that the AHSs corrected the contracted feet in these yearling horses.

  13. Numerical Simulation of Projection Welding Processes for Door Hinge of Automobile Based on Coupled Fields Analysis

    Institute of Scientific and Technical Information of China (English)

    QIAN Chang-ming; LUO Ai-hui; CHEN Guan-long

    2007-01-01

    Projection welding is a variation of electric resistance welding with the dynamic changes of the flow paths for heat and electrical properties with changing temperature caused by the large plastic deformation collapse of projection. As the joint type between the auto door hinge and the inner plate, projection welding may bring welding distortions and would affect the assembly quality of auto body. A comprehensive electric-thermal-mechanical numerical simulation was performed to quantitatively simulate the processes of projection welding by using a coupled finite element method. The mechanism of projection collapse and the formation process of nugget were discussed and good conclusions have been achieved comparing with the test results.

  14. Mechanism of Epac activation: structural and functional analyses of Epac2 hinge mutants with constitutive and reduced activities.

    Science.gov (United States)

    Tsalkova, Tamara; Blumenthal, Donald K; Mei, Fang C; White, Mark A; Cheng, Xiaodong

    2009-08-28

    Epac2 is a member of the family of exchange proteins directly activated by cAMP (Epac). Our previous studies suggest a model of Epac activation in which cAMP binding to the enzyme induces a localized "hinge" motion that reorients the regulatory lobe relative to the catalytic lobe without inducing large conformational changes within individual lobes. In this study, we identified the location of the major hinge in Epac2 by normal mode motion correlation and structural alignment analyses. Targeted mutagenesis was then performed to test the functional importance of hinge bending for Epac activation. We show that substitution of the conserved residue phenylalanine 435 with glycine (F435G) facilitates the hinge bending and leads to a constitutively active Epac2 capable of stimulating nucleotide exchange in the absence of cAMP. In contrast, substitution of the same residue with a bulkier side chain, tryptophan (F435W), impedes the hinge motion and results in a dramatic decrease in Epac2 catalytic activity. Structural parameters determined by small angle x-ray scattering further reveal that whereas the F435G mutant assumes a more extended conformation in the absence of cAMP, the F435W mutant is incapable of adopting the fully extended and active conformation in the presence of cAMP. These findings demonstrate the importance of hinge motion in Epac activation. Our study also suggests that phenylalanine at position 435 is the optimal size side chain to keep Epac closed and inactive in the absence of cAMP while still allowing the proper hinge motion for full Epac extension and activation in the presence of cAMP.

  15. The rise in health care coverage and affordability since health reform took effect: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014.

    Science.gov (United States)

    Collins, Sara R; Rasmussen, Petra W; Doty, Michelle M; Beutel, Sophie

    2015-01-01

    New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act's subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.

  16. The effect of payment reform on physician practices. Part 2. Physicians and health plans prepare for health care's brave new world.

    Science.gov (United States)

    Hettiger, Stacey; Natinsky, Paul; Neller, Joe

    2012-01-01

    In our last installment, we wrote globally about the nature and permanence of trends in physician payment models, particularly the shift from fee-for-service to fee-for-value. In our second communique, we will look specifically at major health plans with which physicians will be working and provide an overview of the payment methods, programs, and demonstrations affecting Michigan physicians and the health care delivery model.

  17. Educational Reform in Mexico.

    Science.gov (United States)

    Fuentes, Bertha Orozco; Elizando Y Carr, Sandra

    1993-01-01

    Since the 1970s, each presidential regime has presented an educational modernization reform program for Mexico. Although the various reforms have widened educational opportunities, the quality of education has continued to deteriorate because of student and teacher desertion, a low scholastic progress index, accessibility problems, lack of an…

  18. Comments on UN Reform

    Institute of Scientific and Technical Information of China (English)

    YangHongxi; ZhangYaowu

    2004-01-01

    On October 9-13 2004, United Nations SecretaryGeneral Kofi Annan paid an official visit to China.During his stay, he had discussions with Chinese leaders on UN reform and changes in the international situation and etc. In recent 59th UN General Assembly Session, UN reform was also one of the hot topics.

  19. Reforming Organizational Structures

    NARCIS (Netherlands)

    S.G.J. Van de Walle (Steven)

    2016-01-01

    textabstractPublic sectors have undergone major transformations. Public sector reform touches upon the core building blocks of the public sector: organizational structures, people and finances. These are objects of reform. This chapter presents and discusses a set of major transformations with

  20. Innovation in Medicare and Medicaid will be central to health reform's success.

    Science.gov (United States)

    Guterman, Stuart; Davis, Karen; Stremikis, Kristof; Drake, Heather

    2010-06-01

    The health reform legislation signed into law by President Barack Obama contains numerous payment reform provisions designed to fundamentally transform the nation's health care system. Perhaps the most noteworthy of these is the establishment of a Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. This paper presents recommendations that would maximize the new center's effectiveness in promoting reforms that can improve the quality and value of care in Medicare, Medicaid, and the Children's Health Insurance Program, while helping achieve health reform's goals of more efficient, coordinated, and effective care.

  1. [Equity and health systems reform in Latin America].

    Science.gov (United States)

    Vargas, Ingrid; Vazquez, Maria Luisa; Jane, Elisabet

    2002-01-01

    The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.

  2. The Chilean Health System: 20 Years of Reforms

    Directory of Open Access Journals (Sweden)

    Manuel Annick

    2002-01-01

    Full Text Available The Chilean health care system has been intensively reformed in the past 20 years. Reforms under the Pinochet government (1973-1990 aimed mainly at the decentralization of the system and the development of a private sector. Decentralization involved both a deconcentration process and the devolution of primary health care to municipalities. The democratic governments after 1990 chose to preserve the core organization but introduced reforms intended to correct the system's failures and to increase both efficiency and equity. The present article briefly explains the current organization of the Chilean health care system. It also reviews the different reforms introduced in the past 20 years, from the Pinochet regime to the democratic governments. Finally, a brief discussion describes the strengths and weaknesses of the system, as well as the challenges it currently faces.

  3. Health System Reform in the United States

    Directory of Open Access Journals (Sweden)

    John E McDonough

    2014-01-01

    Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.

  4. An African Reformation

    Directory of Open Access Journals (Sweden)

    Erna Oliver

    2017-02-01

    Full Text Available The year 2017 is the year in which the Reformation, started by Martin Luther, is celebrating its 500th birthday. This depicts a milestone in the life of the Church of the Reformation and also in the life of Christians worldwide. This is a good time to ponder on the epistemological question of the validity and necessity of the (European Reformation (i.e. improvement, renovation or change. If this question is answered in a positive way, then it could bring us to the realisation that the time is ripe for an African Reformation. This article will argue that this is indeed the case. A reformation, transformation and change is needed for the African Christian context. However, the question could well be asked: Who will be the ‘second Luther?’

  5. Impact and Countermeasure of New Health Care Reform Policy on Large-Scale Integrated Military Hospital%新医改政策对军队大型综合医院的影响及对策探讨

    Institute of Scientific and Technical Information of China (English)

    吴娅利; 周峰; 陈黎明; 蔡耘菲; 袁蕾; 刘国祥

    2013-01-01

    通过分析某地三所军队大型综合医院2008年~2011年的经济收入及收治病种数据,探讨“新医改”政策对军队大型综合医院的影响,指出军队医院要调整学科发展方向,加强与地方行政卫生部门沟通,积极争取地方政府经费支持及做好顶层经费规划等.%Through the analysis of economic income and data on categories of treated diseases in three large -scale integrated military hospitals from 2008 to 2011, the paper investigated the impact of implementation of the new health care reform policy in large -scale integrated military hospitals , and pointed out that the military hospitals need adjust the technology development direction of discipline, strengthen communication with the district health administration, actively seek the financial support of the local government and make good top -level financial planning.

  6. Los valores vinculados a equidad en la reforma de la atención médica en Argentina Equity issues in health care reform in Argentina

    Directory of Open Access Journals (Sweden)

    Susana Belmartino

    2002-08-01

    Full Text Available Este artículo analiza el desarrollo histórico y contemporáneo del sistema de atención médica en Argentina desde el punto de vista de la equidad, principio que no se formula explícitamente en sus fundamentos organizativos. Entre éstos se identifican otros valores, universalidad, accesibilidad, solidaridad, que pueden acercarse al valor equidad. Sin embargo la dinámica política que caracterizó el desarrollo del sistema de servicios condujo a la supresión de los enfoques más universalistas, permaneciendo tan sólo como principio ordenador del sistema la solidaridad grupal. La crisis financiera de los años 80 puso de manifiesto el relativo valor de ese principio para fundar un sistema equitativo. Para ilustrar la situación actual, se utiliza alguna informacion disponible sobre las condiciones de cobertura de beneficiarios del sistema de seguridad social médica.This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

  7. Study on Utilization of LVL Sengon (Paraserianthes falcataria for Three-Hinged Gable Frame Structures

    Directory of Open Access Journals (Sweden)

    Ali Awaludin

    2016-07-01

    Full Text Available This study focuses on the utilization of non-prismatic LVL members of wood species Sengon (Paraserianthes falcataria for three-hinged gable frame structures. This wood species matures in 6 to 8 years, and the innovative application as LVL product for these structures is evaluated. A full-scale model of a beam-column connection is produced and tested to validate the moment-rotation response predicted by the numerical study using ABAQUS. The FEM results showed a linear-elastic moment-rotation curve response up to a joint rotation of 0.015 radians which is in very good agreement with the experiment. This validated FE model for the beam-column joint was further utilized to generate predictions for the moment-rotation relation using different bolt diameters and configurations. The last part of this study presents an evaluation of the maximum load bearing capacity of three-hinged gable frame timber structures considering a rigid and semi-rigid beam-column joint model. If the load carrying capacity is governed by the yielding of the bolt, the gable frame structure with the rigid beam-column joint overestimates the load bearing capacity by 17% to 25%.

  8. The length of a lantibiotic hinge region has profound influence on antimicrobial activity and host specificity

    Directory of Open Access Journals (Sweden)

    Liang eZhou

    2015-01-01

    Full Text Available Lantibiotics are ribosomally synthesized (methyllanthionine containing peptides which can efficiently inhibit the growth of Gram-positive bacteria. As lantibiotics kill bacteria efficiently and resistance to them is difficult to be obtained, they have the potential to be used in many applications, e.g. in pharmaceutical industry or food industry. Nisin can inhibit the growth of Gram-positive bacteria by binding to lipid II and by making pores in their membrane. The C-terminal part of nisin is known to play an important role during translocation over the membrane and forming pore complexes. However, as the thickness of bacterial membranes varies between different species and environmental conditions, this property could have an influence on the pore forming activity of nisin. To investigate this, the so-called hinge region of nisin (residues NMK was engineered to vary from one to six amino acid residues and specific activity against different indicators was compared. Antimicrobial activity in liquid culture assays showed that wild type nisin is most active, while truncation of the hinge region dramatically reduced the activity of the peptide. However, one or two amino acids extensions showed only slightly reduced activity against most indicator strains. Notably, some variants (+2, +1, -1, -2 exhibited higher antimicrobial activity than nisin in agar well diffusion assays against Lactococcus lactis MG1363, Listeria monocytogenes, Enterococcus faecalis VE14089, Bacillus sporothermodurans IC4 and Bacillus cereus 4153 at certain temperatures.

  9. Mid-term results after implantation of rotating-hinge knee prostheses: primary versus revision

    Directory of Open Access Journals (Sweden)

    Turgay Efe

    2012-12-01

    Full Text Available The aim of the study was to evaluate the mid-term clinical results and survivorship of a rotating-hinge knee prosthesis (LINK® Endo-Model in difficult primary and complex revision situations. Results after primary implantation were compared with those of revision procedures. Forty-nine prostheses in 45 patients were reviewed clinically during follow up. Twenty-one of these were implanted in primary and 28 in revision situations. Outcome was evaluated using commonly used scores (Knee Society, UCLA Activity, Lequesne and a visual analog scale after a mean follow up of 56±37 months for 49 prostheses. Implant survival was analyzed using the Kaplan-Meier method. There were no significant differences in clinical examination and evaluation scores between the two groups (P>0.05. Survival rates at final follow up were 95% after primary implantation and 76% in revision procedures. The risk of prosthesis loss (odds ratio 5.7 was significantly higher after revision procedures (P=0.004. These data suggest that rotating-hinge knee prostheses provided good clinical and functional results in selected cases of advanced primary gonarthrosis associated with severe bone loss, ligamentous instability or comminuted fractures. They also provide good results in revision situations. However, the failure rate was significantly higher in cases of revision surgery.

  10. RAG2’s Acidic Hinge Restricts Repair-Pathway Choice and Promotes Genomic Stability

    Directory of Open Access Journals (Sweden)

    Marc A. Coussens

    2013-09-01

    Full Text Available V(DJ recombination-associated DNA double-strand breaks (DSBs are normally repaired by the high-fidelity classical nonhomologous end-joining (cNHEJ machinery. Previous studies implicated the recombination-activating gene (RAG/DNA postcleavage complex (PCC in regulating pathway choice by preventing access to inappropriate repair mechanisms such as homologous recombination (HR and alternative NHEJ (aNHEJ. Here, we report that RAG2’s “acidic hinge,” previously of unknown function, is critical for several key steps. Mutations that reduce the hinge’s negative charge destabilize the PCC, disrupt pathway choice, permit repair of RAG-mediated DSBs by the translocation-prone aNHEJ machinery, and reduce genomic stability in developing lymphocytes. Structural predictions and experimental results support our hypothesis that reduced flexibility of the hinge underlies these outcomes. Furthermore, sequence variants present in the human population reduce the hinge’s negative charge, permit aNHEJ, and diminish genomic integrity.

  11. Encephalomyocarditis virus Leader protein hinge domain is responsible for interactions with Ran GTPase.

    Science.gov (United States)

    Bacot-Davis, Valjean R; Palmenberg, Ann C

    2013-08-15

    Encephalomyocarditis virus (EMCV), a Cardiovirus, initiates its polyprotein with a short 67 amino acid Leader (L) sequence. The protein acts as a unique pathogenicity factor, with anti-host activities which include the triggering of nuclear pore complex hyperphosphorylation and direct binding inhibition of the active cellular transport protein, Ran GTPase. Chemical modifications and protein mutagenesis now map the Ran binding domain to the L hinge-linker region, and in particular, to amino acids 35-40. Large deletions affecting this region were shown previously to diminish Ran binding. New point mutations, especially K35Q, D37A and W40A, preserve the intact L structure, abolish Ran binding and are deficient for nucleoporin (Nup) hyperphosphorylation. Ran itself morphs through multiple configurations, but reacts most effectively with L when in the GDP format, preferably with an empty nucleotide binding pocket. Therefore, L:Ran binding, mediated by the linker-hinge, is a required step in L-induced nuclear transport inhibition.

  12. The length of a lantibiotic hinge region has profound influence on antimicrobial activity and host specificity.

    Science.gov (United States)

    Zhou, Liang; van Heel, Auke J; Kuipers, Oscar P

    2015-01-01

    Lantibiotics are ribosomally synthesized (methyl)lanthionine containing peptides which can efficiently inhibit the growth of Gram-positive bacteria. As lantibiotics kill bacteria efficiently and resistance to them is difficult to be obtained, they have the potential to be used in many applications, e.g., in pharmaceutical industry or food industry. Nisin can inhibit the growth of Gram-positive bacteria by binding to lipid II and by making pores in their membrane. The C-terminal part of nisin is known to play an important role during translocation over the membrane and forming pore complexes. However, as the thickness of bacterial membranes varies between different species and environmental conditions, this property could have an influence on the pore forming activity of nisin. To investigate this, the so-called "hinge region" of nisin (residues NMK) was engineered to vary from one to six amino acid residues and specific activity against different indicators was compared. Antimicrobial activity in liquid culture assays showed that wild type nisin is most active, while truncation of the hinge region dramatically reduced the activity of the peptide. However, one or two amino acids extensions showed only slightly reduced activity against most indicator strains. Notably, some variants (+2, +1, -1, -2) exhibited higher antimicrobial activity than nisin in agar well diffusion assays against Lactococcus lactis MG1363, Listeria monocytogenes, Enterococcus faecalis VE14089, Bacillus sporothermodurans IC4 and Bacillus cereus 4153 at certain temperatures.

  13. Study on the Behavior of Solar Array Deployment with Root Hinge Drive Assembly

    Institute of Scientific and Technical Information of China (English)

    DING Xilun; LI Xin; XU Kun; YANG Qiaolong; PU Hailing

    2012-01-01

    In this paper,a method of using a root hinge drive assembly (RHDA) to control the solar array deployment is provided and a multi-DOF mechanism dynamic model of the system is established.In this way,the root hinge torque can be calculated iteratively.Then taking the predicted torque as a reference,a RHDA is designed for a large multiple-stage packaging and deployable solar array system.The control effect of the drive assembly is validated by ground tests.The test results indicate that the solar arrays can be deployed smoothly,and the deployment velocities are restricted by the drive assembly as expected.During the tests,the RHDA output speed and output torque are obtained.In order to examine the impact force when the yoke is lock-up with a hard stop,dynamics simulations are performed according to the actual behavior.The simulation result indicates that the designed RHDA reduces the impact force significantly and improves the lock-up reliability effectively.

  14. Free Vibrations of a Trapezoidal Plate with an Internal Line Hinge

    Directory of Open Access Journals (Sweden)

    María Virginia Quintana

    2014-01-01

    Full Text Available This paper deals with a general variational formulation for the determination of natural frequencies and mode shapes of free vibrations of laminated thin plates of trapezoidal shape with an internal line hinge restrained against rotation. The analysis was carried out by using the kinematics corresponding to the classical laminated plate theory (CLPT. The eigenvalue problem is obtained by employing a combination of the Ritz method and the Lagrange multipliers method. The domain of the plate is transformed into a rectangular domain in the computational space by using nonorthogonal triangular coordinates and the transverse displacements are approximated with a set of simple polynomials automatically generated and expressed in the triangular coordinates. The developed algorithm allows obtaining approximate analytical solutions for mentioned plate with different geometries, aspect ratio, position of the line hinge, and boundary conditions including translational and rotational elastically restrained edges. It allows studying the influence of the mentioned line on the vibration frequencies and respective mode shapes. The algorithm can easily be programmed and it is numerically stable. Additionally, as a particular case, the results of triangular plates can be easily generated.

  15. Determination of Elevator and Rudder Hinge Forces on the Learjet Model 55 Aircraft

    Science.gov (United States)

    Boroughs, R. R.; Padmanabhan, V.

    1983-01-01

    The empennage structure on the Learjet 55 aircraft was quite similar to the empennage structure on earlier Learjet models. However, due to an important structural change in the vertical fin along with the new loads environment on the 50 series aircraft, a structural test was required on the vertical fin, but the horizontal tail was substantiated by a comparative analysis with previous tests. NASTRAN analysis was used to investigate empennage deflections, stress levels, and control surface hinge forces. The hinge force calculations were made with the control surfaces in the deflected as well as undeflected configurations. A skin panel buckling analysis was also performed, and the non-linear effects of buckling were simulated in the NASTRAN model to more accurately define internal loads and stress levels. Comparisons were then made between the Model 55 and the Model 35/36 stresses and internal forces to determine which components were qualified by previous tests. Some of the methods and techniques used in this analysis are described.

  16. College Chinese Curriculum Reform and Comprehensive Quality Improvement from the Perspective of Humanistic Care%人文关怀视野下大学语文课程改革与综合素养的提升

    Institute of Scientific and Technical Information of China (English)

    陈亚琼

    2014-01-01

    社会经济的高速发展与大学教育的普及化浪潮巩固了大学应用型、实用型学科课程教学的中心地位,而作为人文科学基础学科的大学语文课却没有得到应有的重视。语文课程是当代大学生内在精神发展的动力,也是提升大学生综合素养的基础所在。鉴于人文关怀的缺失是目前大学课程设置中普遍存在的问题,大学语文课程的改革应当立足于学科的人文性目标定位,通过“知、情、行”三者的有机结合,构建充满人文关怀的语文教学模式。%Rapid social and economic development and college education popularization have consolidated the central role of college applied and practical disciplines in curriculum teaching, but college Chinese, as the basic discipline of humanities, has not been given due attention. The Chinese course is the driving force for the internal spiritual development of contemporary college students, as well as the basis for the improvement of college stu-dents' comprehensive quality. In view of the common problem that humanistic care is insufficient in the current college curricu-lum setting, college Chinese curriculum reform should be orient-ed by its humanistic objective, and construct a Chinese teaching model full of humanistic care through the organic integration of"cognition, emotion and behavior".

  17. New Health Care Reform in the Form of Strengthening the Management of Medical Students%新医改形式下加强进修生管理保障医疗安全初探

    Institute of Scientific and Technical Information of China (English)

    计玉超

    2015-01-01

    结合医改的新背景,介绍了安徽省立医院南区近年来在进修生教学管理方面的探索。主要包括院严格资格审核,确保进修生的质量;加强岗前培训,保证对院情的了解;实行导师责任制,发挥带教老师专长;结合新的医学发展模式,加强循证医学教育;以人为本,加强人文关怀;加强督查,保证学习效果。通过不断的摸索,在实践过程中持续改进,医院在进修生管理工作方面不断进步。%With the new background of health care reform, this paper introduces the exploration of the teaching manage-ment of the students in the Southern District of Anhui Provincial Hospital in recent years. Mainly includes: the rigorous qualification to ensure students' quality education; strengthening pre job training, ensure the understanding to the hospital;implementation of supervisor responsibility system, bring into play the teacher expertise; combined with the new medical model, strengthening evidence-based medical education;people-oriented, strengthening humanistic care;strengthen supervi-sion to ensure learning effect. Through continuous exploration, continuous improvement in the process of practice, the hos-pital continues to progress in the management of advanced learning.

  18. Multi-objective optimization of flexure hinge mechanism considering thermal–mechanical coupling deformation and natural frequency

    Directory of Open Access Journals (Sweden)

    Lufan Zhang

    2017-01-01

    Full Text Available Flexure hinge mechanism plays a key part in realization of terminal nano-positioning. The performance of flexure hinge mechanism is determined by its positioning design. Based on the actual working conditions, its finite element model is built and calculated in ANSYS. Moreover, change trends of deformation and natural frequency with positioning design parameters are revealed. And sensitivity analysis is performed for exploration response to these parameters. These parameters are used to build four objective functions. To solve it conveniently, the multi-objective optimization problem is transferred to the form of single-objective function with constraints. An optimal mechanism is obtained by an optimization method combining ANSYS with MATLAB. Finite element numerical simulation has been carried out to demonstrate the superiority of the optimal flexure hinge mechanism, and the superiority can be further verified by experiment. Measurements and tests have been conducted at varying accelerations, velocities, and displacements, to quantify and characterize the amount of acceleration responses obtained from flexure hinge mechanism before and after optimization. Both time- and frequency-domain analyses of experimental data show that the optimal flexure hinge mechanism has superior effectiveness. It will provide a basic for realizing high acceleration and high precision positioning of macro–micro motion platform.

  19. The Impacts of Hinged and Solid Ankle-Foot Orthoses on Standing and Walking in Children with Spastic Diplegia

    Science.gov (United States)

    DALVAND, Hamid; DEHGHAN, Leila; FEIZI, Awat; HOSSEINI, Seyed Ali; AMIRSALARI, Susan

    2013-01-01

    Objective The purpose of this study was to examine the impacts of hinged and solid anklefoot orthoses (AFOs) on standing and walking abilities in children with spastic diplegia. Materials & Methods In a quasi-experimental design, 30 children with spastic diplegia, aged 4-6 years were recruited. They were matched in terms of age, IQ, and level of GMFCS E&R. Children were randomly assigned into 3 groups: a hinged AFO group (n=10) plus occupational therapy (OT), a solid AFO group (n=10) plus OT, a control group who used only OT for three months. Gross motor abilities were measured using Gross Motor Measure Function (GMFM). Results We obtained statistically significant differences in the values between baseline and after treatment in all groups. The groups were also significantly different in total GMFM after intervention. Furthermore, there were differences between hinged AFOs and solid AFOs groups, and between hinged AFOs and control groups. Conclusion We concluded that gross motor function was improved in all groups; however, hinged AFOs group appears to improve the gross motor function better than solid AFOs and control groups. PMID:24665312

  20. The Impact of Health Insurance Reform on Insurance Instability

    Science.gov (United States)

    Freund, KM; Isabelle, AP; Hanchate, A; Kalish, RL; Kapoor, A; Bak, S; Mishuris, RG; Shroff, S; Battaglia, TA

    2015-01-01

    We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six Community Health Centers pre-(2004–2005) and post-(2007–2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p.001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%-CI 0.88–1.09). Our analysis is limited by changes in the populations in the pre and post reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches. PMID:24583490

  1. The impact of health insurance reform on insurance instability.

    Science.gov (United States)

    Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A

    2014-02-01

    We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.

  2. Coverage, access, and affordability under health reform: learning from the Massachusetts model.

    Science.gov (United States)

    Long, Sharon K; Stockley, Karen; Nordahl, Kate Willrich

    While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

  3. 舱门铰链结构分析和单轴铰链的应用%Hinge Structures Analysis of Compartment Doors and Application of Single-axis Hinge

    Institute of Scientific and Technical Information of China (English)

    于敬平; 张跃进

    2012-01-01

    The structure and usage of some hings of the side compartment doors are introduced. The design and ap- plication of a new single-axis hinge which can give references for the designers is presented emphatically.%简析客车用几种舱门铰链的结构、使用状况;重点介绍新型单轴铰链在客车舱门上的开发应用,为同行提供参考。

  4. Atuarfitsialak: Greenland's Cultural Compatible Reform

    Science.gov (United States)

    Wyatt, Tasha R.

    2012-01-01

    In 2002, Greenlandic reform leaders launched a comprehensive, nation-wide reform to create culturally compatible education. Greenland's reform work spans the entire educational system and includes preschool through higher education. To assist their efforts, reform leaders adopted the Standards for Effective Pedagogy developed at the Center for…

  5. High stability of the hinge region in the membrane-active peptide helix of zervamicin: paramagnetic relaxation enhancement studies.

    Science.gov (United States)

    Shenkarev, Zakhar O; Paramonov, Alexander S; Balashova, Tamara A; Yakimenko, Zoya A; Baru, Michael B; Mustaeva, Leila G; Raap, Jan; Ovchinnikova, Tatyana V; Arseniev, Alexander S

    2004-12-17

    Zervamicin IIB is a 16 amino acid peptaibol that forms voltage dependent ion channels with multilevel conductance states in planar lipid bilayers and vesicular systems. Stability of the hinge region and intermolecular interactions were investigated in the N- and C-terminally spin-labelled peptide analogues. Intermolecular and intramolecular paramagnetic enhancement indicates that zervamicin behaves as a rigid helical rod in methanol solution. There are no high amplitude hinge-bending motions, and the peptaibol is monomeric up to concentration 1.5 mM. Stability of the hinge region illustrates the helix stabilising propensity of the Pro residue in membrane mimic environments and implies absence of significant conformational rearrangement due to voltage peptaibol activation.

  6. Rational Design of Coumarin Derivatives as CK2 Inhibitors by Improving the Interaction with the Hinge Region.

    Science.gov (United States)

    Zhang, Na; Chen, Wen-Juan; Zhou, Yue; Zhao, Hongtao; Zhong, Ru-Gang

    2016-01-01

    Design of novel coumarin derivatives as CK2 inhibitors were attempted by targeting the interaction with the hinge region. A set of substituents capable of forming a hydrogen bond or halogen bond with the hinge region were screened in silico, and trifluoromethyl emerges as a promising motif by forming favorable electrostatic interaction and a presumable halogen bond with the hinge region. As proof of concept, three trifluoromethyl derivatives of coumarin were synthesized and tested in vitro. The results indicated that replacement of methyl by trifluoromethyl leads to a modest 5-fold improvement in potency, with the most active compound being 0.4 µM. The newly designed compounds were further screened on one lung cancer cell line A549, showing low micromolar anti-proliferative activity.

  7. Non-catalytic recuperative reformer

    Energy Technology Data Exchange (ETDEWEB)

    Khinkis, Mark J.; Kozlov, Aleksandr P.; Kurek, Harry

    2015-12-22

    A non-catalytic recuperative reformer has a flue gas flow path for conducting hot flue gas from a thermal process and a reforming mixture flow path for conducting a reforming mixture. At least a portion of the reforming mixture flow path is embedded in the flue gas flow path to permit heat transfer from the hot flue gas to the reforming mixture. The reforming mixture flow path contains substantially no material commonly used as a catalyst for reforming hydrocarbon fuel (e.g., nickel oxide, platinum group elements or rhenium), but instead the reforming mixture is reformed into a higher calorific fuel via reactions due to the heat transfer and residence time. In a preferred embodiment, extended surfaces of metal material such as stainless steel or metal alloy that are high in nickel content are included within at least a portion of the reforming mixture flow path.

  8. Modification of Baksi sloppy hinge elbow to minimize the stresses at the humeral bone cement interface- An early experience

    Directory of Open Access Journals (Sweden)

    Baksi D

    2005-01-01

    Full Text Available Background : Baksi sloppy hinge elbow is an all metal prosthesis having 7 0 - 10 0 varus - valgus inherent laxity at the hinge section with minimal motion bearing contact area. Due to the presence of laxity at it′s hinge section, any strain on the prosthesis dissipates primarily to the surrounding soft tissues thus protecting the cement bone interfaces. However, from our long term clinical experiences on the use of our sloppy hinge design since 1984 and the knowledge of literature review of the results of using other semi-constrained (sloppy or unconstrained designs, it was observed that radiolucency or loosening at the bone-cement interface occurred mainly around the humeral stem in the long run due to the continued effect of rotational torque of forearm and hand. Hence, an attempt in the improvement of the design concept is being made. Methods : In this respect one flange each of one cm height and breadth and three mm thickness has been incorporated on either sides of the shank of humeral stem of the sloppy hinge at medio-lateral (coronal plane which will be seated in the corresponding longitudinal groove cut on either side of humeral shaft extending from its transverse cut end to become single assembly during the rotation of humerus. Results : The preliminary results of clinical application of the modified sloppy hinge elbow in ten cases are found satisfactory. Conclusion : The cyclical compression and distraction forces during flexion and extension of the elbow will be distributed over the larger bony area of lower end of humerus where flanges of the humeral shank being seated. The rotational torque effect of forearm and hand particularly with the arm in abduction will be minimised at the humeral bone cement interface as the humerus and the prosthetic stem act as a single assembly by the snugly fitting of the prosthetic flange in the humural shaft

  9. The recent health reform in Croatia: true reforms or just a fundraising exercise?

    Science.gov (United States)

    Svaljek, Sandra

    2014-03-01

    Croatia's most recent reform of the healthcare system was implemented in 2008. The aim of the reform was to enhance financial stability of the system by introducing additional sources of financing, as well as increase the efficiency of the system by reducing sick pay transfers to households, rationalising spending on pharmaceuticals, restructuring hospitals etc. This paper attempts to assess the success of the 2008 healthcare system reform in reaching financial stability and sustainability, and to evaluate the effects of the reform on equity in funding the system. It takes into account the fact that the reform coincided with a severe economic crisis and decline in the overall living standard of Croatian citizens. The paper shows that the reform ended up being expansionary and thus impaired the necessary fiscal adjustment. Finally, it is argued that in circumstances of declining disposable incomes, increased co-payments aimed at the financial stabilisation of the health system made health services less affordable and could have had detrimental effects on equity in the utilisation of health care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Pivotal role of amino acid at position 138 in the allosteric hinge reorientation of cAMP receptor protein.

    OpenAIRE

    Ryu, S.; KIM, J.; Adhya, S; Garges, S

    1993-01-01

    The cAMP receptor protein (CRP) of Escherichia coli needs cAMP for an allosteric change to regulate gene expression by binding to specific DNA sites. The hinge region connecting the DNA-binding domain to the cAMP-binding domain has been proposed to participate in the cAMP-induced allosteric change necessary to adjust C and D alpha-helices for movement of the DNA-binding F alpha-helix away from the protein surface. The role of the hinge region for a conformation change in CRP was tested by stu...

  11. Visualization of the hinge flow in a 5:1 scaled model of the medtronic parallel bileaflet heart valve prosthesis

    Science.gov (United States)

    Healy, T. M.; Fontaine, A. A.; Ellis, J. T.; Walton, S. P.; Yoganathan, A. P.

    In this work, a flow visualization experiment was performed to elucidate features of the retrograde hinge flow through a 5:1 scaled model of the Medtronic Parallel bileaflet heart valve. It was hypothesized that this model would provide detailed flow information facilitating identification of flow structures associated with thrombus formation in this valve. The experimental protocol was designed to ensure fluid dynamic similarity between the model and prototype heart valves. Flow was visualized using dye injection. The detailed flow structures observed showed the hinge's inflow channel was the most suspect region for thrombus formation. Here a complex helical structure was observed.

  12. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.

    Science.gov (United States)

    Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba

    2014-01-01

    Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

  13. Reformer Fuel Injector

    Science.gov (United States)

    Suder, Jennifer L.

    2004-01-01

    Today's form of jet engine power comes from what is called a gas turbine engine. This engine is on average 14% efficient and emits great quantities of green house gas carbon dioxide and air pollutants, Le. nitrogen oxides and sulfur oxides. The alternate method being researched involves a reformer and a solid oxide fuel cell (SOFC). Reformers are becoming a popular area of research within the industry scale. NASA Glenn Research Center's approach is based on modifying the large aspects of industry reforming processes into a smaller jet fuel reformer. This process must not only be scaled down in size, but also decrease in weight and increase in efficiency. In comparison to today's method, the Jet A fuel reformer will be more efficient as well as reduce the amount of air pollutants discharged. The intent is to develop a 10kW process that can be used to satisfy the needs of commercial jet engines. Presently, commercial jets use Jet-A fuel, which is a kerosene based hydrocarbon fuel. Hydrocarbon fuels cannot be directly fed into a SOFC for the reason that the high temperature causes it to decompose into solid carbon and Hz. A reforming process converts fuel into hydrogen and supplies it to a fuel cell for power, as well as eliminating sulfur compounds. The SOFC produces electricity by converting H2 and CO2. The reformer contains a catalyst which is used to speed up the reaction rate and overall conversion. An outside company will perform a catalyst screening with our baseline Jet-A fuel to determine the most durable catalyst for this application. Our project team is focusing on the overall research of the reforming process. Eventually we will do a component evaluation on the different reformer designs and catalysts. The current status of the project is the completion of buildup in the test rig and check outs on all equipment and electronic signals to our data system. The objective is to test various reformer designs and catalysts in our test rig to determine the most

  14. Railway Reform in China.

    OpenAIRE

    1998-01-01

    The purpose of this working paper is to consider the current situation of Chinese Railways, the progress of reforms to date, and possible future developments. The first section describes the current problems of Chinese Railways, as a vast organisation subject to strong central control, facing enormous and rapidly growing demands which it is unable to satisfy. The progress of reform in Chinese Railways to date, and in particular the Economic Contract Responsibility System instituted in the lat...

  15. Biomechanical evaluation of wrist-driven flexor hinge orthosis in persons with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Yeoun-Seung Kang, MD, PhD, CPO

    2013-11-01

    Full Text Available The wrist-driven flexor hinge orthosis (WDFHO is a device used to restore hand function in persons with tetraplegic spinal cord injury by furnishing three-point prehension. We assessed the effectiveness and biomechanical properties of the WDFHO in 24 persons with cervical 6 or 7 tetraplegia who have severely impaired hand function. This study introduces a mechanical operating model to assess the efficiency of the WDFHO. Experimental results showed that pinch force increased significantly (p < 0.001 after using the WDFHO and was found to positively correlate with the strength of wrist extensor muscles (r = 0.41, p < 0.001. However, when the strength of the wrist extensors acting on the WDFHO was greater, the reciprocal wrist and finger motion that generates three-point prehension was less effective (r = 0.79, p < 0.001. Reliable and valid biomechanical evaluation of the WDFHO could improve our understanding of its biomechanics.

  16. Adjoint-based optimization of flapping plates hinged with a trailing-edge flap

    Directory of Open Access Journals (Sweden)

    Min Xu

    2015-01-01

    Full Text Available It is important to understand the impact of wing-morphing on aerodynamic performance in the study of flapping-wing flight of birds and insects. We use a flapping plate hinged with a trailing-edge flap as a simplified model for flexible/morphing wings in hovering. The trailing-edge flapping motion is optimized by an adjoint-based approach. The optimized configuration suggests that the trailing-edge flap can substantially enhance the overall lift. Further analysis indicates that the lift enhancement by the trailing-edge flapping is from the change of circulation in two ways: the local circulation change by the rotational motion of the flap, and the modification of vortex shedding process by the relative location between the trailing-edge flap and leading-edge main plate.

  17. Numerical modeling of cold room's hinged door opening and closing processes

    Science.gov (United States)

    Carneiro, R.; Gaspar, P. D.; Silva, P. D.; Domingues, L. C.

    2016-06-01

    The need of rationalize energy consumption in agrifood industry has fasten the development of methodologies to improve the thermal and energy performances of cold rooms. This paper presents a three-dimensional (3D) transient Computational Fluid Dynamics (CFD) modelling of a cold room to evaluate the air infiltration rate through hinged doors. A species transport model is used for modelling the tracer gas concentration decay technique. Numerical predictions indicate that air temperature difference between spaces affects the air infiltration. For this case study, the infiltration rate increases 0.016 m3 s-1 per K of air temperature difference. The knowledge about the evolution of air infiltration during door opening/closing times allows to draw some conclusions about its influence on the air conditions inside the cold room, as well as to suggest best practices and simple technical improvements that can minimize air infiltration, and consequently improve thermal performance and energy consumption rationalization.

  18. Distraction arthrodesis of subtalar joint using a laterally placed hinged distractor.

    Science.gov (United States)

    Shibuya, Naohiro; Agarwal, Monica R

    2012-01-01

    Many joint-depressive, neglected calcaneal fractures need distraction arthrodesis of the subtalar joint. Because the calcaneal tuberosity is usually malunited in the varus position, more distraction is required on the medial side to place the tuberosity in the everted position before insertion of a bone graft. Traditionally, a distractor is placed on the medial side to achieve this task. However, the medially placed distractor hinders with the positioning of the extremity and exposure of the main operative site, which is commonly on the lateral side. We introduce a technique to avoid this burden by placing a hinged distractor device on the lateral aspect of the foot while maintaining the correction of the varus deformity. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Design of a Shape Memory Alloy deployment hinge for reflector facets

    Science.gov (United States)

    Anders, W. S.; Rogers, C. A.

    1991-01-01

    A design concept for a Shape Memory Alloy (SMA) actuated hinge mechanism for deploying segmented facet-type reflector surfaces on antenna truss structures is presented. The mechanism uses nitinol, a nickel-titanium shape memory alloy, as a displacement-force micro-actuator. An electrical current is used to resistively heat a 'plastically' elongated SMA actuator wire, causing it to contract in response to a thermally-induced phase transformation. The resulting tension creates a moment, imparting rotary motion between two adjacent panels. Mechanical stops are designed into the device to limit its range of motion and to establish positioning accuracy at the termination of deployment. The concept and its operation are discussed in detail, and an analytical dynamic simulation model is presented. The model has been used to perform nondimensionalized parametric design studies.

  20. Biomechanical evaluation of wrist-driven flexor hinge orthosis in persons with spinal cord injury.

    Science.gov (United States)

    Kang, Yeoun-Seung; Park, Yoon-Ghil; Lee, Bum-Suk; Park, Hyung-Soon

    2013-01-01

    The wrist-driven flexor hinge orthosis (WDFHO) is a device used to restore hand function in persons with tetraplegic spinal cord injury by furnishing three-point prehension. We assessed the effectiveness and biomechanical properties of the WDFHO in 24 persons with cervical 6 or 7 tetraplegia who have severely impaired hand function. This study introduces a mechanical operating model to assess the efficiency of the WDFHO. Experimental results showed that pinch force increased significantly (p < 0.001) after using the WDFHO and was found to positively correlate with the strength of wrist extensor muscles (r = 0.41, p < 0.001). However, when the strength of the wrist extensors acting on the WDFHO was greater, the reciprocal wrist and finger motion that generates three-point prehension was less effective (r = 0.79, p < 0.001). Reliable and valid biomechanical evaluation of the WDFHO could improve our understanding of its biomechanics.