Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

ObjectiveTo provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.MethodsSystematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).ResultsOf the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.ConclusionAlthough HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.     

Comparison of dose distribution in IMRT and RapidArc technique in prostate radiotherapy

AimThe aim was to provide a dosimetric comparison between IMRT and RapidArc treatment plans with RPI index with simultaneous comparison of the treatment delivery time.BackgroundIMRT and RapidArc provide highly conformal dose distribution with good sparing of normal tissues. However, a complex spatial dosimetry of IMRT and RapidArc plans hampers the evaluation and comparison between plans calculated for the two modalities. RPI was used in this paper for treatment plan comparisons. The duration of the therapeutic session in RapidArc is reported to be shorter in comparison to therapeutic time of the other dynamic techniques. For this reasons, total treatment delivery time in both techniques was compared and discussed.Materials and methods15 patients with prostate carcinoma were randomly selected for the analysis. Two competitive treatment plans using respectively the IMRT and RapidArc techniques were computed for each patient in Eclipse planning system v. 8.6.15. RPIwin^® application was used for RPI calculations for each treatment plan.Additionally, total treatment time was compared between IMRT and RapidArc plans. Total treatment time was a sum of monitor units (MU) for each treated field.ResultsThe mean values of the RPI indices were insignificantly higher for IMRT plans in comparison to rotational therapy. Comparison of the mean numbers of monitor units confirmed that the use of rotational technique instead of conventional static field IMRT can significantly reduce the treatment time.ConclusionAnalysis presented in this paper, demonstrated that RapidArc can compete with the IMRT technique in the field of treatment plan dosimetry reducing the time required for dose delivery.     

Artificial incubation of California condor Gymnogyps californianus eggs removed from the wild

The currrent California condor (Gymnogyps californianus) recovery plan entails increasing the reproductive rate via replacement-clutch manipulation of eggs. During the period from 1983 to 1985, 15 eggs were removed from wild nesting pairs for artificial incubation. The eggs were incubated at a dry bulb temperature of 36.4°C in modified forced-air Lyon Electric incubators. The incubation humidity was adjusted for individual eggs based on weight loss data (water = weight), 25.6–30.0°C wet bulb (41.0–63.0% Relative Humidity (RH)). The chicks were hatched initially under forced-air conditions of 36.1°C dry bulb, 31.1–01.7°C wet bulb (70.0–73.0% RH). In 1984, hatching parameters were changed to still-air conditions, 36.1°C dry bulb (top of the egg), 35.0°C dry bulb (bottom of the egg), 31.1–31.7°C wet bulb (70.0-73.0% RH). Tactile and auditory stimulation was utilized during the pip-to-hatch interval. From among 15 eggs collected, 13 hatched, and 12 condor chicks were raised successfully (hatchability: 86.7%; survivability: 92.3%).     

Line and crossing effects in a diallel mating system with highly inbred lines of White Leghorn chickens

Summary Seven highly inbred lines of White Leghorn chickens were used in a near complete diallel mating plan during eight years. The lines originated from three different base populations selected for egg weight. Average inbreeding coefficients of parents of chicks hatching in successive years were 0.75, 0.80, 0.84, 0.86, 0.89, 0.91, 0.93 and 0.94. The composition of line, specific combining ability and reciprocal effects and their estimated values are given. These effects were estimated for age at first egg (AFE), average weight of all eggs laid to 40 weeks (EW40), body weight at 40 weeks (BW40), number of eggs to 40 weeks (EP40) and number of eggs between 41 and 60 weeks (EP60). Records of 3247 hens surviving to 40 weeks and of 3133 birds to 60 weeks could be used. Large differences between line effects could be found in all traits. They were only partly due to the preceding selection in the base populations. All specific combining effects were in the expected direction, negative for AFE and positive for EW40, BW40, EP40 and EP60. Recovery of inbreeding depression inflated these effects rather substancially. Average heterosis, defined as the relative superiority of a line combination over the mid parent value, was –11.3%, 5.8%, 7.8%, 45.1% and 35.8% for AFE, EW40, BW40, EP40 and EP60 respectively. One line showed a relative superiority in AFE of -19.3% compared to about –7.9% for all other combinations. Reciprocal or sex-linked effects were generally smaller in all traits than specific combining effects, they were considerably smaller in AFE, EP40 and EP60. General reciprocal effects could be found for several lines in one or more traits. Offspring of two lines, when used as sire lines, showed a negative correlation between reciprocal effects of egg weight and body weight.     

国家公园规划制度功能定位与空间属性

我国将构建统一的国土空间规划体系, 整体谋划国土空间开发保护格局, 强化对各类专项规划的指导约束, 这必将对国家公园保护制度产生重大影响。本文分析了国土空间规划视角下国家公园规划制度的定位, 阐述了国家公园规划承载空间规划与发展规划两大体系的基本属性, 应在国土空间规划体系中具有优先权和前置权; 重点分析了各国家公园总体规划在国家规划体系中的功能与属性特征, 作为空间规划应承接好上位空间规划对国家公园的控制指标和管控要求, 作为建设规划应承接好上位或同域国民经济发展规划等对国家公园的目标任务要求, 作为管理规划要明确国家公园顺畅运行的要求。国家公园应在分区规划、控制性详细规划等专项规划方面寻求创新, 探索国家公园用途管制的实现模式。     

美国州立公园体系的发展、特征与评估

美国州立公园与国家公园相比,更强调满足州内居民就近户外休闲游憩需求的功能,这使得其在美国整体公共户外休闲空间体系中占据特殊的位置。在中国第一次全面地研究了美国州立公园体系的发展、特征及与国家公园体系的关系,特别是以部分州为例研究了美国州立公园的分类、质量评估、可达性与空间分布评估等关键问题。研究认为,州立公园的意义在于既缓解了美国国家公园面临的巨大旅游游憩压力,也满足了大众户外休闲游憩的需求。这值得中国在目前构建国家公园与自然保护地体系的同时予以借鉴。最后基于中国的实际需求与挑战,探讨了在省域/区域层次加强构建地方公园、保护地和游憩地体系建设的必要性与途径。     

胰腺假性囊肿手术方式应根据囊肿具体位置制定

为筛选胰腺假性囊肿的手术方法,本研究选取胰腺假性囊肿患者73例,观察各患者手术治疗效果。73例患者中,行囊肿十二指肠吻合术者13例(A组),行囊肿胃吻合术者29例(B组),行囊肿空肠吻合术者19例(C组),行胰腺囊肿切除术者12例(D组)。研究发现,各组间术后复发率、吻合口瘘发生率、吻合口出血发生率、住院时间和治疗费用差异不显著(p>0.05);各组术后72 h丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)和尿素氮(BUN)均较术前显著升高(p<0.05);术后72 h,各组间ALT、AST和BUN差异不显著(p>0.05)。研究表明,可根据胰腺假性囊肿具体位置制定合理的手术方案,取得较好的治疗效果,不同手术方式有其适应条件,不应盲目推崇某种手术方式。