599 research outputs found
sj-docx-1-mcr-10.1177_10775587231162681 – Supplemental material for Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders
No full textSupplemental material, sj-docx-1-mcr-10.1177_10775587231162681 for Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders by Chris Miller-Rosales, Susan H. Busch, Ellen R. Meara, Ashleigh King, Thomas A. D’Aunno and Carrie H. Colla in Medical Care Research and Review</p
The Medical Treatment of Depression, 1991-1996: Productive Inefficiency, Expected Outcome Variations, and Price Indexes
No full textWe examine the price of treating episodes of acute phase major depression over the 1991-1996 time period. We combine data from a large retrospective medical claims data base (MarketScanTM, from the MedStat Group) with clinical literature and expert clinical opinion elicited from a two-state Delphi procedure. This enables us to construct a variety of treatment price indexes that include variations over time in the proportion of off-frontier' production, as well as the corresponding variations in expected treatment outcomes. We also incorporate the fact that the no treatment option ( waiting list') frequently results in spontaneous remission of depressive symptoms. We find that in general the incremental cost of successfully treating an episode of acute phase major depression has generally fallen over the 1991-96 time period. Based on hedonic regression equations that account for the effects of changing patient mix, we find price reductions that range from about -1.66% to -2.13% per year. An implication of this is that, since expenditures on depression are thought to be increasing since at least 1991, the source of the spending increases is volume (quantity) increases, and not price increases.
Price Indexes for Acute Phase Treatment of Depression
No full textAlthough broad trends in medical spending in the U.S. over the last decade have received widespread attention from policymakers, very little attention has focused on the components of those changes. For many other industries, economists typically divide nominal expenditures by an official government price index to decompose these expenditures into price and quantity components. In this paper we construct a new price index for the treatment of one illness depression. Making use of results from the published clinical literature and from official treatment guideline standards, we identify therapeutically similar treatment bundles. These bundles can then be linked and weighted to construct price indexes for specific forms of major depression. In doing so, we construct CPI and PPI-like medical price indexes that deal with prices of treatment episodes rather than prices of discrete inputs, that are based on transaction rather than list prices, that take quality changes and expected outcomes into account employ current, time-varying expenditure weights in the aggregation computations. We find that regardless of which index number procedure is employed time period the treatment price index for the acute phase of major depression has hardly changed remaining at 1.00 or falling slightly to around 0.97. This index grows considerably less rapidly than the various official PPIs -- thus the price index for the treatment of the acute phase of major depression has fallen over the 1991-95 time period. A hedonic approach to price index measurement yields broadly similar results. These results imply that given a budget for treatment of depression accomplished in 1995 than in 1991. Our results suggest that at least in the case of acute phase major depression, aggregate spending increases are due to a larger number of effective treatments being provided.
Inhibitory effects of oxidants on n-type K+ channels in T lymphocytes and Xenopus oocytes (Szabo è corresponding author)
No full textReactive oxygen species (ROS) appear to be involved in Fas-induced programmed cell death. We have previously demonstrated a tyrosine-kinase-dependent inhibition of the n-type K+ channels (Kn) by Fas stimulation. Thus, the effect of hydrogen peroxide (H2O2) on the function of Kn was examined using the patch-clamp technique. Incubation of Jurkat human T lymphocytes with 100 microM H2O2 resulted in a 46 +/- 5% inhibition of the macroscopic whole-cell current. Experiments performed at the single-channel level using the cell-attached configuration revealed that the probability of the channel being open diminished upon incubation in H2O2. The effect was not dependent on src-like kinases, since H2O2 did not trigger tyrosine phosphorylation of the Kn channel protein and herbimycin A did not prevent channel inhibition. Kv1.3 channels underly the Kn of T lymphocytes and were expressed in Xenopus oocytes and subjected to electrophysiological analysis by the two-electrode voltage-clamp technique. Application of 1 mM H2O2 and 500 microM t-BOOH (tert, butylhydroperoxide) resulted in a marked inhibition of the K+ current within 20 min. Both the membrane-permeable thiol-group oxidizing agent DTNP [2,2'-dithiobis-(5-nitropyridine)] and the membrane-impermeable DTNB [5,5'-Dithiobis-(2-nitrobenzoic acid)] (50 microM) inhibited Kv1.3 channels, suggesting that extracellular domains of Kv1.3 are affected. These results point to a direct modulation of Kn by various oxidative agents
Selective Water Addition: Investigations of hydratases from the genus Rhodococcus
No full textWater addition reactions to (un)-activated double bonds are very rewarding reactions as they elegantly introduce a hydroxyl-group thereby often adding value to the generated product by establishing a novel stereocentre in tertiary, chiral alcohols. However, performing selective water addition reactions is an extremely challenging task using classical, chemical approaches. Next to overall unfavourable reaction equilibria, the unreactive water molecule is a poor nucleophile and therefore requires activation. Furthermore, due to its small size, a controlled, stereo- and regioselective addition is difficult to achieve. Consequently, establishing straightforward processes with a preferably high selectivity under reaction conditions as environmentally benign as possible is of high interest to both industry and academia...BT/Biocatalysi
Development of An Economically Viable H2O2-based, Liquid-Phase Ethylene Oxide Technology: Reactor Engineering and Catalyst Development Studies
No full textEthylene Oxide (C2H4O, abbreviated as EO), a high volume chemical intermediate is used as a raw material for a variety of consumer products, such as plastic bottles, anti-freeze, sports gear, detergents and paints. In 2009, approximately 19 million metric tons of EO were produced and its demand is projected to grow at an average rate of 3-4% per year over the next decade. Currently, EO is manufactured by the silver catalyzed ethylene epoxidation process which is highly energy intensive and wasteful because much of the ethylene (feedstock) and EO (product) burns to form carbon dioxide, a greenhouse gas. Worldwide, commercial production of EO releases 3.4 million metric tonnes of CO2 each year making it the second largest emitter of CO2 among all chemical processes. Furthermore, loss of ethylene feedstock to burning represents a loss of $1.1 billion per year worldwide. In this dissertation, an alternative liquid phase ethylene epoxidation technology (henceforth referred to as CEBC EO process) has been demonstrated with both homogeneous Re-based and heterogeneous Ce- and W-based catalysts. In this process, the ethylene gas is compressed under pressure (50 bars) and dissolved in a liquid reaction medium containing the oxidant 50 wt% H2O2/H2O, promoter pyridine N-oxide and catalyst (methyl trioxorhenium or W-KIT-6 or W-KIT-5). The ensuing catalytic reaction produces EO with near complete selectivity with no CO2 detected in either the liquid or gas phases. Methanol is employed as a co-solvent to enhance the ethylene solubility in the liquid phase. At the operating conditions (P = 50 bars, T = 20-40 °C), the volumetric expansion studies reveal that the liquid reaction phase (methanol+H2O2/H2O) is expanded by up to 12% by compressed ethylene. The corresponding ethylene solubility is 22 mole %, converting ethylene from being the limiting reactant in the liquid phase at ambient pressure to an excess reactant at the higher pressures. Fundamental engineering studies (volumetric expansion, mass transfer and conversion studies) essential for achieving pressure-intensification established the optimum agitation speed for Re-catalyzed ethylene epoxidation to be 1200 rpm. Operating at conditions that enhanced the ethylene solubility and eliminated interphase mass transfer limitations maximized the EO productivity (1.61-4.97 g EO/h/g metal) on MTO catalyst, rendering it comparable to the conventional silver-catalyzed process. Further, intrinsic kinetic parameters, estimated from fixed time semi-batch reactor studies, disclosed the moderate activation energy (57±2 kJ/mol). Based on a plant-scale simulation of the CEBC EO process using Aspen HYSYS®, preliminary economic and environmental assessments of the process are performed, both of which are benchmarked against the conventional silver-catalyzed ethylene epoxidation process. The capital costs for both processes lie within prediction uncertainty. The EO production cost for the conventional process is estimated to be 71.6 ¢/lb EO. The CEBC process has the potential to be competitive with the conventional process if the MTO catalyst remains active, selective and stable for at least six months at a leaching rate of approximately 0.11 lb MTO/h (or 5 ppm Re in the reactor effluent). Comparative cradle-to-gate life cycle assessments (LCA) reveal that the overall environmental impacts on air quality, water quality and greenhouse gas emissions are similar for both processes given the uncertainties involved in such predictions. The LCA results implicate sources outside the EO production plants as the major contributors to potential environmental impacts: fossil fuel-based energy required for natural gas processing (used for producing ethylene, hydrogen and methanol) in both processes and to the significant requirements of coal-based electrical power for compressing large volumes of recycled ethylene and other gases in the conventional process. These results of the economic analysis prompted the evaluation of alternative catalysts that are inexpensive and exhibit the best performance metrics (high activity, near complete selectivity towards desired product and high stability). These evaluation studies identified tungsten and cerium based catalysts as possible alternatives. W-based catalysts formed EO with near complete selectivity and recycle studies established catalyst durability. Further, the EO productivity with these catalysts (0.3-3.2 g EO/h/g W) is of the same order of magnitude as the Re-based and Ag-based catalysts
Fred Hayden Carruth : Author and Journalist, 1862-1932
No full textThis study was undertaken to compile information about Fred Hayden Carruth during the period of his life-time, 1862-1932, his activity as author and journalist forming the guidelines. Carruth\u27s success as a western humorist and local journalist on two Dakota Territory weeklies, the Estelline Bell and the Dakota Bell, was probably the factor which helped him obtain a position as a humorous editorial witer with the New York Tribune, foremost paper in the country in 1888. He went on his own in 1892 and after free-lancing his way onto the pages of more than nineteen popular periodicals, Carruth began a thirty-four year career with the Woman\u27s Home Companion (1905-1932). In 1915 he established the Postscript page, the Companion feature which formed the focal point of his later fame. Carruth authored four books for boys: The Adventures of Jones (1895), The Voyage of the Rattletrap (1897), Mr. Milo Busch and Other Worthies (1899), and Track\u27s End (1911). “South Dakota: State Without End, an essay which appears in E. H. Gruening\u27s These United States, is his best known short article. The absurd exaggeration of the tall tale combined with droll western wit to recapture the lighter aspects of frontier life earmark Carruth’s writing
Family coverage expansions: Impact on insurance coverage and health care utilization of parents
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