Modulation of transferrin receptors in bone marrow cells by changes in lipid fluidity

The hypothesis that modulation of transferrin receptors during haematopoiesis is mediated by changes in the lipid fluidity of the cell membranes was tested in this study with bone marrow cells. Binding conditions were first established, under which internalization of fluorescently-labelled transferrin was reduced to a minimum during the binding assays. Cholesterol depletion, which was achieved by a mild physiological treatment, and which increased the membrane-lipid fluidity, resulted in a substantial increase in the average number of the available transferrin receptors per bone marrow cell. Cholesterol enrichment mediated a converse effect. These findings correlate well with the changes observed in the availability of transferrin receptors and membrane microviscosity during differentiation of erythroid cells. In line with the notion of passive modulation, it is proposed that the transferrin receptor is a cross-membrane protein with a substantial portion facing the cytoplasm.

Carrier discretionary practices and physician payment under Medicare Part B: a preliminary report

Although Medicare is a national program, administration of Part B payments to physicians is in the hands of insurance organizations in ten Medicare regions. The carriers follow varying practices in using actual charges within localities as the basis for determining reasonable charges for physicians' services. While some of these practices have already been shown to influence fee levels, reasonable charge determination involves many more whose influence has not been systematically studied. This paper reviews preliminary findings from a study which examines carrier differences in discretionary practices as to specialties, localities and other claims data that may be merged or compared with Medicare data in determining customary and prevailing prices used to set limits on Medicare payments, and other practices reported in an official questionnaire to carriers. The effect on fee levels and other measures of program performance is being studied after taking into account social, economic and health resource variables extracted from the Area Resource File, that are expected to influence local medical prices through the demand for and supply of physicians' services. Dependent variables representing fees are the 50th percentile of the distribution of weighted customary charges of individual physicians in an area and Supplementary Medical Insurance expenditure per enrollee. The preliminary findings in this paper concern discretionary practices, socioeconomic variables and fee distributions.

[Necrosis of the lesser curve of the stomach after proximal selective vagotomy]

Necrosis of lesser curve of stomach after proximal selective vagotomy is a specific but rare hazard of this operation. Anatomical and pathophysiological findings speak in favour of ischaemic pathogenesis, even if a peptic factor may exceptionally play a role in some cases. Local tissue trauma enhances the risk of later sloughing of lesser curve. Three own reported cases without fatality point out the importance of previous massive ulcer bleeding with hypovolemic shock and severe anaemia. Early recognition and immediate reoperation only may avoid an otherwise fatal course. Simple oversewing has proved successful in treating even large lesions. Careful, atraumatic technique of skeletonization and reperitonealization of lesser curve help to prevent this life threatening complication.

Hormonal control of male reproductive behavior in the lizard, Anolis carolinensis: role of testosterone, dihydrotestosterone, and estradiol

The androgen aromatization hypothesis was examined in the male lizard, Anolis carolinensis. After castration, sc silastic implants of testosterone (T) restored both challenge and courtship behavior, while dihydrotestosterone (DHT) or 17beta-estradiol (E) had no effect on male behaviors. Both T and DHT, but not E, stimulated hypertrophy and colloid production by the renal sex segment, a secondary sexual characteristic of male lizards. In two separate studies, castrates received DHT in combination with E. In each replicate, half of the castrates responded with increases in courtship behavior after hormone treatment. Epithelial cell height of the sex segment of all DHT and E-treated castrates was comparable to T- or DHT-treated castrates, but colloid production was not stimulated. These experiments indicate that in this species, treatment with T stimulates both sexual behavior and secondary sex character development, whereas treatment with E alone is without effect centrally or peripherally.

[Socio-psychological concepts of status, role and norm, and systemic mechanisms in the psychotic family]

Socio-psychological contributions can improve the systemic approach to family therapy. For instance, the notions of "role", "status" and "norm" discussed in this paper, can be applied to the concept of "identified patient". This appears to be the only pathological designation, as role assignment per se is not necessarily abnormal. It is suggested that pathogenic mechanisms playing a part in psychotic families, can also be used therapeutically. Family therapy tends to confirms the principle that small group norms are more readily modified than those of single individuals.

Cost factors in urban telemedicine

This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions. As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of $18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of $5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear. If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is $7.55 per consult in a five-clinic network. Geographic and other barriers to physician availability enhance the potential for application fo telemedicine.

Reproductive efficiency as a social indicator

An index of reproductive effiency (RE) is proposed as a social indicator that will meet the need to consider various forms of pregnancy wastage, to compare their relative costs, and to guide reproductive health policy accordingly. This article discusses conceptual and measurement aspects of RE. Conversion of wanted to unwanted pregnancies and the reverse, interpretation of abortion in relation to other pregnancy outcomes, defining the end point for the reproductive process and criteria for the events to be included as significant outcomes are conceptual issues. Measurement problems include: whether aggregation is justified, prospective and retrospective tracking of outcomes, record limitations, duplication of adversities in a single pregnancy, and selection of optimal rate for comparison. A measurement of RE for the entire United States based on the National Natality Survey of 1964-1966 is presented, showing 74.5 percent of pregnancies resulting in healthy liveborn infants. For those years, data on abortions could not be included. Within the group of reported pregnancy losses, the importance of congenital abnormalities and low-birth-weight babies is enhanced by application of economic weights based on associated medical care costs. Changing opportunities for birth timing, prenatal and infant care, and control of family size are social means of reducing adverse outcomes associated with teenage pregnancy and high-parity births, often found together with poverty. Successive increments in RE may be progressively more expensive to achieve, and cost effectiveness comparison will be necessary.

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement

This study analyzes the institutional, economic, and regulatory deficiencies of the long-term care sector of the health industry and develops an incentive reimbursement model as a means for correcting or ameliorating some of the stated deficiencies. The reimbursement model presents a schema which attempts to match patients to facilities, needs to services, and services to cost. A capital expansion coupon program is proposed, both as a suitable vehicle for channeling incentive rewards accruing to nonprofit institutions, and as a mechanism for subsidizing the approved expansion and/or renovation plans of "efficient" providers of care.

Capital expenditures and the availability of funds

Data on capital expenditures and the availability of funds assembled from the annual financial and service records of 42 short-term voluntary hospitals in New York City over two decades were used to analyze the behavior of annual capital expenditures on building and equipment assets. Desired expenditures on capital as a factor of production are viewed as being the result of changes in anticipated output and of the substitution of capital for labor. Actual capital expenditures in each year also reflect the availability of flows of nonoperating revenues and the completion of capital programs initiated in previous years. Nonoperating revenues include philanthropy and earnings on financial assets as principal sources. A monetary revenue series, adjusted for changes in hospital charges, was used to measure output and thus to seperate the effects of demand for hospital services and supply of funds on investment behavior. The data were approached as annual aggregates for 42 hospitals over the years 1946-1966 and as annual hospital averages for teaching and nonteaching hospitals over the same period. In both approaches four causal factors-output, substitution, the flow of nonoperating revenues, and a distributed lag-explained about 95 per cent of the sample variance of capital expenditures. Allowing for available funds reduced the average time required for 95 per cent completion of a capital adjustment from 7 to 3 years. Responsiveness of hospitals to these economic variables suggests that socially desired investment can be attained by (a) "monetizing" needs of groups now underserved; (b) improving availability of funds if used for acceptable public purposes; and (c) including consumers in determining institutional and regional priorities.

An index of insurance adequacy for fertility-related health care

Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits are expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.

Recent Stratospheric Spectra of NO and NO2

NO and NO2 spectra obtained by means of a grid spectrometer from a balloon gondola and from a Concorde are presented. The corresponding stratospheric abundance of these species is deduced.

Drug benefits in health insurance

Benefits for drugs are becoming an integral component of health insurance plans in the United States, with 52.1 per cent of the population carrying some form of coverage for drugs by 1971. This paper describes the basic features of several plans currently being offered in the United States and Canada, and evaluates the various methods of administering them, including rationale for specifying benefits, and methods of reimbursement, cost-control, and distribution. Financing of drug costs through insurance should permit additional control of quality and utilization, although the correlation of drug use with total patient diagnosis and medical care for purposes of reviewing and improving utilization is impeded by the wide variation in compliance found among the population. Some mechanisms for controlling utilization include limiting quantities and refills, requiring copayments by the patient, prescribing generically, and influencing physicians to prescribe less frequently. Provisions for drug benefits in a recently proposed national health insurance scheme are briefly discussed.