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Best Care at Lower Cost
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.
The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.
About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.
This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.
eBook
The smell of battle, the taste of siege : a sensory history of the Civil War
\"Historical accounts of major events have almost always relied upon what those who were there witnessed. Nowhere is this truer than in the nerve-shattering chaos of warfare, where sight seems to confer objective truth and acts as the basis of reconstruction. In The Smell of Battle, The Taste of Siege, historian Mark M. Smith considers how all five senses, including sight sound, smell, taste, and touch, shaped the experience of the Civil War and thus its memory, exploring its full sensory impact on everyone from the soldiers on the field to the civilians waiting at home. From the eardrum-shattering barrage of shells announcing the outbreak of war at Fort Sumter; to the stench produced by the corpses lying in the mid-summer sun at Gettysburg; to the siege of Vicksburg, once a center of Southern culinary aesthetics and starved into submission, Smith recreates how Civil War was lived. Relying on first-hand accounts, Smith focuses on sense, one for each event, offering a wholly new perspective. At Bull Run, the similarities between the colors of the Union and Confederate uniforms created concern over what later would be called 'friendly fire' and helped decide the outcome of the first major battle. He evokes what it might have felt like to be in the HL Hunley submarine, in which eight men worked in darkness in a space 48 inches high, 42 inches wide. Often argued to be the first 'total war,' the Civil War overwhelmed the senses because of its unprecedented nature and scope, rendering sight less reliable and engaging the nonvisual senses. Sherman's March was little less than a full-blown assault on Southern sense and sensibility, leaving nothing untouched. The Smell of Battle, The Taste of Siege offers readers a way to experience of the Civil War with fresh eyes\"--Provided by publisher.
Book
A plug-and-play approach to antibody-based therapeutics via a chemoselective dual click strategy
Although recent methods for the engineering of antibody–drug conjugates (ADCs) have gone some way to addressing the challenging issues of ADC construction, significant hurdles still remain. There is clear demand for the construction of novel ADC platforms that offer greater stability, homogeneity and flexibility. Here we describe a significant step towards a platform for next-generation antibody-based therapeutics by providing constructs that combine site-specific modification, exceptional versatility and high stability, with retention of antibody binding and structure post-modification. The relevance of the work in a biological context is also demonstrated in a cytotoxicity assay and a cell internalization study with HER2-positive and -negative breast cancer cell lines.
Antibody–drug conjugates are a class of therapeutic combining the directing ability of antibodies with the cell-killing ability of cytotoxic drugs. Here the authors describe an approach based on click chemistry that enables the rapid assembly of dual-modified antibodies with potential for new therapeutic modalities.
Journal Article
Profiling Living Bacteria Informs Preparation of Fecal Microbiota Transplantations
Fecal microbiota transplantation is a compelling treatment for recurrent Clostridium difficile infections, with potential applications against other diseases associated with changes in gut microbiota. But variability in fecal bacterial communities-believed to be the therapeutic agent-can complicate or undermine treatment efficacy. To understand the effects of transplant preparation methods on living fecal microbial communities, we applied a DNA-sequencing method (PMA-seq) that uses propidium monoazide (PMA) to differentiate between living and dead fecal microbes, and we created an analysis pipeline to identify individual bacteria that change in abundance between samples. We found that oxygen exposure degraded fecal bacterial communities, whereas freeze-thaw cycles and lag time between donor defecation and transplant preparation had much smaller effects. Notably, the abundance of Faecalibacterium prausnitzii-an anti-inflammatory commensal bacterium whose absence is linked to inflammatory bowel disease-decreased with oxygen exposure. Our results indicate that some current practices for preparing microbiota transplant material adversely affect living fecal microbial content and highlight PMA-seq as a valuable tool to inform best practices and evaluate the suitability of clinical fecal material.
Journal Article
Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: A systematic review and meta-analysis
Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus.
Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus.
Nine trials met the inclusion criteria-one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD = -0.31, 95% CI -0.71-0.09, P = 0.13, trail making test part A SMD = 0.28, 95% CI -0.20-0.77 P = 0.25, trail making test part B SMD = -0.15, 95% CI -0.64-0.34 P = 0.54, digit symbol SMD = 0.09, 95% CI -0.39-0.57 P = 0.72), and memory (immediate memory SMD = 0.20, 95% CI -0.28-0.69, P = 0.41 and delayed memory SMD = -0.06, 95% CI -0.55-0.42, P = 0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials.
Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results.
Protocol was registered (CRD42017058526) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).
Journal Article
The Russia Anxiety : And How History Can Resolve It
\"With proof of election-meddling and the relationship between Donald Trump and Vladimir Putin an ongoing conundrum, little wonder many Americans are experiencing what historian Mark B. Smith calls \"the Russia Anxiety.\" This is no new phenomenon. Time and time again, the West has judged Russia on assumptions of its inherent cunning, malevolence, and brutality. Yet for much of its history, Russia functioned no differently-or at least no more dysfunctionally-than other absolutist, war-mongering European states. So what is it about this country that so often provokes such excessive responses? And why is this so dangerous? Russian history can indeed be viewed as a catalog of brutal violence, in which a rotation of secret police-from Ivan the Terrible's Oprichina to Andropov's KGB and Putin's FSB-hold absolute sway. However, as Smith shows, there are nevertheless deeper political and cultural factors that could lead to democratic outcomes. Violence is not an innate element of Russian culture, and Russia is not unknowable. From foreign interference and cyber-attacks to mega-corruption and nuclear weapons, Smith uses Russia's sprawling history to throw light on contemporary concerns. Smith reveals how the past has created today's Russia and how this past offers hints about its future place in the world-one that reaches beyond crisis and confrontation\"-- Provided by publisher.
Book
Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians
The adult primary care \"physician shortage\" is more accurately portrayed as a gap between the adult population's demand for primary care services and the capacity of primary care, as currently delivered, to meet that demand. Given current trends, producing more adult primary care clinicians will not close the demand-capacity gap. However, primary care capacity can be greatly increased without many more clinicians: by empowering licensed personnel, including registered nurses and pharmacists, to provide more care; by creating standing orders for nonlicensed health personnel, such as medical assistants, to function as panel managers and health coaches to address many preventive and chronic care needs; by increasing the potential for more patient self-care; and by harnessing technology to add capacity. [PUBLICATION ABSTRACT]
Journal Article