Improved bandwidth and F/B ratio of a CPW-fed planar monopole antenna.

A directional planar monopole antenna is described. The antenna comprises of a circular monopole, coplanar waveguide (CPW) feed line and a ground plane. To achieve unidirectional radiation, a stub is also attached to on the ground plane to increase the lower end impedance bandwidth and also increase the Front-to-Back ratio (F/B). The proposed antenna is etched on a 50 × 50 mm2 FR4 substrate. Simulated and experimental results reveal that the proposed antenna can achieve an impedance bandwidth from 2.3 - 10.5 GHz for S11 < -10 dB, and unidirectional radiation patterns with high gain and high efficiency.

Patterns of prescription opioid abuse and comorbidity in an aging treatment population.

Very little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems. Women had more pain than men and much worse psychiatric issues in all age groups. Our results indicate that a "one-size-fits-all" approach to prevention, intervention, and treatment of opioid abuse that ignores the shifting needs of opioid-abusing men and women as they age is destined to fail.

The Internet for Louisiana physicians.

Fewer than 50% of Louisiana physicians actively use the Internet, and many of them confine their usage to e-mailing among family and friends. The purpose of this article is to acquaint the reader with many of the benefits of exploiting the incredible potential of this technological invention. I provide addresses and information about sites that I believe warrant usage by our colleagues. Of the vast smorgasbord of data available we highlight educational Web sites for professionals and the public, how to determine credibility of information, clinical research of scientific articles, computer security, federal and state government sites, newspapers, political and socioeconomic functions, medical supply shops, e-mail and other computerized communication, electronic medical records, personal or professional Web sites, and future medical internet uses. It is hoped that this process will encourage nonparticipating colleagues to begin using this modality while also supplying sites that current users may not yet have discovered.

Mouse mammary tumor virus-Ki-rasB transgenic mice develop mammary carcinomas that can be growth-inhibited by a farnesyl:protein transferase inhibitor.

For Ras oncoproteins to transform mammalian cells, they must be posttranslationally modified with a farnesyl group in a reaction catalyzed by the enzyme farnesyl:protein transferase (FPTase). Inhibitors of FPTase have therefore been developed as potential anticancer agents. These compounds reverse many of the malignant phenotypes of Ras-transformed cells in culture and inhibit the growth of tumor xenografts in nude mice. Furthermore, the FPTase inhibitor (FTI) L-744,832 causes tumor regression in mouse mammary tumor virus (MMTV)-v-Ha-ras transgenic mice and tumor stasis in MMTV-N-ras mice. Although these data support the further development of FTIs, it should be noted that Ki-ras is the ras gene most frequently mutated in human cancers. Moreover, Ki-RasB binds more tightly to FPTase than either Ha- or N-Ras, and thus higher concentrations of FTIs that are competitive with the protein substrate may be required to inhibit Ki-Ras processing. Given the unique biochemical and biological features of Ki-RasB, it is important to evaluate the efficacy of FTIs or any other modulator of oncogenic Ras function in model systems expressing this Ras oncoprotein. We have developed strains of transgenic mice carrying the human Ki-rasB cDNA with an activating mutation (G12V) under the control of the MMTV enhancer/promoter. The predominant pathological feature that develops in these mice is the stochastic appearance of mammary adenocarcinomas. High levels of the Ki-rasB transgene RNA are detected in these tumors. Treatment of MMTV-Ki-rasB mice with L-744,832 caused inhibition of tumor growth in the absence of systemic toxicity. Although FPTase activity was inhibited in tumors from the treated mice, unprocessed Ki-RasB was not detected. These results demonstrate the utility of the MMTV-Ki-rasB transgenic mice for testing potential anticancer agents. Additionally, the data suggest that although the FTI L-744,832 can inhibit tumor growth in this model, Ki-Ras may not be the sole mediator of the biological effects of the FTI.

Liability issues in managed care.

The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.

Current and energy in external cardiac defibrillation.

External (Transthoracic) defibrillation is achieved by passing a large uniaxial current through the chest for a brief period of time. This current is determined by 1) the applied voltage and 2) the transthoracic impedance (TTI). In modern defibrillators the source of voltage is universally from a charged capacitor, the discharge waveform being modified in some cases by the inclusion of an inductor in the discharge circuit (Lown & Edmark waveforms, fig. 1), in others by direct discharge of a capacitor, such discharge being electrically truncated after a given period of time (Truncated Exponential, fig. 1). Although it is current that is responsible for successful defibrillation, defibrillator output is most commonly measured in units of energy (Joules) which is easily calculated knowing the voltage to which the defibrillation capacitor has been charged. Recent measurements of TTI show wide variations from 28 to 150 ohms3. Attempts at defibrillation (assuming the same energy setting) will thus result in a wide range of delivered currents. It is known that high defibrillation currents produce myocardial damage, conversely, currents which are too low will fail to achieve defibrillation. There is increasing evidence to suggest that defibrillators employing truncated exponential (trapezoidal) waveforms may be ineffective in subjects having high TTI. Additionally, there remains a need for a "smart" defibrillator which can calculate pre-discharge TTI and automatically adjust delivered current such that it is neither too low nor too high for the patient undergoing defibrillation.

The Louisiana Medicare payments of Part A and B.

Current health system reform efforts are based on the notion that the government can best design a cost efficient system. The government already operates several health care systems, including Medicare and Medicaid. Despite the development of a plethora of cost-control initiatives, such as price-fixing, utilization and peer review, and Diagnostic Related Groups, the government has been unable to control the burgeoning costs of these programs. Health system reform efforts appear directed toward the expansion of many of these same failed efforts. Only by first evaluating where the money goes can real efforts at improving the economics of the system--without jeopardizing quality of care--be successful. The author has examined the Louisiana Medicaid program in a previous article. This article examines the function and expenditures of the Louisiana Medicare program: Part B, the "physician's component" and Part A, the "hospital component."

Analysis of the Louisiana Medicaid program: a microcosm of the U.S. health cost crisis.

While the "health care crisis" is a major topic of discussion, it is apparent that to properly evaluate and manage the "ailment," we must first establish a proper diagnosis. To that end, we have provided actual statistics for the Medicaid program in Louisiana. As is the case in many states today, Medicaid has become a major component of the overall governmental health cost figures, involving over one-half of actual government expenditures, and consuming $140 billion of the total $800 billion national figure. In the debate over the cost of health care, we face an issue of trying to compare apples to oranges. Health care costs in the United States are not being portrayed accurately, especially in comparisons to other nations. In the United States, in part because of programs such as Medicaid, categories such as transportation, substance abuse, care of the mentally retarded, insurance administrative costs, long term institutional or custodial care of the elderly, capital equipment costs, and medical education and research are all counted as "health care" costs. In 1991, nursing home care alone cost over $60 billion with $32.3 billion being paid by Medicaid. In other nations, however, many of these categories are classified as social, educational, or welfare programs. If health care spending decisions are to be made on the basis of statistical comparisons to other countries, then it is critical that we develop a standardized international classification system, and similarly effective methods for the collection of data. In lieu of this approach, at the very least, we should be factoring in these tremendous differences in classification of costs into the comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)

Slip-knot suspension technique: a fail-safe microanastomosis for small-caliber vessels.

The most common technical error associated with microvascular anastomotic failure is accidentally snagging the opposite wall and including it in the stitch, thereby reducing the vessel lumen diameter or occluding it altogether. A simple, safe microsuturing technique is described that combines the use of the slip-knot and the suspension technique in a procedure that allows direct visual inspection of suture placement from first to last stitch. This technique is applicable to end-to-end and end-to-side microvascular anastomoses, for thick-walled ducts such as the vas deferens and the fallopian tube, and in laparoscopic suturing.

Stemming the tide of health care costs.

The government and third party carriers have concentrated their cost containment efforts in the wrong areas: reducing physician payments and restricting patients' access to care, while increasing bureaucratic administrative costs at all levels. There has been no net benefit from this cost containment effort. Shifting income from one group to another is not the solution. For those economists who require proof of this assertion, a study for validation is recommended. For one year a single state could be chosen to implement these recommendations: rapid reimbursement to avoid costly appeals; no utilization review or second opinions; no precertification; notification of patients before a procedure of the reimbursement amount; providing a percentage share of any insurance company savings resulting from physician review of itemized hospital bills; enacting meaningful tort reform to affect that 17% of physicians' costs and countless "defensive" lab and hospital expense; publishing comparative costs of common procedures by hospitals; and publishing comparative prices for common drugs by pharmacies. My hypothesis is that the costs of health care will be reduced below other states, while saving enormous "managed care" administrative costs. Dramatically reducing the huge noncaregiving costs of medicine, which make up at least 30% to 40% of the health care dollar, would enable all the uninsured and uninsurables to have the excellent, readily accessible health care they need at no increase over current expenditures. "Cost shifting" in all its many forms could be eliminated. We simply must cause a proper allocation of funds through appropriate regulation of insurance companies and their excessive administrative charges, meaningful tort reform, and the education of our physicians and the public in cost efficient, high-quality medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

Suture technique for caudal septal deviations.

The "buckled" or severely deviated nasal septum has resisted a variety of techniques devised for its correction. This paper will present a new technique which the author has found useful in many of these cases. This method utilizes in reverse the procedure popularized by Mustardé for managing the protruding ear. Instead of bending the cartilage into a harmonious shape, the bent cartilage is straightened with submucosal permanent sutures. The paper will illustrate this technique.