Partial oxidation of methanol on well-ordered V(2)O(5)(001)/Au(111) thin films.

The partial oxidation of methanol to formaldehyde on well-ordered thin V(2)O(5)(001) films supported on Au(111) was studied. Temperature-programmed desorption shows that bulk-terminated surfaces are not reactive, whereas reduced surfaces produce formaldehyde. Formaldehyde desorption occurs between 400 K and 550 K, without evidence for reaction products other than formaldehyde and water. Scanning tunnelling microscopy shows that methanol forms methoxy groups on vanadyl oxygen vacancies. If methanol is adsorbed at low temperature, the available adsorption sites are only partly covered with methoxy groups after warming up to room temperature, whereas prolonged methanol dosing at room temperature leads to full coverage. In order to explain these findings we present a model that essentially comprises recombination of methoxy and hydrogen to methanol in competition with the reaction of two surface hydroxyl groups to form water.

Perspectives on the pharmaceutical industry.

This paper seeks to provide an economic perspective on the pharmaceutical industry, which has come under increasing criticism on a number of issues. In the main, that criticism amounts to a rather ineffective flailing at the supply side of the market for pharmaceutical products-much of it based on inaccurate perceptions-when a more productive policy would be to strengthen the hitherto weak and poorly informed demand side of the market.

The defined-contribution paradox.

In theory, defined contributions for health insurance would free employers from having to manage their employees' insurance, and employees would acquire health insurance tailored to their own economic and health circumstances. But in practice, a move to defined contributions could be traumatic, depending on whether employers shift to a "parental" or "mature-adult" model of defined benefits.

The rise and fall of the physician practice management industry.

The dominant view among academic economists is that the financial markets value financial securities "efficiently," in the sense that the prevailing prices of widely traded securities fully and properly reflect, at any time, all publicly available information that bears on these securities. Although that theory has great intuitive appeal, it requires intellectual effort to reconcile it with the rise and fall of the physician practice management industry. This paper explores how acquisition-driven firms are valued in the financial markets and what structural factors may stand in the way of truly efficient security valuation.

The economics of for-profit and not-for-profit hospitals.

This paper examines the economics of for-profit and not-for-profit hospitals through the prism of capital acquisitions. The exercise suggests that of two hospitals that are equally efficient in producing health care, the for-profit hospital would have to charge higher prices than the not-for-profit hospital would, to break even on capital acquisitions. The reasons for this divergence are (1) the typically higher cost of equity capital that for-profit hospitals face; and (2) the income taxes they must pay. The paper recommends holding tax-exempt hospitals more formally accountable for the social obligation they shoulder, in return for their tax preference.

Health care trends, Part 2. The new health care team. Panel discussion.

In Part 2 of this third annual panel discussion, six experts talk about the growing diversity of health care providers and what it means for consumers and physicians. Americans are getting their wellness and health care services from a wider variety of non-physician practitioners than ever before. The number of allied health and alternative providers with direct patient access is likely to continue growing. This trend is being driven by consumer demand, by the lobbying efforts of non-physician providers, and by federal, state, and private payers who see the potential for reduced health care spending, greater consumer satisfaction, and better outcomes. In practice, this means physicians and non-physician providers, some of whom may not be sanctioned by the medical establishment, are obligated to collaborate as a team. Members of this new provider team will have to communicate effectively (with each other, with consumers, and with payers) and make evidence-based clinical decisions. Physicians may have to share decision-making with other members of this new health care team.

Health care trends, Part I. The promise and perils of evidence-based medicine ... panel discussion.

Numerous studies have demonstrated that there are wide variations in the way physicians manage similar patients. This suggests that an evidence-based approach could lead to better outcomes with less cost. But practicing evidence-based medicine requires new skills, such as using computerized databases and applying the rules of evidence to primary and integrative studies in the medical literature. The progress of evidence-based medicine will depend in large measure on how quickly these new skills can be developed and integrated into the practice environment. Here's how six experts see the promise and the perils of evidence-based medicine, now and in the new millennium. Part 2 of the panel discussion will explore the new provider team, which includes nurses and, more recently, pharmacists, who are collaborating with physicians to provide disease management and drugs therapy management services.

[Investigations into synchronisation of heart rate and musical rhythm in a relaxation therapy in patients with cancer pain]. / Untersuchungen zur Synchronisation von Herz-frequenz und musikalischem Rhythmus im Rahmen einer Entspannungstherapie bei Patienten mit tumorbedingten Schmerzen.

OBJECTIVE: Registration of the influence of musical rhythm on synchronisation and coordination of heart rate. DESIGN: Randomized pilot study. PROBANDS: 28 patients with chronic cancer pain in a stable phase of the disease. INTERVENTION: 14-day training of a relaxation therapy designed for improving the falling asleep, including a 30-minute lullaby-like, rhythmically dominated music with gradually decreasing tempi. No training in the control group. OUTCOME MEASURES: Continuous registration of heart rate and comparison with musical beat on day 1 and 15. Analysis of the degree of synchronisation, i.e. the coordination of systole and musical central time point (1st beat of the 6/8 time alla breve). Recording of the time of falling asleep and registration of the patient's subjective evaluation of the relaxation therapy and the pain intensity using verbal rating scales. Documentation of the use of analgetics. RESULTS: Under the relaxation therapy trained patients showed an increasing synchronisation and coordination of heart rate and musical beat. At a musical tempo between 48 and 42 beats per min a very stable 2 : 3 synchronisation occurred. Trained patients who reported the best relaxing and analgetic effects showed the highest degree of synchronisation. Relaxation therapy led to an improvement of falling asleep and to a decrease in consumption of analgetics. CONCLUSIONS: Lullaby-like music within a special range of tempi can induce a trainable synchronisation of heart rate, functionally associated with the formation and intensity of a relaxation reaction. Further investigations are promising, however, substantial improvements in the measurement and documentation methods are needed.

Reforming American healthcare: an interim report.

At the beginning of this decade, health policy analysts and health management consultants went about the United States proclaiming that the sky was falling because something called "managed care" was about to revolutionize the financing and delivery of healthcare. In the process, it would rob US physicians not only of their long accustomed clinical freedom, but also of their long accustomed handsome incomes and job security. Understandably, in the face of many negative predictions, US physicians felt as if they were in dire straits. To be sure, the odd skirmish has been waged over healthcare costs and over clinical freedom. Viewed across the United States as a whole, however, managed care so far has been, in the words of a recent magazine article, "a mouse that roared." However, it is possible that a second revolution in the US healthcare system is yet to come, as Medicare and Medicaid turn over more and more of the functions of cost and quality control to private regulators. It is likely that the private regulators will consist of physician-driven integrated healthcare delivery systems, which take full capitation from Medicare and Medicaid and therefore assume full clinical control over healthcare, along with the financial risk inherent in capitation. For rheumatologists, this approach to healthcare represents both a danger and an opportunity.

Fludarabine and epirubicin in the treatment of chronic lymphocytic leukaemia: a German multicenter phase II study.

PURPOSE: Fludarabine has been reported to be the most effective single-agent in previously treated chronic lymphocytic leukaemia (CLL). Based on the in vitro synergism of fludarabine with anthracyclines and on results showing a higher efficacy of CHOP against COP we attempted to improve treatment results with a combination of fludarabine and an anthracycline. PATIENTS AND METHODS: The aim of the multicenter study was to evaluate the rate and duration of remissions and investigate the toxic and immunosuppressive effects of fludarabine and epirubicin in the treatment of CLL in Binet stages B and C as first-line therapy or in first relapse. Thirty-eight patients were treated with fludarabine 25 mg/m2 on days 1-5 and epirubicin 25 mg/m2 on days 4 and 5. RESULTS: The overall response rate (OR) was 82% (95% confidence interval (95% CI): 66%-92%) with a CR rate of 32% (95% CI: 18%-49%). For the 25 previously untreated patients the OR was 92% (95% CI: 74%-99%) including 40% CRs (95% CI: 21%-61%). Granulocytopenia grade 3 occurred in 23% of all evaluable cycles, and grade 4 in 17%. The median remission duration was 19 months (range 6-37 months). CONCLUSION: The results show that the combination of fludarabine and epirubicin is tolerable and highly effective in the treatment of CLL. With the addition of epirubicin to fludarabine, it appears possible to achieve a higher response rate and a more rapid response, especially of nodal manifestations. This regimen can be administered in an outpatient facility except for the first cycle because of the risk of a tumour lysis. The possible benefit of the combination presented here in the treatment of CLL in comparison to single-agent fludarabine treatment is presently under study in a prospective randomized multicenter study.