RADIATION PROTECTIVE ACTIVITY DURING IMPLEMENTATION OF THE STATE PROGRAM FOR THE PROTECTION OF POPULATION OF ZHOVTI VODY TOWN

The town of Zhovti Vody is a 'capital' of uranium mining and processing industry of Ukraine. The mining and processing of uranium has been carried out in this area for more than 60 y. During this period, due to increasing production activities, the town has grown significantly. As a result of production activities and also due to the human factor, the territory of the town was contaminated by radioactive rocks. In addition, out of ignorance, radioactive rocks were used in the construction of houses and roads. To normalize the radiation situation in the town, a targeted State Programme was adopted in 2003 for a period of 10 y. In 2013, the Programme was subsequently extended until 2022. In accordance with this Programme, decontamination of the urban territory, measurements of radon isotopes in houses and anti-radon reconstructions of the premises have been performed. The results of these works are described in this article.

Charge transport in thin layer Na x CoO2 (x ∼ 0.63) studied by terahertz spectroscopy

Charge transport in Na0.63CoO2 thin film deposited by a spin-coating method was investigated experimentally by time-domain terahertz spectroscopy and theoretically using Monte Carlo calculations of charge response in nano-structured materials. The dominating type of transport mechanism over the entire investigated range of temperatures (20-300 K) is a metallic-like conductivity of charges partly confined in constituting nano-sized grains. Due to the granular character of our thin film, the scattering time at low temperatures is limited by scattering on grain boundaries and the conductivity is strongly suppressed due to capture of a major fraction of charge carriers in deep traps. Nevertheless, our experimental setup and the applied model allowed us to distinguish the parameters related to the grain interior from those influenced by grain boundaries, and to conclude that the metallic type of conductivity is the intrinsic property relevant to single crystal materials.

Complete sequences of maternally inherited mitochondrial genomes in mussels Unio pictorum (Bivalvia, Unionidae)

Mitochondrial genomes are frequently used to infer phylogenetic relationships. Some taxa are, however, poorly represented. To facilitate better understanding of the potential of mitochondrial genome data in freshwater mussels, we present here, for the first time, the mitochondrial sequences of 4 complete F-type mitochondrial genomes from the European freshwater bivalve Unio pictorum (Unionidae). These genomes are very compact (15,761 bp) but have a typical gene complement for bilaterian mitochondrial genomes and a very similar organization to other unionid genomes available in databases. Very low nucleotide diversity within the species suggests a small effective population size of Polish U. pictorum, a phenomenon of potential importance for environmental management policies.

Optometry and ophthalmology: the Internet connection--assessing consumer health web sites

BACKGROUND

The Internet is a major conduit of health information. Consumers frequently rely on it without verifying its validity. The purpose of this study was to assess the accuracy and currency of Internet-based information on the roles and practice of optometrists, which has been found to be misleading, inaccurate, and often outdated.

METHODS

Using search engines and ranking directories, 16 popular health Web sites were examined for differentiation between optometry and ophthalmology. Each site's eye care content was reviewed for syndication, definitions, provider directories, linkages to eye organizations, and provider recommendations in treatment of certain conditions.

RESULTS

Many Web sites use a syndicated source for their health content and several use Merriam-Webster as their primary dictionary. A majority of sites provided poor definitions for optometry. Most Web sites were biased in recommending ophthalmologists and do not include optometrists as licensed providers in treatment of certain eye diseases. For example, Intelihealth, Aetnaushc, and Noah-Health recommend only ophthalmologists for the treatment of conjunctivitis.

CONCLUSIONS

Inaccuracies and misleading information about optometry do exist and undermine the role of optometrists in delivery of eye care. When alerted, several Web sites were receptive to proposed changes. While some efforts have been undertaken to monitor Web sites, the profession must develop a concrete effort to ensure that it is correctly represented on the Internet.

Eye care providers in managed care

The integrated relationship and roles in managed care of ophthalmologists, optometrists, and opticians have changed profoundly in recent years. The change is in part the result of the advancement of optometric education and license in the diagnosis and treatment of ocular disease. The change has also evolved because of the influence of managed care and its objective to reduce costs while elevating quality of care. The authors explain that vertical integration of all ophthalmic services, ranging from eye examination to eyeglass dispensing to ocular surgery, can help MCOs maximize quality and minimize costs.

Optimal clinical management of eye problems: the role of optometrists in managed care plans

BACKGROUND

Recent developments in the education and licensure of optometrists have created new opportunities for more-efficient provision of eye care. This study was conducted to determine the extent to which optometrists provided various kinds of eye care independently in managed care organizations. We compared optometric practices in health plans located in states in which the legal authority of optometrists was limited, to optometric practices in plans situated in states in which optometric licensure permitted broader prescribing authority. The volume and nature of referrals to ophthalmologists were assessed in relation to state law and organizational protocols.

METHODS

A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a 4-week period in 1998. Specific conditions were selected and criteria developed to help determine whether referrals to ophthalmologists were appropriate, or if they could have been managed by the optometrist These referrals were assessed by an independent panel of four optometrists.

RESULTS

This study documented that optometrists provide a substantial range of eye care, and their individual scope of practice is influenced not only by legal boundaries, but also by financial and organizational factors found within managed care organizations. The pattern of referrals to ophthalmologists helped indicate the extent to which optometrists were underutilized or used appropriately in various settings.

CONCLUSIONS

There is no single reliable predictor of whether optometrists will be used at the highest level of their abilities and scope of license. Although state licensure sets the overall parameters for care, optometric practice in managed care plans may be modified by internal protocols and organizational factors.

Optometry as practiced in health plans within different state jurisdictions

This study was conducted to determine how managed care plans use optometrists to provide vision and eye care. The study documents the variety of optometric practice patterns found within six health plans in several states, each having different organizational characteristics, professional staffing patterns, and payment arrangements, and each regulated by dissimilar state licensure laws. A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a four-week period. The instrument included information on patient demographics, medical/ocular history, reason for the visit, procedures performed, diagnosis, therapy provided, ocular medications prescribed, prognosis, disposition, referrals, and duration of the visit. A variety of patterns were found, some of which did not necessarily closely follow the legal boundaries of optometric care. This study documented that optometrists provide a substantial volume and range of vision care, and their scope of practice is influenced by legal, financial, and organizational factors. In some plans, optometrists' skills were underutilized relative to their legal authority in certain situations; in others, creative, cooperative arrangements extended the benefits of optometry beyond the existent practice laws. Licensure is certainly a major influence on the scope of practice of health providers. This study revealed, however, that licensure alone does not appear to be the only determinant of use, delegation, and division of labor among health professionals, and that organizational factors seem to play a very significant role.

[The occurrence of Ixodes ricinus in the select recreative areas in the Province of Szczecin. Part I]

Among Polish ticks species the most common Ixodes ricinus has the biggest medical importance. Within the last few years, the incidence of disease transmitted by ticks has rapidly increased. We have made a thorough analysis of the quantative and rate per cent of occurrence of various stages Ixodes ricinus in the forest areas of some places in Szczecin province and in the parks of Szczecin, that are known as highly recreative and frequently visted by many people. A total of 426 (68% numphs) specimens collected there show that ticks frequently occupy habitats closely associated with man.

Quality assurance in managed vision benefits

Quality assurance is an important responsibility of those who purchase managed vision care benefits. In conducting a quality assurance program, it is important to respect patient confidentiality and the practitioner's right to exercise professional discretion. An effective program will not only accomplish its main objective of attaining high-quality care, but it can also enhance member satisfaction and improve provider relations.

The future of Medicare and managed care: implications for optometry

BACKGROUND

Medicare, the major health entitlement program for the elderly, is faced with many challenges. Health costs and managed care have been instrumental in restructuring delivery of health care in this country. The Medicare program, the last bastion of unmanaged and fee-for-service care, is now under pressure to conform to the changes already embraced within the private sector.

METHODS RESULTS

Data obtained from the Health Care Finance Administration (HCFA) demonstrate how marketing strategies and enrollment programs are successful in enrolling Medicare beneficiaries into health maintenance organizations (HMOs). Enrollment in Medicare risk-contract HMOs has doubled in the last 2 years as HMOs actively market the Medicare population. New managed care options are being developed for Medicare patients.

CONCLUSIONS

HMOs are marketing their plans specifically toward Medicare beneficiaries and are offering increased benefits-including vision care-to encourage increased enrollment. Optometric participation in the Medicare program will be affected Freedom of choice will be restricted to panel practitioners who participate with these HMOs. Practitioners will be subject to credentialing criteria established by the HMOs, site visitations, audits, and other aspects of quality assurance implemented by the HMOs.

Medicaid, managed care and optometry: a review

BACKGROUND

Significant changes are restructurng the U.S. health care delivery system. National health reform is now extending itself into the public sector. Increased health and medical costs by federal and state governments are forcing a reevaluation of major entitlement programs, especially Medicaid.

METHODS/RESULTS

Because Medicaid is the single largest item in many state budgets, states are now enrolling Medicaid patients into managed and coordinated care arrangements as a means to control costs and increase access to care. HMOs are not only competing for private patients but also actively seeking the Medicaid population. Nationally, almost one-fourth of all Medicaid patients are now enrolled in managed care plans. Various models and approaches have been developed by individual states.

CONCLUSIONS

Because managed care enrollment in the Medicaid program has increased substantially in recent years, selected services including vision care are no longer rendered by any practitioner willing to accept Medicaid fees. Freedom of choice is now restricted to pre-selected and panel practitioners participating with the managed care program. The rules, regulations, billing procedures, fees, and program requisites will differ under managed care programs. Private optometric practitioners must consider entering economic and organizational relationships and linkages that make them attractive to managed care organizations.

Medicare, managed care, and vision services to the elderly

Proportionately, fewer Medicare patients are enrolled in HMOs than in fee-for-service programs. Despite the advantages of selecting the HMO option, only 2.9 million beneficiaries are enrolled. Integrating Medicare into health care reform will be a major challenge to this administration. There is general recognition that it will be difficult to control health costs if people at least 65 years of age remain outside the system. With renewed marketing programs directed toward the elderly, we can expect further increases in Medicare HMO enrollment.

Delivery systems for vision care benefits

The best way to provide a vision care benefit is with a managed care plan. With this type of design, there is cost containment without cost shifting, and quality assurance and member satisfaction are readily attainable at relatively inexpensive rates.

Long term follow up after percutaneous mitral commissurotomy with the Inoue balloon-incidence of restenosis

The long term outcome of 300 consecutive patients following percutaneous mitral commissurotomy (PMC) with the Inoue balloon was analyzed with regard to the incidence of restenosis. There were 256 females and 44 males (mean age 44.4 +/- 9.9 years, range 18-69 years), 52 had previous surgical commissurotomy, 96 were in atrial fibrillation, and 16 had a history of embolism. PCM was carried out with a success rate of 84% (no significant mitral regurgitation and mitral valve area (MVA) > 1.5 cm2). Two hundred and seventy patients were available for clinical and serial echocardiographic studies at six months, 12 months and once a year thereafter (18 patients operated on for mitral regurgitation less than six months after PMC, three patients lost to follow up, nine patients refused to return). MVA increased with PMC from 1.18 cm2 +/- 0.3 to 2.0 +/- 0.3 cm2 and then decreased to 1.8 +/- 0.3 at a mean follow up of 24.0 +/- 13.5 months (range 6-55). Echocardiographic restenosis (RS) (MVA at follow up < 1.5 cm2 with a 50% loss of the initial gain) was found in 38 patients (14%). Twenty-five (66%) of them remained in NYHA class I or II. Restenosis free survival according to the Kaplan-Mayer curve was 93%, 86%, 77% and 73% at 12,24,36 and 55 months respectively. None of the 24 clinical, hemodynamic, echocardiographic or procedural variables used on the Cox proportional hazard regression analysis identified predictors of restenosis free survival.

CONCLUSIONS

The overall incidence of echocardiographic restenosis post PMC is low (12.6%) in patients followed for a mean period of two years and often occurs without worsened clinical symptoms. It may be difficult to define clinical, echocardiographic or procedural factors as significant predictors of restenosis free survival.

Guideline development process for optometric care of the patient with diabetes mellitus. American Optometric Association

BACKGROUND

The aim of this project was to develop a standard of optometric care for patients with diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. These guidelines are intended to assist optometric practitioners in the prevention, diagnosis, treatment, management, and rehabilitation of their patients. The guidelines are based on the best available research and professional judgment regarding the effectiveness and appropriateness of optometric care and procedures.

METHODS

This paper details the methodology used by the AOA's Clinical Guidelines Coordinating Committee, Consensus Panel and the Center for Vision Care Policy of the State College of Optometry, SUNY, to develop practice guidelines for patients with diabetes mellitus.

A meeting of the mindsets: chart completion vs. clinical pertinence

The authors describe their hospital's success in addressing a delinquent record crunch. As a result of its program, the hospital reduced accounts receivable by 45 percent.

A contribution to the structure-activity relationship in glutamate receptor ligands: 2. Characterization of 2-amino-4-oxo-5-pentanoic acid as NMDA receptor antagonist

Pharmacological properties of 2-amino-4-oxo-5-phosphonopentanoic acid (AOPA) on excitatory amino acids mediated responses have been tested in CA1 rat hippocampal neurones, using intracellular recordings and current and voltage clamp techniques. These properties were compared with those of the well-known NMDA antagonist, D(-)2-amino-5-phosphonopentanoic acid (AP-5). AOPA completely abolished the response to NMDA but had no effects on the responses to AMPA, quisqualate and kainate. In voltage clamp experiments AOPA antagonized NMDA-induced currents and produced a parallel shift of the NMDA concentration-response curve. Schild analysis gave a Kd value of 26 microM. AP-5 also produced a similar shift in this curve with a Kd of 6.9 mu.

A contribution to the structure-activity relationship in glutamate receptor ligands: 1. omega-Aminophosphonic acids do not antagonize NMDA receptors

Pharmacological properties of a series of alpha, omega-diamino-omega-phosphonocarboxylic acids and alpha, omega-diamino-alpha, omega-bis(phosphonic acids) on different excitatory amino acids mediated responses have been tested in CA1 rat hippocampal neurones, using intracellular recordings and current and voltage clamp techniques. In contrast with known antagonists as D(-)2-amino-5-phosphonopentanoic acid (AP-5) and 2-amino-4-oxo-5-phosphonopentanoic acid, which completely abolished the NMDA-response, no antagonistic activity was found. We conclude that the introduction of an omega-amino function abolishes the NMDA-antagonistic activity of alpha-amino-omega-phosphonocarboxylic acids.

Specialty differentials, limited license practitioners, and Medicare's new fee schedule

The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.

Standards of care

The health care community is quickly progressing in the direction of the development and acceptance of the concept of standards of care. Optometry has lagged behind other health disciplines in this process and must develop its own or face the likelihood of having to conform to standards created by others. The argument is no longer whether standards should be created, but rather the creation of appropriate standards and guidelines that will best serve the profession and the public.

The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and ophthalmologists

This paper compares various costs estimates for the expansion of optometric services under the Medicare program that were developed prior to the enactment the Medicare Parity Amendment of 1986. The new law, effective April 1, 1987 redefines the conditions of optometric participation and expanded coverage to include all Medicare covered services for which optometrists are authorized to perform under the state law. The paper describes the impact of the Medicare amendment with regard to payments to optometrists and ophthalmologists. Payments to optometrists increased from $12 million in 1986, a year before the Medicare Amendment to $81 million in 1988, the first full year after the law's implementation increasing their market share of Medicare payments from 2.6% to 11.1%. Ophthalmology incurred a significant decrease in market share from 97.9% to 88.9% during this period.