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Schepers SA, Okado Y, Russell K, Long AM, Phipps S. Adjustment in Childhood Cancer Survivors, Healthy Peers, and Their Parents: The Mediating Role of the Parent-Child Relationship. J Pediatr Psychol 2020; 44:186-196. [PMID: 30247631 DOI: 10.1093/jpepsy/jsy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Aims were to (1) determine whether the associations between parent psychological functioning and adjustment outcomes of childhood cancer survivors (CCS) were mediated by the parent-child relationship and (2) examine possible differences in pathways for CCS and healthy peers. Method The study included CCS (n = 206), healthy peers (n = 132), and their primary caregivers. Youth (8-21 years) reported on the quality of the parent-child relationship and on their positive and negative adjustment outcomes. Parents reported on their own distress, posttraumatic growth, quality of the parent-child relationship, and their child's positive and negative adjustment outcomes. Two mediation models were tested, first examining youth-reported adjustment as the outcome and second examining parent-reported youth adjustment. Differences between model path coefficients of CCS and healthy peers were assessed by multigroup analyses. Results In the youth-reported model, the parent-child relationship mediated the relation between parental distress and adjustment, with more care leading to better youth-reported adjustment outcomes and more overprotection leading to poorer adjustment outcomes. In the parent-reported model, relational frustration and attachment mediated the link between parental distress/growth and parent-reported youth adjustment, with more relational frustration and less attachment relating to poorer youth adjustment outcomes. Multigroup analyses revealed no differences in model path coefficients between CCS and healthy peers. Conclusions Parental distress and the parent-child relationship likely play an important role in both youth- and parent-reported adjustment, and associations among these constructs do not differ between CCS and healthy peers. Families with less optimal parental functioning may benefit from interventions improving the quality of parent-child interactions.
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Affiliation(s)
| | - Yuko Okado
- Department of Psychology, California State University
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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Tillery R, Willard VW, Howard Sharp KM, Klages KL, Long AM, Phipps S. Impact of the parent‐child relationship on psychological and social resilience in pediatric cancer patients. Psychooncology 2019; 29:339-346. [DOI: 10.1002/pon.5258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Rachel Tillery
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Victoria W. Willard
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | | | - Kimberly L. Klages
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
- Department of Psychology The University of Memphis Memphis Tennessee
| | - Alanna M. Long
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Sean Phipps
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
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Okado Y, Rowley C, Schepers SA, Long AM, Phipps S. Profiles of Adjustment in Pediatric Cancer Survivors and Their Prediction by Earlier Psychosocial Factors. J Pediatr Psychol 2019; 43:1047-1058. [PMID: 29800307 DOI: 10.1093/jpepsy/jsy037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/01/2018] [Indexed: 11/14/2022] Open
Abstract
Objective To examine individual differences in pediatric cancer survivors' psychosocial adjustment and test the psychosocial predictors, assessed 2-3 years earlier, of those differences. Method Pediatric cancer survivors (n = 209, aged 8-17 years at baseline) and their parents were followed for 4 years. They provided reports of survivors' psychosocial adjustment at 3 years post-baseline, and latent profile analysis (LPA) was used to identify subgroups of survivors who differed on those reports. Multinomial logistic regression was used to predict group membership from self- and parent-reported psychosocial factors at baseline (child adjustment, disposition, and parental functioning) and at 1 year post-baseline (child social relations). Results The LPA revealed a 3-class model as the best fit: a "Resilient" group (65%), characterized by good psychosocial adjustment; a "Self-Reported At-Risk" group (23%), characterized by subclinical elevations in self-reported internalizing and attention problems; and a "Parent-Reported At-Risk" group (12%), characterized by subclinical elevations in parent-reported internalizing, externalizing, and attention problems and in self-reported attention problems. Several psychosocial predictors, including child posttraumatic stress, affectivity, and connectedness to school, as well as parental distress and overprotection, differentiated the Resilient group from the other groups, in expected directions. Conclusions The majority of pediatric cancer survivors exhibit enduring resilience. The protective factors identified for them-including positive affectivity and strong connectedness to school-may inform targeted prevention strategies for the minority of survivors who are at risk for maladjustment.
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Affiliation(s)
- Yuko Okado
- Department of Psychology, California State University, Fullerton
| | - Christina Rowley
- Department of Psychology, California State University, Fullerton
| | | | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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4
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Sharp KMH, Lindwall JJ, Willard VW, Long AM, Martin-Elbahesh KM, Phipps S. Cancer as a stressful life event: Perceptions of children with cancer and their peers. Cancer 2017; 123:3385-3393. [PMID: 28472536 DOI: 10.1002/cncr.30741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors' knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children. METHODS Children with cancer (254 children) and demographically similar peers without a history of serious illness (202 children) identified their most stressful life event as part of a diagnostic interview assessing for symptoms of posttraumatic stress disorder (PTSD). The events identified as most stressful were categorized thematically, with categories established separately for cancer-related and non-cancer-related events. Events also were examined to assess whether they met Diagnostic and Statistical Manual of Mental Disorders (DSM) A criteria for PTSD. RESULTS In the group of children with cancer, 54% described a cancer-related event as the most stressful event they had experienced. Six distinct categories of cancer-related events and 10 categories of non-cancer-related events were identified. The same noncancer events were identified by children in both groups, and occurred at similar frequencies. The percentage of cancer-related events that met DSM A criteria for PTSD differed dramatically depending on which version of the DSM was applied. CONCLUSIONS Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD. Cancer 2017;123:3385-93. © 2017 American Cancer Society.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer J Lindwall
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Orchard GE, Shams M, Nwokie T, Fernando P, Bulut C, Quaye CJ, Gabriel J, Ramji Z, Georgaki A, Watt M, Cole Z, Stewart K, McTaggart V, Padayachy S, Long AM, Ogden A, Andrews C, Birchall A, Shams F, Neesam H, Haine N. A multicentre study of the precision and accuracy of the TruSlice and TruSlice Digital histological dissection devices. Br J Biomed Sci 2016; 73:163-167. [PMID: 27922431 DOI: 10.1080/09674845.2016.1233791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Five key factors enabling a good surgical grossing technique include a flat uniformly perpendicular specimen cutting face, appropriate immobilisation of the tissue specimen during grossing, good visualisation of the cutting tissue face, sharp cutting knives and the grossing knife action. TruSlice and TruSlice Digital are new innovative tools based on a guillotine configuration. The TruSlice has plastic inserts whilst the TruSlice Digital has an electronic micrometre attached: both features enable these dissection factors to be controlled. The devices were assessed in five hospitals in the UK. MATERIAL AND METHODS A total of 267 fixed tissue samples from 23 tissue types were analysed, principally the breast (n = 32) skin (30), rectum (28), colon (27) and cervix (17). Precision and accuracy were evaluated by measuring the defined thickness, and the consistency of achieving the defined thickness of tissue samples taken respectively. Both parameters were expressed as a total percentage of compliance for the cohort of samples accessed. RESULTS Overall, the mean (standard deviation) score for precision was 81 (11) % whilst the accuracy score was 82 (11) % (both p < 0.05, chi-squared test), although this varied with type of tissue. Accuracy and precision were strongly correlated (rp = 0.83, p < 0.001). CONCLUSION The TruSlice Digital devices offer an assured precision and accuracy performance which is reproducible across an assortment of tissue types. The use of a micrometre to set tissue slice thickness is innovative and should comply with laboratory accreditation requirements, alleviating concerns of how to tackle issues such as the 'measurement of uncertainty' at the grossing bench.
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Affiliation(s)
- G E Orchard
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - M Shams
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - T Nwokie
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - P Fernando
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - C Bulut
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - C J Quaye
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - J Gabriel
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - Z Ramji
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - A Georgaki
- a Viapath, St John's Institute of Dermatology , St. Thomas' Hospital , London , UK
| | - M Watt
- b Crosshouse Hospital , Kilmarnock , UK
| | - Z Cole
- b Crosshouse Hospital , Kilmarnock , UK
| | - K Stewart
- b Crosshouse Hospital , Kilmarnock , UK
| | | | - S Padayachy
- c Southampton General Hospital , Southampton , UK
| | - A M Long
- c Southampton General Hospital , Southampton , UK
| | - A Ogden
- c Southampton General Hospital , Southampton , UK
| | - C Andrews
- d Heartlands Hospital , Birmingham , UK
| | - A Birchall
- e Wythenshawe Hospital , Manchester , UK
| | - F Shams
- f Barts and the London School of Medicine, Queen Mary University of London , London , UK
| | | | - N Haine
- g CellPath Ltd. , Powys , UK
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Okado Y, Howard Sharp KM, Tillery R, Long AM, Phipps S. Profiles of Dispositional Expectancies and Affectivity Predict Later Psychosocial Functioning in Children and Adolescents With Cancer. J Pediatr Psychol 2015; 41:298-308. [PMID: 26476282 DOI: 10.1093/jpepsy/jsv096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/19/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Examined how individual differences in disposition among pediatric cancer patients predict their later psychosocial functioning. METHODS Patients aged 8-17 years (N = 223) reported on their disposition at baseline. One and three years later, self-reports and parent reports of patient psychosocial functioning were obtained. Latent profile analysis was used to identify subgroups that differed on baseline disposition and to compare them on later outcomes. ESULTS Three groups were identified: The "Positive" group (59%) had high optimism and positive affectivity and low pessimism and negative affectivity; the "Moderate" group (39%) had a similar profile, with less exaggerated scores; a small, "Negative" group (2%) had the opposite profile (low optimism/positive affectivity; high pessimism/negative affectivity). These groups differed in psychosocial functioning at follow-up, generally in expected directions. CONCLUSIONS Most patients have a disposition that may be protective. A small minority at high risk for maladjustment is distinguished by their disposition.
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Affiliation(s)
- Yuko Okado
- Department of Psychology, California State University, Fullerton, Department of Psychology, St. Jude Children's Research Hospital
| | - Katianne M Howard Sharp
- Department of Psychology, St. Jude Children's Research Hospital, Department of Psychology, University of Memphis, and Department of Psychiatry, University of Mississippi Medical Center
| | - Rachel Tillery
- Department of Psychology, St. Jude Children's Research Hospital, Department of Psychology, University of Memphis, and
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital,
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Okado Y, Tillery R, Sharp KH, Long AM, Phipps S. Effects of Time since Diagnosis on the Association between Parent and Child Distress in Families with Pediatric Cancer. Child Health Care 2015; 45:303-322. [PMID: 27630380 DOI: 10.1080/02739615.2014.996883] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although parental distress and child distress have been linked in families of children with cancer, how these associations change over time is unknown. The present study examined how the amount of time elapsed since the child's diagnosis moderates the associations between self-reported parent and child symptoms of depression, anxiety, and post-traumatic stress in 255 parent-child dyads. Time since diagnosis moderated the associations between parental symptoms and child-reported anxiety and post-traumatic stress. Dyads farther out from diagnosis exhibited stronger associations between parental and child symptoms. Findings suggest the importance of monitoring the psychological adjustment of parents and children over time.
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Okado Y, Long AM, Phipps S. Association between parent and child distress and the moderating effects of life events in families with and without a history of pediatric cancer. J Pediatr Psychol 2014; 39:1049-60. [PMID: 25064801 DOI: 10.1093/jpepsy/jsu058] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Examined the associations between parental and child distress, and moderating effects of child exposure to life events, in families with and without a history of pediatric cancer. METHODS Children with cancer and their parents (N = 255) and healthy comparison dyads (N = 142) completed self-report measures of depression, anxiety, and posttraumatic stress symptoms. Children reported on the total number of stressful life events they had experienced. Correlations between parental and child symptoms were examined. Moderating effects of child exposure to life events were tested using multiple regression. RESULTS Parent and child symptoms were significantly related only in the cancer group. Child exposure to life events attenuated this relationship. Moderation effects were significant at or below average levels of life stress. CONCLUSIONS The experience of childhood cancer may strengthen the link between parent and child psychological functioning. However, child exposure to other life events may weaken this link.
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Affiliation(s)
- Yuko Okado
- Department of Psychology, St. Jude Children's Research Hospital
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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9
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Long AM, Smith-Williams J, Mayell S, Couriel J, Jones MO, Losty PD. S77 Benchmarking standards in paediatric pleural infection management. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE To describe the development of a brief measure of benefit finding for children. Data regarding the psychometrics and validity of the instrument were examined in a sample of children with cancer. METHODS A cross-sectional sample of children with cancer (N = 199, ages 7-18 years) completed the Benefit Finding Scale for Children (BFSC) along with measures of adaptive style, optimism/pessimism, post-traumatic stress symptoms, and health-related quality of life. RESULTS The BFSC was found to be a unidimensional measure with excellent internal reliability. Benefit finding was not related to age or gender, but differed as a function of race/ethnicity. No differences were found by diagnostic category, but a significant relationship was found with age at diagnosis and time elapsed since diagnosis. Small, but significant positive correlations were found with measures of optimism and self-esteem, and a negative correlation with anxiety. No relation was found between benefit finding and post-traumatic stress symtpoms or other domains of health-related quality of life. CONCLUSION The BFSC shows promise as a measure of benefit finding in children. The measure could be readily adapted for other populations of children experiencing trauma.
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Affiliation(s)
- Sean Phipps
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA.
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Cowan CA, Lazenby HC, Martin AB, McDonnell PA, Sensenig AL, Smith CE, Whittle LS, Zezza MA, Donham CS, Long AM, Stewart MW. National health expenditures, 1999. Health Care Financ Rev 2001; 22:77-110. [PMID: 12378783 PMCID: PMC4194743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The health care spending share of gross domestic product (GDP) remained steady between 1993 and 1999 as moderate-to-strong economic growth coincided with a rapid shift to managed care. This shift, along with decelerating growth in Medicare spending, appears to have generated a mostly one-time saving that lowered aggregate health expenditure growth.
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Cowan CA, Lazenby HC, Martin AB, McDonnell PA, Sensenig AL, Stiller JM, Whittle LS, Kotova KA, Zezza MA, Donham CS, Long AM, Stewart MW. National health expenditures, 1998. Health Care Financ Rev 1999; 21:165-210. [PMID: 11481774 PMCID: PMC4194653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In 1998, national health care expenditures reached $1.1 trillion, an increase of 5.6 percent from the previous year. This marked the fifth consecutive year of spending growth under 6 percent. Underlying the stability of the overall growth, major changes began taking place within the Nation's health care system. Public payers felt the initial effects of the Balanced Budget Act of 1997 (BBA), and private payers experienced increased health care costs and increased premium growth.
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Affiliation(s)
- C A Cowan
- Office of the Actuary, National Health Statistics Group, Health Care Financing Administration, 7500 Security Boulevard, N3-02-02, Baltimore, MD 21244-1850, USA
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Abstract
DNA polymerases change their specificity for nucleotide substrates with each catalytic cycle, while achieving error frequencies in the range of 10(-5) to 10(-6). Here we present a 2.2 A crystal structure of the replicative DNA polymerase from bacteriophage T7 complexed with a primer-template and a nucleoside triphosphate in the polymerase active site. The structure illustrates how nucleotides are selected in a template-directed manner, and provides a structural basis for a metal-assisted mechanism of phosphoryl transfer by a large group of related polymerases.
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Affiliation(s)
- S Doublié
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Braden BR, Cowan CA, Lazenby HC, Martin AB, McDonnell PA, Sensenig AL, Stiller JM, Whittle LS, Donham CS, Long AM, Stewart MW. National health expenditures, 1997. Health Care Financ Rev 1998; 20:83-126. [PMID: 10387428 PMCID: PMC4194531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 1997 health spending in the United States increased just 4.8 percent to $1.1 trillion. As a share of gross domestic product (GDP), national health expenditures (NHE) absorbed 13.5 percent of the country's output in 1997--a share that has remained relatively constant for 5 years. Despite the relative stability in recent years, signs of changing trends are emerging.
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Affiliation(s)
- B R Braden
- U.S. Health Care Financing Administration, Office of the Actuary, USA
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Abstract
BACKGROUND The central player in the replication of RNA viruses is the viral RNA-dependent RNA polymerase. The 53 kDa poliovirus polymerase, together with other viral and possibly host proteins, carries out viral RNA replication in the host cell cytoplasm. RNA-dependent RNA polymerases comprise a distinct category of polymerases that have limited sequence similarity to reverse transcriptases (RNA-dependent DNA polymerases) and perhaps also to DNA-dependent polymerases. Previously reported structures of RNA-dependent DNA polymerases, DNA-dependent DNA polymerases and a DNA-dependent RNA polymerase show that structural and evolutionary relationships exist between the different polymerase categories. RESULTS We have determined the structure of the RNA-dependent RNA polymerase of poliovirus at 2.6 A resolution by X-ray crystallography. It has the same overall shape as other polymerases, commonly described by analogy to a right hand. The structures of the 'fingers' and 'thumb' subdomains of poliovirus polymerase differ from those of other polymerases, but the palm subdomain contains a core structure very similar to that of other polymerases. This conserved core structure is composed of four of the amino acid sequence motifs described for RNA-dependent polymerases. Structure-based alignments of these motifs has enabled us to modify and extend previous sequence and structural alignments so as to relate sequence conservation to function. Extensive regions of polymerase-polymerase interactions observed in the crystals suggest an unusual higher order structure that we believe is important for polymerase function. CONCLUSIONS As a first example of a structure of an RNA-dependent RNA polymerase, the poliovirus polymerase structure provides for a better understanding of polymerase structure, function and evolution. In addition, it has yielded insights into an unusual higher order structure that may be critical for poliovirus polymerase function.
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Affiliation(s)
- J L Hansen
- Department of Chemistry and Biochemistry, University of Colorado, Boulder 80309, USA
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16
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Levit KR, Lazenby HC, Braden BR, Cowan CA, Sensenig AL, McDonnell PA, Stiller JM, Won DK, Martin AB, Sivarajan ML, Donham CS, Long AM, Stewart MW. National health expenditures, 1996. Health Care Financ Rev 1997; 19:161-200. [PMID: 10179997 PMCID: PMC4194488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities.
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Affiliation(s)
- K R Levit
- Office of the Actuary, Health Care Financing Administration, Baltimore, MD 21244-4850, USA
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Levit KR, Lazenby HC, Sivarajan L, Stewart MW, Braden BR, Cowan CA, Donham CS, Long AM, McDonnell PA, Sensenig AL, Stiller JM, Won DK. National health expenditures, 1994. Health Care Financ Rev 1996; 17:205-42. [PMID: 10158731 PMCID: PMC4193598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1994. Although these statistics for 1994 show the slowest growth in more than three decades, health spending continued to grow faster than the overall economy. The Federal Government continued to fund an increasing share of health care expenditures in 1994, offset by a falling share from out-of-pocket sources. Shares paid by State and local governments and by other private payers including private health insurance remained unchanged from 1993.
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Affiliation(s)
- K R Levit
- Office of the Actuary, Health Care Financing Administration, USA
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18
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Levit KR, Lazenby HC, Braden BR, Cowan CA, McDonnell PA, Sivarajan L, Stiller JM, Won DK, Donham CS, Long AM, Stewart MW. National health expenditures, 1995. Health Care Financ Rev 1996; 18:175-214. [PMID: 10165031 PMCID: PMC4193619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1995. In 1995, $988.5 billion was spent to purchase health care in the United States, up 5.5 percent from 1994. Growth in spending between 1993 and 1995 was the slowest in more than three decades, primarily because of slow growth in private health insurance and out-of-pocket spending. As a result, the share of health spending funded by private sources fell, reflecting the influence of increased enrollment in managed care plans.
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Affiliation(s)
- K R Levit
- Health Care Financing Administration, Baltimore, MD 21244, USA.
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Abstract
This report describes a case of hydrometrocolpos presenting antenatally as a cystic mass arising from the pelvis of a female fetus. The baby was born at 33 weeks and died within an hour due to pulmonary hypoplasia. Postmortem examination demonstrated hydrometrocolpos, dense adhesions in the abdomen and pulmonary hypoplasia.
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Affiliation(s)
- R Saxena
- Department of Histopathology, Farnborough Hospital, Kent, UK
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20
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Abstract
Experience with an indwelling subcutaneous Teflon cannula for insulin delivery to 10 children with diabetes mellitus is described. There were no significant complications during a one year trial period. The device may particularly benefit children during the early phase after diagnosis and for those with true needle phobia.
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Affiliation(s)
- A M Long
- Department of Child Health, University of Wales, College of Medicine, Cardiff
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Abstract
Derbyshire was one of the best known centres of endemic goitre in Great Britain. Some 160 km from the coast in the direction of the prevailing wind, topsoils in the area are generally low in iodine (mean = 5.44 mg l/kg). Weathered rocks and soils are richer in iodine than the unweathered bedrocks, with soils developed over limestones being richer than those over sandstones, shales and dolomites. Highest iodine contents in soil profiles over limestones occur in the upper horizons while over sandstones, iodine concentrates in the lower horizons. The major cause of endemic goitre in north Derbyshire is likely to be relatively low levels of iodine, while the calcium rich soils of the area may contribute by reducing plant iodine uptake.
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Affiliation(s)
- R Fuge
- Centre for Applied Geochemistry, Institute of Earth Studies, University College of Wales, SY23 3DB, Aberystwyth, Dyfed, Wales
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Affiliation(s)
- P J Fleming
- University of Bristol, Department of Child Health, Bristol Maternity Hospital, United Kingdom
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Abstract
A simple model of a feedback loop controlling ventilation is analysed. This model is intended to describe the response of the system, initially at equilibrium, to a sudden fall in CO2 concentration in the lung, brought about by a deep sigh. A previous paper described the model in detail and the general method of analysis. Here we continue the discussion of stability, first in terms of local stability after a small displacement from equilibrium and then by computer simulation to illustrate the behaviour after large displacements. The local analysis is used to select representative sets of system parameters to illustrate the different types of trajectory obtained by computer simulation. When the equilibrium point is stable the response to a disturbance is overdamped, underdamped or critically damped. When the equilibrium point is unstable the system responds by going into a limit cycle. The transition between these two cases proceeds via a Hopf Bifurcation. The limit cycle type of ventilatory pattern, i.e. a periodic, underdamped waxing and waning of ventilation is commonly seen in premature infants and in term infants between 1 and 6 months of age.
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Abstract
A case of fatal neonatal infection with enteric cytopathogenic human orphan virus (echovirus) type 6 is presented. The measures taken to prevent further spread of infection with special reference to the use of human normal immunoglobulin are described.
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Wyrwicka W, Long AM. The effect of companion on consumption of ethanol solution in cats. Pavlov J Biol Sci 1983; 18:49-53. [PMID: 6856364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Social influences on drinking ethanol solution were studied in two cats ("drinkers") who voluntarily drank small amounts of 10% ethanol solution in milk and three other cats ("nondrinkers") who served as companions to the drinkers. A 15-minute session was conducted daily in a compartment divided into two even parts with a transparent Plexiglass partition. The cats were introduced to the compartment either singly or in pairs. Each pair consisted either of two drinkers or one drinker and one nondrinker. Each cat of the pair was placed in one part of the compartment; the cats could see each other, but they could not make physical contact. Each drinker was offered 10% ethanol solution in milk, while each nondrinker was given plain milk, and the amount of consumption was measured. A series of five to ten sessions with a drinker was followed by a series of sessions with a nondrinker or with no companion. There were a total of 13 series of sessions for each drinker. A statistical analysis of the data showed that, in most series, the mean amount of consumption of ethanol solution was significantly higher in the presence of a companion (either drinker or nondrinker) than in its absence.
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