Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA).

The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA) changes the regulatory environment within which health insurance policies on the small-group market are bought and sold. New regulations include rate bands that limit premium price variation, risk-adjustment policies that will transfer funds from low-actuarial-risk to high-actuarial-risk plans, and requirements that plans include "essential health benefits." While the new regulations will be applied to all non-grandfathered fully insured policies purchased by businesses with 100 or fewer workers, self-insured plans are exempt from these regulations.

Minimum information about a marker gene sequence (MIMARKS) and minimum information about any (x) sequence (MIxS) specifications.

Here we present a standard developed by the Genomic Standards Consortium (GSC) for reporting marker gene sequences--the minimum information about a marker gene sequence (MIMARKS). We also introduce a system for describing the environment from which a biological sample originates. The 'environmental packages' apply to any genome sequence of known origin and can be used in combination with MIMARKS and other GSC checklists.

Solution structure of RNase P RNA.

The ribonucleoprotein enzyme ribonuclease P (RNase P) processes tRNAs by cleavage of precursor-tRNAs. RNase P is a ribozyme: The RNA component catalyzes tRNA maturation in vitro without proteins. Remarkable features of RNase P include multiple turnovers in vivo and ability to process diverse substrates.

Shoulder hemiarthroplasty for fractures of the proximal humerus.

Proximal humeral fractures were managed with primary hemiarthroplasty in 57 patients, 53 women (93%) and 4 men (7%) aged 51-87 years (mean 72.2). The mean follow-up period was 52 months (range 12-98), and the mean Constant score was 59.

Large-particle calcium hydroxylapatite injection for correction of facial wrinkles and depressions.

Background: Small-particle calcium hydroxylapatite (Radiesse, Merz, Frankfurt, Germany) is safe and effective for facial wrinkle reduction, and has medium-term persistence for this indication. There is patient demand for similar fillers that may be longer lasting.

Objective: We sought to assess the safety and persistence of effect in vivo associated with use of large-particle calcium hydroxylapatite (Coaptite, Merz) for facial augmentation and wrinkle reduction.

Prevention of pain on injection of propofol: systematic review and meta-analysis.

Objective: To systematically determine the most efficacious approach for preventing pain on injection of propofol.

Design: Systematic review and meta-analysis.

Data Sources: PubMed, Embase, Cochrane Library, www.

Maternal and neonatal health expenditure in Mumbai slums (India): a cross sectional study.

Background: The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty.

Methods: We used expenditure data for maternal and neonatal care, collected during post-partum interviews.

Cutaneous malignant melanoma among white Hispanics and non-Hispanics in the United States.

Aim: To explore whether disparities exist in melanoma incidence and prognosis between White Hispanics and White non-Hispanics.

Methods: Analyses were based on 42,770 patients with malignant melanoma in the United States, 2004 through 2006.

Results: Hispanics were significantly less likely to be diagnosed with superficial spreading melanoma or Hutchinson's melanotic freckle, but significantly more likely to be diagnosed with nodular melanoma or acral lentiginous melanoma.

The Earth Microbiome Project: Meeting report of the "1 EMP meeting on sample selection and acquisition" at Argonne National Laboratory October 6 2010.

This report details the outcome the first meeting of the Earth Microbiome Project to discuss sample selection and acquisition. The meeting, held at the Argonne National Laboratory on Wednesday October 6(th) 2010, focused on discussion of how to prioritize environmental samples for sequencing and metagenomic analysis as part of the global effort of the EMP to systematically determine the functional and phylogenetic diversity of microbial communities across the world.

Audio-visual distraction during spinal anaesthesia for orthopaedic surgery.

Spinal anaesthesia is an effective method of delivering anaesthesia for primary total knee replacement. A regional technique has several benefits over an opioid based general anaesthetic (Fischer 2009) (Figure 1). Pre-medication and sedation is commonly used as an adjunct to create anxiolysis and reduce stress which could be provoked by being awake in the theatre environment.

Disease phenotype and genotype are associated with shifts in intestinal-associated microbiota in inflammatory bowel diseases.

Background: Abnormal host-microbe interactions are implicated in the pathogenesis of inflammatory bowel diseases. Previous 16S rRNA sequence analysis of intestinal tissues demonstrated that a subset of Crohn's disease (CD) and ulcerative colitis (UC) samples exhibited altered intestinal-associated microbial compositions characterized by depletion of Bacteroidetes and Firmicutes (particularly Clostridium taxa). We hypothesize that NOD2 and ATG16L1 risk alleles may be associated with these alterations.

Positive end-expiratory pressure (PEEP) during anaesthesia for the prevention of mortality and postoperative pulmonary complications.

Background: General anaesthesia causes atelectasis which can lead to impaired respiratory function. Positive end-expiratory pressure (PEEP) is a mechanical manoeuvre which increases functional residual capacity (FRC) and prevents collapse of the airways thereby reducing atelectasis. It is not known whether intra-operative PEEP alters the risk of postoperative mortality and pulmonary complications.

The human nasal microbiota and Staphylococcus aureus carriage.

Background: Colonization of humans with Staphylococcus aureus is a critical prerequisite of subsequent clinical infection of the skin, blood, lung, heart and other deep tissues. S. aureus persistently or intermittently colonizes the nares of approximately 50% of healthy adults, whereas approximately 50% of the general population is rarely or never colonized by this pathogen.

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study.

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups.

Effect of body mass index on the ED50 volume of bupivacaine 0.5% for supraclavicular brachial plexus block.

Background: The aim of this study was to determine whether the ED(50) dose of bupivacaine 0.5% for supraclavicular brachial plexus block increases with increasing body mass index (BMI).

Methods: This double-blind, non-randomized trial followed an up-and-down sequential allocation design.

Microbial species richness and metabolic activities in hypersaline microbial mats: insight into biosignature formation through lithification.

Microbial mats in the hypersaline lake of Salt Pan, Eleuthera, Bahamas, display a gradient of lithification along a transect from the center to the shore of the lake. These mats exist under similar geochemical conditions, with light quantity and quality as the sole major environmental difference. Therefore, we hypothesized that the microbial community may be driving the differences in lithification and, by extension, mineral biosignature formation.

Mapping the tree of life: progress and prospects.

The intent of this article is to provide a critical assessment of our current understanding of life's phylogenetic diversity. Phylogenetic comparison of gene sequences is a natural way to identify microorganisms and can also be used to infer the course of evolution. Three decades of molecular phylogenetic studies with various molecular markers have provided the outlines of a universal tree of life (ToL), the three-domain pattern of archaea, bacteria, and eucarya.

Culture-independent microbiological analysis of foley urinary catheter biofilms.

Background: Prevention of catheter-associated urinary tract infection (CAUTI), a leading cause of nosocomial disease, is complicated by the propensity of bacteria to form biofilms on indwelling medical devices [1,2,3,4,5].

Methodology/principal Findings: To better understand the microbial diversity of these communities, we report the results of a culture-independent bacterial survey of Foley urinary catheters obtained from patients following total prostatectomy. Two patient subsets were analyzed, based on treatment or no treatment with systemic fluoroquinolone antibiotics during convalescence.

An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

Introduction: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses.

Response surface model predictions of emergence and response to pain in the recovery room: An evaluation of patients emerging from an isoflurane and fentanyl anesthetic.

Introduction: Sevoflurane-remifentanil interaction models that predict responsiveness and response to painful stimuli have been evaluated in patients undergoing elective surgery. Preliminary evaluations of model predictions were found to be consistent with observations in patients anesthetized with sevoflurane, remifentanil, and fentanyl. This study explored the feasibility of adapting the predictions of sevoflurane-remifentanil interaction models to an isoflurane-fentanyl anesthetic.

Opportunistic pathogens enriched in showerhead biofilms.

The environments we humans encounter daily are sources of exposure to diverse microbial communities, some of potential concern to human health. In this study, we used culture-independent technology to investigate the microbial composition of biofilms inside showerheads as ecological assemblages in the human indoor environment. Showers are an important interface for human interaction with microbes through inhalation of aerosols, and showerhead waters have been implicated in disease.

Religious practice, blood transfusion, and major medical procedures.

In this debate, we explore the dilemmas between the law, the ethical issues, the good clinical practice, and the wishes of the family. In the scenario chosen, the issues center around not only the senior family members but also of an older child with some rights to self-determination. There are no absolute rights or wrongs to this case, which is based on a synthesis of other actual clinical scenarios.

Microbial diversity in modern marine stromatolites, Highborne Cay, Bahamas.

Living marine stromatolites at Highborne Cay, Bahamas, are formed by microbial mat communities that facilitate precipitation of calcium carbonate and bind and trap small carbonate sand grains. This process results in a laminated structure similar to the layering observed in ancient stromatolites. In the modern marine system at Highborne Cay, lamination, lithification and stromatolite formation are associated with cycling between three types of microbial communities at the stromatolite surface (Types 1, 2 and 3, which range from a leathery microbial mat to microbially fused sediment).