Assisted Living: The Politics of Medicaid and Medicare

In this paper I examine the structure of the current assisted living industry in order to explain how and why it is appealing and effective, as well as look at its limitations. I discuss the politics of Medicaid and Medicare, and how through these programs the federal and state governments are failing to provide adequate care for the nation’s senior population. Like the rest of our health care system, these two public health insurance systems are fragmented, and consequently, financing long-term care is complicated and insufficient. Ultimately, this paper will function as a policy report and I will propose: standardized requirements for assisted living facilities; a stricter and new way to regulate assisted living on the state level; restructured models for the public insurance programs, including Medicaid, Medicare, and the State Children’s Health Insurance Program.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Plataforma para o suporte de blended peer assisted learning

Este projecto foi realizado na Universidade da Madeira, no âmbito do Mestrado em Engenharia Informática e tem como título “Plataforma para o suporte de Blended Peer Assisted Learning”. Ao longo da nossa pesquisa sobre os vários métodos de aprendizagem online, deparamo-nos com uma grande lacuna que abrange a maior parte dos sistema de ensino assistidos por computador, ou seja, todas elas preocupam-se com a passagem de conhecimentos, mas raras são aquelas que têm em atenção o tipo de utilizador, qual a seu percurso académico e profissional, qual a metodologia que fará com que o mesmo capte melhor os conteúdos, etc. Com este objectivo em mente, e tendo em atenção as diversas plataformas e metodologias de ensino existentes, optou-se por elaborar uma arquitectura de uma plataforma capaz de centralizar na mesma, um conjunto de funcionalidades e metodologias que possibilitassem um acompanhamento mais específico do utilizador, proporcionando um maior conhecimento, através do qual poderia encaminhar o utilizador para a estratégia de aprendizagem que mais se adequasse a um utilizador com as suas características. Como se poderá constatar no decorrer desta dissertação, a plataforma desenhada e o módulo desenvolvido têm como base teórica o Peer Assisted Learning (PAL) e as suas estratégias de aprendizagem. O PAL é um conceito relativamente novo, que se encontra em plena ascensão, sendo cada vez maior o número de instituições/organizações que adoptam o PAL como metodologia de ensino para a formação dos seus membros. Este crescimento deve-se em grande parte às várias estratégias PAL que visam uma maior adequação ao tipo de utilizador, contribuindo assim para uma aprendizagem mais rápida e eficaz. Uma vez que a implementação da plataforma na sua totalidade seria de todo impossível, optouse por desenvolver apenas um dos módulos referente à estratégia de PAL – Peer Tutoring (PT). No final, o objectivo principal, passa não só por fornecer as bases necessárias ao desenvolvimento da referida plataforma, mas também pela disponibilização do módulo de PT que servirá de referência para o desenvolvimento das restantes estratégias. Tendo em atenção toda a investigação efectuada, facilmente se depreende as inúmeras vantagens que podem advir da utilização do PAL, das quais se salienta, a adequação da estratégia PAL mais indicada para cada tipo de utilizador.

Biodistribution of the radiophamarceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

To evaluate the biodistribution of sodium pertecnetate (Na99mTcO4) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. Methods: Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.l mL of Na99mTcO4, with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gama Counter WizardTM 1470, PerkinElmer. The percentage of radioactivity per gram of tissue (%ATI-g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as signifi cant. Results: There were no signifi cant differences in %ATI-g of the Na99mTcO4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was signifi cantly greater than that of C and sham rats (p<0.05). Conclusion: In rats with experimentally-produced short bowel syndrome, an adaptive response by the intestinal mucosa reduced weight loss. The biodistribution of Na99mTcO4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated

Chemical Composition of Lipids Present in Cat and Dog Oocyte by Matrix-Assisted Desorption Ionization Mass Spectrometry (MALDI- MS)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effects of discontinuous Percoll gradient centrifugation on the quality of bovine spermatozoa evaluated with computer-assisted semen analysis and fluorescent probes association

The objective of this study was to evaluate the quality of bovine frozen-thawed sperm cells after Percoll gradient centrifugation. Frozen semen doses were obtained from six bulls of different breeds, including three taurine and three Zebu animals. Four ejaculates per bull were evaluated before and after discontinuous Percoll gradient centrifugation. Sperm motility was assessed by computer-assisted semen analysis and the integrity of the plasma and acrosomal membranes, as well as mitochondrial function, were evaluated using a combination of fluorescent probes propidium iodide, fluorescein isothiocyanate-conjugated Pisum sativum agglutinin and 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolcarbocyanine iodide. The procedure of Percoll gradient centrifugation increased the percentage of total and progressive sperm motility, beat frequency, rectilinear motility, linearity and rapidly moving cells. In addition, the percentage of cells with intact plasma membrane and mitochondrial membrane potential was increased in post-centrifugation samples. However, the percentage of sperm cells with intact acrosomal membrane was markedly reduced. The method used selected the motile cells with intact plasma membrane and higher mitochondrial functionality in frozen-thawed bull semen, but processing, centrifugation and/or the Percoll medium caused damage to the acrosomal membrane.

Demecolcine Effects on Microtubule Kinetics and on Chemically Assisted Enucleation of Bovine Oocytes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Chemically Assisted Enucleation Results in Higher G6PD Expression in Early Bovine Female Embryos Obtained by Somatic Cell Nuclear Transfer

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Validation of microsatellite markers for assisted selection of soybean genotypes resistant to powdery mildew

Powdery mildew is one of the most serious diseases of soybean and is found in all producing countries. The purpose of this study was to validate microsatellite markers previously identified as associated with resistance to powdery mildew in soybean. The study was conducted in two F, parent populations with contrasting resistance to powdery mildew, In the analysis 10 SSR primers were used for the populations. and tour polymorphic markers were identified for cross I (MGBR95-20937 x IAC-Foscarin 31) and three for cross 2 (MGBR-46 x Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA) 48). The Chi-square analysis of the phenotypic evaluation confirmed the expected segregation (3: 1) of a dominant gene related to resistance. The polymorphic markers also segregated as expected (1:2:1). The markers Sat 366 and Sat 393 in the crosses 1 and 2. respectively, located at 9.41 and 12.45 cM from the gene. were considered promising for marker-assisted selection for resistance to powdery mildew in soybean. at a selection efficiency of 92.7% and 60.3% respectively.

Air-assisted boom sprayer and spray deposition on bean plants

A possibilidade do desenvolvimento de técnicas de aplicação de produtos fitossanitários mais seguras, com menores volumes de calda, número de aplicações e deriva, aliados à necessidade de se obter melhores níveis de controle dos agentes nocivos às plantas cultivadas, justificam o uso da assistência de ar junto à barra de pulverização. Com o objetivo de avaliar a deposição da pulverização na cultura do feijoeiro (Phaseolus vulgaris), em presença e ausência da assistência de ar junto à barra de pulverização, com diferentes pontas de pulverização e volumes de calda, foi conduzido um experimento em delineamento inteiramente casualizado, utilizando-se como traçador o óxido cuproso. Alvos artificiais (papel filtro com 3 x 3 cm) foram afixados nas superfícies adaxial e abaxial de folíolos posicionados nos terços superior e inferior de plantas, selecionadas ao acaso, distribuídas perpendicularmente ao deslocamento do pulverizador. Após a aplicação do traçador os coletores foram lavados individualmente em solução extratora de ácido nítrico a 1,0 mol L-1. A determinação quantitativa dos depósitos foi realizada com o uso da espectrofotometria de absorção atômica. A assistência de ar junto à barra de pulverização não aumentou a deposição do traçador em folíolos de feijoeiro, aos 48 dias após a emergência da cultura.

Morphological and Structural changes of CaxSr1-xTiO3 Powders Obtained by the Microwave-Assisted Hydrothermal Method

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Photoluminescence of barium-calcium titanates obtained by the microwave-assisted hydrothermal method (MAH)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

DFT study of the water-assisted tautomerization process between hydrated oxide, MO(H2O)(+), and dihydroxide, M(OH)(2)(+) cations (M = V, Nb and Ta)

Density functional theory (DFT) calculations point out that the participation of water can effectively lower the barrier height for the isomerization process between hydrated oxide cation, MO(H2O)(+), and dihydroxide cation, M(OH)(2)(+), (M = V, Nb and Ta). The catalytic effect is achieved by a water-assisted mechanism in which water acts as proton donor and acceptor, via a transition structure corresponding to a six-membered ring. In the case of vanadium atom, the presence of two water molecules has been taken into account and the tautomerization becomes nearly barrierless, decreasing both the stability of the transition structures relative to intermediates and the depths of wells associated with the intermediates. (C) 2003 Elsevier B.V. All rights reserved.

Structural and optical properties of CaTiO3 perovskite-based materials obtained by microwave-assisted hydrothermal synthesis: An experimental and theoretical insight

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)