952 resultados para third party payers


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This 30-year-old woman presented with clinical symptoms and signs of intracranial hypertension and Parinaud syndrome secondary to ventriculoperitoneal shunt dysfunction. Magnetic resonance (MR) imaging revealed gross triventricular hydrocephalus with a large suprapineal recess due to aqueductal stenosis. Using an endoscopic approach, a ventriculostomy was performed within the floor of the dilated suprapineal recess. Following this procedure the patient experienced alleviation of all her neurological symptoms and signs. Postoperative MR imaging and cerebrospinal fluid flow studies demonstrated a functioning ventriculostomy. The anatomy of the suprapineal recess and its suitability for endoscopic ventriculostomy are discussed.

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The Spanish automobile industry had a late start. Although the country proved capable of short production runs of high-quality vehicles during the first third of the century it never managed to build up its own industry, unlike Great Britain, France, or Italy. What then, were the critical shortcomings that prevented the establishment of large Spanish motor manufacturers? Put another way, why did all of the companies set up during the first half-century fail to survive? This paper attempts to shed some light on these questions, employing a wide-ranging analysis of both internal and external factors affecting the industry. A feeble internal market, lack of resources and production factors are usually adduced as reasons, as are Spain's general economic backwardness and the role played by the public authorities. However, this paper mainly focuses on the internal factors concerning company strategy and organisation. A comparison with the Italian case helps put the traditional arguments in proper perspective and highlights those covering business strategies. Finally, we argue that a broad range of factors needs to be analysed to fully understand why Spain failed to establish a motor industry.

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The aim of this paper is to assess whether cost-containment has beenaffected by recent pharmaceutical reimbursement reforms that have beenintroduced in the Spanish health care system over the period 1996-2002,under the conservative Popular Party government. Four main reimbursementpolicies can be observed in the Spanish pharmaceutical market after1996, each of them largely unintegrated with the other three. First, asecond supplementary negative list of excluded pharmaceutical productswas introduced in 1998. Second, a reference pricing system wasintroduced in December 2000, with annual updating and enlargement.Third, the pharmacies payment system has moved from the traditionalset margin on the consumer price to a margin that varies according tothe consumer price of the product, the generic status of the product,and the volume of sales by pharmacies. And fourth, general agreementsbetween the government and the industry have been reached with costcontainment objectives. In the final section of this paper we presentan overall assessment of the impact of these pharmaceuticalreimbursement policies on the behaviour of the agents in thepharmaceutical market.

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Description of the third larval instar and pupa of Geniates barbatus Kirby (Coleoptera, Scarabaeidae, Rutelinae). The last larval instar and pupa of the Neotropical Geniatini Geniates barbatus Kirby, 1819 are described and illustrated. Biological notes and a key to the third instar larvae of Neotropical Rutelinae are also provided.

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Description of the third instar larvae of five species of Cyclocephala (Coleoptera, Melolonthidae, Dynastinae) from Mexico. Larvae of four species of Cyclocephala are described for the first time based on specimens collected in Mexican localities: C. barrerai Martínez, 1969 from Puebla, C. sinaloae Howden & Endrödi, 1966 from Sinaloa, C. fasciolata Bates, 1888 from Veracruz, and C. jalapensis Casey, 1915 from Hidalgo. Larva of C. lunulata Burmeister, 1847, is redescribed based on specimens from the Mexican states of Morelos, Puebla, and Veracruz. Diagnostic structures are illustrated and the differences and similarities of each species with other previously described larvae of the genus are commented.

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Selostus: Sian kasvuominaisuuksien perinnölliset tunnusluvut arvioituna kolmannen asteen polynomifunktion avulla

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BACKGROUND--Oesophageal motor abnormalities have been reported in alcoholism. AIM--To investigate the effects of chronic alcoholism and its withdrawal on oesophageal disease. PATIENTS--23 chronic alcoholic patients (20 men and three women; mean age 43, range 23 to 54). METHODS--Endoscopy, manometry, and 24 hour pH monitoring 7-10 days and six months after ethanol withdrawal. Tests for autonomic and peripheral neuropathy were also performed. Motility and pH tracings were compared with those of age and sex matched control groups: healthy volunteers, nutcracker oesophagus, and gastro-oesophageal reflux disease. RESULTS--14 (61%) alcoholic patients had reflux symptoms, and endoscopy with biopsy showed oesophageal inflammation in 10 patients. One patient had an asymptomatic squamous cell carcinoma. Oesophageal motility studies in the alcoholic patients showed that peristaltic amplitude in the middle third was > 150 mm Hg (95th percentile (P95) of healthy controls) in 13 (57%), the ratio lower/ middle amplitude was < 0.9 in 15 (65%) (> 0.9 in all control groups), and the lower oesophageal sphincter was hypertensive (> 23.4 mm Hg, P95 of healthy controls) in 13 (57%). All three abnormalities were present in five (22%). Abnormal reflux (per cent reflux time > 2.9, P95 of healthy controls) was shown in 12 (52%) alcoholic patients, and was unrelated to peristaltic dysfunction. Subclinical neuropathy in 10 patients did not effect oesophageal abnormalities. Oesophageal motility abnormalities persisted at six months in six patients with ongoing alcoholism, whereas they reverted towards normal in 13 who remained abstinent; reflux, however, was unaffected. CONCLUSIONS--Oesophageal peristaltic dysfunction and reflux are frequent in alcoholism. High amplitude contractions in the middle third of the oesophagus seem to be a marker of excessive alcohol consumption, and tend to improve with abstinence.

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AbstractThis article demonstrates the importance of Angela Carter's translations of Charles Perrault's contes into English and argues for their profound influence on her subsequent literary career. Against feminist critics who rejected fairy tales as conservative and informed by patriarchal structures and values, Carter reclaimed Perrault for feminism by recovering the critical edge and emancipating potential of his Histoires ou contes du temps passé, Avec des Moralités. This essay shows, through a comparative reading of "La Belle au bois dormant" and "The Sleeping Beauty in the Wood," that Carter opposed the worldly "politics of experience" that she found in Perrault to the Disneyfied imagery of the Sleeping Beauty myth and modernized the critique of early marriages already contained in Perrault's Moralités. The subversive power of Carter's work, therefore, is not directed against Perrault but rather toward cultural and commercial appropriations of the fairy tale, which promote a naïve view of marriage.Recommended CitationHennard Dutheil de la Rochère, Martine. ""But marriage itself is no party": Angela Carter's Translation of Charles Perrault's "La Belle au bois dormant"; or, Pitting the Politics of Experience against the Sleeping Beauty Myth." Marvels & Tales 24.1 (2010).

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Voting Advice Applications (VAAs) have become a central component of election campaigns worldwide. Through matching political preferences of voters to parties and candidates, the web application grants voters a look into their political mirror and reveals the most suitable political choices to them in terms of policy congruence. Both the dense and concise information on the electoral offer and the comparative nature of the application make VAAs an unprecedented information source for electoral decision making. In times where electoral choices are found to be highly individualized and driven by political issue positions, an ever increasing number of voters turn to VAAs before casting their ballots. With VAAs in high demand, the question of their effects on voters has become a pressing research topic. In various countries, survey research has been used to proclaim an impact of VAAs on electoral behavior, yet practically all studies fail to provide the scientific evidence that would allow for making such claims. In this thesis, I set out to systematically establish the causal link between VAA use and electoral behavior, using various data sources and appropriate statistical techniques in doing so. The focus lies on the Swiss VAA smartvote, introduced in the forefront of the 2003 Swiss federal elections and meanwhile an integral part of the national election campaign, smartvote has produced over a million voting recommendations in the last Swiss federal elections to an active electorate of two million, potentially guiding a vast amount of voters in their choices on the ballot. In order to determine the effect of the VAA on electoral behavior, I analyze both voting preferences and choice among Swiss voters during two consecutive election periods. First, I introduce statistical techniques to adequately examine VAA effects in observational studies and use them to demonstrate that voters who used smartvote prior to the 2007 Swiss federal elections were significantly more likely to swing vote in the elections than non- users. Second, I analyze preference voting during the same election and show that the smartvote voting recommendation inclines politically knowledgeable voters to modify their ballots and cast candidate specific preference votes. Third, to further tackle the indication that smartvote use affects the preference structure of voters, I employ an experimental research design to demonstrate that voters who use the application tend to strengthen their vote propensities for their most preferred party and adapt their overall party preferences in a way that they consider more than one party as eligible vote options after engaging with the application. Finally, vote choice is examined for the 2011 Swiss federal election, showing once more that the VAA initiated a change of party choice among voters. In sum, this thesis presents empirical evidence for the transformative effect of the Swiss VAA smartvote on the electoral behavior.

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[cat] En aquest treball es presenta un model eclèctic que sistematitza la dinàmica de les crisis que s’autoconfimen, usant els principals aspectes de les tres tipologies dels models de crisis canviàries de tercera generació, amb la finalitat de descriure els fets que precipiten la renúncia al manteniment d’una paritat fixada. Les contribucions més notables són les implicacions per a la política econòmica, així com la pèrdua del paper del tipus de canvi com instrument d’ajust macroeconòmic, quan els efectes de balanç són una possibilitat real.