The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Effects of a positive emotion-based adjuvant psychological therapy in colorectal cancer patients: a pilot study

Objective: To examine the effectiveness of an “Enhancing Positive Emotions Procedure” (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up.Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient’s assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales.Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource.Conclusions: CRC patients receiving EPEP during chemotherapy believed that this intervention was important. Furthermore, EPEP seems to improve positive affect and quality of life. EPEP has potential benefits, and its implementation to CRC patients should be considered.

Bienestar psicológico, optimismo y resiliencia en mujeres con cáncer de mama

Objective: To evaluate the relationship between Perceived Psychological well-being, Optimism and Resilience in women survivors of breast cancer.Method: The sample was composed of 30 women diagnosed with breast cancer who were undergoing adjuvant treatment in Oncology Units General Hospital of Jerez de la Frontera and the University Hospital Puerta del Mar (Cadiz). The average age was 47.47 years (SD = 6,356) and the average of months from diagnosis of the disease was 9.93 (SD = 8,541). Scale of Psychological Well-being administered Perceived Ryff (1989), the Life Orientation Test Revised (LOT-R) Scheier, Carver and Bridges (1994) and the Scale of Resilience Wagnild and Young (1993) to assess psychological well-being the dispositional optimism and resilience respectivelyResults: Descriptive analyzes show that women diagnosed with breast cancer have levels of psychological well-being, dispositional optimism and higher than the average values provided by Resilience scales. On the other hand, regression analyses revealed that only some of the dimensions of resilience allowed to explain and predict some dimensions of psychological wellbeing, not dispositional optimism.Conclusions: The results seem to confirm the idea that if the capacity of women with breast moderate negative affect generated by the diagnosis itself and the consequences of their cancer treatment works and to promote their adaptation to the new situation we can contribute to increasing psychological well-being.

Feeding of larval sardine Sardina pilchardus (Walbaum) off the north coast of Spain

In April and May 1991 and between March and June 1992 data regarding the diet of larval S. pilchardus in relation to food availability was gathered. Interpretation of results is compromised by the tendency of sardine larvae to defecate their gut contents during sampling. The most common food organisms in the guts (78-89%) were the developmental stages of copepods (eggs, nauplii and copepodites). Percentage composition of copepod nauplii in the diet decreased with increasing larval size, while copepodites increased. There was no consistent relationship between food availability and feeding success, probably because feeding conditions were generally adequate.

Colectivos sociales y ciborgs: hacia una lectura feminista de los drones

Este artículo analiza el papel de los drones en la emergencia de nuevas formas de participación política e impugnación del poder por parte de colectivos sociales. El artículo plantea una lectura feminista de los drones como ciborgs (humanos-máquinas) para explorar las agencias distribuidas entre actores humanos y no humanos con el propósito de visibilizar las relaciones de poder y analizar la configuración de contra-realidades. Se presentan ocho casos de colectivos sociales que, con la ayuda de un dron, disputan el poder de gobiernos, empresas transnacionales además de desempeñar innovadoras intervenciones públicas.

Exchange protein directly activated by cyclic AMP (EPAC) activation reverses neutrophil dysfunction induced by β2-agonists, corticosteroids, and critical illness

Background Neutrophils play a role in the pathogenesis of asthma, chronic obstructive pulmonary disease, and pulmonary infection. Impaired neutrophil phagocytosis predicts hospital-acquired infection. Despite this, remarkably few neutrophil-specific treatments exist. 

Objectives We sought to identify novel pathways for the restoration of effective neutrophil phagocytosis and to activate such pathways effectively in neutrophils from patients with impaired neutrophil phagocytosis. 

Methods Blood neutrophils were isolated from healthy volunteers and patients with impaired neutrophil function. In healthy neutrophils phagocytic impairment was induced experimentally by using β₂-agonists. Inhibitors and activators of cyclic AMP (cAMP)-dependent pathways were used to assess the influence on neutrophil phagocytosis in vitro. 

Results β₂-Agonists and corticosteroids inhibited neutrophil phagocytosis. Impairment of neutrophil phagocytosis by β₂-agonists was associated with significantly reduced RhoA activity. Inhibition of protein kinase A (PKA) restored phagocytosis and RhoA activity, suggesting that cAMP signals through PKA to drive phagocytic impairment. However, cAMP can signal through effectors other than PKA, such as exchange protein directly activated by cyclic AMP (EPAC). An EPAC-activating analog of cAMP (8CPT-2Me-cAMP) reversed neutrophil dysfunction induced by β₂-agonists or corticosteroids but did not increase RhoA activity. 8CPT-2Me-cAMP reversed phagocytic impairment induced by Rho kinase inhibition but was ineffective in the presence of Rap-1 GTPase inhibitors. 8CPT-2Me-cAMP restored function to neutrophils from patients with known acquired impairment of neutrophil phagocytosis. 

Conclusions EPAC activation consistently reverses clinical and experimental impairment of neutrophil phagocytosis. EPAC signals through Rap-1 and bypasses RhoA. EPAC activation represents a novel potential means by which to reverse impaired neutrophil phagocytosis.