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Biomedical subjects

A Liberman

Publications and source records attributed to A Liberman.

At least 19 recordsLinked to original sources
PubMed2004

Effects of dietary restriction and metal supplementation on the accumulation of iron-laden glial inclusions in the aging rat hippocampus.

The mechanisms responsible for the pathological deposition of iron and other redox-active metals in the aging and degenerating mammalian CNS remain poorly understood. We previously demonstrated that normal aging and pharmacological (oxidative) stressors promote the transformation of astroglial mitochondria to iron-laden, diaminobenzidine (DAB)-positive cytoplasmic inclusions in sub-cortical regions of the rat brain. In the current study, we demonstrate that (1) numbers of DAB-positive glial granules in the rat dorsal hippocampus, an area implicated in learning and memory, progressively increase between 3, 12 and 22 months of age; (2) dietary restriction (40%), a manipulation that attenuates many mammalian aging processes, has no effect on the age-related accumulation of these gliosomes in the rat hippocampus; and (3) the latter can be accelerated by dietary supplementation of iron and copper. Our data support the view that dietary exposure to iron and/or copper in adult life can impact the sequestration of redox-active metals in aging hippocampal astroglia.

Aging↗
PubMed2003

Screening colonoscopy in the asymptomatic 50- to 59-year-old population.

BACKGROUND: In an effort to decrease the death rate from colorectal cancer, a multitude of medical societies and task forces recommend routine screening for colorectal cancer beginning at age 50. Yet, there is no consensus as to the best and most cost-effective screening method. Medicare now pays for screening colonoscopies for its average risk beneficiaries [3]. Many insurance companies, however, will not cover this test in younger patients. We therefore reviewed our institution's colonoscopy experience with asymptomatic 50- to 59-year-olds, with negative fecal occult blood tests and negative family histories. METHODS: Between January 1999 and January 2002, 4779 colonoscopies were performed at our institution. The charts for 619 persons 50-59 years of age were retrospectively reviewed, with 91 patients meeting the strict requirements of this study. We defined polyps with high-grade neoplasias as those with villous or tubulovillous components, and cancerous lesions included those with carcinoma in situ. The distal colon was defined as the rectum and sigmoid colon. RESULTS: There was a 58% incidence of neoplastic polyps in this younger asymptomatic population. More than 4% of our subjects had high-grade neoplasias or cancerous lesions. In the absence of any distal findings, flexible sigmoidoscopy would have missed up to 38% of these polyps. CONCLUSIONS: The findings generally support the recommendations by the American College of Gastroenterology for average-risk patients to preferentially undergo a screening colonoscopy at age 50 in lieu of other methods.

Adenocarcinoma↗
PubMed2002

Role of heme oxygenase-1 in the biogenesis of corpora amylacea.

Corpora amylacea (CA) are glycoproteinaceous inclusions that accumulate in the human brain during normal aging and to a greater extent in Alzheimer's disease. We previously demonstrated that, in cultured rat astroglia, cysteamine (CSH) upregulates heme oxygenase-1 (HO-1) and promotes the transformation of normal mitochondria into CA-like inclusions. In the current study, primary cultures of neonatal rat astroglia were exposed to 880 micro M CSH for three months in the presence or absence of dexamethasone, a suppressor of HO-1 gene transcription. Cells were double-labeled with periodic acid-Schiff reagent (PAS) and antisera against ubiquitin, HO-1, or a mitochondrial epitope. CA were quantified and their immunostaining characteristics analyzed using confocal microscopy. HO-1 immunofluorescence was more abundant in cultures exposed to CSH alone relative to untreated control cultures and cultures exposed to both CSH and dexamethasone. Mature CA appeared as large (5-50 microM), spherical or polygonal, intensely PAS-positive inclusions within glial cytoplasm or deposited extracellularly. The inclusions manifested intense rim and, less commonly, homogeneous or stippled patterns of immunoreactivity for ubiquitin, HO-1, and the mitochondrial marker. Monolayers exposed to CSH exhibited 660% more CA relative to untreated controls (P < 0.05). Numbers of CA in cultures exposed to CSH were diminished by co-administration of 50 microg/ml dexamethasone (P < 0.05 relative to CSH alone) or 100 microg/ml dexamethasone (P < 0.05 relative to CSH alone). Numbers of CA in cultures co-treated with CSH and 50 microg/ml dexamethasone or 100 microg/ml dexamethasone were not significantly different from untreated control values. Up-regulation of HO-1 may contribute to the formation of CA in aging astroglia.

Animals↗
PubMed2001

Proinflammatory cytokines promote glial heme oxygenase-1 expression and mitochondrial iron deposition: implications for multiple sclerosis.

Proinflammatory cytokines, pathological iron deposition, and oxidative stress have been implicated in the pathogenesis of multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE). HO-1 mRNA levels and mitochondrial uptake of [(55)Fe]Cl(3)-derived iron were measured in rat astroglial cultures exposed to interleukin-1beta (IL-1beta) or tumor necrosis factor-alpha (TNF-alpha) alone or in combination with the heme oxygenase-1 (HO-1) inhibitors, tin mesoporphyrin (SnMP) or dexamthasone (DEX), or interferon beta1b (INF-beta). HO-1 expression in astrocytes was evaluated by immunohistochemical staining of spinal cord tissue derived from MS and control subjects. IL-1beta or TNF-alpha promoted sequestration of non-transferrin-derived (55)Fe by astroglial mitochondria. HO-1 inhibitors, mitochondrial permeability transition pore (MTP) blockers and antioxidants significantly attenuated cytokine-related mitochondrial iron sequestration in these cells. IFN-beta decreased HO-1 expression and mitochondrial iron sequestration in IL-1beta- and TNF-alpha-challenged astroglia. The percentage of astrocytes coexpressing HO-1 in affected spinal cord from MS patients (57.3% +/- 12.8%) was significantly greater (p < 0.05) than in normal spinal cord derived from controls subjects (15.4% +/- 8.4%). HO-1 is over-expressed in MS spinal cord astroglia and may promote mitochondrial iron deposition in MS plaques. In MS, IFN-beta may attenuate glial HO-1 gene induction and aberrant mitochondrial iron deposition accruing from exposure to proinflammatory cytokines.

Animals↗
PubMed2001

An RBRVS approach to financial analysis in health care organizations.

Resource-based relative value scales (RBRVS) have altered the outpatient reimbursement system of America's health care system and established a method of standardization whereby the efficiency of medical practices of varying size and complexity can be compared using a standard (the cost conversion factor) for analysis. This article compares the utility of RBRVS with earlier systems of reimbursement and concludes with a brief speculative assertion regarding the emergence of the next stage of ambulatory care reimbursements through ambulatory payment classifications.

Costs and Cost Analysis↗
PubMed2001

The media's perspectives of health care fraud and abuse--an objective assessment.

The media make it seem that greedy health care professionals are perpetrating a widespread conspiracy to defraud the Medicare trust fund of billions of taxpayer dollars. However, the media often underreport another side to the health care fraud and abuse issue-the flawed, inordinately complex, and ill-equipped Medicare payment system itself. It is difficult to quantify the purported loss of billions of dollars to fraud or estimate the costs to the U.S. health care system of the advocated increased controls. However, this discussion serves to divert attention from key health care issues--the many Americans who are uninsured, underinsured, or lack access to care and the system's administrative complexities.

Diagnosis-Related Groups↗
PubMed2001

Marketing in today's health care environment.

The application of health care marketing is seen as a relatively recent phenomenon. Marketing is discussed as a sophisticated managerial tool that includes five critical components: product, price, place, promotion, and partners. The triumvirate of health care decision makers (i.e., patients, insurance organizations, and employers) are examined vis-à-vis these five components.

Consumer Behavior↗
PubMed2001

Ambulatory surgery outcomes: a survey of office-based delivery.

Due to a few well-publicized stories about patient injury and death, office-based ambulatory surgery has recently been thrust upon the forefront of current discussions about clinical outcomes. This has stimulated interest among ambulatory surgery stakeholders, including physicians, patients, and elected officials. An analysis of medical office-based surgical facilities in Florida indicates that office-based surgeons tend to work independently, with limited peer oversight, although as a whole, they professionally subscribe to a high level of ethical standards and offer patients an expected high quality level of clinical expertise. The results did not definitively indicate a relationship between unaccredited medical offices and unacceptable surgical procedures. The paper concludes by offering fifteen medical office standards that can aid in developing office surgery oversight policies.

Accreditation↗
PubMed2001

Constructive engagement: an integrative method of involving students in the learning process.

Providing a meaningful learning environment for each student represents a constant and ongoing challenge for faculty. This objective can be facilitated by active student participation in class interactions. The authors have developed the Constructive Engagement Method (CEM), an integrative method for actively involving students in the learning process. CEM permits students to hone interpersonal skills through the development of interrelated practical applications of critical listening and peer evaluation. The CEM approach introduces a method of student performance evaluation that has been judged as fair and equitable by almost all student participants. CEM fully involves all students, even in classes with very large enrollments. CEM as a teaching strategy utilizes a modified debate format that begins with a period of student preparation followed by a debate between two competing teams. The debate is followed by an evaluation period, during which the non-participating students practice the all-important task of determining the value of each team's investment in the process. CEM comprises five stages as follows: Phase 1--Preparation; Phase 2--Opening Statements; Phase 3--Intense Interaction; Phase 4--Closing Statements; and Phase 5--Evaluation. The CEM methodology has enjoyed strong support among graduate and undergraduate students.

Humans↗
PubMed2000

Health care alliances and alternative dispute resolution: managing trust and conflict.

The U.S. health care industry has entered an unprecedented era of alliance activity. These alliances involve medical groups and hospitals, as well as many of the newer health care entities such as managed care organizations and integrated delivery systems. The increase in organizational collaboration has resulted in an increase in organizational conflict. Alternative dispute resolution (ADR) techniques can serve as a valuable tool for mitigating this type of conflict. The role of ADR is to refocus partners' attentions away from an adversarial posture and toward a complementary existence. This will permit the partners to realize the intended outcomes of the collaboration.

Conflict, Psychological↗
PubMed2000

Objective employee assessments--establishing a balance among supervisory evaluations.

Objectivity, predictability, and consistency in a supervisor represent character traits that are recognized and appreciated by employees. When evaluating employees, these attributes assume added significance. This article outlines a methodology, the Quartile Rating Index (QRI), for objectively addressing disparities in the rating habits of various supervisors when evaluating the work of employees under their supervision.

Employee Performance Appraisal↗
PubMed2000

Pre-employment decision trees: job applicant self-election.

Human resource administration is an instrumental factor in determining the degree of organizational success. This is especially true in the labor-intensive health care industry, which uses teams of health care providers to deliver treatment and services. A key function of human resource management is recruiting, since the quality of health care treatment is positively correlated with the quality of employees. Therefore, the recruiting function can consume a disproportionate share of organizational resources. This article discusses how managers can reduce the amount of resources spent dealing with inappropriate job applicants by using the Pre-Employment Decision Tree, which directs pre-applicants to self-elect to apply or not apply, given the degree of fit between the pre-applicant and the organization.

Decision Trees↗
PubMed2000

Professional liability insurance for health care organizations--several significant considerations.

The purchase of professional liability insurance coverage represents one of the more important financial and administrative decisions in terms of managing a health services organization. This manuscript outlines a decision process for evaluating and determining the most viable option(s). Also addressed are some significant caveats in assessing the strengths and weaknesses of various coverage options.

Decision Making, Organizational↗
PubMed2000

Stakeholder management in a hyperturbulent health care environment.

The fast-paced change in today's health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.

Communication↗
PubMed2000

Medical care program compliance--a year 2000 recipient perspective of Medicare claims.

This article provides a brief assessment of patient and provider views and concerns regarding reimbursements under the Medicare program. Specifically targeted is the payment of pharmaceutical claims. Also addressed are the ongoing and respective responsibilities of individual clinical providers, associated hospitals, and recipients of care. A summation of significant results of direct interviews and follow-up discussions with 10 Medicare recipients also is provided.

Aged↗
PubMed2000

Pathologists' roles in clinical utilization management. A financing model for managed care.

In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

Health Resources↗
PubMed1999

Behavioral contract management: a prescription for employee and patient compliance.

A health care manager's responsibilities of offering efficient service while ensuring effective outcomes is hampered frequently by both employees and patients whose unacceptable behaviors are detrimental to one or both of these mandates. Behavioral contracts offer a structured method that allows both patients and employees to self-actualize the required behavioral changes. When noncompliant behavior is diagnosed, behavioral contracts are the prescription that places the responsibility for corrective action squarely on the shoulders of the offending individual.

Humans↗