Section 1115 waivers and budget neutrality: using Medicaid funds to expand coverage.
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Budgets↗
Biomedical subjects
C Milligan
Publications and source records attributed to C Milligan.
'Breaking out of the asylum': developments in the geography of mental ill-health--the influence of the informal sector.
This paper focuses on the changing role of the voluntary sector in the provision of care and support to community-based individuals with mental ill-health (MIH) in contemporary Scotland. In doing so, it reflects on the ways in which deinstitutionalisation is contributing to changing interrelationships between the formal and informal sector, the influence of the voluntary sector in the development of the locational geographies of individuals with MIH, and factors contributing to geographical variations in access and availability of voluntary sector supports. These developments are considered within the framework of the shadow state.
Community Mental Health Services↗
Peripheral target regulation of the development and survival of spinal sensory and motor neurons in the chick embryo.
Unilateral limb-bud removal (LBR) before the outgrowth of sensory or motor neurons to the leg of chick embryos was used to examine the role of limb (target)-derived signals in the development and survival of lumbar motoneurons and sensory neurons in the dorsal root ganglia (DRG). After LBR, motor and sensory neurons underwent normal initial histological differentiation, and cell growth in both populations was unaffected. Before their death, target-deprived motoneurons also expressed a cell-specific marker, the homeodomain protein islet-1. Proliferation of sensory and motor precursor cells was also unaffected by LBR, and the migration of neural crest cells to the DRG and of motoneurons into the ventral horn occurred normally. During the normal period of programmed cell death (PCD), increased numbers of both sensory and motor neurons degenerated after LBR. However, whereas motoneuron loss increased by 40-50% (90% total), only approximately 25% more sensory neurons degenerated after LBR. A significant number of the surviving sensory neurons projected to aberrant targets in the tail after LBR, and many of these were lost after ablation of both the limb and tail. Treatment with neurotrophic factors (or muscle extract) rescued sensory and motor neurons from cell death after LBR without affecting precursor proliferation of either population. Activity blockade with curare failed to rescue motoneurons after LBR, and combined treatment with curare plus muscle extract was no more effective than muscle extract alone. Treatment with the antioxidant N-acetylcysteine rescued motoneurons from normal cell death but not after LBR. Two specific inhibitors of the interleukin beta1 converting enzyme (ICE) family of cysteine proteases also failed to prevent motoneuron death after LBR. Taken together these data provide definitive evidence that the loss of spinal neurons after LBR cannot be attributed to altered proliferation, migration, or differentiation. Rather, in the absence of limb-derived trophic signals, the affected neurons fail to survive and undergo PCD. Although normal cell death and cell death after target deprivation share many features in common, the intracellular pathways of cell death in the two may be distinct.
Acetylcysteine↗
Pathways of dependence: the impact of health and social care restructuring--the voluntary experience.
The current emphasis on community over institutionally based modes of health and social care delivery in the UK, together with legislative change, has placed a renewed emphasis on the role of the informal sector in service provision. Simultaneously, there has been an attempt to modify the provider-role of the statutory sector, in favour of an evolving role as purchaser and enabler of independently provided services. Drawing on material that forms part of a 3 year study into health and social care restructuring, and its effect on the caring networks of elderly dependent populations, this paper focuses on the changing role of the voluntary sector. Using empirical material drawn from the Scottish environment, it illustrates how the restructuring process may be modifying the voluntary sector and contributing to a growth in geographical inequity in voluntary service provision. In doing so, it considers four main factors affecting local voluntary organisations--the growth of contracting, external constraints on voluntary provisioning, the influence of the local authority and Wolch's concept of the "Shadow State". It highlights the emerging social and spatial manifestations arising from such change, and how these modifications may also be contributing to a growth in geographical inequity for service recipients linked within the dependence network.
Catchment Area, Health↗
Effects of feeding and confinement on nitrogen metabolism and excretion in the gulf toadfish Opsanus beta
In order to elucidate further the cues for, and the biochemical mechanisms of, the transition to ureogenesis in the gulf toadfish Opsanus beta, experiments on the effects of feeding (i.e. nitrogen loading) were carried out. Baseline nitrogen excretion rates were first measured on solitary toadfish in large water volumes (i.e. unconfined conditions). These nitrogen excretion rates were higher, and had a higher proportion as ammonia (61 %), than previously published 'control' measurements. Feeding of unconfined toadfish elevated total nitrogen excretion approximately threefold, with little change in the proportion of urea versus ammonia. During the first 24 h of confinement of unfed toadfish, absolute levels of urea excretion remained constant while ammonia excretion rates fell to near zero, so that toadfish became 90 % ureotelic. When fed prior to confinement, urea excretion rates remained constant for the first 24 h, and the bulk of the nitrogen was excreted as ammonia (80 %); excretion of the excess dietary nitrogen took up to 48 h to complete. If pre-adapted to confinement and then fed, toadfish excreted only about 55 % of their nitrogenous waste as ammonia, and excretion of excess dietary nitrogen was completed by 24 h. Elevations of hepatic glutamine synthetase (GNS) activities accompanied confinement and were shown to be almost exclusively in the cytosolic compartment and to be correlated with a decrease in the ratio of hepatic levels of glutamate:glutamine. These GNS activity increases also appear to account in part for the decrease in the percentage of ammoniotely in toadfish under conditions of nitrogen loading after confinement. However, additional means of regulating total nitrogen excretion (e.g. changes in protein turnover rates) and the degree of ureogenesis versus ammoniogenesis (e.g. N-acetylglutamate stimulation of carbamoylphosphate synthetase) must be postulated to account fully for changes in nitrogen excretion rates and activation of ureogenesis under some circumstances.
Journal Article↗
Screening for cervical cancer.
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Colposcopy↗
Nurses' knowledge of pain management: implications for staff education.
Among the 217 nurses responding (one third of those queried), average scores on the NKAS were slightly higher (68%) than that reported in the literature but still inadequate. Nurses' greatest knowledge deficits were related to pharmacotherapeutics. Knowledge scores were uncorrelated with self-assessed level of knowledge about pain. Strategies for re-dressing these nurses' knowledge through Department of Nursing Education interventions are explored.
Adult↗