A Turbulent Opposition: The ACA and the South

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network ---- with 36 states and 61 researchers ---- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.The South is often been portrayed as being resistant to "Obamacare." It is from many of these states that legal challenges were filed against the Patient Protection and Affordable Care Act (ACA) after its enactment. Rather than operate their own exchanges, many southern states have defaulted to the federal health insurance exchange. Most have refused or deferred on Medicaid expansion. Some states have employed obstructionist tactics to complicate enrollment assistance provided by navigators and others. What accounts for this posture? Electoral politics and ideological differences among the parties certainly play roles. But as our preliminary research indicates, there are other factors as well that reflect ambivalence, caution, and uncertainty about state administrative and fiscal capacity, health demographics, and market conditions. Through the review of nine state-level field reports conducted under the auspices of the Managing Health Reform research network and through analysis of other relevant literature and data, this report concentrates on the intensity and sources of opposition within the southern states towards the ACA

West Virginia: Round 1 - State Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.As noted throughout this report, West Virginia's experience is a tale of two reforms or experiences. The state has adopted a hands-off, but nonhostile, posture toward the health insurance exchange. Unique policy and political dynamics contributed to the state first embracing the concept of its own exchange and then moving toward a very passive role in a state-federal partnership. In contrast, the state has been proactive in reaching out and enrolling those newly eligible under Medicaid expansion. As ACA implementation gains traction and best practices are discovered and shared, West Virginia's aggressive approach of utilizing SNAP enrollment lists as a means of reaching potential Medicaid applicants may be one of those stories that come to the fore

Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD

Rationale and design of the Clinical Evaluation of Magnetic Resonance Imaging in Coronary heart disease 2 trial (CE-MARC 2): a prospective, multicenter, randomized trial of diagnostic strategies in suspected coronary heart disease

Background: A number of investigative strategies exist for the diagnosis of coronary heart disease (CHD). Despite the widespread availability of noninvasive imaging, invasive angiography is commonly used early in the diagnostic pathway. Consequently, approximately 60% of angiograms reveal no evidence of obstructive coronary disease. Reducing unnecessary angiography has potential financial savings and avoids exposing the patient to unnecessary risk. There are no large-scale comparative effectiveness trials of the different diagnostic strategies recommended in international guidelines and none that have evaluated the safety and efficacy of cardiovascular magnetic resonance.<p></p> Trial Design: CE-MARC 2 is a prospective, multicenter, 3-arm parallel group, randomized controlled trial of patients with suspected CHD (pretest likelihood 10%-90%) requiring further investigation. A total of 1,200 patients will be randomized on a 2:2:1 basis to receive 3.0-T cardiovascular magnetic resonance–guided care, single-photon emission computed tomography–guided care (according to American College of Cardiology/American Heart Association appropriate-use criteria), or National Institute for Health and Care Excellence guidelines–based management. The primary (efficacy) end point is the occurrence of unnecessary angiography as defined by a normal (>0.8) invasive fractional flow reserve. Safety of each strategy will be assessed by 3-year major adverse cardiovascular event rates. Cost-effectiveness and health-related quality-of-life measures will be performed.<p></p> Conclusions: The CE-MARC 2 trial will provide comparative efficacy and safety evidence for 3 different strategies of investigating patients with suspected CHD, with the intension of reducing unnecessary invasive angiography rates. Evaluation of these management strategies has the potential to improve patient care, health-related quality of life, and the cost-effectiveness of CHD investigation

The early stages of heart development: insights from chicken embryos

The heart is the first functioning organ in the developing embryo and the detailed understanding of the molecular and cellular mechanisms involved in its formation provides insights into congenital malformations affecting its function and therefore the survival of the organism. Because many developmental mechanisms are highly conserved, it is possible to extrapolate from observations made in invertebrate and vertebrate model organisms to human. This review will highlight the contributions made through studying heart development in avian embryos, particularly the chicken. The major advantage of chick embryos is their accessibility for surgical manipulations and functional interference approaches, both gain- and loss-of-function. In addition to experiments performed in ovo, the dissection of tissues for ex vivo culture, genomic or biochemical approaches, is straightforward. Furthermore, embryos can be cultured for time-lapse imaging, which enables tracking of fluorescently labeled cells and detailed analyses of tissue morphogenesis. Owing to these features, investigations in chick embryos have led to important discoveries, often complementing genetic studies in mouse and zebrafish. As well as including some historical aspects, we cover here some of the crucial advances made in understanding of early heart development using the chicken model

Taxonomy of segmental myocardial systolic dysfunction.

The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms 'viable' and 'hibernating' are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction

A pedagogia de alternância enquanto possibilidade

A Pedagogia da Alternância é um sistema de ensino complexo que propõe oferecer formação integral e contribuir ao desenvolvimento do meio, atendendo a necessidades educacionais de determinados grupos sociais. O método de investigação deste ensaio é a pesquisa bibliográfica, discutindo as bases da Pedagogia da Alternância enquanto sistema de educação. Busca-se um diálogo com os principais conceitos da Pedagogia da Alternância apresentados por Jean-Claude Gimonet, a Pedagogia de Paulo Freire e o Pensamento Complexo de Edgar Morin para entender por que as Casas Familiares Rurais se expandem pelo Brasil, contribuindo para a permanência dos jovens no meio rural, consolidando suas profissões e sua vida como agricultoresThe Pedagogy of Alternation is a complex education system that proposes to offer comprehensive training and contribute to the development of the medium, serving the educational needs of specific social groups. The research method of this paper is the literature, discussing the bases while the Pedagogy of Alternation education system. Looking up a dialogue with the main concepts of the Pedagogy of Alternation presented by Jean-Claude Gimonet, Paulo Freire's Pedagogy and Complex Thinking of Edgar Morin to understand why the Rural Family Houses expand in Brazil, contributing to the permanence of youth in rural areas, consolidating their professions and their lives as farmer