BibMe Free Bibliography Citation Maker MLA, APA, Chicago, Harvard. Private Parts is the first book written by American radio personality Howard Stern. Released on October 7, 1993 by Simon Schuster, it is the fastestselling book in. In approximately 95 of children with Down syndrome, the condition is sporadic because of nonfamilial trisomy 21, in which there are 47 chromosomes with a free extra. What Is the Governments Role in US Health Care HBS Working Knowledge. Summing Up. This months exchange of ideas regarding U. S. healthcare reform ranged far and wide. Some of us were interested primarily in the issue of cost escalation and how to contain it. Others addressed issues of quality. For still others, it was a matter of inequality of treatment. If this is a microcosm of current concerns and suggested solutions, does it bode well for the formation of a consensus, political or otherwise, leading to progress But a number of respondents raised the question of whether the most feasible solution may lie primarily in the free market, with perhaps some help from government. Private Parts Howard Stern Pdf Free' title='Private Parts Howard Stern Pdf Free' />Suggestions of causes of the current challenge of rapidly rising costs in relation to quality of outcomes, at least by the imperfect measure of life expectancy, included waste in the system Julie Maire, Edward Hare, and Jack Flanagan as well as fraud Kate Mc. Clelland, risk avoidance on the part of physicians, a litigious society, and inadequate protection from it for physicians Rowland Freeman, defensive medicine leading to unnecessary tests and treatments, an insurance system that is costly and inadequate for those who really need it Amar Sahay and David Albert Newman, the high cost of new technology, artificial restrictions on the supply of drugs Sergey Mirkiin and healthcare providers David Stahl and Michael Robbins, the size and complexity of the problem itself James Sullivan, government involvement Paul Jackson, and uninformed or unnecessarily needy consumers Hakan Hillerstrom. In addition to these issues, Elizabeth Benbrooks reminds us that healthcare comes freighted with a host of fundamental moral, ethical, and emotional issues that simply dont exist for other industries. Perhaps this is why Hakeem Yesufu asserted, I am an ardent free market capitalist who realizes capitalism has no place in healthcare provision. But Tery Tennant asks what is perhaps the ultimate philosophical question when did an individuals medical needs become an inalienable right that the government has to insureA number of responses suggested various free market mechanisms for addressing these issues. Where to start Paul Jackson suggests that The only thing the government should be involved with is controlling the drug, insurance, and medical industry advertising spending which would bring down costs. On the other hand, Wayne Baldwin argued that Containing costs will come at the expense of something technological advances, profit, access to certain services, and patient choice are likely candidates. One line of thinking would make both talent and drugs more competitive. Sergey Merkin asks, Why not open the country to foreign medications In citing the need for more doctors and nurses, David Stahl comments that it could be a way to help open immigration in this country. Michael Robbins adds, Healthcare has been a closed guild. David Othmer cited the maze of regulations that keep, for example, nurses from using all their skills in providing basic healthcare. And Hakan Hillerstrom implied that consumer education and choice may be an important response to many of these challenges. In spite of the issues complexity, Richard Fallis offered the observation that Reform is coming because Wal Mart and GM want it. He thinks it could come in the form of a Two Percent Solution in which everyone would pay 2 percent of their income to be held by the Government for their healthcare, with competition maintained through private providers and the bills of those unable to contribute paid by the Government. Keith Butler believes that it could come in the form of a two tiered system of private treatment at personal expense layered on a service free to all with protections for healthcare givers and the elimination of third party insurance. Are these the free market answers weve been waiting forWhat do you think Original Article. Healthcare will grab more and more headlines in the U. S. in the coming months. Any service that is on track to consume 4. Business management already feels the effects of healthcare costs more acutely than most consumers. Several recent studies and proposals shed light on the problem and possible solutions. They leave us with questions, too. To put things in perspective, U. TAKE JUDICIAL NOTICE This public record is an opinion published under Freedom of the Press by the registered publisher Inside on the Outside and includes tiered. Torrentz will always love you. Farewell. 20032016 Torrentz. S. healthcare currently costs about 2 trillion per year. Of this, more than 6. It goes for administration. On a per capita basis, it is roughly 2. U. S., all of whom have some form of taxpayer financed, single payer system, the kind that used to be referred to by detractors as socialized medicine. Worse yet, the current system leaves more than 4. Americans without health insurance. Because many are not employed or have very low incomes, programs that provide incentives through employers and tax relief dont help them. With this much room for possible improvement, the incentives should be sufficient to foster changes in behavior. A recent Mc. Kinsey study estimates that more than half of the 9. Private Parts Howard Stern Pdf Free' title='Private Parts Howard Stern Pdf Free' />Its estimate does not include the costs of sorting out acceptable applicants or denying payments under existing policies, another substantial amount. And it does not include the costs that doctors and hospitals incur in denying applications for payment, often in the form of payments to consultants who specialize in this kind of responsibility shifting activity. By contrast, Mc. Kinsey estimates that it would cost only 7. Americas uninsured. If made available along with consumer education, others have suggested that all of this amount could be recouped eventually through the elimination of healthcare expenses incurred by those unable to pay now. Now comes Robert Frank, a Cornell economist, who has proposed ways of overcoming opposition to some kind of government and therefore taxpayer funded solution to the problem. Microsoft Visual Studio 2008 Express PORTABLE: Full Version Free Software Download. He has put his finger on the two main obstacles to major change in the current system, insurance company opposition and higher taxes. He suggests that insurance companies, who have acted in good faith to respond to incentives provided by the market, could be subsidized for their losses while their managements shift their health insurance strategies, perhaps to provide only supplemental private coverage. A portion of the 2. He proposes that the other obstacle, higher taxes, could be overcome through an effort to educate the public about the long term economic benefits of such a move. How his proposal would fare in the face of previous failures is a real question. Given their magnitude, failure to solve these problems in the U. S. could have global economic impact. But are we addressing them with the creativity they deserve For example, to combat opposition to a tax increase, could tax credits for later use when savings kick in be issued to individuals and businesses in the amounts by which their taxes are increasedTo provide universal insurance, could the government provide vouchers along with consumer oriented education to all uninsured to be used at their discretion for their own care In other words, could a consumer driven solution be combined with a single payer system What can the U. S. What is the governments role in U. S. healthcare What do you thinkTo Read More Robert H. Frank, A Health Care Plan So Simple, Even Stephen Colbert Couldnt Simplify It, The New York Times, February 1. C3. He is the author of a book, The Economic Naturalist, to be published this spring. Mc. Kinsey Co., Accounting for the Cost of Health Care in the United States, January 2. Health Supervision for Children With Down Syndrome From the American Academy of Pediatrics. Abstract. These guidelines are designed to assist the pediatrician in caring for the child in whom a diagnosis of Down syndrome has been confirmed by chromosome analysis. Although a pediatricians initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given a prenatal diagnosis of Down syndrome will be referred for review of the condition and the genetic counseling provided. Therefore, this report offers guidance for this situation as well. INTRODUCTIONChildren with Down syndrome have multiple malformations, medical conditions, and cognitive impairment because of the presence of extra genetic material from chromosome 2. Although the phenotype is variable, there typically are multiple features that enable the experienced clinician to suspect the diagnosis. Among the more common physical findings are hypotonia, small brachycephalic head, epicanthal folds, flat nasal bridge, upward slanting palpebral fissures, Brushfield spots, small mouth, small ears, excessive skin at the nape of the neck, single transverse palmar crease, and short fifth finger with clinodactyly and wide spacing, often with a deep plantar groove between the first and second toes. The degree of cognitive impairment is variable and may be mild IQ of 5. IQ of 3. 55. 0, or occasionally severe IQ of 2. There is a significant risk of hearing loss 7. Hirschsprung disease lt 1 Table 1. The social quotient may be improved with early intervention techniques, although the level of function is exceedingly variable. Children with Down syndrome often function more effectively in social situations than would be predicted on the basis of cognitive assessment results. TABLE 1. Medical Problems Common in Down Syndrome. APPENDIX 1. Health Supervision for Children With Down Syndrome. In approximately 9. Down syndrome, the condition is sporadic because of nonfamilial trisomy 2. In approximately 3 to 4 of persons with the Down syndrome phenotype, the extra chromosomal material is the result of an unbalanced translocation between chromosome 2. Approximately three quarters of these unbalanced translocations are de novo, and the remainder result from familial translocations. If the child has a translocation, a balanced translocation must be excluded in the parents. When there is a translocation in a parent, additional familial studies and genetic counseling should be provided. In the remaining 1 to 2 of persons with the Down syndrome phenotype, a mix of 2 cell lines is present one normal and the other with trisomy 2. This condition is called mosaicism. Persons with mosaicism may be more mildly affected than persons with complete trisomy 2. Recurrence risks for families with an affected child depend on many factors, and families benefit from counseling by a clinical genetic professional. Medical management, home environment, early intervention, education, and vocational training can significantly affect the level of functioning of children and adolescents with Down syndrome and facilitate their transition to adulthood. The following outline is designed to help the pediatrician provide care for children with Down syndrome and their families in the medical home. It is organized by the issues that need to be addressed in various age groups see Appendix 1. Several areas require ongoing assessment throughout childhood and should be reviewed at every physician visit and at least annually. These areas include. Down syndromerelated medical and developmental conditions financial and medical support programs for which the child and family may be eligible injury and abuse prevention with special consideration of developmental skills andnutrition and activity to maintain appropriate weight. THE PRENATAL VISITThe American College of Obstetricians and Gynecologists recommends that all pregnant women, regardless of age, be offered the option of diagnostic testing for Down syndrome and consider less invasive screening options. Screening options have improved significantly with the introduction of first trimester screening, which incorporates maternal age, nuchal translucency ultrasonography, and measurement of maternal serum human chorionic gonadotropin h. CG and pregnancy associated plasma protein A PAPP A. Second trimester screening is available for patients who first seek medical care in the second trimester or in locations where first trimester screening is not available. The second trimester screening, often called the quad screen, incorporates maternal age risk with measurement of maternal serum h. CG, unconjugated estriol, fetoprotein AFP, and inhibin levels. The detection rate of Down syndrome by first trimester screening is 8. These screening tests are reported to have a 5 false positive rate. Pediatricians may be asked to counsel a family whose fetus has been identified with or is at increased risk of Down syndrome. In some settings, the pediatrician may be the primary resource for counseling. At other times, counseling may have been provided for the family by a certified genetic counselor, a clinical geneticist, obstetrician, or developmental behavioral pediatrician. In addition, parents may have received information from a Down syndrome program, a national Down syndrome organization, or an Internet site. Because the pediatrician often has a previous relationship with the family, he or she should be prepared to review this information and assist in the decision making process. When asked, the pediatrician should discuss the following topics with the family. The prenatal laboratory studies that lead to the diagnosis and any fetal imaging studies that have been or will be performed. The mechanism for occurrence of the disorder in the fetus and the potential recurrence rate for the family as provided by genetic counseling. The prognosis and phenotypic manifestations, including the wide range of variability seen in infants and children with Down syndrome. Families benefit from hearing a fair and balanced perspective, including the many positive outcomes of children with Down syndrome and their effect on the family. Any additional studies performed that may refine the estimation of the prognosis eg, fetal echocardiogram, ultrasonographic examination for gastrointestinal tract malformations. Consultation with an appropriate medical subspecialist, such as a pediatric cardiologist or a pediatric surgeon, should occur prenatally if abnormal findings are detected. Currently available treatments and interventions. This discussion needs to include the efficacy, potential complications and adverse effects, costs, and other burdens associated with treatments. Discuss early intervention resources, parent support programs, and any appropriate future treatments. The options available to the family for management and rearing of the child should be discussed using a nondirective approach. In cases of early prenatal diagnosis, this may include discussion of pregnancy continuation or termination, raising the child in the family, foster care placement, and adoption. Availability of genetic counseling or meeting with a genetics professional. If the pregnancy is continued. Develop a plan for delivery and neonatal care with the obstetrician and the family. As the pregnancy progresses, additional studies should be performed if available, if recommended by subspecialty consultants, andor if desired by the family for modifying this management plan eg, detection of a complex heart defect by echocardiography. Offer parent to parent contact and information about local and national support organizations. Offer referral to a clinical geneticist for a more extended discussion of clinical outcomes and variability, recurrence rates, future reproductive options, and evaluation of the risks for other family members. HEALTH SUPERVISION FROM BIRTH TO 1 MONTH NEWBORN INFANTSExamination.