Health insurance marketplace

In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act (ACA, known colloquially as "Obamacare") at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
ACA health exchanges were fully certified and operational by January 1, 2014, under federal law. Enrollment in the marketplaces started on October 1, 2013, and continued for six months. 8.02 million people had signed up through the health insurance marketplaces. An additional 4.8 million joined Medicaid. Enrollment for 2015 began on November 15, 2014 and ended on December 15, 2014. As of April 14, 2020, 11.41 million people had signed up through the health insurance marketplaces.
Private non-ACA health care exchanges also exist in many states, responsible for enrolling 3 million people. These exchanges predate the Affordable Care Act and facilitate insurance plans for employees of small and medium size businesses.
Background.
Health insurance exchanges in the United States expand insurance coverage while allowing insurers to compete in cost-efficient ways and help them to comply with consumer protection laws. Exchanges are not themselves insurers, so they do not bear risk themselves, but they do determine which insurance companies participate in the exchange. An ideal exchange promotes insurance transparency and accountability, facilitates increased enrollment and delivery of subsidies, and helps spread risk to ensure that the costs associated with expensive medical treatments are shared more broadly across large groups of people, rather than spread across just a few beneficiaries. Health insurance exchanges use electronic data interchange (EDI) to transmit required information between the exchanges and carriers (trading partners), in particular the "834" transaction for enrollment information and the "820" transaction for premium payment.
History.
Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost. An additional advantage was the ability of small businesses to offer a range of plans to employees, allowing them to compete with larger corporations. The largest such exchange prior to the ACA is CaliforniaChoice, established in 1996. By 2000, CaliforniaChoice's membership included 140,000 individuals from 9000 business groups.
Obamacare maintained the concept of health insurance exchanges as a key component of health care. President Obama stated that it should be "a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest." Although the House of Representatives had sought a single national exchange as well as a public option, the Patient Protection and Affordable Care Act (ACA) as passed used state-based exchanges, and the public option was ultimately dropped from the bill after it did not win filibuster-proof support in the Senate. States may choose to join together to run multi-state exchanges, or they may opt out of running their own exchange, in which case the federal government will step in to create an exchange for use by their citizens.
ACA was signed into law on March 23, 2010. The law required that health insurance exchanges commence operation in every state on October 1, 2013. In the first year of operation, open enrollment on the exchanges ran from October 1, 2013, to March 31, 2014, and insurance plans purchased by December 15, 2013, began coverage on January 1, 2014. For 2015 open enrollment began on November 15, 2014 and ended on February 15, 2015.
Implementation of the individual exchanges changed the practice of insuring individuals. The expansion of this market was a major focus of ACA. Over 1.3 million people had selected plans for 2015 marketplace coverage in the first three weeks of the year's open enrollment period, including people who renewed their coverage and new customers.
As of January 3, 2014, 2 million people had selected a health plan through the health insurance marketplaces. By April 19, 2014, 8.0 million people had signed up through the health insurance marketplaces and an additional 4.8 million joined Medicaid. As of February, 2015, about 11.4 million people had signed up for or been automatically renewed for 2015 marketplace coverage. Today, more than 1,400 local outreach events have been conducted in federally facilitated marketplace states across the country.
Patient Protection and Affordable Care Act regulations.
Subsidies.
The subsidies for insurance premiums are given to individuals who buy a plan from an exchange and have a household income between 133% and 400% of the poverty line. Section 1401(36B) of PPACA explains that each subsidy will be provided as an advanceable, refundable tax credit and gives a formula for its calculation:
A refundable tax credit is a way to provide government benefits to individuals who may have no tax liability (such as the earned income tax credit). The formula was changed in the amendments (HR 4872) passed March 23, 2010, in section 1001. To qualify for the subsidy, the beneficiaries cannot be eligible for other acceptable coverage. The U.S. Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) on May 23, 2012, issued joint final rules regarding implementation of the new state-based health insurance exchanges to cover how the exchanges will determine eligibility for uninsured individuals and employees of small businesses seeking to buy insurance on the exchanges, as well as how the exchanges will handle eligibility determinations for low-income individuals applying for newly expanded Medicaid benefits. Premium caps have been delayed for a year on group plans, to give employers time to arrange new accounting systems, but the caps are still planned to take effect on schedule for insurance plans on the exchanges; the HHS and the Congressional Research Service calculated what the income-based premium caps for a for a family of four would be in 2014:

Guaranteed issue.
In the individual market, sometimes thought of as the "residual market" of insurance, insurers have generally used a process called underwriting to ensure that each individual paid for his or her actuarial value or to deny coverage altogether. The House Committee on Energy and Commerce found that, between 2007 and 2009, the four largest for-profit insurance companies refused insurance to 651,000 people for previous medical conditions, a number that increased significantly each year, with a 49% increase in that time period. The same memorandum said that 212,800 claims had been refused payment due to pre-existing conditions and that insurance firms had business plans to limit money paid based on these pre-existing conditions. These persons who might not have received insurance under previous industry practices are guaranteed insurance coverage under the ACA. Hence, the insurance exchanges will shift a greater amount of financial risk to the insurers, but will help to share the cost of that risk among a larger pool of insured individuals. The ACA's prohibition on denying coverage for pre-existing conditions began on January 1, 2014. Previously, several state and federal programs, including most recently the ACA, provided funds for state-run high-risk pools for those with previously existing conditions. Several states have continued their high-risk pools even after the first marketplace enrollment period.
Limit to price variation.
Pricing variation will be allowed by area (within a state) and family composition ("tier") as well.
Comparable tiers of plans.
Within the exchanges, insurance plans are offered in four tiers designated from lowest premium to highest premium: bronze, silver, gold, and platinum. The plans cover ranges from 60% to 90% of bills in increments of 10% for each plan. For those under 30 (and those with a hardship exemption), a fifth "catastrophic" tier is also available, with very high deductibles.
Insurance companies select the doctors and hospitals that are "in-network".
Proponents of health care reform believe that allowing comparable plans to compete for consumer business in one convenient location will drive prices down. Having a centralized location increases consumer knowledge of the market and allows for greater conformation to perfect competition. Each of these plans will also cap liabilities for consumers with out-of-pocket expenses at $6,350 for individuals and $12,700 for families.
2015.
A study by Avalere Health says that healthcare insurance premiums of popular plans available under Obamacare for 2015 rose by 3-4% .
According to the US Department of Health & Human Service, as enrollment for the Health Insurance Marketplace began on November 15, about 11.4 million people have explored their options, learned about the financial assistance available, and signed up for or renewed a health plan that meets their needs and fits their budget. As of February, 2015, $268 was the average monthly tax credit for people who qualify for financial assistance in 37 states using HealthcCare.gov through January 30.
Economics of health insurance exchanges: the individual mandate.
The health insurance advocacy group America's Health Insurance Plans was willing to accept these constraints on pricing, capping, and enrollment because of the individual mandate: The individual mandate requires that all individuals purchase health insurance. This requirement of the ACA allows insurers to spread the financial risk of newly insured people with pre-existing conditions among a larger pool of individuals.
Additionally, a study done by Pauly and Herring estimates that individuals with pre-existing conditions in the 99th percentile of financial risk represented 3.95 times the average risk (mean). Figures from the House Committee on Energy and Commerce would indicate that approximately 1 million high-risk individuals will pursue insurance in the health benefits exchanges. Congress has estimated that 22 million people will be newly insured in the health benefits exchanges. Thus the high-risk individuals do not number in high enough quantities to increase the net risk per person from previous practice. It is thus theoretically profitable to accept the individual mandate in exchange for the requirements presented in the ACA.
Acronym.
HIX (Health Insurance eXchange) is emerging as the "de facto" acronym across state and federal government stakeholders, and the private sector technology and service providers that are helping states build their exchanges. The acronym HIX differentiates this topic from health information exchange, or HIE.
The de facto acronym of HIX will be replaced with HIEx in the "3rd Edition of the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations",
Criticism and controversy.
First week of operation.
The message, "Please try again later", greeted many people who tried to view information on marketplace websites across the United States during the first week of operation. Websites were reported to have either crashed or to offer very sluggish response times. A statement by Todd Park, U.S. Chief Technology Officer, resolved the initial disagreement about whether the culprit was the high volume of views or deeper technical issues : he asserted that glitches were caused by unexpected high volume at the federal health exchange (HealthCare.gov), when the site drew 250 thousand visitors instead of the 50-60 thousand expected, and claimed that the site would have worked with fewer visitors. More than 8.1 million people visited the site from October 1–4, 2013.
On the date the Patient Protection and Affordable Care Act of 2010 was enacted, only a few health insurance exchanges across the country were up and running. Among them were the Massachusetts Health Connector, the New York HealthPass - a non-profit exchange, and the Utah Health Exchange. Advocates claim these exchanges make these "markets" more efficient, providing oversight and structure, arguing that previous health insurance markets in the United States are poorly-organized and deal with wide variations in coverages and requirements among different companies, employers, and policies.
It was unknown how many people in total successfully enrolled in the first week. The federal marketplace website was scheduled for maintenance on the weekend. Some reporters nicknamed the program "Slowbamacare".
CGI Group came under media scrutiny as a developer behind several marketplace websites, after numerous issues surfaced with the federal health insurance marketplace, HealthCare.gov.
On October 1, 2013, the state-run marketplaces also opened to the public, and some of them reported first statistics. During the first week of enrollment:
Postponement of tax penalty.
On October 23, 2013, "The Washington Post" reported that Americans with no health insurance would have an additional six weeks before they would be penalized. That deadline was extended to March 31, and those who do not enroll by then may still avoid incurring penalties and getting locked out of the healthcare enrollment system this year. Exemptions and extensions apply to:
Congressional reaction.
On October 28 and 29, 2013, Sen. Lamar Alexander (R-TN) and Rep. Lee Terry (R, NE-2) introduced the Exchange Information Disclosure Act ( and , respectively). Terry's bill would have required the United States Department of Health and Human Services to submit weekly reports to Congress on the status of HealthCare.gov including "…weekly updates on the number of unique website visitors, new accounts, and new enrollments in a qualified health plan, as well as the level of coverage," separating the data by state, as well as reports on efforts to fix the broken portions of the website. The reports would have been due every Monday until March 31, 2015, and would have been available to the public.
On January 16, 2014, Terry's bill passed the House of Representatives; 226 Republicans and 33 Democrats voted yes. Alexander's bill died in committee.
Cover Oregon website failure.
In March 2015, Oregon officially abolished its state-run health insurance marketplace, "Cover Oregon", in favor of a federally-run exchange.
Private health insurance exchanges.
A private health insurance exchange is an exchange run by a private sector company or nonprofit. Health plans and insurance carriers in a private exchange must meet certain criteria defined by the exchange management. Private exchanges combine technology and human advocacy, and include online eligibility verification and mechanisms for allowing employers who connect their employees or retirees with exchanges to offer subsidies. They are designed to help consumers find plans personalized to their specific health conditions, preferred doctor/hospital networks, and budget. These exchanges are sometimes called marketplaces or intermediaries, and work directly with insurance carriers, effectively acting as extensions of the carrier. The largest and most successful private health care exchange is CaliforniaChoice, established by the Word & Brown General Agency in 1996.
Private health exchanges predate the Affordable Care Act. One example of an early health care exchange is International Medical Exchange (IMX), a company venture financed in Louisville, Kentucky, by Standard Telephones and Cables, a large British technology company (now Nortel), to develop the exchange concept in the U.S. using on-line technology. The product was created in the mid-1980s. IMX developed an eligibility verification system, a claims management system, and a bank-based payments administration system that would manage payments between the patient, the employer, and the insurance carrier. Like proposed exchanges today, it focused on standards of care, utilization review by a third party, private insurer participation, and cost reduction for the health care system through product simplification. The focus was on creating local or regional exchanges that offered a series of standardized health care plans that reduced the complexity and cost of acquiring or understanding health care insurance, while simplifying claims administration. The system was modeled after the standardized stock exchange and banking industry back office processes. The major difference was that IMX health care exchanges would provide their products through a national network of existing commercial banks rather than setting up a duplicate payment and administration systems network as proposed today. The IMX product rights were acquired by Anthem (then Blue Cross and Blue Shield of Kentucky). The exchange product became the basis for inter-carrier claims settlement between commercial insurance carriers and Blue Cross organizations. The founders of IMX were from top management at Humana, and top management of First Tennessee National Corp (now First Horizon).
In overlapping markets, the co-existence of public and private exchange plans can lead to confusion when speaking of an "exchange plan." In California, Anthem Blue Cross offers HMO plans through both the state-run Covered California exchange and the private CaliforniaChoice exchange, but doctor networks are not identical. Physicians advertising acceptance of Anthem Blue Cross Exchange HMOs may misinform individuals enrolled in Anthem Blue Cross Exchange HMOs through the private exchange.


Myriad Genetics

Myriad Genetics, Inc. is an American molecular diagnostic company based in Salt Lake City, Utah, United States. Myriad employs a number of proprietary technologies that permit doctors and patients to understand the genetic basis of human disease and the role that genes play in the onset, progression and treatment of disease. This information is used to guide the development of new molecular diagnostic products that assess an individual's risk for developing disease later in life (predictive medicine), identify a patient's likelihood of responding to a particular drug therapy (precision medicine), assess a patient's risk of disease progression and disease recurrence (precision medicine), and measure disease activity.
Following the discovery by Mary-Claire King that a gene on chromosome 17 is associated with an increased risk of breast cancer, Myriad attempted to patent this gene. These patents were the subject of scrutiny after Myriad became involved in a lawsuit over its patenting practices, which led to the landmark Supreme Court decision "Association for Molecular Pathology v. Myriad Genetics, Inc." which ruled these patents illegal.
History.
The global search for the genetic basis of breast and ovarian cancers began in earnest in 1988. In 1990, at an American Society of Human Genetics Meeting, a team of scientists led by Mary-Claire King, Ph.D., from the University of California, Berkeley announced the localization through linkage analysis of a gene associated with increased risk for breast cancer ("BRCA1") to the long arm of chromosome 17. In August 1994, Mark Skolnick and researchers at Myriad, along with colleagues at the University of Utah, the U.S National Institutes of Health (NIH), and McGill University sequenced "BRCA1".
In August 2016, Myriad announced it would acquire Assurex Health for up to $410million, expanding the company's genetic testing for psychotropic medicine selection.
In July 2018, Myriad completed an acquisition of reproductive genetic testing firm Counsyl for $375million, expanding the company's testing capabilities to carrier and prenatal screening.
Founders.
The founders of Myriad are Peter Meldrum (past President and CEO of Agridyne and past CEO and President of Myriad Genetics, Inc.), Kevin Kimberlin (Chairman of Spencer Trask & Co.), Dr. Walter Gilbert (Founder of Biogen) and Mark Skolnick (Adjunct Professor in the Department of Medical Informatics at the University of Utah).
Subsidiaries.
Subsidiaries of Myriad Genetics include Myriad Genetic Laboratories, Inc., Myriad RBM, Crescendo Bioscience, Sividon Diagnostics, Assurex Health, and, most recently, Counsyl.
Products.
Among the prognostic tests developed and marketed by Myriad is "Prolaris", which uses gene expression profiling to provide a 10-year prostate cancer-specific risk of death. Another prognostic test, marketed as "myRisk Hereditary Cancer", reviews genetic markers correlated with elevated risk of developing any of eight hereditary cancers.
Controversies.
Myriad Genetics's patents on human genes became quite controversial. Because genes occur naturally in every human, in addition to raising moral questions, some believe that patents constitute an obstacle to biomedical research worldwide. Additionally, the discovery of their relevance to breast cancer was funded by the public.
USA: "Association for Molecular Pathology v. Myriad Genetics" (2013).
Myriad Genetics was a defendant in the case "Association for Molecular Pathology v. Myriad Genetics" (formerly "Association For Molecular Pathology et al. v. United States Patent and Trademark Office").
Lawyers at the ACLU served as counsel for the plaintiffs. In the suit, medical associations, doctors, and patients sued Myriad Genetics to challenge seven United States patents on genes related to breast cancer and ovarian cancer.
Two of the company's patents on the BRCA1 and BRCA2 genes were ruled invalid on March 29, 2010, by Judge Robert W. Sweet in the U.S. District Court for the Southern District of New York. On appeal, the Court of Appeals for the Federal Circuit reversed the trial court in an opinion dated July 29, 2011 and held that the genes were eligible for patents.
On December 7, 2011, the ACLU filed a petition for a writ of certiorari to the Supreme Court. On March 26, 2012, the Supreme Court vacated the Federal Circuit's judgment and remanded the case for further consideration in light of "Mayo Collaborative Services v. Prometheus Laboratories, Inc.", in which the Supreme Court had ruled, just six days earlier, that more restrictive rules were required to patent observations about natural phenomena.
On August 16, 2012, the Federal Circuit reaffirmed Myriad's right to patent the genes although they denied rights to patent comparisons of DNA sequences. On November 30, 2012, the Supreme Court agreed to hear a second challenge to the two gene patents held by Myriad. Oral argument took place on April 15, 2013. On June 13, 2013, in Association for Molecular Pathology v. Myriad Genetics (No. 12-398), the US Supreme Court unanimously ruled that "A naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated", invalidating Myriad's patents on the BRCA1 and BRCA2 genes. However, the Court also held that manipulation of a gene to create something not found in naturesuch as a strand of synthetically-produced complementary DNA (cDNA)could still be eligible for patent protection.
Australia: "D'Arcy v Myriad Genetics Inc " (2015).
Myriad Genetics has also been involved in litigation in Australia over the patentability of DNA sequences. Regarding BRCA1, the company succeeded in the Federal Court, both at first instance and on appeal to the full court, but in October 2015 lost in a unanimous decision of the High Court, "D'Arcy v Myriad Genetics Inc".
In Australia an invention is patentable if, to begin with, it is a "manner of manufacture". The plurality in the High Court formulated the key question as: "Whether the invention as claimed is for a product made, or a process producing an outcome as a result of human action" (para [28]). It held that the product in issue continued to consist basically of genetic information that occurs naturally, had not been altered as a result of human action, therefore had not been "manufactured" and consequently was not patentable. The plurality reflected that a broader conception of patentability could, both by creating virtual monopolies and by blurring the boundaries of what might come to be patented, produce a chilling effect on research and application, contrary to the purposes of patent protection.
The appellant had cited the recent US Supreme Court decision for comparison. The High Court was also aware that its decision could conflict with recent judicial decisions, as well as patents legislation, in other countries, and possibly with Australia's international obligations; however, it considered these to be issues for the legislature, as well as denying that its decision in this case was intended to set a precedent with regard to genetic patenting generally. In addition, the rest of the court did not dissent from Gordon J's concluding observation: "It is important to notice that the claims made in the patents in suit in the United States of America considered in "Association for Molecular Pathology v Myriad Genetics Inc" 186 L Ed 2d 124 (2013) were claims to the particular genetic sequences and therefore radically different from the disputed claims in this appeal" (note 232).


Wayne Fenton

Wayne Fenton (March 24, 1953 – September 3, 2006) was an American psychiatrist, well known for his academic contributions to the study of schizophrenia including key contributions to the classification of subtypes.
In 2006 he was killed at his office in Bethesda, Maryland, by a 19-year-old patient.
Professional career.
Dr Fenton obtained his medical qualification from George Washington University School of Medicine in 1979 and psychiatric qualification from Yale and was a staff member at Chestnut Lodge for more than 15 years.
He worked for the National Institute of Mental Health as researcher and academic, writing a chapter on therapy for schizophrenia in a leading psychiatry textbook and had a significant impact on his clinical profession.


Rehmannia glutinosa

Rehmannia glutinosa is one of the 50 fundamental herbs used in traditional Chinese medicine, where it has the name "shēng dì huáng" (). It is often sold as "gān dì huáng" (), "gān" meaning "dried".
Chemical constituents.
A number of chemical constituents including iridoids, phenethyl alcohol, glycosides, cyclopentanoid monoterpenes, and norcarotenoids, have been reported from the fresh or processed roots of "R. glutinosa"".


Ira B. Lamster

Ira B. Lamster is an American board certified periodontist. He is a professor of health and policy management at Columbia University's Mailman School of Public Health. Formerly, he was the dean and professor of dentistry at the Columbia University College of Dental Medicine until stepping down the end of the 2012 school year.
Education.
Lamster received his bachelor's degree from Queens College in 1971 and received an S.M. from University of Chicago in 1972. He received his DDS in 1977 from the State University of New York at Stony Brook School of Dental Medicine and his certificate in periodontics from Harvard School of Dental Medicine in 1980, along with a MMSc from Harvard University in the same year.
Academic career.
Lamster served as the director of the Division of Periodontology at Columbia University from 1988 to 1998 and as vice dean of the institution from 1998 to 2001. In December 2001, he was also named vice president of the Columbia University Medical Center.
Lamster has authored over 150 research papers and textbook chapters. He is also board certified by the American Board of Oral Medicine.
Together with Drs. Murray Schwartz and James Burke Fine, he co-authored "Clinical Guide to Periodontics".
In March 2012, Lamster announced that he would be stepping down from his position as dean of Columbia University College of Dental Medicine, effective at the end of the 2012 school year. He moved to the Columbia University Mailman School of Public Health, where he serves the function of a facilitator and thinking counselor.


Stark Law

Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
The term "referral" means "the request by a physician for the item or service" for Medicare Part B services and "the request or establishment of a plan of care by a physician which includes the provision of the designated health service" for all other services. DHS includes "clinical laboratory services"; "physical therapy services"; "occupational therapy services"; "radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services"; "radiation therapy services and supplies"; "durable medical equipment and supplies"; "parenteral and enteral nutrients, equipment, and supplies"; "prosthetics, orthotics, and prosthetic devices and supplies"; "home health services"; "outpatient prescription drugs"; "inpatient and outpatient hospital services"; and "outpatient speech-language pathology services." A "financial relationship" includes ownership, investment interest, and compensation arrangements.
Stark Law contains several exceptions, including physician services, in-office ancillary services, ownership in publicly traded securities and mutual funds, rental of office space and equipment, and bona fide employment relationship. It is named for United States Congressman Pete Stark (D-CA) who sponsored the initial bill.
History.
In 1988, Stark introduced an "Ethics in Patient Referrals Act" bill concerning physician self-referrals. Some of the ideas in the bill became law as part of the Omnibus Budget Reconciliation Act of 1990. In specific, what is referred to as "Stark I" prohibited a physician referring a Medicare patient to a clinical laboratory if the physician or his/her family member has a financial interest in that laboratory. It was codified in the United States Code, Title 42, Section 1395nn (42 U.S.C. 1395nn, "Limitation on certain physician referrals").
The Omnibus Budget Reconciliation Act of 1993 contained what is known as "Stark II" amendments to the original law. "Stark II" extended the "Stark I" provisions to Medicaid patients and to DHS other than clinical laboratory services.
The Centers for Medicare and Medicaid Services has issued rules in the Federal Register to implement Stark Law, including a 2001 "Phase I" final rule, a 2004 "Phase II" interim final rule, and a 2007 "Phase III" final rule.
Penalties.
Penalties for violations of Stark Law include: denial of payment for the DHS provided; refund of monies received by physicians and facilities for amounts collected; payment of civil penalties of up to $15,000 for each service that a person "knows or should know" was provided in violation of the law, and three times the amount of improper payment the entity received from the Medicare program; exclusion from the Medicare program and/or state healthcare programs including Medicaid; and payment of civil penalties for attempting to circumvent the law of up to $100,000 for each circumvention scheme.
Physician self-referral.
Physician self-referral is the practice of a physician referring a patient to a medical facility in which the physician has a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics argue that this practice is an inherent conflict of interest, because the physician benefits from the physician's own referral. They suggest that such arrangements may encourage overutilization of services, in turn driving up health care costs. In addition, they believe that it would create a captive referral system, which limits competition by other providers.
Those who defend the practice contend that these problems are not widespread. They argue that physicians who own, invest in, or operate medical facilities are responding to a need for medical services which would otherwise not be met, particularly in medically under-served areas. In addition, it is often the case that physician owned entities present a lower-cost alternative to the facilities that are located at hospitals. This is due mostly to higher overhead costs that hospitals must pass down to their services.
Enforcement.
Multiple federal entities oversee enforcement of Stark Law. These include the Department of Justice, CMS, and the Department of Health and Human Services. In recent years, enforcement of Stark Law has become increasingly aggressive, largely as a result of the Patient Protection and Affordable Care Act and its amendments to the False Claims Act.
2014 saw some of the largest Stark Law violation settlements to date. On June 9, 2015, the Office of Inspector General issued a fraud alert targeting physician compensation arrangements with hospitals and health systems.
Risk abatement.
Contracts between physicians and hospitals must fit within the seven safe harbors for Stark Law in order to fully alleviate violation risk: the contract's duration must be at least a year; in writing and signed by both parties; specify aggregate payment which is set in advance; payment is reasonable and fair market value; payment must not relate to volume or value of business; the exact services to be performed must be outlined; and be commercially reasonable. Because current processes for monitoring contract compliance and logging physician work hours are often done on paper, the majority of Stark Law violation settlements are the result of technical violations.
Healthcare experts agree that information technology is necessary to streamline hospital processes, including those relating to compliance and Stark Law. Certain electronic health record companies help healthcare systems collect, organize, and store data. Multiple technology solutions exist that specifically automate physician time logging and eliminates Stark Law violation risk.
Reform proposal.
The Stark law may impede certain pay for performance value-based arrangements, which led to discussions around reform as of 2019.


John Cavallaro

John Cavallaro Jr. is an American prosthodontist well known for his scholarship and overall contribution to evidence-based periodontal and dental implant literature.
Education and scholarship.
Cavallaro graduated from New York University College of Dentistry in 1982. He then completed a general practice residency at the Manhattan Veterans Administration in 1986, followed by certificate in prosthodontics from NYU in 1990. He then completed a fellowship in implant dentistry at NYU College of Dentistry in 2002.
Career.
Cavallaro is a clinical professor of prosthodontics and implant dentistry at Columbia University College of Dental Medicine and maintains a private practice limited to prosthodontics and implant dentistry in Brooklyn, New York.
Cavallaro received the Eugene Rothschild Memorial Award for Excellence in Fixed Prosthodontics from the Academy of Oral Rehabilitation at NYU.


Dennis Harris (alternative medicine)

Dr. Dennis Howard Harris (born March, 1938, in Akron, Ohio) is a medical doctor known for selling alternative medicine remedies. Harris has developed and marketed several products, including one that was the subject of a 2003 Federal Trade Commission complaint resulting in an order essentially banning his company and its officers from making health claims not backed by scientific evidence.
Biography.
In 1963, Harris received his degree from Ohio State University College of Medicine. After residency-training in physical medicine and rehabilitation at Ohio State University and Southwestern Medical School, University of Texas, Harris moved to Scottsdale, Arizona, to begin private practice. In 1968, Harris established the Department of Physical Medicine and Rehabilitation at Scottsdale Memorial Hospital in 1968 and later established the Southwest Pain Control Program.
Alternative medicine.
Harris has been involved with several alternative medicine products and markets them nationally on radio commercials and infomercials.
Harris was the subject of a Federal Trade Commission complaint, closed on July 29, 2003 with an order essentially banning his company and its officers from making health claims not backed by scientific evidence. In the complaint the claims and actions of Harris, associates, and the company that produced and marketed the Dr Harris’ Original Snore Formula constituted "unfair or deceptive acts or practices", including the creation of "false advertisements", in violation of the Federal Trade Commission Act.


Lida Holmes Mattman

Lida Holmes Mattman Ph.D. (1912–2008) was an immunologist.
She graduated with a M.S. in Virology from the University of Kansas and a Ph.D. in Immunology from Yale University. Mattman taught in the fields of immunology, microbiology, bacteriology, virology and pathology for over 30 years. She worked at various schools and institutions including Harvard University, Howard Hughes Institute, Oakland University and Wayne State University. She was a Professor Emeritus in the Department of Biological Sciences at Wayne State University in Detroit where she was engaged in research and lecturing. She has served as President of the Michigan Branch of the American Society for Microbiology, as Chairman of the Medical Division of the Michigan Academy of Sciences, and held various offices in the local chapter of Sigma Xi.
Her studies have concerned investigating the role of surface tension depressants in immunological systems, the first complement fixation with a bacteria-free virus, the first report of wound botulism, geotrichum mycemia, nasal carriage of "Clostridium tetani", antibiotic cure of rhinoscleroma, antibiotic sensitivity testing of "Coccidiodes immitis", and electron microscope studies of "Peptococci". The most in-depth studies relate to L Forms spontaneously occurring "in vivo" and "in vitro".
Mattman developed a new method for culturing "B. burgdorferi" from patients with purported chronic Lyme disease. This culture method was discredited when it was found that the method used a medium that killed "B. burgdorferi". Mattman also authored the book "Cell Wall Deficient Forms: Stealth Pathogens". A 2014 literature review found that Cell Wall Deficient forms, also known as L-forms, do not have a role in Lyme disease.
Mattman was nominated for the 1997 Nobel Prize in Medicine or Physiology. She died in 2008 at the age of 96.


New York Blood Center

The New York Blood Center (NYBC) is a community, nonprofit blood bank based in New York City. Established in 1964 by Dr. Aaron Kellner, NYBC supplies blood to approximately 200 hospitals in the Northeast United States. NYBC and its operating divisions also provide transfusion-related medical services to over 500 hospitals nationally.
NYBC, along with its operating divisions Community Blood Center of Kansas City, Missouri (CBC), Innovative Blood Resources (IBR), Blood Bank of Delmarva (BBD), and Rhode Island Blood Center (RIBC), collect approximately 4,000 units of blood products each day and serve local communities of more than 75 million people in the Tri-State area (NY, NJ, CT), Mid Atlantic area (PA, DE, MD, VA), Missouri and Kansas, Minnesota, Nebraska, Rhode Island, and Southern New England.
In addition to serving the New York City metropolitan area, New Jersey, Connecticut and Pennsylvania, in May 2014, NYBC merged its operations with Community Blood Center of Greater Kansas City (CBC). In February 2016, NYBC and CBC announced the creation of the Kansas City-based National Center for Blood Group Genomics, a new laboratory that will focus on precision testing of blood donor samples.
NYBC maintains close relationships with both New York City's Police Department (NYPD) and Fire Department (FDNY). Among NYBC's largest donor groups is the NYPD, which donated more than 11,000 pints of blood through November 2015. At the same time, the FDNY participates with NYBC in the "Be The Match Program" operated by the National Marrow Donor Program (NMDP). More than 8,000 FDNY members are on the potential donor list, and 179 members have already given this life saving gift to those in need. FDNY members represent more than 10% of all NYBC bone marrow donors. Each year, at an annual induction ceremony hosted by FDNY and NYBC at FDNY headquarters, donors and their recipients meet for the first time. In 2016, Firefighter Mike Wilson was introduced to a recipient from Erie, Pennsylvania, who received his lifesaving bone marrow to treat her acute myeloid leukemia (AML), while Firefighter Frank Perdue met a recipient diagnosed with essential thrombocythemia, a rare chronic blood disorder. In 2015, firefighter Michael McCauley of Staten Island met his recipient, a United States Marine Sergeant who saw combat in Iraq, and who was subsequently diagnosed with acute myeloid leukemia (AML). Through FDNY’s participation in NYBC’s program, McCauley’s bone marrow is credited with saving the recipient's life.
NYBC houses Lindsley F. Kimball Research Institute and the Howard P. Milstein National Cord Blood Center, a public cord blood bank named after board member Howard Milstein. The National Cord Blood Program (NCBP), directed by Dr. Pablo Rubinstein, is the oldest and largest in the world. In August 2015, the NCBP announced a new collaboration with the University of California, Davis Health System to manufacture specialized lines of highly adaptable stem cells for potential new therapies for diseases that include anemia, leukemia, lymphoma, sickle cell disease and severe combined immunodeficiency.
The Lindsley F. Kimball Research Institute (LFKRI) has been awarded grants to conduct research in such areas as epidemiology and the development of HIV self-testing interventions, cellular therapy and transfusion medicine, in vitro platelet production, blood genomics, immunology, the development of infectious disease screening techniques and preventions for diseases like severe acute respiratory syndrome, Hepatitis B and Hepatitis C.
History.
In 2013, LFKRI was awarded a Grand Challenges Explorations Grant from a grant initiative engaging field leaders in global health to bring progress to targeted world problems. The Grand Challenges Explorations Grant was launched by the Bill and Melinda Gates Foundation in 2007. The LFKRI used grant money to study the transmission of parasites from Filarial Worm larvae to humans in order to develop a preventative drug to kill mature worms and prevent parasitic infection.
In 2014, the New York Blood Center's National Cord Blood Program (NCBP) at the Howard P. Milstein Cord Blood Center received the Prix Galien USA “Best Biotechnology Product” distinction for the development of HEMACORD, an innovative hematopoietic stem cell product and the first of its kind to be approved by the Food and Drug Administration.
In August 2016, NYBC also combined operations with Innovative Blood Resources, a blood center with operations in Minnesota and Nebraska.
LFKRI also oversaw a clinical trial of Immucor’s PreciseType HEA test, resulting in the approval of the product by the FDA in October 2016. The PreciseType HEA test screens blood donors for sickle cell trait (SCT), an inherited blood disorder that affects 1 million to 3 million Americans, including 8-10% of African Americans. PreciseType HEA is the only FDA-approved molecular test that provides clinicians and blood banks with detailed genetic matching information. Through its work with cord blood, stem cells and sickle cell treatments, NYBC is a leader in precision medicine, which takes into account individual variability in genes, environment, and lifestyle to more accurately match treatments to individual patients.
In 2019, New York Blood Center merged with the Rhode Island Blood Center (RIBC). The latter continues to do business as the Rhode Island Blood Center.
In 2020 New York Blood Center was the first blood center to collect convalescent blood plasma donations from people who have recovered from COVID-19 to treat other patients with advanced illness. On March 27, 2020, the first unit of convalescent blood plasma was drawn. In convalescent plasma treatment, the patient is transfused with the plasma from a recovered COVID-19 patient with the goal of using the donor’s antibodies to help clear the virus more rapidly.In January 2021, Research by the Mayo Clinic validate using convalescent plasma treatment for COVID-19 patients amid widespread vaccine shortages.
Primate research in Liberia.
For a thirty-year period starting in the mid-1970s, the NYBC conducted research experiments on a group of chimpanzees in Liberia. At the time, such primate testing was considered a standard part of medical research and drug development, reaching its peak in the early 1970s. After the studies were complete, NYBC moved the survivors onto six islands on the Farmington River. According to "The New York Times", an NYBC employee stated at the time that NYBC recognized a responsibility for the lifetime care of the chimps, but NYBC disputes this, stating that its employee's comment was not authorized. The "Times" also noted that the quote in question was published in an article seeking financial support from a foundation for the care of the chimpanzees. The chimpanzees are owned by the Liberian government: NYBC voluntarily supported the chimps for seven years after its relationship with the Liberian government ended. NYBC argues that it spent millions on the chimps since the mid-2000s and "repeatedly" reached out to the Liberian government and animal rights groups "in an attempt to assist in a long term solution" but was ignored. In order to keep the chimps alive, locals who had been employed by NYBC to deliver food and water began to care for them on a volunteer basis. With virtually no resources and burdened by an Ebola outbreak, these volunteers kept the chimpanzees alive until a Humane Society of the United States (HSUS)-led coalition of over 30 animal conservation groups raised funds from the public to pay for the chimps' care on an emergency basis.
According to NBC's "Today Show", NYBC held discussion with HSUS that ended unsuccessfully in the summer of 2016, but NYBC is open to partnering with other organizations. NYBC maintains they were confronted with requests that "have nothing to do with NYBC's original involvement in Liberia," which involved research "essential to the development of a hepatitis vaccine."
In June 2015, activist groups in New York launched a campaign to demand that the NYBC reinstate funding for the chimpanzees. The campaign consists of protests at the homes of board members and major donors who have refused to engage with the advocacy community. According to NBC News, the campaign has led to threats and social media campaigns that NYBC says have personally threatened their employees over the issue. On March 31, 2016, Citigroup, a former NYBC donor, issued a public statement asserting that "the situation is not tolerable" and made a $50,000 contribution to HSUS. On May 19, New York State Senator Tony Avella and New York State Assemblywoman Linda Rosenthal held a press conference at New York City Hall to demand that NYBC fulfill its promise to provide lifelong care for the chimpanzees.


Donetsk National Medical University

Donetsk National Medical University (abbreviated as DNMU, ) is one of the largest medical universities in Ukraine and the former USSR. The University is considered as one of the best medical schools in Ukraine. Originally located in Donetsk, it was relocated to Kropyvnytskyi, Kramatorsk and Mariupol in 2014 due to the War in Donbass.
History.
Donetsk National Medical University was established in 1930 as the Maxim Gorky Donetsk Medical Institute. In 1994 it was given the status of University and in 2007 it gained the status of National Medical University (NMU). The name of M. Gorky was removed from the title in 2017.
Rankings & Reputations.
Donetsk National Medical University was recognized as the best medical university in Ukraine in 2011. DNMU was ranked as the first among Ukrainian medical universities constantly since 2001 till 2016 according to the rating of the Ministry of Healthcare and Ministry of Education of Ukraine. In the latest national university rankings (Top 200 in Ukraine, years 2013 and 2014), DNMU was ranked as the first best medical university, and was the 23rd best university overall in Ukraine. When other indicators (i.e. Scopus citations and webometrics) were included, DNMU kept its status as the best medical university in Ukraine also in 2014.
Due to the quality of training and comparatively low tuition fees DNMU is an attractive study choice among Ukrainian medical universities for foreigners. The Donetsk National Medical University is listed in the medical directories of the World Health Organization (WHO) and I-Med Schools.
Internationally, Donetsk National Medical University is ranked 3003rd out of 11,000 universities in the world according to the 4icu Ranking and 2021st on the Webtronics world ranking.
Students and studies.
Approximately 15200 students study at the eight faculties of Donetsk National Medical University from Ukraine, Russia, Georgia, Armenia, Azerbaijan, Turkmenistan, USA, the UK, Germany, Poland, Greece, Israel, Turkey, India, Nepal, Sri Lanka, China, Malaysia, Mauritius, Pakistan, Ghana, Nigeria, Cameroon, Peru, Palestine, Iran, Iraq, Kuwait, Jordan, Syria, Tunisia, Kenya, Namibia, Zambia, Somalia, Lebanon, Bahrain and other countries.
So far, the university has granted 45,000 degrees, to doctors, well-known scientists, researchers, health care providers from Ukraine, Russia, other ex-Soviet republics and 89 countries in Asia, Africa, Europe and Americas.
At the Donetsk National Medical University there are eight faculties including a preparatory faculty for foreign students. The Donetsk National Medical University trains specialists along the following education or qualification levels as junior specialists, specialists, or Masters for the following specialties:
Donetsk National Medical University provides training in English, Russian and in Ukrainian languages in all faculties.
According to the Ukrainian Health Ministry Order N°148 of March 22, 2004 DNMU has been appointed as the regional centre of Bologna Process management in Ukraine. In the 2005/06 academic year, DNMU started teaching its students in accordance with the Bologna Agreement on specialists training using the credit-modular system, which makes it possible to obtain the European Diploma at the end of the study. Students of Donetsk National Medical University can transfer of their credits to any other European medical university at any time after completing their first year of education at DonNMU. Transfers to other European universities are made under the auspices of the Bologna process. The Donetsk National Medical University has signed cooperation agreements concerning the exchange of students with almost 160 different universities in the CIS, Europe, Canada, USA and with some Arab countries.
Campus.
The students of DNMU get their professional training at 26 specialized bases (including Donetsk multi-field medical and preventive organizations and research institutes) and 28 highly equipped clinical bases (including the main hospitals of Donetsk) under the supervision of highly qualified specialists.
Donetsk National Medical University provides its students with accommodation and study facilities. The students' campus has 13 study buildings equipped with 37 computer classes and libraries, 9 student hostels with reading halls and sports rooms, a health center for preventive care, stadium, sports and health service complexes, summer camping at the Seversky Donets river.
Staff.
At present the total teaching staff at Donetsk National Medical University is 1147. Among them are 150 professors and 243 associate professors, academic title of doctors and candidates of medical sciences are respectively 117 and 449 people. The Donetsk National Medical University is a member of the National Academy of Sciences of Ukraine and two corresponding members of AMS of Ukraine, 4 laureates of the State Prize of Ukraine, 18 distinguished scientists and engineers, 8 distinguished doctors, 2 Honorary Workers of Education of Ukraine, 37 full members of international and departmental academies science, and 1 Hero of Ukraine.


Niacin test

The niacin test has been widely used since the 1960s to identify mycobacteria at the species level in the clinical laboratory. The niacin test detects niacin (nicotinic acid) in aqueous extracts of a culture. "M. tuberculosis" strains that test negative for the niacin test are very rare.
Redox reactions happening in Mycobacterium species produce niacin as a part of energy metabolism. Even though all mycobacteria produce niacin, "M. tuberculosis" accumulates an excess of niacin because of its inability to process niacin, excreting the excess niacin into the culture media, thus allowing it to be detected using the niacin test. The niacin test is typically only conducted on slow-growing, granular, tan colored colonies, as these are the morphology characteristics of "M. tuberculosis" on an agar plate. Because of its affordability compared to expensive identification methods like pyrosequencing or MALDI-TOF MS that require expensive machines and reagents.
Biochemical processes.
Biochemical pathway.
The nicotinamide adenine dinucleotide (NAD+) degradation pathway in "M. tuberculosis" has a blockade that the scavenging pathway resulting in an excess of niacin that cannot be processed by the organism. Because of this abundance, the "M. tuberculosis" along with "Mycobacterium canetti" and varied types of "Mycobacterium africanum" release the excess niacin into their outside environment, in this case, the agar plate or another medium. Niacin is water-soluble, so the culture media can be tested for the presence of niacin to determine whether a Mycobacterium isolate is one of the three mentioned species. Those three species are members of the Mycobacterium tuberculosis complex.
Test strip process.
The niacin test strip is typically composed of potassium thiocyanate, chloramine-T, citric acid, and 4-Aminosalicylic acid. In the presence of citric acid, chloramine-T and potassium thiocyanate will react to form cyanogen chloride. This chemical will break apart the pyridine ring of niacin to produce y-carboxy glutaconic aldehyde and joins an aromatic amine to form a yellow color.
Testing procedure.
A niacin test strip is similar in appearance to a pH test strip. It is small, thin, rectangular, and white in color. Water is placed onto the culture plate and touched with a test strip for 15–20 minutes inside a small, sterile tube. If excess amounts of niacin are detected, the liquid inside the tube will turn yellow, a positive test. If the liquid in the tube is clear, there are no excess amounts of niacin and the test is negative. A positive niacin test does not necessarily indicate the presence of "M. tuberculosis" because other Mycobacterium species can test positive for excess niacin.
Along with each batch of specimens being tested, a positive control of "M. tuberculosis" and a negative control with no organism will be included. If the positive control tests negative, there was probably an error with the batch, and likewise for a negative test showing positive.
Because lab samples that are determined to be acid-fast bacilli are possibly "M. tuberculosis", a biosafety level 3 organism, all niacin tests must be conducted in a biosafety cabinet with a full gown, respirator, gloves, and sealed laboratory to ensure the safety of the lab technologist performing the test. All tests must also be conducted with sterile technique.


Rory Collins

Sir Rory Edwards Collins FMedSci FRS (born 3 January 1955) is a British physician who is Professor of Medicine and Epidemiology at the Clinical Trial Service Unit within the University of Oxford, the head of the Nuffield Department of Population Health and a Fellow of Green Templeton College, Oxford. His work has been in the establishment of large-scale epidemiological studies of the causes, prevention and treatment of heart attacks, other vascular disease, and cancer, while also being closely involved in developing approaches to the combination of results from related studies ("meta-analyses").
Education.
Collins was educated at Dulwich College and studied Medicine at St Thomas's Hospital Medical School, part of the University of London (1974-1980), and Statistics at George Washington University from 1976 to 1977 and the University of Oxford from 1982 to 1983.
Career and research.
Since 1985, Collins has been co-director with Sir Richard Peto of the University of Oxford's Clinical Trial Services and Epidemiological Studies units. In 1996, he was appointed Professor of Medicine and Epidemiology at Oxford, supported by the British Heart Foundation. Since September 2005, he has also been acting as the Principal Investigator and Chief Executive of the UK Biobank, a prospective study of 500,000 British people, aged 40–69 at recruitment.
Collins' work has been in the establishment of large-scale epidemiological studies of the causes, prevention and treatment of heart attacks, other vascular disease, and cancer.
He has created and led large studies that transformed statins from esoteric drugs for familial hypercholesterolaemia into widely used generics that reportedly prevent millions of heart attacks and ischaemic strokes annually. His large placebo-controlled trials and worldwide Cholesterol Treatment Trialists' meta-analyses confirmed heart attack reduction, discovered stroke reduction, and demonstrated safety and efficacy in many different types of patient. His research has been funded by the Medical Research Council (MRC).
Awards and honours.
Collins was knighted in the
2011 New Year Honours for services to science. He was elected as a Fellow of the Academy of Medical Sciences in 2004 and a Fellow of the Royal Society (FRS) in 2015.


Caldicott Report

The Caldicott Committee's "Report on the Review of Patient-Identifiable Information", usually referred to as the Caldicott Report was a review commissioned in 1997 by the Chief Medical Officer of England due to increasing worries concerning the use of patient information in the National Health Service (NHS) in England and Wales and the need to avoid the undermining of confidentiality because of the development of information technology in the NHS, and its ability to propagate information concerning patients in a rapid and extensive way.
A committee was established under the chairmanship of Dame Fiona Caldicott, Principal of Somerville College, Oxford, and previously President of the Royal College of Psychiatrists. Its findings were published in December 1997.
The Caldicott Report highlighted six key principles, and made 16 specific recommendations.
In 2012 Dame Fiona produced a follow up report which made 26 further recommendations including the addition of a seventh principle which is included in the list below.
In 2016 a further follow-up report was produced following controversy over the care.data initiative from HSCIC.
Caldicott principles.
These principles have been subsumed into the NHS confidentiality code of practice.


Arthus reaction

In immunology, the Arthus reaction () is a type of local type III hypersensitivity reaction. Type III hypersensitivity reactions are immune complex-mediated, and involve the deposition of antigen/antibody complexes mainly in the vascular walls, serosa (pleura, pericardium, synovium), and glomeruli. This reaction is usually encountered in experimental settings following the injection of antigens.
History.
The Arthus reaction was discovered by Nicolas Maurice Arthus in 1903. Arthus repeatedly injected horse serum subcutaneously into rabbits. After four injections, he found that there was edema and that the serum was absorbed slowly. Further injections eventually led to gangrene.
Process.
The Arthus reaction involves the in situ formation of antigen/antibody complexes after the intradermal injection of an antigen. If the animal/patient was previously sensitized (has circulating antibody), an Arthus reaction occurs. Typical of most mechanisms of the type III hypersensitivity, Arthus manifests as local vasculitis due to deposition of IgG-based immune complexes in dermal blood vessels. Activation of complement primarily results in cleavage of soluble complement proteins forming C5a and C3a, which activate recruitment of PMNs and local mast cell degranulation (requiring the binding of the immune complex onto FcγRIII), resulting in an inflammatory response. Further aggregation of immune complex-related processes induce a local fibrinoid necrosis with ischemia-aggravating thrombosis in the tissue vessel walls. The end result is a localized area of redness and induration that typically lasts a day or so.
Arthus reactions have been infrequently reported after vaccinations containing diphtheria and tetanus toxoid. The CDC's description:
Arthus reactions (type III hypersensitivity reactions) are rarely reported after vaccination and can occur after tetanus toxoid–containing or diphtheria toxoid–containing vaccines. An Arthus reaction is a local vasculitis associated with deposition of immune complexes and activation of complement. Immune complexes form in the setting of high local concentration of vaccine antigens and high circulating antibody concentration. Arthus reactions are characterized by severe pain, swelling, induration, edema, hemorrhage, and occasionally by necrosis. These symptoms and signs usually occur 4–12 hours after vaccination. ACIP has recommended that persons who experienced an Arthus reaction after a dose of tetanus toxoid–containing vaccine should not receive Td more frequently than every 10 years, even for tetanus prophylaxis as part of wound management.


Anne-Marie Staub

Anne-Marie Staub (13 November 1914 – 30 December 2012) was a French biochemist who spent most of her career at the Institut Pasteur. She is most known for her work in antihistamines, serology and immunology including her research on Salmonella and tyvelose.
Biography.
Early life and education.
Anne-Marie Staub was born on 13 November 1914 in Pont-Audemer, France into a Pasteurian family: Louis Pasteur was the witness to her grandfather's wedding, and her father André Staub was a researcher in the Institut Pasteur. As a child she learned to read and write from her mother before completing her education at the Ecole Normale catholique where she obtained her baccalaureate.
She earned her degrees in general mathematics, chemistry and general physics, physiology and biochemistry from the Sorbonne. She later added to her education by attending microbiology courses at the Institut Pasteur from 1935 to 1936, before joining the institute to work on her PhD thesis.
Work and research.
While conducting research at the Institut Pasteur in 1937, she worked for Daniel Bovet and her first published works led to the discovery of antihistamines. This discovery was the basis of the Nobel prize that would be awarded to her boss D. Bovet in 1957. The molecules that she developed were still too toxic to be successfully used but they are the basis for the research that followed.
In 1940 she started working on a vaccine for anthrax. From 1941-1946 she worked with the "B. anthracis" antigens and successfully injected a sheep with a vaccine for the bacteria. During this time she also taught French, German and first aid to soldiers engaged in WWII. From 1947 to 1948 she received funding from the Medical Research Council and went to works at the Lister Institute in the laboratories of Paul Fildes and Gareth Gladstone. Then, from 1955 to 1975, in collaboration with O. Lüderitz and O. Wespthal, researchers at the Max Planck Institute, she took part in research on antigens of Salmonella. It was during this time that she identified tyvelose as a component of the O-antigen of Salmonella. In 1953 she as promoted to head of laboratory in the vaccine department of the Institut Pasteur and in 1967 she became head of the Bacterial Antigen unit. She co-directed the immunology course from 1960 to 1974 and became a professor in 1970.
Throughout her career she published many articles about her research, often in collaboration with D. Bovet and O. Westphal.
Retirement and death.
Anne-Marie Staub retired in 1977 and joined a Christian movement called "Vie Montante". She spent most of her time reading for the blind and visiting patients in hospitals. Staub died on 30 December 2012 in Saint-Germain-en-Laye, France.


Bruce Dohrenwend

Bruce Philip Dohrenwend (born July 26, 1927) is an American psychiatric epidemiologist. He is Professor of Social Science in Columbia University's Department of Psychiatry and Professor of Epidemiology in the University's Mailman School of Public Health. He received his PhD from Cornell University in 1955, and served as president of the American Psychopathological Association in 1994. He was married to Barbara Snell Dohrenwend prior to her death in 1982. The two of them frequently collaborated on research projects, and they co-authored or co-edited a total of four books together. In 1980, both Dohrenwends were honored with the Award for Distinguished Contributions to Community Psychology and Community Mental Health from division 27 of the American Psychological Association, the Society for Community Research and Action. He is known for his research on the prevalence and predictors of post-traumatic stress disorder among veterans of the Vietnam War.


B. Ramana Rao

Dr Bhogaraju Ramana Rao is an Indian physician and cardiologist from Bangalore. He was born in Hyderabad. His parents belonged to West Godavari District of Andhra Pradesh. Rao has been offering health care to rural people free of cost for the last 36 years. He was awarded the Padma Shri in 2010 for his contribution to the field of medicine. Rao was Kannada thespian Rajkumar’s consulting physician. Dr B Ramnna Rao married to Smt Hema a Delhi based on 25 Dec 1975. He also contributed toilet and drinking water in rural areas of 16 villages.


Neonatology

Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations (birth defects), sepsis, pulmonary hypoplasia or birth asphyxia.
History.
While high infant mortality rates were recognized by the British medical community at least as early as the 1860s, modern neonatal intensive care is a relatively recent advance. In 1898 Dr. Joseph DeLee established the first premature infant incubator station in Chicago, Illinois. The first American textbook on prematurity was published in 1922. In 1931 Dr A Robert Bauer invented the first incubator to combine heat, and oxygen, as well as humidity while at Henry Ford Hospital. In 1952 Dr. Virginia Apgar described the Apgar score scoring system as a means of evaluating a newborn's condition. It was not until 1965 that the first American newborn intensive care unit (NICU) was opened in New Haven, Connecticut. In 1975 the American Board of Pediatrics established sub-board certification for neonatology.
The 1950s brought a rapid escalation in neonatal services with the advent of mechanical ventilation of the newborn. This allowed for survival of smaller and smaller newborns. In the 1980s, the development of pulmonary surfactant replacement therapy further improved survival of extremely premature infants and decreased chronic lung disease, one of the complications of mechanical ventilation, among less severely premature infants. In 2006 newborns as small as 450 grams and as early as 22 weeks gestation have a chance of survival. In modern NICUs, infants weighing more than 1000 grams and born after 27 weeks gestation have an approximately 90% chance of survival and the majority have normal neurological development.
Academic training.
In the United States, a "neonatologist" is a physician (MD or DO) practicing neonatology. To become a neonatologist, the physician initially receives training as a pediatrician, then completes an additional training called a fellowship (for 3 years in the US) in neonatology. In the United States of America most, but not all neonatologists, are board certified in the specialty of Pediatrics by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics and in the sub-specialty of Neonatal-Perinatal Medicine also by the American Board of Pediatrics or American Osteopathic Board of Pediatrics. Most countries now run similar programs for post-graduate training in Neonatology, as a subspecialisation of pediatrics.
In the United Kingdom, after graduation from medical school and completing the two-year foundation programme, a physician wishing to become a neonatologist would enroll in an eight-year paediatric specialty training programme. The last two to three years of this would be devoted to training in neonatology as a subspecialty.
Neonatal Nurse Practitioners (NNPs) are advanced practice nurses that specialize in neonatal care. They are considered providers and often share the workload of NICU care with resident physicians. They are able to treat, plan, prescribe, diagnose and perform procedures within their scope of practice, defined by governing law and the hospital where they work.
Spectrum of care.
Rather than focusing on a particular organ system, neonatologists focus on the care of newborns who require Intensive Care Unit (ICU) hospitalization. They may also act as general pediatricians, providing well newborn evaluation and care in the hospital where they are based. Some neonatologists, particularly those in academic settings, may follow infants for months or even years after hospital discharge to better assess the long-term effects of health problems early in life. Some neonatologists perform clinical and basic science research to further our understanding of this special population of patients.
The infant is undergoing many adaptations to extrauterine life, and its physiological systems, such as the immune system, are far from fully developed. Diseases of concern during the neonatal period include:
Compensation.
Neonatologists significantly out-earn general pediatricians. In 2018, a typical pediatrician salary ranged from $221,000 to $264,000, whereas the average salary for a neonatologist was about $299,000 to $355,000.
Treatment.
Premature birth is one of the most common reasons for hospitalization. The average hospital costs from 2003–2011 for the maternal and neonatal surgical services were the lowest hospital costs in the U.S. In 2012, maternal or neonatal hospital stays constituted the largest proportion of hospitalizations among infants, adults aged 18–44, and those covered by Medicaid.
Between 2000 and 2012, the number of neonatal stays (births) in the United States fluctuated around 4.0 million stays, reaching a high of 4.3 million in 2006. Maternal and Neonatal stays constituted 27 percent of hospital stays in the United States in 2012. However, the mean hospital costs remained the lowest of the three types of hospital stay (medical, surgical, or maternal and neonatal). The mean hospital cost for a maternal/neonatal stay was $4,300 in 2012 (as opposed to $8,500 for medical stays and $21,200 for surgical stays in 2012).


B. Timothy Walsh

Bernard Timothy Walsh, MD, FAED, is William and Joy Ruane Professor of Pediatric Psychopharmacology in the Department of Psychiatry at Columbia University, and Director of the Division of Clinical Therapeutics at New York State Psychiatric Institute, and the author and editor and co-editor of five books on adolescent health and eating disorders.
Publications.
Books
Journal Articles


Hessam Nowzari

Hessam Nowzari is the Director of the University of Southern California Advanced Periodontics program, since 1995, and is a Diplomate of the American Board of Periodontology.
Biography.
Nowzari was born in Shiraz, Iran and was the youngest director at the University of Southern California Advanced Periodontics program (1995-2012) where he established a program that mirror's Nowzari's stances on key issues in periodontology.
Nowzari is the founder of the Taipei Academy of Reconstructive Dentistry in Taiwan and one of only two American members of the Dnipropetrovsk State Academy of Medical Sciences in Ukraine. For the first time in the recent history of Israel, he was the first non-Jewish Iranian of a Persian heritage to be the keynote speaker at the Israel Dental Association Congress, possibly the largest dental event to be held in Israel.
In 2002, he joined the National Institute of Transplantation (NIT) to study the relationship between periodontal disease and transplant complications. He is also an editor of one of the leading reference publications, Aesthetic Periodontal Therapy: Periodontology 2000.
He also established a periodontic/orthodontic course at the University of Southern California. Its biological research stresses the role of viruses, mainly the herpes virus family, in periodontal disease. Surgically, it is known for its position against using animal or human cadaver products in bone or soft tissue augmentation due to their potential for contamination of the surgical site. Nowzari is known for his advocacy against early in life periodontal disease (aggressive periodontitis). In an effort to bring international attention to this cause, he made the movie "The Enemy of the Smile: AA - An Ancient Bacterium" which debuted in 2010.
Research.
In 1994, Nowzari challenged membrane guided tissue regeneration through a series of research publications, showing that the membrane is actually a source of infection to the grafted site.
Guided Tissue Regeneration.
The theory of guiding periodontal healing with the use of a barrier membrane was challenged by Nowzari and Jorgen Slots in a series of articles: Guided bone and tissue regeneration.


Seaver Autism Center

The Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai conducts research studies and provides care to children and adults with autism spectrum disorder (ASD). The Seaver Autism Center works to understand the biological causes of ASD and to develop treatments, as well as provide education and training opportunities.
As a collaborative effort that integrates the fields of psychiatry, psychology, neurology, molecular genetics, neuroscience, and neuroimaging, the Center receives funding from diverse sources, including the National Institutes of Health (NIH) in addition to multiple foundations and the pharmaceutical industry. The Center receives over 600 new referrals each year and 100 contacts per month, including patients enrolled in ongoing treatment.
History.
The Seaver Autism Center was founded in 1993 by a grant to the Icahn School of Medicine at Mount Sinai from the Beatrice and Samuel A. Seaver Foundation. The Foundation was established in 1984 and created exclusively for charitable, scientific, literary, and educational endeavors.
Leadership.
Director: Joseph Buxbaum, PhD
Clinical Director: Alex Kolevzon, MD
Chief Psychologist: Paige M. Siper, PhD
Director of Community Outreach: Michelle Gorenstein-Holtzman, PsyD
Director of Psychology Training: Danielle B. Halpern, PsyD
Research.
Members of the research team participate in interrelated ASD research programs in genetics, experimental therapeutics, neuroimaging, and cognitive neuroscience. Researchers publish over 40 related articles per year in peer-reviewed journals. The Center uses methods of genetic epidemiology, molecular and cell biology, genetics, and animal models to identify genes that contribute to ASD susceptibility and use that knowledge to develop novel therapeutics.
The Seaver Autism Center offers an integrated series of clinical research studies in treatments, genetics, and brain imaging. All services provided as part of research studies are free of charge to eligible participants and can include gold standard diagnostic assessments such as the Autism Diagnostic Observation Schedule – Second Edition (ADOS-2), the Autism Diagnostic Interview-Revised (ADI-R), psychiatric evaluations, and neuropsychological testing.
Clinical Services.
The Center provides comprehensive clinical services, including but not limited to psychiatric evaluations and Autism Diagnostic Observation Schedules (ADOS). These services are provided free-of-charge to people with autism, with participation in a research study. The Center also provides support and training for parents and siblings of individuals with autism.


Chi Park

Chi Park, MD — is a character of the American medical drama series "House". Portrayed by Los Angeles born actress and comedian Charlyne Yi, she joins Dr. Greg House's team of diagnosticians in the department of Diagnostic Medicine at the fictional Princeton-Plainsboro Teaching Hospital in New Jersey based on Yale-New Haven Hospital.
Dr. Chi Park joins the diagnostic team in Season 8 after she hits her supervisor in the neurology department when he gropes her during a procedure. Dr. Park is introduced in the episode "Transplant", in which she joins Dr. House on a case.
Dr. Chi Park has been described as a "diminutive brainiac with often hilarious anger issues". Park was born in the United States and is of Korean and Philippine ancestry. Park lives with her parents, was a top student at medical school before becoming a neurology resident at Princeton-Plainsboro hospital.


Achilles bursitis

Achilles bursitis is bursitis (inflammation of synovial sac) of bursa situated above the insertion of tendon to calcaneus. It results from overuse and wearing of tight shoes.


PhrS

PhrS is a bacterial small RNA found in Pseudomonas aeruginosa. It was first identified in a RNAomics screen and has since been found to act as a link between oxygen availability and quorum sensing.
Synthesis of PhrS is dependent on the oxygen-responsive global regulator ANR, which is required for PhrS synthesis. The Hfq protein may also bind to PhrS. In turn, PhrS regulates the transcriptional regulator PqsR which positively controls those genes involved in quorum sensing regulation in P. aeruginosa.


Viral strategies for immune response evasion

The mammalian immune system has evolved complex methods for addressing and adapting to foreign antigens. At the same time, viruses have co-evolved evasion machinery to address the many ways that host organisms attempt to eradicate them. DNA and RNA viruses use complex methods to evade immune cell detection through disruption of the Interferon Signaling Pathway, remodeling of cellular architecture, targeted gene silencing, and recognition protein cleavage.
Interferon system.
The human immune system relies on a plethora of cell-cell signaling pathways to transmit information about a cell's health and microenvironment. Many of these pathways are mediated by soluble ligands, cytokines, that fit like a lock-and-key into adjacent cell surface receptors. This language of cell communication imparts both specificity and spatiotemporal control for the transmission of data.
The Interferon System is composed of a family of cytokines. Type-I Interferons, IFN-α/β, and Type-III Interferons, IFN-λ play key roles in adaptive immunity, acting as communication highways between cells infected with foreign double stranded DNA or double stranded RNA. Mammalian cells utilize specialized receptors known as Pattern Recognition Receptors(PRRs) to detect viral infection; these receptors are able to recognize pathogen-associated molecular patterns (PAMPs) inscribed in viral DNA and RNA. These pattern recognition receptors, often localized to either the cytosol or the nucleus, are responsible for notifying infected cells and initiating the secretion of interferon cytokines.
Double-stranded RNA mediated immune response.
The precise role of double-stranded (ds)RNA is still widely investigated as a central player in the Interferon System. Groups have found that positive-strand RNA viruses and dsRNA viruses produced significant amounts of dsRNA, but the precise methods mammalian cells leverage to distinguish between self vs. non-self dsRNA have yet to be uncovered. Studies suggest that recognition must extend beyond simple identification of dsRNA structure and likely relies on other epigenetic markers.
Double-stranded RNA recognition.
Protein kinase activation.
dsRNA has been implicated in the activation of the interferon system through the activation of Protein Kinase R, PKR. Cytoplasmic PKR is often associated with the ribosome in mammalian cells where it is able to recognize double-stranded and single-stranded RNA and subsequently phosphorylate varies substrates, arresting protein synthesis. The activation of PKR subsequently triggers interferon signaling, initiating cell death in response to viral dsRNA recognition. While the PKR The roles of PKR activation have been deeply studied with groups finding that it is insensitive to the presence of short dsRNA and siRNA but showing significant affinity for dsRNA and ssRNA with secondary structure.
2'-5'- Oligoadenylate synthetase.
Groups have found that the Interferon Signaling promotes the activation of a 2'-5'-oligoadenylate synthestase, sensitive to the presence of dsRNA longer than 15 base pairs. Because this mechanism is not sensitive to self vs. non-self dsRNA binding, results indicate overall reduction in protein synthesis but indicated no specificity for a sole reduction of viral protein synthesis.
Viral evasion strategies.
In recent years, studies have focused on how viruses evade Pattern Recognition Receptors, target adaptor proteins and their kinases, inhibit transcription factors for Interferon induction, and evade Interferon Stimulated Genes.
Pattern recognition receptor evasion.
Viruses of the flaviviridae Family, such as hepatitis C virus, have developed complex viral mechanisms to rearrange the cell membrane, creating a membranaceous web designed to house viral replication machinery. These viruses utilize endogenous host cell nuclear pore complex proteins to shield viral RNA from Pattern Recognition Receptors by excluding PRRs from the interior of the viral membrane compartment. By utilizing architectural rearrangement of the membrane, viruses have developed a method to evade cytoplasm localized pattern recognition proteins such as RIG-I. In order to evade pattern recognition, other viruses such as Enterovirus have evolved multi-functional proteins that not only help in viral protein processing but also cleave cytoplasmic recognition proteins MDA5 and RIG-I, further demonstrating the extent to which viruses can reduce Interferon Signaling through various pathways. Other viruses have been reported to target upstream activators of pattern recognition proteins, antagonizing upstream proteins that removed inhibitory post-translational modifications.
Nucleic acid shielding.
Other viruses utilize host cell proteins to shield viral DNA until it has reached the nucleus. Upon entry into the host cell cytoplasm, the HIV-1 capsid is recognized and bound by cyclophilin A (CypA); this affinity interaction stabilizes the capsid and prevents exposure of the HIV-1 cDNA to pattern recognition receptors in the cytoplasm. This shielding allows the HIV-1 cDNA to translocate to the nucleus where it may begin replication.


Monica Bharel

Monica Bharel is the Commissioner of the Massachusetts Department of Public Health, appointed in February 2015. She is also an Associate Professor of Medicine at Boston University.
She earned her medical degree from Boston University School of Medicine and completed her residency in internal medicine at Boston City Hospital/Boston Medical Center. She received her Master of Public Health degree through the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy.
She practiced general internal medicine at Massachusetts General Hospital, Boston Medical Center and the Veterans Administration. She taught at Harvard Medical School, Boston University School of Medicine, and Harvard School of Public Health. Bharel was a leader in the creation of the Public Health Data Warehouse in 2017, as part of the newly created Office of Population Health. Immediately before becoming Commissioner, she served as the Chief Medical Officer of Boston Health Care for the Homeless.


Hop stunt viroid

The hop stunt viroid (abbreviated HSVd) is a viroid species that infects the common hop plant, citrus plants and grapevines, among others. It is a member of the Pospiviroidae family and the Hostuviroid genus.
There are quite a few different sub-species of the hop stunt viroid.
Genome.
The hop stunt viroid has a single stranded RNA genome; the genome is 297 nucleotides long.


Sanders T. Frank

Dr. Sanders T. Frank M.D. (May 11, 1938 – September 14, 1997) was an American pulmonologist known for describing Frank's sign. He was born in Middletown, Connecticut and qualified from New York Medical College. He worked as director of respiratory medicine and associate clinical professor of medicine at the Garfield Medical Centre, Monterey Park, California.


Josef Warkany

Josef Warkany (1902–1992) was a Jewish Austrian American pediatrician known as the "father of teratology".
Early life.
Warkany was born in Vienna and this is where he completed his medical studies. By 1932, he had published over 23 articles, before moving to Cincinnati, Ohio, on January 5, 1932, where he remained for the rest of his life.
Career.
Two genetic syndromes are named for him: Warkany syndrome 1 and Warkany syndrome 2 is named after him.
Awards.
Warkany received many awards in his lifetime for his work, including:


Michael Kotlikoff

Michael I. Kotlikoff is an American researcher, academic leader, and veterinarian, who is currently the Provost of Cornell University. He has been continuously funded by the NIH since 1986, and made significant contributions to muscle biology, heart repair, and mouse genetics.
Kotlikoff received his BA degree from the University of Pennsylvania magna cum laude in literature, and his doctorate of veterinary medicine (VMD) summa cum laude from the University of Pennsylvania. He then pursued research training earning a Ph.D. degree in Physiology at the University of California, Davis in 1994, before returning for postdoctoral training at the University of Pennsylvania in the Veterinary and Medical schools. He was a faculty member at Penn, appointed in the Veterinary and Medical Schools from 1985 to 2000, and chaired the Department of Animal Biology at Penn from 1996 to 2000, while also serving as Director of the Center for Animal Transgenesis and Germ Cell Research from 1998-2000.
In 2000, he was recruited to Cornell University to chair the newly formed Department of Biomedical Sciences, and to chair the Mammalian Genomics Initiative. As chair, Kotlikoff markedly expanded departmental research, oversaw the university's strategy to develop core mouse facilities, and established and oversaw the university transgenesis facility. In 2007, Kotlikoff was appointed dean of the New York State College of Veterinary Medicine, and in 2015, he was appointed Cornell's 16th Provost. Following the death of President Beth Garrett, Kotlikoff served as acting President of Cornell for several months, until the appointment of Hunter Rawlings as interim President.
Kotlikoff's laboratory works on cardiovascular biology and heart repair, and he leads a National Heart Lung and Blood Resource (the Cornell Heart, Lung, Blood Resource for Optogenetic Mouse Signaling) developing combinatorial mouse resources for in vivo biology. His laboratory reported development of the first mouse strain expressing genetically encoded Ca2+ sensing molecules and the first in vivo recording of heart cell Ca2+ signaling. In 2007, Kotlikoff's lab demonstrated the limited lineage potential of c-kit+ heart cells using a mouse line they developed expressing green fluorescent proteins in c-kit+ cells. This finding contradicted claims that c-kit+ precursor cells in the heart can act as heart stem cells after injury or isolation and transplantation. Numerous subsequent studies have confirmed these findings. In 2012 they showed that neonatal mammalian heart cells do have the potential to support neomyogenesis following heart infarction shortly after birth.


Paul Elliott (epidemiologist)

Paul Elliott FFPH FRCP FMedSci (born April 1954) has been professor of epidemiology and public health medicine at Imperial College London since 1995. He is director of REACT (Real-time Assessment of Community Transmission), a community coronavirus testing programme.


Denver Medical Society

The Denver Medical Society is the "Rocky Mountain region's oldest and largest local medical society" It was founded in 1871 to improve public health through education and professional standards. It tackled issues such as epidemics, tuberculosis, and development of sanitation systems, including initiating the construction of the systems sewer system. Between 1889 and 1902, its scope included Arapahoe County. Then, it returned to an organization focused on the city and county of Denver.
Denver Medical Association.
In April 1871 the Denver Medical Association was founded. The Denver Medical Association created the public health system for Denver, Colorado to improve the health of its citizens. Its goals were to "raise the standard of the profession" and "encourage better medical education".
In 1871 the Dr. Henry King Steele led an initiative to establish a state medical society. The Territorial Medical Society was established on September 19, 1871 when physicians from across the territory attended a meeting in a Denver district courtroom. It became the Colorado State Medical Society in 1876.
A key public health risk was the spread of syphilis. Dr. Frederick J. Bancroft, the Denver city physician, estimated in 1872 that due to the prevalence of prostitution, "probably every third man who reaches the age of twenty-five has acquired . . . syphilis" from the brothels in the city. Bancroft, with the Denver Medical Association, advocated licensing, stipulation of allowed services, and testing and examinations of the city's prostitutes. The proposed program was to be managed by physicians and police. The city decided instead to outlaw prostitution and fine prostitutes. In 1875, the Denver Medical Association's physicians decided that management of prostitutes was a solely a police matter. Bancroft continued to advocate a licensing system, as well as making abortion an attempted murder crime. Denver, though, was not ready to relinquish its "sex-drugs-and-gambling lifestyle" from the gold rush days.
In the 1870s, tuberculosis became more prevalent in the city. Bancroft noted in a March 1873 report to the city council that, of tuberculosis deaths that he reported, 75 of 79 were ill before they sought treatment in Colorado. He had also noted in the 1870s that Denver's citizens had injuries or illnesses due to livestock being driven through and penned on the city streets, sewage and other debris on the city streets, and outhouses placed too close to wells. He stated in a couple of annual reports that the contamination is a significant public health issue and could result in typhus and tuberculosis epidemic, he cautioned the city council. Although there were earlier attempts, it was not until 1880 that Denver began construction of a sewer system.
By that point there had been a flood on May 22, 1878 of Cherry Creek, which was then contaminated with animal remains and other material. Then, an epidemic ensued in 1879. John W. Graham, then, became the city's physician and soon after ordered the immediate construction of a sewer. Due to public health concerns, the association asked the Denver city council to forbid cattle running throughout the city streets in 1879.
The first women members—Drs. Mary Barker Bates, Alisa Avery, and Edith Root—joined in 1881.
Denver and Arapahoe counties.
The organization was broadened in scoped when it became the Denver Medical Association and Arapahoe County Medical Society in 1889. Its name was shortened three years later to Denver and Arapahoe Medical Society. It separated from Arapahoe County in November 1902.
Denver city and county.
It became the Medical Society of the City and County of Denver in 1902. In 1955, it became the Denver Medical Society.


William Branson (physician)

William Philip Sutcliffe Branson CBE FRCP (1874-1950) was a senior British physician and author.
Biography.
Born on 17 September 1874 in Calcutta, India, William Branson was educated at Bedford School, at Trinity College, Cambridge, and at the Medical College of St Bartholomew's Hospital. He was Consultant Physician at the Royal Free Hospital and at St Andrew's Hospital, Dollis Hill. During the First World War he joined the Duchess of Westminster's Hospital at Le Touquet and, in 1916, was made Consultant Physician to the Fifth Army, British Expeditionary Force, with Colonel’s rank. He was Associate Examiner in Medicine for the University of London.
The brother of The Right Hon. Sir George Arthur Harwin Branson PC (the grandfather of Sir Richard Branson), William Branson died at Bury St Edmunds on 5 March 1950.
Publications.
"Medical Morbid Anatomy and Pathology", 1909, "Songs and Sober Pieces", 1938.


Auguste Chauveau

 Jean-Baptiste "Auguste" Chauveau ForMemRS (23 November 1827 – 4 January 1917) was a French professor and veterinarian.
Life.
Born in Villeneuve-la-Guyard, he received his education at the École nationale vétérinaire d'Alfort and the École Nationale Vétérinaire de Lyon. At the age of 21 he joined the staff at the latter institution, where in 1875 he became the school's director. In 1886, he was appointed professor of comparative pathology at the Muséum national d'histoire naturelle in Paris.
Throughout his career Chauveau conducted investigations in the fields of microbiology, virology, biochemistry, muscle thermodynamics and cardiology. With Étienne-Jules Marey (1830–1904), he performed important studies involving the different phases of the cardiac cycle and intracardiac pressure.
In 1867 he made decisive experiments on the transmission of tuberculosis and his work affected public health regulations. He had a role in the invention of cardiac catheterization.
He attracted the ire of a number of anti-vivisection writers for his experiments on animals at the turn of the twentieth century.
The bacterial species "Clostridium chauvoei" is named after him.
He was the author of "Traité d'anatomie comparée des animaux domestiques", a work that was published in English as "The comparative anatomy of the domesticated animals". Also, he collaborated with Charles-Joseph Bouchard (1837–1915) in the founding of the "Journal de Physiologie et de Pathologie Générale".


Jean Blancou

Jean Blancou (August 28, 1936 (Bangui, Central African Republic - November 10, 2010) was a French veterinarian, microbiologist and author of several well known book chapters on the subject of rabies and vaccinations.


Branchial cyst