A call for action. The Pepper Commission's blueprint for health care reform

After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.     

Fracturing a dysfunctional Edwards Perimount bioprosthetic valve to facilitate percutaneous valve‐in‐valve placement of SAPIEN 3 valve with modified delivery system

Pulmonary valve replacement via surgical implantation of a bioprosthetic valve (BPV) is a well‐established treatment for patients with dysfunctional RV outflow tracts. BPVs are prone to structural deterioration, and will eventually require replacement. Recently, percutaneous valve‐in‐valve (VIV) placement of transcatheter valves has established itself as a safe and effective alternative to surgical revision. Unfortunately, VIV therapy is inherently limited by the inner diameter of the BPV, which restricts the number of eligible patients. Other centers have reported on the feasibility of cracking certain BPVs with ultra high‐pressure balloons in bench testing. We now report cracking an Edwards Perimount BPV in the pulmonary position to facilitate VIV placement of an Edwards SAPIEN 3. The ability to crack the Perimount valve allowed placement of a larger valve than previously considered and minimized the final valve gradient. In an effort to avoid the morbidity and mortality of surgical pulmonary valve replacement, this new strategy will expand the number of patients eligible for percutaneous VIV therapy.     

Psycho-physiological analysis of an aerobic dance programme for women

The purpose of this study was to determine: (1) the energy cost and (2) the psycho-physiological effects of an aerobic dance programme in young women. Twenty-one college-age women participated 40 minutes a day, three days a week, for a 10-week training period. Each work session included a five-minute warm-up period, a 30-minute stimulus period (including walk-runs) and a five-minute cool-down period. During the last four weeks of the training period, the following parameters were monitored in six of the subjects during two consecutive sessions: perceived exertion (RPE) utilising the Borg 6-20 scale, Mean = 13.19; heart rate (HR) monitored at regular intervals during the training session, Mean = 166.37; and estimated caloric expenditure based on measured oxygen consumption (O₂) utilising a Kofranyi-Michaelis respirometer, Mean = 289.32. Multivariate analysis of variance (MANOVA) computed between pre and post tests for the six dependent variables revealed a significant approximate F-ratio of 5.72 (p <.05). Univariate t-test analysis of mean changes revealed significant pre-post test differences for O₂ max expressed in ml/kg min^-1, maximal pulmonary ventilation, maximal working capacity on the bicycle ergometer, submaximal HR and submaximal RPE. Body weight was not significantly altered. It was concluded that the aerobic dance training programme employed was of sufficient intensity to elicit significant physiological and psycho-physiological alterations in college-age women.     

Selective abnormality of the cone B-wave in a patient with retinal degeneration

A 44-year-old woman with midperipheral pigmentary changes that resemble retinitis pigmentosa (RP) is described; unlike typical patients with RP, her photopic b-wave was markedly attenuated as compared with her photopic a-wave. Otherwise, her electroretinogram (ERG) was typical of patients with early stages of photoreceptor degeneration. Scotopic and photopic a-wave amplitudes were reduced about 50%; her scotopic b/a appeared normal.