Name list

Name list

Summary

This page lists each of the hash ids in each page of the planning web. 


Introduction

The name list provides a way to obtain the 'hash' id's of each page in a frame

awffwpwac.htm ( Competitor analysis ), awffwpwanhp.htm ( Analysis frame ), awffwpwapy.htm ( Payer analysis ), awffwpwate.htm ( Influential amplifiers ), awffwpwbeco13.htm ( Economic situation ), awffwpwbopt.htm ( Options ), awffwpwbphp.htm ( Adaptive business plan frame ), awffwpwbpol13.htm ( Political situation ), awffwpwbres.htm ( Resources ), awffwpwbsc.htm ( Schedule summary ), awffwpwbsoc13.htm ( Socio cultural situation ), awffwpwbtec13.htm ( Technology situation ), awffwpwbvds13.htm ( Value delivery system ), awffwpwchhp.htm ( Review frame ), awffwpwcohp.htm ( Competition frame ), awffwpwcomn.htm ( Communications ), awffwpwcuhp.htm ( Customer frame ), awffwpwcxp.htm ( Corporate execution ), awffwpwcxpfin.htm ( Finance ), awffwpwcxphr.htm ( Human resources ), awffwpwcxpilog.htm ( Inbound logistics ), awffwpwcxpinf.htm ( Infrastructure ), awffwpwcxpmar.htm ( Marketing ), awffwpwcxpolog.htm ( Outbound logistics ), awffwpwcxpops.htm ( Operations ), awffwpwcxpproc.htm ( Procurement ), awffwpwcxprad.htm ( R&D execution ), awffwpwcxpsal.htm ( Sales ), awffwpwcxpser.htm ( Service ), awffwpwcxpst.htm ( Execution frame ), awffwpwdis.htm ( Disease systems ), awffwpwdr.htm ( Disruption ), awffwpwehra.htm ( Electronic health records ), awffwpwfa.htm ( Financial analysis ), awffwpwgco.htm ( General competitor ), awffwpwgcu.htm ( General customer ), awffwpwgehp.htm ( General frame ), awffwpwgitsted1.htm ( Editor 1's branch ), awffwpwgitsted2.htm ( Editor 2's branch ), awffwpwgitsthp.htm ( Git status frame ), awffwpwgitstmaintainer.htm ( Maintenance status ), awffwpwgl.htm ( Glossary ), awffwpwgocu.htm ( Government constraints ), awffwpwgsu.htm ( General supplier ), awffwpwhiea.htm ( Health information exchange analysis ), awffwpwlva.htm ( Long view ), awffwpwnam.htm ( Name list ), awffwpwpacu.htm ( General patient ), awffwpwpal.htm ( Patient analysis ), awffwpwpo.htm ( Power ), awffwpwpp.htm ( Program process ), awffwpwprhp.htm ( Program frame ), awffwpwque.htm ( Questions ), awffwpwref.htm ( References ), awffwpwrp.htm ( Check process ), awffwpwru.htm ( Rules ), awffwpwser.htm ( Search list ), awffwpwsigov.htm ( Government analysis ), awffwpwsin.htm ( Strategic idea network ), awffwpwxphp.htm ( Execution frame ),



awffwpwac.htm ( Competitor analysis ): ../demodwbp/awffwpwac.htm#Competitor_analysis_ (Competitor_analysis_ Competitor analysis),
../demodwbp/awffwpwac.htm#Provider_business_analysis (Provider_business_analysis Provider business ),
../demodwbp/awffwpwac.htm#Customer_segmentation_analysis_ (Customer_segmentation_analysis_ Customer ),
../demodwbp/awffwpwac.htm#pressured_by_political_actions (pressured_by_political_actions pressured ),
../demodwbp/awffwpwac.htm#Christensen_argues_that_each_business (Christensen_argues_that_each_business Christensen ),
../demodwbp/awffwpwac.htm#Patient_centered_hospitals (Patient_centered_hospitals Patient centered ),
../demodwbp/awffwpwac.htm#Medical_system_quality_differentiation (Medical_system_quality_differentiation Medical ),
../demodwbp/awffwpwac.htm#Medical_system_cost_leadership (Medical_system_cost_leadership Medical system cost ),
../demodwbp/awffwpwac.htm#during_the_1990s_Kaiser_abandoned (during_the_1990s_Kaiser_abandoned during the 1990s ),
../demodwbp/awffwpwac.htm#Hospital_network_power_ (Hospital_network_power_ Hospital network power ),
../demodwbp/awffwpwac.htm#Medical_system_Innovation_focus (Medical_system_Innovation_focus Medical system ),
../demodwbp/awffwpwac.htm#amc_S1 (amc_S1 1: Extensive education & ),
../demodwbp/awffwpwac.htm#amc_S2 (amc_S2 2: Advanced clinical labs ),
../demodwbp/awffwpwac.htm#amc_S3 (amc_S3 3: Perfect partners for drug ),
../demodwbp/awffwpwac.htm#amc_S4 (amc_S4 4: Colocation with health ),
../demodwbp/awffwpwac.htm#amc_S5 (amc_S5 5: Organization setup to ),
../demodwbp/awffwpwac.htm#amc_S6 (amc_S6 6: Benefit from presence of ),
../demodwbp/awffwpwac.htm#amc_S7 (amc_S7 7: Experts in ),
../demodwbp/awffwpwac.htm#amc_S8 (amc_S8 8: Powerful brands (),
../demodwbp/awffwpwac.htm#amc_S9 (amc_S9 9: Clinical labs history data ),
../demodwbp/awffwpwac.htm#amc_S10 (amc_S10 10: Imaging history supports ),
../demodwbp/awffwpwac.htm#amc_S11 (amc_S11 11: Citizen's United (SCOTUS) ),
../demodwbp/awffwpwac.htm#amc_W1 (amc_W1 1: Lack of patients for ),
../demodwbp/awffwpwac.htm#amc_W2 (amc_W2 2: AMC investment strategies ),
../demodwbp/awffwpwac.htm#amc_W3 (amc_W3 3: Margins demanded by ),
../demodwbp/awffwpwac.htm#amc_W4 (amc_W4 4: Lack of leverage of ),
../demodwbp/awffwpwac.htm#amc_W5 (amc_W5 5: Disconnected from health ),
../demodwbp/awffwpwac.htm#amc_W6 (amc_W6 6: Current procedure lags best ),
../demodwbp/awffwpwac.htm#amc_W7 (amc_W7 7: Limited power, relative to ),
../demodwbp/awffwpwac.htm#amc_W8 (amc_W8 8: Influx of new trainee ),
../demodwbp/awffwpwac.htm#amc_W9 (amc_W9 9: ),
../demodwbp/awffwpwac.htm#amc_W10 (amc_W10 10: ),
../demodwbp/awffwpwac.htm#amc_W11 (amc_W11 11: ),
../demodwbp/awffwpwac.htm#amc_W12 (amc_W12 12: ),
../demodwbp/awffwpwac.htm#amc_W13 (amc_W13 13: ),
../demodwbp/awffwpwac.htm#amc_W14 (amc_W14 14: ),
../demodwbp/awffwpwac.htm#amc_W15 (amc_W15 15: ),
../demodwbp/awffwpwac.htm#amc_W16 (amc_W16 16: ),
../demodwbp/awffwpwac.htm#amc_W17 (amc_W17 17: ),
../demodwbp/awffwpwac.htm#amc_W18 (amc_W18 18: ),
../demodwbp/awffwpwac.htm#amc_W19 (amc_W19 19: ),
../demodwbp/awffwpwac.htm#amc_W20 (amc_W20 20: ),
../demodwbp/awffwpwac.htm#amc_W21 (amc_W21 21: ),
../demodwbp/awffwpwac.htm#amc_W22 (amc_W22 22:  ),
../demodwbp/awffwpwac.htm#amc_W23 (amc_W23 23:   ),
../demodwbp/awffwpwac.htm#amc_W24 (amc_W24 24:   ),
../demodwbp/awffwpwac.htm#amc_O1 (amc_O1 1: ),
../demodwbp/awffwpwac.htm#amc_O2 (amc_O2 2: Research focus allows ),
../demodwbp/awffwpwac.htm#amc_O3 (amc_O3 3: Integration with larger ),
../demodwbp/awffwpwac.htm#amc_O4 (amc_O4 4: Attract clinical researchers ),
../demodwbp/awffwpwac.htm#amc_O5 (amc_O5 5: Early ),
../demodwbp/awffwpwac.htm#amc_O6 (amc_O6 6: Participation in random ),
../demodwbp/awffwpwac.htm#amc_O7 (amc_O7 7: Experts help in handling ),
../demodwbp/awffwpwac.htm#amc_O8 (amc_O8 8: Able to leverage all health ),
../demodwbp/awffwpwac.htm#amc_O9 (amc_O9 9: Can participate in ),
../demodwbp/awffwpwac.htm#amc_O10 (amc_O10 10: Desperate patients want ),
../demodwbp/awffwpwac.htm#amc_O11 (amc_O11 11: Improving ),
../demodwbp/awffwpwac.htm#amc_O12 (amc_O12 12: Use brand to leverage ),
../demodwbp/awffwpwac.htm#amc_O13 (amc_O13 13: ),
../demodwbp/awffwpwac.htm#amc_O14 (amc_O14 14: Leverage ),
../demodwbp/awffwpwac.htm#amc_O15 (amc_O15 15: ),
../demodwbp/awffwpwac.htm#amc_O16 (amc_O16 16: Increasing network returns ),
../demodwbp/awffwpwac.htm#amc_O17 (amc_O17 17: ),
../demodwbp/awffwpwac.htm#amc_O18 (amc_O18 18: ),
../demodwbp/awffwpwac.htm#amc_O19 (amc_O19 19: ),
../demodwbp/awffwpwac.htm#amc_O20 (amc_O20 20: ),
../demodwbp/awffwpwac.htm#amc_O21 (amc_O21 21: ),
../demodwbp/awffwpwac.htm#amc_O22 (amc_O22 22:   ),
../demodwbp/awffwpwac.htm#amc_T1 (amc_T1 1: Cost of advanced medicines ),
../demodwbp/awffwpwac.htm#amc_T2 (amc_T2 2: No opportunity to share ),
../demodwbp/awffwpwac.htm#amc_T3 (amc_T3 3: High cost chronic complex ),
../demodwbp/awffwpwac.htm#amc_T4 (amc_T4 4: Stark laws block ),
../demodwbp/awffwpwac.htm#amc_T5 (amc_T5 5: Cost of ),
../demodwbp/awffwpwac.htm#amc_T6 (amc_T6 6: Trial failures include risk ),
../demodwbp/awffwpwac.htm#amc_T7 (amc_T7 7: Follow early treatment ),
../demodwbp/awffwpwac.htm#amc_T8 (amc_T8 8: ),
../demodwbp/awffwpwac.htm#amc_T9 (amc_T9 9: Powerful insurers entering ),
../demodwbp/awffwpwac.htm#amc_T10 (amc_T10 10: Endowment management ),
../demodwbp/awffwpwac.htm#amc_T11 (amc_T11 11: Complexity of genomic ),
../demodwbp/awffwpwac.htm#amc_T12 (amc_T12 12: ),
../demodwbp/awffwpwac.htm#amc_T13 (amc_T13 13: ),
../demodwbp/awffwpwac.htm#amc_T14 (amc_T14 14: Dependence on ),
../demodwbp/awffwpwac.htm#amc_Imbalances (amc_Imbalances Imbalances). ),
../demodwbp/awffwpwac.htm#AMC_SWOT_Cl1 (AMC_SWOT_Cl1 Cluster 1 -  ?? (W9, W10, W22, ),
../demodwbp/awffwpwac.htm#Partners_Healthcare_has_used_geographic (Partners_Healthcare_has_used_geographic ),
../demodwbp/awffwpwac.htm#Hospital_business_model_focus_strategies (Hospital_business_model_focus_strategies Hospital ),
../demodwbp/awffwpwac.htm#Reengineering_ED_use (Reengineering_ED_use Reengineering ED use),
../demodwbp/awffwpwac.htm#Government_sustained_safety_net_focus_ (Government_sustained_safety_net_focus_ Government ),
../demodwbp/awffwpwac.htm#Medical_system_for_profit (Medical_system_for_profit Medical system for ),
../demodwbp/awffwpwac.htm#Geographic_niche_hospital_strategies (Geographic_niche_hospital_strategies Geographic ),
../demodwbp/awffwpwac.htm#Key_flows_in_the_health_care_provider (Key_flows_in_the_health_care_provider Key flows ),
../demodwbp/awffwpwac.htm#US_Congress_and_trade_deals (US_Congress_and_trade_deals US Congress, ),
../demodwbp/awffwpwac.htm#Formilary_blocks_and_copayments_removed (Formilary_blocks_and_copayments_removed ),
../demodwbp/awffwpwac.htm#Hospitals_limiting_access_to_pricing (Hospitals_limiting_access_to_pricing Hospitals ),
../demodwbp/awffwpwac.htm#Independent_doctors_have_invested (Independent_doctors_have_invested 'Independent' ),
../demodwbp/awffwpwac.htm#Process_to_handle_epidemic_infected (Process_to_handle_epidemic_infected Process ),
../demodwbp/awffwpwac.htm#Medicare_Part_B_drug_payment (Medicare_Part_B_drug_payment ),
../demodwbp/awffwpwac.htm#Saline_purchased_by_hospital_purchasing_ (Saline_purchased_by_hospital_purchasing_ Saline ),
../demodwbp/awffwpwac.htm#High_cost_biologic_insulin_manufacturer (High_cost_biologic_insulin_manufacturer High cost ),
../demodwbp/awffwpwac.htm#reduced_wealth_and_aging (reduced_wealth_and_aging reduced ),

awffwpwanhp.htm ( Analysis frame ): ../demodwbp/awffwpwanhp.htm#Analysis_Frame_ (Analysis_Frame_ Analysis Frame),
../demodwbp/awffwpwanhp.htm#generated_web_structure (generated_web_structure generated web ),
../demodwbp/awffwpwanhp.htm#Successive_governments_have (Successive_governments_have ),
../demodwbp/awffwpwanhp.htm#EHR_technology_has_enabled_Geisingers (EHR_technology_has_enabled_Geisingers ),
../demodwbp/awffwpwanhp.htm#Hospitals_must_also_develop_strategies (Hospitals_must_also_develop_strategies Hospitals ),
../demodwbp/awffwpwanhp.htm#Hospital_suppliers_including_the_big (Hospital_suppliers_including_the_big Hospital ),
../demodwbp/awffwpwanhp.htm#Trends_in_the_Environment (Trends_in_the_Environment Trends in the ),
../demodwbp/awffwpwanhp.htm#After_many_years_when_health_care (After_many_years_when_health_care After many years ),
../demodwbp/awffwpwanhp.htm#reduced_wealth_and_aging (reduced_wealth_and_aging reduced ),
../demodwbp/awffwpwanhp.htm#Singapore_as_a_vision_of_a (Singapore_as_a_vision_of_a Singapore is a ),
../demodwbp/awffwpwanhp.htm#Single_payer_scenario (Single_payer_scenario Single-payer scenario),
../demodwbp/awffwpwanhp.htm#Key_influences_of_the_health_care (Key_influences_of_the_health_care Key influences ),
../demodwbp/awffwpwanhp.htm#Genomic_proteomic_and_medical_knowledge (Genomic_proteomic_and_medical_knowledge Genomic, ),
../demodwbp/awffwpwanhp.htm#Device_trends (Device_trends Device trends - leverage of Nano-scale ),
../demodwbp/awffwpwanhp.htm#Pharmaceutical_trends_-_Slow_expansion (Pharmaceutical_trends_-_Slow_expansion Pharmaceutical ),
../demodwbp/awffwpwanhp.htm#Trial_trends (Trial_trends ),
../demodwbp/awffwpwanhp.htm#dfp1 (dfp1 P1: Deregulation),
../demodwbp/awffwpwanhp.htm#dfp2 (dfp2 P2: Globalization and extended phenotypic ),
../demodwbp/awffwpwanhp.htm#dfp3 (dfp3 P3: GATT and regional trade deals),
../demodwbp/awffwpwanhp.htm#dfp4 (dfp4 P4: Anti-trust - Microsoft, IBM & ),
../demodwbp/awffwpwanhp.htm#dfp5 (dfp5 P5: Intellectual property rights),
../demodwbp/awffwpwanhp.htm#dfp6 (dfp6 P6: Euro),
../demodwbp/awffwpwanhp.htm#dfp7 (dfp7 P7: ),
../demodwbp/awffwpwanhp.htm#dfp8 (dfp8 P8: (2002) Terrorism & Ethnic/religious ),
../demodwbp/awffwpwanhp.htm#dfp9 (dfp9 P9: 8 Billion people increasingly in cities ),
../demodwbp/awffwpwanhp.htm#dfp10 (dfp10 P10: US democracy log jam keeps strategies ),
../demodwbp/awffwpwanhp.htm#dfp11 (dfp11 P11: US Democrats gain increasing control ),
../demodwbp/awffwpwanhp.htm#dfp12 (dfp12 P12: ),
../demodwbp/awffwpwanhp.htm#dfp13 (dfp13 P13: ),
../demodwbp/awffwpwanhp.htm#dfe1 (dfe1 ),
../demodwbp/awffwpwanhp.htm#Unpredictable_Infrastructure_build_out_Positive_return (Unpredictable_Infrastructure_build_out_Positive_return E1: ),
../demodwbp/awffwpwanhp.htm#dfe2 (dfe2 E2: Transaction cost ),
../demodwbp/awffwpwanhp.htm#dfe3 (dfe3 E3: Swarms & Communities),
../demodwbp/awffwpwanhp.htm#Financial_measurement_system_and_stock_assessment (Financial_measurement_system_and_stock_assessment ),
../demodwbp/awffwpwanhp.htm#dfe4 (dfe4 E4: Financial measurement system and stock ),
../demodwbp/awffwpwanhp.htm#dfe5 (dfe5 E5: Friction free electronic business ),
../demodwbp/awffwpwanhp.htm#dfe6 (dfe6 E6: Disaggregation/rationalization of ),
../demodwbp/awffwpwanhp.htm#dfe7 (dfe7 E7: Low skilled unemployed can't compete ),
../demodwbp/awffwpwanhp.htm#dfe8 (dfe8 E8: Malthusian down cycle promotes income ),
../demodwbp/awffwpwanhp.htm#dfe9 (dfe9 E9: Not enough skilled IT people (3.1 ),
../demodwbp/awffwpwanhp.htm#dfe10 (dfe10 E10: Global business cycles),
../demodwbp/awffwpwanhp.htm#dfe11 (dfe11 E11: ),
../demodwbp/awffwpwanhp.htm#dfe12 (dfe12 E12: ),
../demodwbp/awffwpwanhp.htm#dfe13 (dfe13 E13: Oil sourcing food for 8 Billion ),
../demodwbp/awffwpwanhp.htm#dfe14 (dfe14 E14: Internet ),
../demodwbp/awffwpwanhp.htm#dfe15 (dfe15 E15: Pressure on low growth aspects of ),
../demodwbp/awffwpwanhp.htm#dfe16 (dfe16 E16: Aging of US population creates ),
../demodwbp/awffwpwanhp.htm#dfe17 (dfe17 E17: Human energy capture still dependent ),
../demodwbp/awffwpwanhp.htm#dfe18 (dfe18 E18: Infrastructure investment leverage ),
../demodwbp/awffwpwanhp.htm#dfe19 (dfe19 E19: Retirement of 80% of US nurses - all ),
../demodwbp/awffwpwanhp.htm#dfe20 (dfe20 E20: 25,000 shortage of ),
../demodwbp/awffwpwanhp.htm#dfe21 (dfe21 E21: Will the collapse of weak hospital ),
../demodwbp/awffwpwanhp.htm#dfe22 (dfe22 E22: Scale of employer shift of workers ),
../demodwbp/awffwpwanhp.htm#dfe23 (dfe23 E23: ),
../demodwbp/awffwpwanhp.htm#dfe24 (dfe24 E24: ),
../demodwbp/awffwpwanhp.htm#dfe25 (dfe25 E25: ),
../demodwbp/awffwpwanhp.htm#dfs1 (dfs1 S1: Cyber communities),
../demodwbp/awffwpwanhp.htm#dfs2 (dfs2 S2: Market to one but sell to the whole ),
../demodwbp/awffwpwanhp.htm#dfs3 (dfs3 S3: Hierarchies and ),
../demodwbp/awffwpwanhp.htm#dfs4 (dfs4 S4: Open source),
../demodwbp/awffwpwanhp.htm#dfs5 (dfs5 S5: 80 year ),
../demodwbp/awffwpwanhp.htm#dfs6 (dfs6 S6: Environmental stress removes glaciation ),
../demodwbp/awffwpwanhp.htm#dfs7 (dfs7 S7: US Job skills training not focused on ),
../demodwbp/awffwpwanhp.htm#dfs8 (dfs8 S8: Ineffective population health care - ),
../demodwbp/awffwpwanhp.htm#dfs9 (dfs9 S9: Hot spots in US population have outsize ),
../demodwbp/awffwpwanhp.htm#dfs11 (dfs11 S11: ),
../demodwbp/awffwpwanhp.htm#dfs12 (dfs12 S12: Stock option and ),
../demodwbp/awffwpwanhp.htm#dfs13 (dfs13 S13: Death decoupled from treatment ),
../demodwbp/awffwpwanhp.htm#dfs14 (dfs14 S14: Consumer empowerment's impact on ),
../demodwbp/awffwpwanhp.htm#dft1 (dft1 T1: Computerized brain which can talk ),
../demodwbp/awffwpwanhp.htm#dft2 (dft2 T2: Global Network (Data, Flight, Disease, ),
../demodwbp/awffwpwanhp.htm#dft3 (dft3 T3: Standards),
../demodwbp/awffwpwanhp.htm#dft4 (dft4 T4: Genetically engineered crops with ),
../demodwbp/awffwpwanhp.htm#dft5 (dft5 T5: Data > Voice),
../demodwbp/awffwpwanhp.htm#Modularity_of_integrated_systems_suspect (Modularity_of_integrated_systems_suspect ),
../demodwbp/awffwpwanhp.htm#dft6 (dft6 T6: Modularity fails when merge systems with ),
../demodwbp/awffwpwanhp.htm#dft7 (dft7 T7: Complexity of growing set of scientific ),
../demodwbp/awffwpwanhp.htm#dft8 (dft8 T8: Appliances ),
../demodwbp/awffwpwanhp.htm#dft9 (dft9 T9: ),
../demodwbp/awffwpwanhp.htm#dft10 (dft10 T10: Cloud),
../demodwbp/awffwpwanhp.htm#dft11 (dft11 T11: Immune system leverage in ),
../demodwbp/awffwpwanhp.htm#dft12 (dft12 T12: Effective Process management ),
../demodwbp/awffwpwanhp.htm#dft13 (dft13 T13: Interoperable ),
../demodwbp/awffwpwanhp.htm#dft14 (dft14 T14: ),
../demodwbp/awffwpwanhp.htm#dft15 (dft15 T15: ),
../demodwbp/awffwpwanhp.htm#SWOT (SWOT 2013 ),
../demodwbp/awffwpwanhp.htm#jm_S1 (jm_S1 1: <strength>),
../demodwbp/awffwpwanhp.htm#jm_S2 (jm_S2 2: <strength>),
../demodwbp/awffwpwanhp.htm#jm_S3 (jm_S3 3: <strength>),
../demodwbp/awffwpwanhp.htm#jm_S4 (jm_S4 4: <strength>),
../demodwbp/awffwpwanhp.htm#jm_S5 (jm_S5 5: <strength>),
../demodwbp/awffwpwanhp.htm#jm_W1 (jm_W1 1: ),
../demodwbp/awffwpwanhp.htm#jm_W2 (jm_W2 2: Lack of accountability for ),
../demodwbp/awffwpwanhp.htm#jm_W3 (jm_W3 3: Limited patient engagement in ),
../demodwbp/awffwpwanhp.htm#jm_W4 (jm_W4 4: Uncertain appropriateness of ),
../demodwbp/awffwpwanhp.htm#jm_W5 (jm_W5 5: Shortage of ),
../demodwbp/awffwpwanhp.htm#jm_W6 (jm_W6 6: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W7 (jm_W7 7: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W8 (jm_W8 8: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W9 (jm_W9 9: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W10 (jm_W10 10: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W11 (jm_W11 11: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W12 (jm_W12 12: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W13 (jm_W13 13: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W14 (jm_W14 14: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W15 (jm_W15 15: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W16 (jm_W16 16: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W17 (jm_W17 17: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_W18 (jm_W18 18: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W19 (jm_W19 19: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W20 (jm_W20 20: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W21 (jm_W21 21: <weakness>),
../demodwbp/awffwpwanhp.htm#jm_W22 (jm_W22 22: <weakness> ),
../demodwbp/awffwpwanhp.htm#jm_O1 (jm_O1 1: ),
../demodwbp/awffwpwanhp.htm#jm_O2 (jm_O2 2: Optimization of resources ),
../demodwbp/awffwpwanhp.htm#jm_O3 (jm_O3 3: Well-designed checklists ),
../demodwbp/awffwpwanhp.htm#jm_O4 (jm_O4 4: Nano technology and ),
../demodwbp/awffwpwanhp.htm#jm_O5 (jm_O5 5: Often an inverse relationship ),
../demodwbp/awffwpwanhp.htm#jm_O6 (jm_O6 6: Widely variable outcomes in ),
../demodwbp/awffwpwanhp.htm#jm_O7 (jm_O7 7: Geographic differences in the ),
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awffwpwbopt.htm ( Options ):
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../demodwbp/awffwpwgco.htm#HIV_Medicine_Association_HIVMA (HIV_Medicine_Association_HIVMA ),
../demodwbp/awffwpwgco.htm#Home_Care_Association_of_America_ (Home_Care_Association_of_America_ ),
../demodwbp/awffwpwgco.htm#Hospitals_in_Pursuit_of_Excellence_ (Hospitals_in_Pursuit_of_Excellence_ ),
../demodwbp/awffwpwgco.htm#Bridging_Worlds (Bridging_Worlds Bridging Worlds: The Future Role ),
../demodwbp/awffwpwgco.htm#Leukemia_and_Lymphoma_Society_LLS_ (Leukemia_and_Lymphoma_Society_LLS_ Leukemia and ),
../demodwbp/awffwpwgco.htm#Lown_Institute_ (Lown_Institute_ ),
../demodwbp/awffwpwgco.htm#LI_Senior_VP_Shannon_Brownlee_ (LI_Senior_VP_Shannon_Brownlee_ LI Senior VP ),
../demodwbp/awffwpwgco.htm#Hospital_infrastructure_competition (Hospital_infrastructure_competition Hospital ),
../demodwbp/awffwpwgco.htm#March_of_Dimes_ (March_of_Dimes_ ),
../demodwbp/awffwpwgco.htm#Medical_Imaging__Technology_Alliance (Medical_Imaging__Technology_Alliance Medical ),
../demodwbp/awffwpwgco.htm#Medical_Information_Working_Group_ (Medical_Information_Working_Group_ Medical ),
../demodwbp/awffwpwgco.htm#Multiple_Myeloma_Research_Foundation (Multiple_Myeloma_Research_Foundation Multiple ),
../demodwbp/awffwpwgco.htm#National_Alliance_on_Mental_Illness (National_Alliance_on_Mental_Illness National ),
../demodwbp/awffwpwgco.htm#National_Association_of_Chain_Drug (National_Association_of_Chain_Drug National ),
../demodwbp/awffwpwgco.htm#National_association_of_Homecare_ (National_association_of_Homecare_ National ),
../demodwbp/awffwpwgco.htm#National_Association_of_Long_Term (National_Association_of_Long_Term National ),
../demodwbp/awffwpwgco.htm#National_Bone_Health_Alliance_NBHA_ (National_Bone_Health_Alliance_NBHA_ National Bone ),
../demodwbp/awffwpwgco.htm#National_Business_Group_on_Health_ (National_Business_Group_on_Health_ National ),
../demodwbp/awffwpwgco.htm#National_Center_for_Assisted_Living (National_Center_for_Assisted_Living National ),
../demodwbp/awffwpwgco.htm#National_Council_on_Aging_NCOA (National_Council_on_Aging_NCOA National Council on ),
../demodwbp/awffwpwgco.htm#National_Community_Pharmacy_Associations (National_Community_Pharmacy_Associations National ),
../demodwbp/awffwpwgco.htm#National_Multiple_Sclerosis_Society_ (National_Multiple_Sclerosis_Society_ ),
../demodwbp/awffwpwgco.htm#National_Osteoporosis_Foundation_NOF (National_Osteoporosis_Foundation_NOF National ),
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../demodwbp/awffwpwgco.htm#PhRMA_and_Stephen_Ubl (PhRMA_and_Stephen_Ubl PhRMA and Stephen Ubl),
../demodwbp/awffwpwgco.htm#Medical_Group_Management_Association_ (Medical_Group_Management_Association_ ),
../demodwbp/awffwpwgco.htm#National_Association_of_Community_Health (National_Association_of_Community_Health National ),
../demodwbp/awffwpwgco.htm#National_Association_of_Manufacturers (National_Association_of_Manufacturers National ),
../demodwbp/awffwpwgco.htm#National_Health_CouncilNHC (National_Health_CouncilNHC National Health ),
../demodwbp/awffwpwgco.htm#National_Health_Law_Program_NHLP (National_Health_Law_Program_NHLP National Health ),
../demodwbp/awffwpwgco.htm#National_Hospice_and_Palliative_Care (National_Hospice_and_Palliative_Care National ),
../demodwbp/awffwpwgco.htm#National_Human_Genome_Research_Institute (National_Human_Genome_Research_Institute National ),
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../demodwbp/awffwpwgco.htm#Personal_Care_Products_Council_PCPC (Personal_Care_Products_Council_PCPC Personal Care ),
../demodwbp/awffwpwgco.htm#Pharmaceutical_Care_Management (Pharmaceutical_Care_Management Pharmaceutical Care ),
../demodwbp/awffwpwgco.htm#PharmedOut_ (PharmedOut_ ),
../demodwbp/awffwpwgco.htm#Planned_Parenthood_ (Planned_Parenthood_ ),
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../demodwbp/awffwpwgco.htm#Republican_Attorneys_General_Association (Republican_Attorneys_General_Association Republican ),
../demodwbp/awffwpwgco.htm#School_Nutrition_Association_ (School_Nutrition_Association_ School Nutrition ),
../demodwbp/awffwpwgco.htm#Society_for_Healthcare_Strategy__Market (Society_for_Healthcare_Strategy__Market ),
../demodwbp/awffwpwgco.htm#Sugar_Association_ (Sugar_Association_ ),
../demodwbp/awffwpwgco.htm#Trust_for_Americas_Health_TFAH (Trust_for_Americas_Health_TFAH ),
../demodwbp/awffwpwgco.htm#United_States_Chamber_of_Commerce_ (United_States_Chamber_of_Commerce_ United States ),
../demodwbp/awffwpwgco.htm#Donohhue_successfully_pushed_large (Donohhue_successfully_pushed_large Donohue scrapped ),
../demodwbp/awffwpwgco.htm#Health_insurers_use_chamber_to_fight_ACA (Health_insurers_use_chamber_to_fight_ACA Health ),
../demodwbp/awffwpwgco.htm#Oct_10_2015_NYT_Big_Tobaccos_Powerful (Oct_10_2015_NYT_Big_Tobaccos_Powerful Oct 10 2015 ),
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../demodwbp/awffwpwgco.htm#Wisconsin_Collaborative_for_healthcare (Wisconsin_Collaborative_for_healthcare Wisconsin ),
../demodwbp/awffwpwgco.htm#Consumer_and_patient_advocates (Consumer_and_patient_advocates Consumer and ),
../demodwbp/awffwpwgco.htm#Georgians_for_a_Healthy_Future_ (Georgians_for_a_Healthy_Future_ ),
../demodwbp/awffwpwgco.htm#Health_Access_California_ (Health_Access_California_ ),
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../demodwbp/awffwpwgco.htm#PFAD_2017_Executive_director_Ben_Wakana. (PFAD_2017_Executive_director_Ben_Wakana. PFAD 2017 ),
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../demodwbp/awffwpwgco.htm#Public_Citizen_ (Public_Citizen_ ),
../demodwbp/awffwpwgco.htm#Public_Library_of_Science_PLOS (Public_Library_of_Science_PLOS Public Library of ),
../demodwbp/awffwpwgco.htm#Project_Tendr_ (Project_Tendr_ ),
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awffwpwgcu.htm ( General customer ):
awffwpwgehp.htm ( General frame ): ../demodwbp/awffwpwgehp.htm#Introduction_ (Introduction_ Introduction),

awffwpwgitsted1.htm ( Editor 1's branch ):
awffwpwgitsted2.htm ( Editor 2's branch ):
awffwpwgitsthp.htm ( Git status frame ): ../demodwbp/awffwpwgitsthp.htm#Introduction_ (Introduction_ Introduction),

awffwpwgitstmaintainer.htm ( Maintenance status ):
awffwpwgl.htm ( Glossary ): ../demodwbp/awffwpwgl.htm#gl_A1AT (gl_A1AT is alpha 1-antitrypsin, an enzyme produced in the liver which protects the lungs from neutrophil elastase. 
),
../demodwbp/awffwpwgl.htm#gl_A1AT_deficiency (gl_A1AT_deficiency is a deficiency in the liver's production of A1AT and consequent failure to protect the connective tissue in the lungs from neutrophil elastase disruption resulting over time in emphysema.  ),
../demodwbp/awffwpwgl.htm#gl_A1C_test (gl_A1C_test is a blood test that assesses a person's average level of blood glucose over a 3 month period.  Because glucose attaches to hemoglobin the 3 month lifetime of red blood cells can be used as a buffer of blood glucose. 
),
../demodwbp/awffwpwgl.htm#gl_AAA (gl_AAA ascending aortic atherosclerosis, is considered an independent predictor of long-term neurologic events, peripheral embolism and mortality. 
),
../demodwbp/awffwpwgl.htm#gl_AAAS (gl_AAAS is the American academy for the Advancement of Science. 
),
../demodwbp/awffwpwgl.htm#gl_AACR (gl_AACR is the American Association for Cancer Research. 
),
../demodwbp/awffwpwgl.htm#gl_AAD (gl_AAD is the American academy of Dermatology. 
),
../demodwbp/awffwpwgl.htm#gl_AAMC (gl_AAMC is the Associaton of American Medical Colleges
),
../demodwbp/awffwpwgl.htm#gl_AAO (gl_AAO is the American Academy of Ophthalmology.  
),
../demodwbp/awffwpwgl.htm#gl_AAV (gl_AAV is adeno-associated virus, which affects humans and other primates.  It used in genetic engineering to deploy gene insertion tools into animal cells.  It was used in constructing optogenetic tools. 
),
../demodwbp/awffwpwgl.htm#gl_AB_1203 (gl_AB_1203 is an act that requires non-contracted general acute care hospitals (not E.D.) billing HMOs for post-stabilization services to on stabilization:
  • Seek the name and contact information of the patient's health care service plan
  • Call the plan
  • Upon request provide the patients diagnosis, and other information required by the plan so it can decide on authorizing post-stabilization care or require transfer of the patient. 
  • Request the patient's medical record from the health plan. 
  • The non-contracted health plan must
    • Be available 24/7 to respond to AB requests within 30 minutes.
    • Arrange for and effect transfer promptly. 
    • Pay for all authorized services, and for all services provided prior to transfer. 
),
../demodwbp/awffwpwgl.htm#gl_ABA (gl_ABA is the:
  • American Bankers Association.  
  • American Board of Anesthesiology. 
),
../demodwbp/awffwpwgl.htm#gl_Abacavir (gl_Abacavir is a nucleoside reverse transcriptase inhibitor, an ARV medication, branded as Ziagen, which is used in the prevention and constraint of AIDS.  It is a WHO essential medicine.  Its use is problematic in about 6% of the patient base.  Pharmacogenomics allows these patients to be identified and treated with an alternative ARV. 
),
../demodwbp/awffwpwgl.htm#gl_ABCDE_Bundle (gl_ABCDE_Bundle in critical care nursing means Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility.  The goal is to improve ventilator weaning, delirium, and mobility in the ICU.  ),
../demodwbp/awffwpwgl.htm#gl_ABFM (gl_ABFM is the American Board of Family Medicine. ),
../demodwbp/awffwpwgl.htm#gl_ABIGAIL (gl_ABIGAIL is Geisinger's patient experience standards, after founder Abigail Geisinger:
  • Accountable
  • Befriend
  • Inform
  • Genuine
  • Acknowledge
  • Involve
  • Listen
),
../demodwbp/awffwpwgl.htm#gl_Abiraterone (gl_Abiraterone is a steroidal androgen synthesis inhibitor used in androgen deprivation therapy for prostate cancer. 
),
../demodwbp/awffwpwgl.htm#gl_ABL (gl_ABL is a gene on human chromosole 22.  In the majority of cases of CML part of ABL is coppied into a merged chromosome with part of BCR from chromosome 9, in a transformation initially noted by Dr. Janet Rowley and colleagues and called the Philadelphia chromosome.  ),
../demodwbp/awffwpwgl.htm#gl_Ablation (gl_Ablation is classically the removal of body tissue by surgery, such as endometrial ablation to treat uterine bleeding, but there are special cases:
  • Cardiac ablation is the deployment of catheters into the heart to correct arrhythmia. 
),
../demodwbp/awffwpwgl.htm#gl_ABN (gl_ABN is a Medicare advance beneficiary notice of non-coverage issued by a provider who believes Medicare will not reimburse the procedure. 
),
../demodwbp/awffwpwgl.htm#gl_ABS (gl_ABS is an asset-backed security defined as backed by nonconforming loans rather than Fannie Mae or Freddie Mac quality loans used in original MBS or CMO. 
),
../demodwbp/awffwpwgl.htm#gl_Abuse-deterrent (gl_Abuse-deterrent pharmaceuticals are formulated to make crushing or altering the pills harder.  However, abuse-deterrent opioids when swallowed can still induce addiction.  Some experts consider conflating abuse-deterrent with less additive as misleading (Nov 2017). 
),
../demodwbp/awffwpwgl.htm#gl_AC (gl_AC is an affiliated contractor.  Fiscal intermediaries and carriers that use a PSC for Medicare benefit integrity protection are termed ACs. 
),
../demodwbp/awffwpwgl.htm#gl_ACA (gl_ACA is the Patient Protection and Affordable Care Act amended by the Health Care and Education Reconciliation Act of 2010 (Obama care).  In part it is designed to make the health care system costs grow slower.  It aims to do this by: increasing competition between insurers and providers, offering free preventative services to limit the development of serious illnesses, constraining patients' use of expensive services, constraining the growth of payments to Medicare providers and piloting new ways for PCPs to manage patient care to keep patients away from costly E.D.s.  It funds these changes with increased taxes on the wealthy.  It follows an architecture developed by Heritage Action's Butler, Moffit, Haislmaier extended by White House OMB health policy advisor Ezekiel Emanuel & architect Jeanne Lambrew.  The Obama administration drafting team included: Bob Kocher; allowing it to integrate ideas from: Dartmouth Institute's Elliot Fischer (ACO).  The ACA did not include a Medicare buy in (May 2016).  The law includes:
  • Alterations, in title I, to how health care is paid for and who is covered.  This has been altered to ensure
    • Americans with preexisting conditions get health insurance cover - buttressed by mandating community rating and
    • That they are constrained by the individual mandate to have insurance but the requirement was supported by subsidies for the poor (those with incomes between 100 & 400% of the federal poverty line).  
    • Children, allowed to, stay on their parents insurance until 26 years of age. 
  • Medicare solvency improvements. 
  • Medicaid expansion, in title II: to poor with incomes below 138% of the federal poverty line; an expansion which was subsequently constrained by the Supreme Court's ruling making expansion an optional state government decision. 
  • Hospital Readmissions Reduction Program (HRRP) which was enforced by CMS mandated rules finalized in 2011 and effected starting Oct 2012.  
  • Medical home models.  
  • Community transformation grants support the transformation of low income stressed neighborhoods to improve their lifestyles and health. 
  • Qualifications for ACOs.  Organizations must:
    • Establish a formal legal structure with shared governance which allows the ACO to distribute shared savings payments to participating providers and suppliers. 
    • Participate in the MSSP for three or more years. 
    • Have a management structure. 
    • Have clinical and administrative systems. 
    • Include enough PCPs to care for Medicare FFS patient population (> 5000) assigned to the ACO. 
    • Be accountable for the quality and cost of care provided to the Medicare FFS patient population. 
    • Have defined processes to promote: Evidence-based medicine, Patient-centeredness, Quality reporting, Cost management, Coordination of care; 
    • Demonstrate it meets HHS patient-centeredness criteria including use of patient and caregiver assessments and individualized care plans.  
  • CMMI Medicare payment experimentation.  
  • Requirements that pharmaceutical companies must report payments made to physicians (Sunshine Act). 
  • A requirement that chain restaurants must report calorie counts on their menus. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_III (gl_ACA_title_III is ACA improving the quality and efficiency of the health care delivery system. 
  • Subtitle A: Transforming the health care delivery system.  
    • Part I: Linking payment to quality outcomes under the Medicare program.  Annual pay raises to hospitals were cut. 
    • Part II: National strategy to improve health care quality. 
    • Part III: Encouraging development of new patient care models. 
  • Subtitle B: Improving Medicare of patients and providers. 
    • Part I: Ensuring beneficiary access to physician care and other services. 
    • Part II: Rural protections. 
    • Part III: Improving payment accuracy.  
  • Subtitle C: Provisions relating to Part C.  
  • Subtitle D: Medicare Part D Improvements for prescription drug plans and MA-PD plans.  
  • Subtitle E: Ensuring Medicare sustainability.  
  • Subtitle F: Health care quality improvements.  
    • 3403 specifies the IPAB
  • Subtitle G: Protecting and improving guaranteed Medicare benefits. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_VII (gl_ACA_title_VII is ACA improving access to innovative medical therapies. 
  • Subtitle A: Biologics price competition and innovation. 
  • Subtitle B: More affordable medicine for children and underserved communities. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_VI (gl_ACA_title_VI is ACA transparency and program integrity. 
  • Subtitle A: Physician ownership and other transparency. 
  • Subtitle B: Nursing home transparency and improvement. 
    • Part I: Improving transparency of information. 
    • Part II: Targeting enforcement. 
    • Part III: Improving staff training. 
  • Subtitle C: Nationwide program for national and state background checks on direct patient access employees of long term care facilities and providers. 
  • Subtitle D: Patient-Centered outcomes research. 
  • Subtitle E: Medicare, Medicaid, and CHIP program integrity provisions. 
  • Subtitle F: Additional Medicaid program integrity provisions. 
  • Subtitle G: Additional program integrity provisions. 
  • Subtitle H: Elder justice act. 
  • Subtitle I: Sense of the senate regarding medical malpractice. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_I (gl_ACA_title_I is ACA quality affordable care for all Americans.  It mandates community rating & essential health benefits.  It includes:
  • Subtitle A: Immediate improvements in health care for all Americans. 
  • Subtitle B: Immediate actions to preserve and expand coverage. 
  • Subtitle C: Quality health insurance coverage for all Americans.  Which reforms the health insurance markets and prohibits preexisting condition exclusions and forms of health status discrimination.  
  • Subtitle D: Available coverage choices for all Americans. 
  • Subtitle E: Affordable coverage choices for all Americans. 
  • Subtitle F: Shared responsibility for health care which mandates individuals and employers to pay for insurance.  
    • The employer mandate requires employers with more than 50 full-time workers to offer most of their employees insurance or face penalties. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_X (gl_ACA_title_X is ACA strengthening quality, affordable health care for all Americans.  
  • Subtitle A: Provisions relating to title I.  
  • Subtitle B: Provisions relating to title II. 
  • Subtitle C: Provisions relating to title III. 
  • Subtitle D: Provisions relating to title IV. 
  • Subtitle E: Provisions relating to title V. 
  • Subtitle F: Provisions relating to title VI. 
  • Subtitle G: Provisions relating to title VIII. 
  • Subtitle H: Provisions relating to title IX. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_V (gl_ACA_title_V is ACA health care workforce. 
  • Subtitle A: Purpose and definitions. 
  • Subtitle B: Innovations in the health care workforce. 
  • Subtitle C: Increasing the supply of the health care workforce. 
  • Subtitle D: Enhancing health care workforce education and training. 
  • Subtitle E: Supporting the existence health care workforce. 
  • Subtitle F: Strengthening primary care and other workforce improvements. 
  • Subtitle G: Improving access to health care services. 
  • Subtitle H: General provisions. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_IV (gl_ACA_title_IV is ACA preventing of chronic disease and improving public health. 
  • Subtitle A: Modernizing disease prevention and public health systems. 
  • Subtitle B: Increasing access to clinical preventative services. 
  • Subtitle C: Creating healthier communities. 
  • Subtitle D: Support for prevention and public health innovation. 
  • Subtitle E: Miscellaneous provisions. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_IX (gl_ACA_title_IX is ACA revenue proposals. 
  • Subtitle A: Revenue offset provisions. 
  • Subtitle B: Other provisions. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_II (gl_ACA_title_II is ACA role of public programs.  It includes:
  • Subtitle A: Improved access to Medicaid. 
  • Subtitle B: Enhanced support for children's health insurance program. 
  • Subtitle C: Medicaid and CHIP enrolment simplification. 
  • Subtitle D: Improvements to Medicaid services. 
  • Subtitle E: New options for states to provide long-term services and support. 
  • Subtitle F: Medicaid prescription drug coverage. 
  • Subtitle G: Medicaid disproportionate share hospital (DSH) payments.  
  • Subtitle H: Improved coordination for dual eligibles. 
  • Subtitle I: Improving the quality of Medicaid for patients and providers
  • Subtitle J: Improvements to the Medicaid and CHIP payment and access commission (MACPAC)
  • Subtitle K: Protections for American Indians and Alaska natives. 
  • Subtitle L: Maternal and child health services. 
),
../demodwbp/awffwpwgl.htm#gl_ACA_title_VIII (gl_ACA_title_VIII is ACA CLASS act. 
),
../demodwbp/awffwpwgl.htm#gl_ACB (gl_ACB is an ONC-Authorized Certification Body which certifies tested EHR technology as Certified EHR Technology under the ONC HIT Certification Program
),
../demodwbp/awffwpwgl.htm#gl_ACC (gl_ACC is either the
  • Anterior cingulate cortex which:
    • Includes the subgenual ACC and the paragenual ACC, and Brodmann areas 24, 25, 32 and 33. 
    • The gyrus of the ACC has two functional components, which both operate abnormally in mood disorders: depression, anxiety & bipolar.  The
      • Rostral/ventral part is involved in emotional processes and autonomic functions.  It connects to the hippocampus, amygdala, orbital prefrontal cortex, anterior insula, nucleus accumbens.  It is overactive during regular or bipolar depression. 
      • Caudal part is involved in cognition and the control of behavior.  It connects with the dorsal PFC, secondary motor cortex, and posterior cingulate cortex
    • Is a central focus of empathy supporting people relating to other's pain.  This is dependent on oxytocin. 
    • In non-human mammals it processes interoceptive signals.  The ACC focuses the internal signals into high level 'gut intuitions.'  Pain catches the ACC's attention. 
    • Performs discrepancy detection from the outcome that was predicted - at a high level.  The ACC cares about the meaning of what is predicted. 
      • If the ACC has been convinced that a pain killer placebo has inhibited pain signals, the ACC will stay silent about actual pain that is signalled from interoceptive networks.  
      • The ACC will signal: physical pain, emotional pain, metaphorical pain, anxiety, disgust, embarrassment, social exclusion especially in adolescence; as one and the same.  The ACC's abnormalities being associated with major depression. 
    • Has a bridging role between the empathetic and self-interested pain monitor.  Sapolsky notes the ACC is essential for learning fear and conditioned avoidance by observation alone through an intermediate step of shared representation of self.  He concludes "At its core the ACC is about self-interest, with caring about the other person in pain as an add-on." 
  • American College of Cardiology
),
../demodwbp/awffwpwgl.htm#gl_Access_Management (gl_Access_Management is the front end part of RCM.  Scheduling is a significant part of this.  ),
../demodwbp/awffwpwgl.htm#gl_ACCME (gl_ACCME is the Accreditation council for CME which regulates CME for physicians in the US.  ),
../demodwbp/awffwpwgl.htm#gl_ACD (gl_ACD is advance care directive. 
),
../demodwbp/awffwpwgl.htm#gl_ACE (gl_ACE is
  • An acute care episode.  CMS has used an ACE demonstrator to explore the value of bundled payments.  The demonstrator covered 37 cardiac and orthopedic procedures including: bypass surgery, hip replacements, pacemakers, and cardiac stents; in 11 hospitals.  It saved $319 per person, across over 12,000 cases, on average.  
  • Angiotensin-converting-enzyme. 
),
../demodwbp/awffwpwgl.htm#gl_ACE_inhibitor (gl_ACE_inhibitor is angiotensin-converting-enzyme inhibitor.  They help relax blood vessels and are used to treat hypertension and CHF.  ),
../demodwbp/awffwpwgl.htm#gl_Acetaminophen (gl_Acetaminophen is a generic analgesic (pain killer) marketed by many companies including J&J's Tylenol, Paracetamol; discovered in 1877.  At high doses there is risk of liver failure.  Acetaminophen is the most common cause of acute liver failure in the US in 2017. 
),
../demodwbp/awffwpwgl.htm#gl_ACF (gl_ACF is the HHS Administration for Children and Families.  The ACF includes: ORR;
),
../demodwbp/awffwpwgl.htm#gl_ACG (gl_ACG is the American College of Gastroenterology.  ),
../demodwbp/awffwpwgl.htm#gl_ACHC (gl_ACHC is the accreditation commission for health care.  It is recognized by the federal government for:
  • HHA accreditation along with the CHAP and the Joint Commission.  
),
../demodwbp/awffwpwgl.htm#gl_ACHE (gl_ACHE is the American College of Healthcare Executives.  ),
../demodwbp/awffwpwgl.htm#gl_ACI (gl_ACI is advanced care information. 
),
../demodwbp/awffwpwgl.htm#gl_ACID_transactions (gl_ACID_transactions are Atomic, Consistent, Isolated and Durable, allowing the user of the transaction a simple operating paradigm.  In particular if the transaction fails there are no ramifications outside of the local transaction.  ),
../demodwbp/awffwpwgl.htm#gl_ACIP (gl_ACIP is the CDC's Advisory Committee on Immunization Practices.  It includes medical and public health experts who recommend how to use vaccines to control disease in the US. 
),
../demodwbp/awffwpwgl.htm#gl_ACL (gl_ACL is the HHS Administration for Community Living
),
../demodwbp/awffwpwgl.htm#gl_ACMG (gl_ACMG is the American College of Medical Genetics and Genomics. 
),
../demodwbp/awffwpwgl.htm#gl_ACO (gl_ACO is an Accountable Care Organization. These are accredited bundles of companies which together try to offer Dartmouth-Hitchcock like business models (Dec 2015, Sep 2016) focused on wellness, improving the provision of primary care to a large group of Medicare patients, and rewarding doctors for preventing problems.  Advocate health illustrates the idea.  Robert Pearl notes that the transition is difficult: hospitals that find their efficiency improving should reduce the number of doctors they utilize.  But any doctors that are pushed out of the ACO will likely take their patients with them, undermining the revenues that support the FFV business.  The ACA regulates qualification to be a Medicare ACO.  Individual organizations within a Medicare shared savings ACO continue to submit their own claims and are paid by Medicare for FFS.  But the ACO is eligible for shared savings.  Within the shared savings program the CMS innovation center has setup advanced payment ACOs.  As an alternative to shared savings, in a Pioneer ACO, over time 50% of the FFS payments flow directly to the ACO as a bundled payment.  CMS has established quality measures for ACOs for Medicare.  The CMS program's purpose is to reward providers for reducing total cost of care for patients through prevention, disease management, and coordination. 
  • CMS initiated its Physician Group Practice Demonstration in 2005.  By 2008 the congressional budget office reported on Bonus-eligible organizations. 
  • CMS defines ACOs as organizations that "create incentives for health care providers to work together to treat an individual patient across care settings - including doctors' offices, hospitals and long-term care facilities."
  • CMS has developed APMs which include ACOs, and advanced APMs where the ACOs must be risk bearing. 
  • CMMI accepts providers' proposals to test various payment systems including shared savings and partial capitation.  
  • Private market ACOs have formed including: Providence Health & Services, Blue Shield California, Anthem Blue Cross, United Health Care, BCBS Minnesota, BCBS Illinois, Humana, CIGNA, Main Health Management Coalition, BCBS Massachusetts, Aetna.  
),
../demodwbp/awffwpwgl.htm#gl_ACOG (gl_ACOG is the American Congress of Obstetricians and Gynecologists. 
),
../demodwbp/awffwpwgl.htm#gl_ACP (gl_ACP is the American College of Physicians.  ),
../demodwbp/awffwpwgl.htm#gl_ACR (gl_ACR is the American College of Radiology.  It is HHS's PAMA applicable imaging services appropriate use criteria standards body. 
),
../demodwbp/awffwpwgl.htm#gl_ACSC (gl_ACSC is Ambulatory care sensitive condition
),
../demodwbp/awffwpwgl.htm#gl_ACTH (gl_ACTH is adrenocorticotropic hormone which stimulates the adrenal glands to release glucocorticoids. 
),
../demodwbp/awffwpwgl.htm#gl_Action_potentials (gl_Action_potentials Action potentials are the actively generated waves of voltage change across the neuron's membrane that flow down a neuron's axon.  Helmholtz noted that while they propagate far more slowly than electrical transmissions action potentials do not attenuate.  Lord Adrian showed the action potential to be an all-or-nothing signal.  Consequently Adrian extended the neuron doctrine from anatomy to function demonstrating:
  • Sensitivity is indicated by the frequency of transmission of action potentials. 
  • Anatomy indicates the meaning of the signal.  Hodgkin and Huxley's ionic hypothesis completed the characterization of the action potential. 
),
../demodwbp/awffwpwgl.htm#gl_Active_sites (gl_Active_sites Active , on the external surface of folded proteins present amino acids which become catalytic structures.  ),
../demodwbp/awffwpwgl.htm#gl_Active_surveillance (gl_Active_surveillance is an approach to early-stage prostate cancer which replaces treatment, such as surgery or radiation, with monitoring to ensure the cancers aren't growing rapidly.  It started to be used in about 2000 and so will take time to build a predictive history of the success of the regimen (10 year longitudinal study results Sep 2016).  Active surveillance treatements include: Oncotype DX, PSA, STHLM3;),
../demodwbp/awffwpwgl.htm#gl_Activist_strategy (gl_Activist_strategy is where a hedge fund invests a large enough amount in a public company to obtain an influence in a firms decision making and leadership portfolio. 
),
../demodwbp/awffwpwgl.htm#gl_Activity_based_cost_accounting (gl_Activity_based_cost_accounting identifies the process based flow of activities used to perform a task and the cost of each activity to effectively apportion costs. 
),
../demodwbp/awffwpwgl.htm#gl_ACV (gl_ACV is actual cash value. 
),
../demodwbp/awffwpwgl.htm#gl_ADA (gl_ADA is either the Americans with Disabilities Act of 1990 or a label for the gene that encodes the enzyme adenosine deaminase. 
),
../demodwbp/awffwpwgl.htm#gl_ADAA (gl_ADAA is the Anti-Drug Abuse Act of 1988, which established the ONDCP.  ),
../demodwbp/awffwpwgl.htm#gl_Adair_three-circles_model (gl_Adair_three-circles_model is a tool for leadership described in Effective Leadership.  It argues an effective team has distinct but interacting:
  • Individual needs - which must be supported by the leader to ensure the team member's self-motivation is not undermined. 
  • Group needs - Each member's social emotions are supported by being part of a cohesive group or organization performing a worthwhile and demanding task. 
  • Task needs - A task that is too big for an individual, which is agreed to be valuable and achievable, at a stretch, by the group within expected timescales.  Tasks can be seen to be valuable to the organization when they are clearly derived from the corporate Hoshin. 
),
../demodwbp/awffwpwgl.htm#gl_Adalimumab (gl_Adalimumab is a TNF-inhibiting anti-inflammatory.  It reduces the immune system's response because it binds to TNF-alpha inhibiting binding to its receptor and reducing inflamatory response.  Abbvie markets a biologic instance of adalimumab, Humira.  There are a variety of biosimilars. 
),
../demodwbp/awffwpwgl.htm#gl_ADAM (gl_ADAM is a disintegrin and metalloproteinase, a protein family combining cell-surface adhesion and proteinase activity.  They are zinc-dependent metalloproteins.  They are controlled by TIMPs. 
),
../demodwbp/awffwpwgl.htm#gl_Adaptation (gl_Adaptation in evolutionary biology is a trait that increased the number of surviving offspring in an organism's ancestral lineage.  In Deacon's conception of evolution an adaptation is the realization of a set of constraints on candidate mechanisms, and so long as these constraints are maintained, other features are arbitrary. 
),
../demodwbp/awffwpwgl.htm#gl_Adaptive_unconscious (gl_Adaptive_unconscious is Timothy Wilson's idea of a set of high-level cognitive processes, which interpret 'information' quickly without conscious awareness.  It supports: decision making - where it's operation suggests prior gathering of details consciously and then allowing time, including sleeping, for the adaptive unconscious to generate a preference, although it is quick to categorize and rigid and may be overruled by the slower acting consciousness; Kahneman views adaptive unconscious decision making as part of fast thinking. 
),
../demodwbp/awffwpwgl.htm#gl_Adaptive_web (gl_Adaptive_web supports the agents writing and using the dark webs by:
  • Leveraging unstructured HTML documents to allow clusters of related information to be juxtaposed.  
  • Allowing source data to be private to a particular agent or shared and jointly edited within a team. 
  • Allowing the writers to define streams of information (signals) within the source HTML. 
  • Supporting the linkage of the signals to other streams of information deployed into specific dark webs. 
  • Genetic operations can be applied to the source data.  Key items are labelled.  They are prioritized.  But they should never be deleted from the source documents. 
  • Transforming the streams of information as they are gathered for deployment into target dark webs.  Aspects like checklist and glossary references can be augmented with details.  Changes in one area of the dark web can be signalled in other pages. 
  • Constraining which dark webs the information streams will deploy too.  
),
../demodwbp/awffwpwgl.htm#gl_ADCY2 (gl_ADCY2 is a gene which encodes the enzyme adenylyl cyclase type 2.  ),
../demodwbp/awffwpwgl.htm#gl_Addcltag (gl_Addcltag is a filter file command which specifies the AWF tag that marks the start and end of the checklist definition source stream.  It is also the identifier that must be prepended to checklist entry names in the source documents and hence the target dark web checklist page.  For example:
  • The command triple addcltag 'id' = 'cl' tells the generator to include items from the checklist page (identified to the dark web generator by the filter file command addcltext) that have names starting with 'cl_'. 
),
../demodwbp/awffwpwgl.htm#gl_Addcltext (gl_Addcltext is a filter file command which describes to the dark web generator the source file from which the checklist description is loaded.  If this command is not present in the filter file no hover substitution will be performed. 
),
../demodwbp/awffwpwgl.htm#gl_Addgitst (gl_Addgitst is a filter file command which describes to the dark web generator the file name prefix that when appended with a Git branch name and .htm will match a page of the git status web frame.  This allows the <rhlgitsourcestatus> generation process to use Git memo information from the branch page in reporting the merge state of the branch in the Git source maintainer's master branch. 
),
../demodwbp/awffwpwgl.htm#gl_Addglkey (gl_Addglkey is a filter file command which specifies that an item with the key specified from an additional included glossary stream (addglstream) should be merged into the target glossary stream. 
),
../demodwbp/awffwpwgl.htm#gl_Addglstream (gl_Addglstream is a filter file command which specifies a path and file name of a source file containing glossary items delineated by the AWF tag that marks the start and end of the glossary definition source stream.  A number of streams can be included.  The first should have a key 'file0', the second 'file1' etc.  If an addglstream statement is used in a filter file:
  • No glossary items should be declared in the source file containing the basic glossary source within start and end tags.  
  • The basic glossary page should include the target <gltarget> which the merged and sorted glossary items will be deployed into. 
),
../demodwbp/awffwpwgl.htm#gl_Addgltag (gl_Addgltag is a filter file command which specifies the AWF tag that marks the start and end of the glossary definition source stream.  It is also the identifier that must be prepended to glossary entry names in the source documents and hence the target dark web glossary page.  For example:
The command triple addgltag 'id' = 'gl' tells the generator to include items from the glossary page (identified to the dark web generator by the filter file command addgltext) that have names starting with 'gl_'. 
),
../demodwbp/awffwpwgl.htm#gl_Addgltext (gl_Addgltext is a filter file command which describes to the dark web generator the source file from which the glossary description is loaded.  If this command is not present in the filter file no hover substitution will be performed.  ),
../demodwbp/awffwpwgl.htm#gl_Addiction (gl_Addiction results from changes in the operation of the brain's reward network's regulatory regions, altering the anticipation of rewards.  Addictive drugs mediate the receptors of the reward network, increasing dopamine in the pleasure centers of the cortex.  The learned association of the situation with the reward makes addiction highly prone to relapse, when the situation is subsequently experienced.  This makes addiction a chronic disease, where the sufferer must remain vigilant to avoid relapse inducing situations.  Repeated exposure to the addictive drug alters the reward network.  The neurons that produce dopamine are impaired, no longer sending dopamine to the reward target areas, reducing the feeling of pleasure.  But the situational association remains strong driving the addict to repeat the addictive activity.  Destroying the memory of the pleasure inducer may provide a treatment for addiction in the future.  Addiction has a genetic component, which supports inheritance.  Some other compulsive disorders: eating, gambling, sexual behavior; are similar to drug addiction. 
),
../demodwbp/awffwpwgl.htm#gl_Addstatelink (gl_Addstatelink is a filter file command which connects the same execution plan page in two dark webs together providing a mechanism to construct a network of 'open' dark webs.  The command specifies that when generating the target page matching the 'key' any http name associated strategy should have an execution link. 
  • The command triple addstatelink 'fwpwcxprad.htm' = 'http://localhost:3000/fwpwcxprad.htm' would add execution links from the generating page in the target dark web to the same page in another dark web via the internal web server. 
),
../demodwbp/awffwpwgl.htm#gl_Addstatepref (gl_Addstatepref is a filter file command which specifies the prefix used by the dark web generator execution plan monitored region state change processor to help it reconstruct the child execution plan filenames in conjunction with the statelist data items and '.htm'.  
),
../demodwbp/awffwpwgl.htm#gl_Addstatetag (gl_Addstatetag is a filter file command which specifies the AWF tag that defines the file name appended string used to name an execution plans associated execution state dark web page.  For example the command triple addstatetag 'id' = 'st' tells the dark web generator to name any state dark web page it associates with a parent execution plan 'parentplan.htm' with the dark web page name 'parentplanst.htm'. 
),
../demodwbp/awffwpwgl.htm#gl_Addsumtext (gl_Addsumtext is a filter file command which describes to the dark web generator the source file from which the summary text descriptions are loaded.  If this command is not present in the filter file no hover substitution will be performed. 
),
../demodwbp/awffwpwgl.htm#gl_Adenocarcinoma (gl_Adenocarcinoma is a cancer of mucus-secreting glands.  It can occur thoughout the body including the lungs, where 40% of cancers are adenocarcinomas.  Genes ERBB2 and VEGF are often amplified in this cancer. 
),
../demodwbp/awffwpwgl.htm#gl_Adenylyl_cyclase_type_2 (gl_Adenylyl_cyclase_type_2 is a transmembrane enzyme, encoded by the ADCY2 gene, which generates the second messenger, cyclic AMP, from ATP.  It is highly regulated by G-proteins, calcium, calmodulin, and Raf kinase.  It includes six membraine segments and two cytoplasmic domains. 
),
../demodwbp/awffwpwgl.htm#gl_ADHD (gl_ADHD is attention-deficit/hyperactivity disorder, a chronic condition including hyperactivity, impulsiveness and low attention.  Dopamine response profiles to temporal discounting tasks are abnormal for ADHD sufferers.  Imaging studies show differences in the brains of ADHD sufferers.  Stimulants have been found to have a calming effect on ADHD sufferers.  However, overdiagnosis seems likely, with a strong correlation of diagnosis to age at time of school admission!  Causally associated factors include:
  • Family history
  • Genetics
    • May be influenced by high doses of Tylenol during pregnancy (Sep 2016). 
  • Environmental factors - a consistant daily schedule, praise for good behavior, clear bondaries, enough sleep and limiting distractions are all part of behavioral therapy for ADHD.  
  • CNS developmental problems.   
),
../demodwbp/awffwpwgl.htm#gl_Adjuvant (gl_Adjuvant is a strategy or tool that modifies a primary plan.  In cancer treatment adjuvant pharmaceutical and immunological agents modify the effects of other treatments. 
),
../demodwbp/awffwpwgl.htm#gl_ADL (gl_ADL is activities of daily living.  These are daily self-care activities that are used as measures of the functional status of a person. 
),
../demodwbp/awffwpwgl.htm#gl_ADM (gl_ADM is accelular dermal matrix, generated by a soft tissue matrix graft where decellularization leaves the extracellular matrix intact. 
),
../demodwbp/awffwpwgl.htm#gl_ADME (gl_ADME is absorption, distribution, metabolism and excretion of a pharmaceutical compound within the organism.  These aspects all influence the drug levels and kinetics of drug exposure to the tissues.  ),
../demodwbp/awffwpwgl.htm#gl_Adolescence (gl_Adolescence in humans supports the transition from a juvenile configuration, dependent on parents and structured to learn & logistically transform, to adult optimized to the proximate environment.  And it is staged encouraging male adolescents to escape the hierarchy they grew up in and enter other groups where they may bring in: fresh ideas, risk taking; and alter the existing hierarchy: Steve Jobs & Steve Wozniak, Bill Gates & Paul Allen; while females become highly focused on friendships and communications.  It marks the beginning of Piaget's formal operational stage of cognitive development.  The limbic, autonomic and hormone networks are already deployed and functioning effectively.  The frontal cortex has to be pruned: winning neurons move to their final highly connected positions, and are myelinated over time.  The rest dissolve.  So the frontal lobe does not obtain its adult configuration and networked integration until the mid-twenties when prefrontal cortex control becomes optimal.  The evolutionarily oldest areas of the frontal cortex mature first.  The PFC must be iteratively customized by experience to do the right thing as an adult.  Adolescents:
  • Don't detect irony effectively.  They depend on the DMPFC to do this, unlike adults who leverage the fusiform face area.  
  • Regulate emotions with the ventral striatum while the prefrontal cortex is still being setup.  Dopamine projection density and signalling increase from the ventral tegmentum catalyzing increased interest in dopamine based rewards.  Novelty seeking allows for creative exploration which was necessary to move beyond the familial pack.  Criticisms do not get incorporated into learning models by adolescents leaving their risk assessments very poor.  The target of the dopamine networks, the adolescent accumbens, responds to rewards like a gyrating top - hugely to large rewards, and negatively to small rewards.  Eventually as the frontal regions increase in contribution there are steady improvements in: working memory, flexible rule use, executive organization and task shifting.  And adolescents start to see other people's perspective. 
  • Drive the cellular transformations with post-pubescent high levels of testosterone in males, and high but fluctuating estrogen & progesterone levels in females.  Blood flow to the frontal cortex is also diverted on occasion to the groin.  
  • Peer pressure is exceptionally influential in adolescents.  Admired peer comments reduce vmPFC activity and enhance ventral striatal activity.  Adults modulate the mental impact of socially mean treatment: the initial activation of the PAG, anterior cingulate, amygdala, insula cortex; which generate feelings of pain, anger, and disgust, with the VLPFC but that does not occur in adolescents.  
  • Feel empathy intensely, supported by their rampant emotions, interest in novelty, ego.  But feeling the pain of others can induce self-oriented avoidance of the situations. 
),
../demodwbp/awffwpwgl.htm#gl_ADR (gl_ADR is alternative dispute resolution, an alternative to litigation for resolving disputes regarding treatment or payment.  Arbitration and mediation are two of the most common ADR processes.  In each case a completely neutral third party is becomes the dispute resolver. 
),
../demodwbp/awffwpwgl.htm#gl_Adrenal_glands (gl_Adrenal_glands are endocrine glands, situated above the kidneys, that produce: adrenaline, aldosterone and cortisol. 
),
../demodwbp/awffwpwgl.htm#gl_ADT (gl_ADT is admit, discharge, transfer, a backbone HIS allowing the sharing of patient information with other health care providers.  It has a corresponding HL7 message that reports a status change for a patient.  ),
../demodwbp/awffwpwgl.htm#gl_Advair (gl_Advair is GlaxoSmithKline's big selling respiratory medicine. 
),
../demodwbp/awffwpwgl.htm#gl_Advance_directives (gl_Advance_directives specify patients decisions about how they wish to be cared for as they die. 
),
../demodwbp/awffwpwgl.htm#gl_Advance_payment_ACO (gl_Advance_payment_ACO is a CMS Innovation center has developed a model of an ACO for physician-owned and rural providers participating in the Shared Savings Program who would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems.  ),
../demodwbp/awffwpwgl.htm#gl_Advanced_APM (gl_Advanced_APM is a CMS regulated group of APMs that effectively uses FFV.  The list includes: Risk-bearing ACOs, Comprehensive end stage renal disease care, Comprehensive primary care plus, Oncology care model. 
),
../demodwbp/awffwpwgl.htm#gl_Advanced_kidney_cancer (gl_Advanced_kidney_cancer - There are expected to be 61,560 new cases of kidney cancer in the US and 14,080 deaths in 2015.  Drug treatments have increased survival from 10 - 12 months to up to 30.  Exact causes are unknown but risk factors are: smoking, obesity, high blood pressure, genetic mutations and heredity.  ),
../demodwbp/awffwpwgl.htm#gl_Adverse_drug_reactions (gl_Adverse_drug_reactions result from various causes of drug treatments including:
  • Individual pharmacogenomics differences altering the metabolic processing chain of each drug. 
  • Pharmacists' miss-understanding handwritten prescriptions. 
  • Patient's miss-interpreting their treatment instructions. 
  • Complex interactions of multiple drugs being taken by a patient. 
  • Underlying illnesses, especially of the liver & kidneys altering the metabolism and clearing of drugs in the body. 
),
../demodwbp/awffwpwgl.htm#gl_AE (gl_AE is an F.D.A. adverse event, a problem identified in a medical process involving a patient or clinical investigation and reported to the F.D.A.  ),
../demodwbp/awffwpwgl.htm#gl_AF (gl_AF is atrial fibrillation, an abnormal heart rhythm: rapid, irregular.  It:
  • Can lead to blood clots, stroke, CHF, dementia and other complications.  
    • Fibrillations allow blood to pool in the heart chambers and form small clots which can then lodge in small arteries and block blood flow. 
  • Has become much more common being induced by endemic diseases: hypertension, obesity and type-2-diabetes. 
  • Cocoa reduces risk of AF (May 2017)
  • Treatments include: digoxin;
),
../demodwbp/awffwpwgl.htm#gl_AFDC (gl_AFDC is Aid to Families with Dependent Children program, created by the SSA, that ran from 1935 to 1996 when it was replaced by TANF.  The values provided declined over the years. 
),
../demodwbp/awffwpwgl.htm#gl_AFFA (gl_AFFA is Advanced Functional Fabrics of America. 
),
../demodwbp/awffwpwgl.htm#gl_Affinity_maturation (gl_Affinity_maturation is the process by which the immune system develops improved antibodies on repeated exposure to an antigen.  The process involves two interrelated transformations:
  1. Somatic hypermutation
  2. Clonal selection - but the cloned cells must compete for antigen and Tfh cell paracrine signals.  There is positive selection of the B cell progeny with the greatest affinity for the antigen based on cross talk between the Tfh cells and their cognate antigen presenting germinal center B cell.  There are only a limited number of Tfh cells in the germinal center ensuring only highly competitive B cells stably conjugate with the Tfh cells allowing them to survive. 
),
../demodwbp/awffwpwgl.htm#gl_Aflatoxins (gl_Aflatoxins are a family of complex aromatic toxins and carcinogens produced by certain Aspergillus molds.  They are amongst the most carcinogenic substances known.  They are metabolized in the liver to reactive intermediates that mutate p53.  They are regularly found in improperly stored commodities such as chillis, peanuts, rice and wheat.  And they flow through the food distribution system when contaminated food is processed.  Higher animals fed on contaminated food can pass aflatoxin transformation products into the food chain.  They have been found in feed stock, eggs, milk products and meat.  The most toxic aflatoxin can permeate the skin.  ),
../demodwbp/awffwpwgl.htm#gl_African_savanna (gl_African_savanna is the environment where hunter-gatherers primarily evolved.  Its grassland supported large herbivores that could be hunted easily across the plains.  Clumps of Acacia trees: with short trunks, and broad bows; & rocks supported places to hide from large carnivores.  Streams, especially important in times of drought, and paths add to the signals enabling orientation. 
),
../demodwbp/awffwpwgl.htm#gl_Age-related_memory_loss (gl_Age-related_memory_loss , also called benign senescent forgetfulness, is a different condition from Alzheimer's disease.  It initially occurs in the dentate gyrus, reflecting osteocalcin related reduced synthesis of CREB complex's RbAp48 protein.  CREB is critical for controlling the conversion of short-term memory to long-term memory.  Ramping up RbAp48 production in old mice eliminated age-related memory loss.  This suggests that vigorous exercise, which maintains bone density and osteocalcin levels, can help limit age-related memory loss. 
),
../demodwbp/awffwpwgl.htm#gl_AHA (gl_AHA is the American_hospital association. 
),
../demodwbp/awffwpwgl.htm#gl_AHCA (gl_AHCA is American health care act.  The House version (May 2017): removes the ACA's progressive taxes on the wealthy enabling the rest of the Republican's tax cut strategy a chance of passing in the Senate, Cancels the ACA: Medicaid expansion - stripping coverage from 23 million Americans (May 2017), Preexisting conditions constraints, Employee mandate; Provides grants to states to help offset lost ACA federal funding.  
),
../demodwbp/awffwpwgl.htm#gl_AHCD (gl_AHCD is advanced health care directive detailing an incapacitated patients health care goals.  ),
../demodwbp/awffwpwgl.htm#gl_AHCJ (gl_AHCJ is the association of health care journalists. 
),
../demodwbp/awffwpwgl.htm#gl_AHIC (gl_AHIC was the American health information community.  It has become the NeHC.  It is a federally chartered advisory committee making recommendations to the Secretary of HHS, on how to accelerate the development and adoption of health information technology and the nationwide health information network.  ),
../demodwbp/awffwpwgl.htm#gl_AHIMA (gl_AHIMA is the American health information management association.  It has been contracted by HHS to identify best practices for state-level RHIO development.  ),
../demodwbp/awffwpwgl.htm#gl_AHP (gl_AHP is association health plan:
  • Allow small businesses and individuals in particular professions, trades or interest groups to join associations that offer insurance to members. 
  • Are a form of MEWA
),
../demodwbp/awffwpwgl.htm#gl_AHRF (gl_AHRF is Area health resource file
),
../demodwbp/awffwpwgl.htm#gl_AHRQ (gl_AHRQ is the Agency for Healthcare Research and Quality.  It provided the definition of a medical home (PCMH) as both a place and a model of the organization of primary care that delivers core functions of primary health care. 
),
../demodwbp/awffwpwgl.htm#gl_AIA (gl_AIA is the Leahy-Smith America Invents Act of 2011 which aimed to modernize the patent system.  A key provision of AIA was the creation of the Inter Partes Review process which third parties can use to contest the validity of a patent (for not being novel & non-obvious) within 9 months of its issuance to the Patent Trial and Appeal Board. 
),
../demodwbp/awffwpwgl.htm#gl_Aid-in-dying (gl_Aid-in-dying is physician assisted termination of life by application of lethal medications.  It was legalized in Oregon by the Death with Dignity act and other states have followed that blue print (Jan 2017). 
),
../demodwbp/awffwpwgl.htm#gl_AIDA (gl_AIDA - activities that initially create awareness and then interest, desire and subsequently action.  ),
../demodwbp/awffwpwgl.htm#gl_AIDS (gl_AIDS is acquired auto-immune deficiency syndrome, a pandemic disease caused by the HIV.  It also amplifies the threat of tuberculosis.   Initially deadly, infecting and destroying the T-lymphocytes of the immune system, it can now be treated with HAART to become a chronic disease.  And with an understanding of HIV's mode of entry into the T-cells, through its binding to CCR5 and CD4 encoded transmembrane proteins, AIDS may be susceptible to treatment with recombinant DNA to alter the CCR5 binding site, or with drugs that bind to the CCR5 cell surface protein preventing binding by the virus.  Future optimization of drug delivery may leverage nanoscale research (May 2016). 
),
../demodwbp/awffwpwgl.htm#gl_AIM (gl_AIM is Sutter Health's Advanced Illness Management, a home-based primary care program for treating its frail elderly hot spot patients.  By keeping patients out of the hospital whenever possible, it saves Medicare > $2000 per patient per month. 
),
../demodwbp/awffwpwgl.htm#gl_AIP (gl_AIP is anterior intraparietal area of the intraparietal sulcus.  It is involved in grasp planning. 
),
../demodwbp/awffwpwgl.htm#gl_AIRA (gl_AIRA is the American immunization registry association. 
),
../demodwbp/awffwpwgl.htm#gl_Aire (gl_Aire is the autoimmune regulator protein.  It is a specialized transcription factor targeting specific histone markers that indicate transcriptionally inactive chromatin, expressed in the thymus and lymph nodes.  In cooperation with 50 other partner molecules it causes T-cells to be exposed to self-antigens presented by mTEC in the thymus.  Any T-cells that react are signalled to destroy themselves.  In the lymph nodes other Aire dependent tissue-restricted antigens are presented and reactive T-cells are inactivated. 
),
../demodwbp/awffwpwgl.htm#gl_AJAX (gl_AJAX is asynchronous JavaScript and XML.  It is an architecture and techniques for using Web technologies to provide client server communications without reloading a web page or refreshing the browser. 
),
../demodwbp/awffwpwgl.htm#gl_AJCC (gl_AJCC is the American joint commission on cancer CoC.  ),
../demodwbp/awffwpwgl.htm#gl_AKI (gl_AKI is acute kidney injury, where a kidney suddenly fails.  It results in the build-up in the blood of waste products. 
),
../demodwbp/awffwpwgl.htm#gl_ALK (gl_ALK is anaplastic lymphoma kinase is a RTK which affects specific neurons in the brain.  Fusion mutations of the ALK gene are oncogenic.  Significant types of induced cancers are: anaplastic large-cell lymphoma caused by 2;5 chromosome translocation, non-small-cell lung cancer (adenocarcinomas) due to EML4-ALK fusion, neuroblastomas, inflammatory myofibroblastic tumors, renal cell carcinomas, esophageal squamous cell carcinomas, inflammatory breast cancer, colonic adenocarcinoma, glioblastoma, anaplastic thyroid cancer.  ),
../demodwbp/awffwpwgl.htm#gl_ALK_inhibitors (gl_ALK_inhibitors target mutated oncogenic ALK.  These include: crizotinib (Xalkori), ceritinib (Zykadia), alectinib (Alecensa), brigatinib (Alunbrig);
),
../demodwbp/awffwpwgl.htm#gl_ALL (gl_ALL is acute lymphocytic/lymphoblastic leukemia.  The cancer starts in the lymphocytes of the bone marrow.  Too many lymphocytes are produced instead of mature white blood cells.  In 2010 combination chemotherapy, including 6-mercaptopurine, cures 85 to 90% of children suffering from ALL.  ),
../demodwbp/awffwpwgl.htm#gl_All-or-nothing_measures_set (gl_All-or-nothing_measures_set is used by Geisinger because it closely matches the wants and needs of patients to slow chronic disease progression and prevent additional diseases and their impacts by delivery of optimal treatment, and drives care givers to achieve all goals.  It also provides a sensitive scale for measuring improvements.  Not all patients will achieve every measure, but the set encourages the patient, their family, the PCP and specialists to engage and develop a shared understanding. 
),
../demodwbp/awffwpwgl.htm#gl_Allele (gl_Allele , one of multiple alternative forms of a schematic sequence with the same address on a schematic string. 
),
../demodwbp/awffwpwgl.htm#gl_Allergies (gl_Allergies include various conditions: hay fever, food allergies: MMA, Peanut; atopic dermatitis, asthma, and anaphylaxis; caused by over activity of the immune system in response to antigens in the proximate environment.  Initially associated with the English upper-class, allergies have spread across the population with general adoption of: small family size, cleanliness, antibiotic use, public health programs; in line with the hygiene hypothesis, with newborns no longer getting exposed to antigens by their older siblings and proximate higher animals. 
),
../demodwbp/awffwpwgl.htm#gl_Alpha-gal (gl_Alpha-gal is short for galactose-alpha-1,3-galactose.  It is a sugar which is a component of cell membranes. 
),
../demodwbp/awffwpwgl.htm#gl_Alpha-synuclein (gl_Alpha-synuclein is a protein found mainly in the presynaptic terminals of neurons.  It is important in maintaining the supply of synaptic vesicles - it interacts with tubulin.  It simultaneously binds to phospolipids of the plasma membrane and to synaptobrevin-2 becoming a chaperone.  It is encoded by the SNCA gene.  It is a major constituent of Parkinson's disease Lewy bodies.  Knockout mice with targeted inactivation of the expression of alpha-synuclein show impaired spatial learning and working memory.  ),
../demodwbp/awffwpwgl.htm#gl_Alpha_helix (gl_Alpha_helix Alpha provides a structural building block (a helical tube) that can be conserved and used by natural selection.  ),
../demodwbp/awffwpwgl.htm#gl_Alphabet (gl_Alphabet is a writing process where representational signals (letters and graphemes) refer to speech sounds (phonemes) rather than meanings.  Dehaene asserts the principle probably emerged in small groups of people on the fringes of mainstream society.  The first example is Proto-Sinaitic.  Alphabets allow for a drastic reduction in the number of signs required to be learnt. 
),
../demodwbp/awffwpwgl.htm#gl_ALS (gl_ALS is amyotrophic lateral sclerosis which selectively destroys motor neurons. 
),
../demodwbp/awffwpwgl.htm#gl_Alternative_quality_contract (gl_Alternative_quality_contract (AQC) is:
  • A 2009 payment arrangement developed by Blue Cross Blue Shield of Massachusetts.  It was developed to support change.  It differs from capitation in including upside measures for patient safety, appropriateness of care and patient satisfaction.  Its key components are:
    • Integration across the care continuum
    • Accountability for performance measures for ambulatory and inpatient care.  Includes a 10% incentive for performing. 
      • Performance measures are selected that are: Nationally accepted, Vary across providers, Include sufficient data on provider being measured, measured at the level that can influence the outcome. 
    • Global payment for all medical services with health status adjustment and with margin retention. 
    • Five year contract to create a sustained partnership 
),
../demodwbp/awffwpwgl.htm#gl_Altruism (gl_Altruism Altruism, is the property that since kin share genes natural selection will improve the replicator's selfish goals by supporting the survival of such relatives.  Improving the chances of survival of non-kin is hard to explain with a gene preservation theory.  Why help a competitive gene?  Trivers explanation of reciprocal altruism shows the special conditions under which it can occur. 
),
../demodwbp/awffwpwgl.htm#gl_Alveolate (gl_Alveolate are eukaryotes which include flattened vesicles in the outer cortical region. 
),
../demodwbp/awffwpwgl.htm#gl_Alzheimers_disease (gl_Alzheimers_disease is a dementia which correlates with deposition of amyloid plaques in the neurons.  As of 2015 there are 5 million Alzheimer's patients in the USA.  It was originally defined as starting in middle age which is rare, so it was a rare dementia.  But in 1980s it was redefined as any dementia without another known cause. Early indications include mood and behavioral changes (MBI) and declarative memory and thinking problems (MCI).  Specific cells within the hippocampal circuitry and its gateway, the entorhinal cortex, are damaged.  The amygdala, cerebelum and other areas supporting implicit memory are not impacted during the early stages of the disease.  Grid cell destruction results in a sense of being lost.  The default mode network is disrupted.  Variants include: late-onset sporadic; with risk factors - ApoE4 for late onset Alzheimer's, presenilin, androgen deprivation therapy (Dec 2015), type 2 diabetes.  There are multiple theories of the mechanism of Alzheimer's during aging: Allen Roses argues that it is due to gene alleles that limit the capacity of mitochondria to support neuron operation, Neurons of sporadic Alzheimer's sufferers show greater APP gene diversity due to somatic recombination; It may be initiated by: stress induced HHV-6a, HHV7 herpes activation (Jun 2018) and or an increasingly leaky blood-brain barrier; and a subsequent innate immune response to the infections (May 2016).  The Alzheimer's pathway follows:
  • Plaques form.  These are seen in fMRIs 10 to 15 years prior to detecting memory and thinking changes.  APP deployed in the cell membrane is cut into three parts.  The external part becomes amyloid-beta peptide which aggregates into Amyloid plaques, external to the neurons, if too much is generated or it is not removed fast enough. 
    • Solanezumab aimed to inhibit plaque formation but clinical trials failed (Nov 2016). 
    • Encouraging the garbage collection of amyloid and tau with gamma rhythms stimulation retards Alzheimer's in mice studies (Mar 2019)
    • BACE inhibitors block an enzyme needed to form amyloid. 
  • Mutation driven misfolded Tau proteins can form tangles within the cytoplasm of neurons.  The Tau tangles kill nerve cells.  LMTX is a drug treatment targeted at these tangles. 
  • The brain becomes inflamed resulting in the killing of many more nerve cells.  The hippocampus disintegrates and the brain loses critical functions and memory loss becomes noticeable. 
),
../demodwbp/awffwpwgl.htm#gl_AMA (gl_AMA is the American Medical Association. 
),
../demodwbp/awffwpwgl.htm#gl_Ambulatory_blood_pressure_monitoring (gl_Ambulatory_blood_pressure_monitoring uses a device, worn for 24 hours, that automatically measures blood pressure every 15 to 30 minutes during the day and every 30 to 60 minutes at night.  ),
../demodwbp/awffwpwgl.htm#gl_AMC (gl_AMC is Academic medical center.  They perform education, research and patient care.  They include one or more health professions schools, such as a medical school and a hospital.  The major AMCs are represented by the United HealthSystem Consortium.   The costly strategies of the AMCs and increased difficulty of finding enough targeted patients for research studies (Aug 2017) is forcing integration with larger hospital systems.  AMCs offer researchers clinical research support: Virus vectors (Nov 2017);
),
../demodwbp/awffwpwgl.htm#gl_AMD (gl_AMD is age related macular degeneration which is the leading cause of vision loss and blindness among Americans over 65.  It is associated with a damaging buildup of drusen pigments in the dry form and additionally, blood vessels in the wet form.  It is associated with a variety of genetic mutations.  Using HapMap data it was realized that two gene variations on separate chromosomes, both involved in inflammatory response carry high risk for this disease.  These two genetic factors along with smoking and obesity infer 80 percent of the risk.  Treatments can thus target the inflammatory response.  Ranibizumab blocks the VEGF stimulated growth of blood vessels that occur in the wet form.  ),
../demodwbp/awffwpwgl.htm#gl_AMI (gl_AMI is acute myocardial infarction which means that some of the heart muscle has died from a blocked blood supply.  AMI is hard to measure.  Nanosensors offer a possibility (May 2016).   ),
../demodwbp/awffwpwgl.htm#gl_Amino-acids (gl_Amino-acids Amino-acids are the building blocks of proteins.  The 20 main variants differ by the nature of their side chain.  Some are positively charged, others negatively charged.  Some are water seeking while others are fat seeking.  The genetic code mapping of DNA base pair triplets thus specifies the primary sequence of amino-acids in any protein polymer. 
),
../demodwbp/awffwpwgl.htm#gl_Amiodarone (gl_Amiodarone is a drug used to treat irregular heartbeats including: VT, VF, AF, wide complex tachycardia, and paraoxysmal supraventricular tachycardia. 
),
../demodwbp/awffwpwgl.htm#gl_AML (gl_AML is acute myelogenous leukemia is a set of eleven disorders of the bone marrow.  Parents of platelets, white and red blood cells fail to differentiate properly and instead replicate wildly.  Patients are at risk of massive bleeding and sepsis.  One of the causes is mutation of the genes for IDH-2. 
),
../demodwbp/awffwpwgl.htm#gl_Amputation (gl_Amputation is a surgical technique to remove damaged body parts.  The regular method was developed by the 1800s and leaves considerable scope for increasing support for bionic devices: rebuilding agonist antagonist muscle group feedback etc.  ),
../demodwbp/awffwpwgl.htm#gl_AMT (gl_AMT is alternative minimum tax
),
../demodwbp/awffwpwgl.htm#gl_Amygdala (gl_Amygdala contains > 12 distinct areas: Central, Lateral.  It receives simple signals from the lower parts of the brain: pain from the PAG; and abstract complex information from the highest areas: Disgust from the insula cortex, allowing it to orchestrate emotion.  It sends signals to almost every other part of the brain, including to the decision making circuitry of the frontal lobes.  It has high levels of D(1) dopamine receptors.  During extreme fear the amygdala drives the hippocampus into fear learning.  It outputs directly to subcortical reflexive motor pathways when speed is required.  Its central nucleus projects to the BNST.  It signals the locus ceruleus.  It directly signals area 25.  The amygdala:
  • Promotes aggression.  Stimulating the amygdala promotes rage.  It converts anger into aggression and when impaired it impacts the ability to detect angry facial expressions.  
  • Participates in disgust
  • Perceives fear promoting stimuli.  In PTSD sufferers the Amygdala overreacts to mildly fearful stimuli and is slow to calm down and the amygdala expands in size over a period of months.  Fear is processed by the lateral nucleus which serves as the input from various senses, and the central nucleus which outputs to the brain stem (central grey - freezing, lateral hypothalamus - blood pressure, activates paraventricular hypothalamus => crf -> hormone adjustments). 
  • Has lots of receptors for and is highly sensitive to glucocorticoids.  Stress inhibits the GABA interneurons in the basolateral amygdala (BLA) allowing the excitatory glutamate releasing neurons to excite more. 
  • Is sensitive to unsettling/uncertain social situations where it promotes anxiety.  It is also interested in uncertain but potentially painful situations.  The amygdala contributes to social and emotional decision making where the BLA supports rejecting an unacceptable offer, as allowed in the Ultimatum Game, by injecting implicit mistrust and vigilance, generating an anger driven rejection that is used as punishment.  The amygdala is very rapidly excited by subliminal signals from the thalamus of outgroup skin color.  The amygdala subsequently tips social emotions against outgroups unless restrained by the frontal lobe or influenced by subliminal priming to prioritize inclusion.  The fast path from the thalamus rapidly but inaccurately signals its identified a weapon. 
  • Promotes male, but not female, sexual motivation when it is an uncertain potential pleasure. 
  • Responds to the longing for uncertain potential pleasures and fear that the reward will not be worth it if it happens.  The amygdala turns off during orgasm. 
  • Uses but is not directly involved in vision.  
),
../demodwbp/awffwpwgl.htm#gl_Amyloidosis (gl_Amyloidosis is the accumulation of badly folded proteins.  The miss-folding makes them insoluble and so they deposit in the organs and tissues of the body.  The kidney and heart are most often affected.  Often the problem is that two protein subunits fail to bind together.  Once the protein becomes insoluble it becomes inaccessible to the proteases that would otherwise break it down.  Sometimes prions are viewed as participating in amyloidosis.  However in at least some neurons prion re-folding appears to provide long term state transitions for memory.  ),
../demodwbp/awffwpwgl.htm#gl_ANA (gl_ANA is the American nurses association. 
),
../demodwbp/awffwpwgl.htm#gl_Anal_cancer (gl_Anal_cancer is very rare.  The cancer typically develops in the squamous cells of the anus.  It has been associated with HPV.  It is distinct from colon cancer.  ),
../demodwbp/awffwpwgl.htm#gl_Anaplasmosis (gl_Anaplasmosis , in humans, is a lxodes ricinus tick vectored disease caused by Anaplasma phagocytophilum bacteria infecting neutrophils. 
),
../demodwbp/awffwpwgl.htm#gl_Ancillary (gl_Ancillary - an agreement eliminating competition is ancillary if it is subordinate and collateral to a separate legitimate agreement.  Otherwise the FTC views the agreement as per se illegal under the Sherman Antitrust Act.  ),
../demodwbp/awffwpwgl.htm#gl_Andexanet_alfa (gl_Andexanet_alfa , developed by Portola Pharmaceuticals and branded Andexxa, acts as a Xarelto/Eliquis (factor Xa inhibitor) bleeding antidote.  It acts as an alternate receptor for these activated factor X inhibitors, freeing the factor Xa to induce clotting. 
),
../demodwbp/awffwpwgl.htm#gl_Androgen_deprivation_therapy (gl_Androgen_deprivation_therapy lowers the levels of male sex hormones.  These hormones stimulate the growth of prostrate cancer cells.  But the treatment: Bicalutamide, Lupron; is associated with increased rates of: Depression (Apr 2016), Dementia (Oct 2016) including Alzheimer's disease (Dec 2015).  ),
../demodwbp/awffwpwgl.htm#gl_Androgens (gl_Androgens are a class of steroid hormones including testosterone, androstenedione and dihydrotestosterone.  They are precursors of estrogens. 
),
../demodwbp/awffwpwgl.htm#gl_Anemia (gl_Anemia is a decrease in the number of red blood cells or the amount of hemoglobin in the blood.  There are various types: Fanconia anemia, Iron-deficiency anemia, Pernicious anemia, Sickle-cell anemia;
),
../demodwbp/awffwpwgl.htm#gl_Anesthesia (gl_Anesthesia is the temporary removal of sensation.  It can be local, regional or general. 
),
../demodwbp/awffwpwgl.htm#gl_Anesthesiology (gl_Anesthesiology is a four year accredited residency including a one year medical or surgical internship, and three years of anesthesiology training.  This includes specialized testing in anesthesia as well as tests of physiology, pathophysiology, pharmacology and other medical sciences.  There is a board exam at the completion of residency to obtain certification as an anesthesiologist.  Practices as an anesthesiology specialist.  ),
../demodwbp/awffwpwgl.htm#gl_Anesthesiologist (gl_Anesthesiologist is a physician who has completed an accredited residency program in anesthesiology and is trained in anesthesia and perioperative medicine. 
),
../demodwbp/awffwpwgl.htm#gl_Anesthesiology_kits (gl_Anesthesiology_kits are pharmacy kits. 
),
../demodwbp/awffwpwgl.htm#gl_Anesthetist (gl_Anesthetist is used to describe anesthesia providers without the qualification of physician.  Often these are CRNAs. 
),
../demodwbp/awffwpwgl.htm#gl_Anger (gl_Anger is an emotion which protects a person who has been cheated by a supposed friend.  When the exploitation of the altruism is discovered, Steven Pinker explains, the result is a drive for moralistic aggression to hurt the cheater.  Anger is mostly experienced as a rapid wave that then quickly dissipates.  When it is repressed, for example by a strong moral sense (superego), it can sustain, inducing long term stress. 
),
../demodwbp/awffwpwgl.htm#gl_Angiogenesis (gl_Angiogenesis is the formation of new blood vessels from existing vessels.  It is important in growth, development and wound healing.  To become malignant many tumors stimulate angiogenesis. 
),
../demodwbp/awffwpwgl.htm#gl_Angiogram (gl_Angiogram is a diagnostic test where a doctor threads a narrow catheter up from a blood vessel in the groin to the heart and squirts in a dye that allows a cardiologist to see blockages in the arteries on X-ray displays/films. 
),
../demodwbp/awffwpwgl.htm#gl_Angioplasty (gl_Angioplasty involves inserting a catheter, inflating a balloon to expand a narrowed artery, and inserting a stent to keep the area propped open.  Christensen argues angioplasty should be part of a radically lower cost business which should disrupt the solution business of the general hospital.  ),
../demodwbp/awffwpwgl.htm#gl_Angiopoietin (gl_Angiopoietin is in a family of vascular growth factors, signalling embryonic & postnatal angiogenesis. 
),
../demodwbp/awffwpwgl.htm#gl_Angiotensin_receptor_blockers (gl_Angiotensin_receptor_blockers block hormone signals (angiotensin II) from causing the contraction of muscles surrounding blood vessels and so stop the blood vessels contracting, lowering blood pressure. 
),
../demodwbp/awffwpwgl.htm#gl_ANGPTL3 (gl_ANGPTL3 is angiopoietin-like 3, a protein encoded by the ANGPTL3 gene, that participates in angiogenesis in the liver.  The preprotein is proteolytically processed into active proteins which inhibit triglyceride metabolism.  Gene knockouts result in reduced plasma lipid concentrations. 
),
../demodwbp/awffwpwgl.htm#gl_Animal (gl_Animal is a eukaryotic plant eater, directly or indirectly. 
),
../demodwbp/awffwpwgl.htm#gl_ANK3 (gl_ANK3 is a gene encoding ankyrin-3.  GWAS suggest ANK3 SNPs are involved in bipolar disorder. 
),
../demodwbp/awffwpwgl.htm#gl_Ankyrin-3 (gl_Ankyrin-3 is a linker between integral cell membrane proteins and the spectrin-actin cytoskeleton, found in neurons in both central and peripheral networks.  It is also spliced and then found in other tissues. 
),
../demodwbp/awffwpwgl.htm#gl_Anorexia (gl_Anorexia nervosa is an eating disorder.  As of 2015, 50 percent of hospitalized anorexic patients who are discharged at a normal rate relapse within a year.  It has the highest mortality of any mental illness.  It involves brain circuits involved in habitual behavior.  The initial weightloss acts as a reward with compliments relieving anxiety and increasing self-esteem.  Diet gets paired with weight loss (the reward) in the ventral striatum and eventually dieting becomes the reward as the dorsal striatum gets involved in the patient's decision making making it a habit. 
),
../demodwbp/awffwpwgl.htm#gl_Anterior_insula (gl_Anterior_insula is a rich club hub within the insula cortex.  It is anatomically subdivided by sulci into gyri.  It is where self-awareness and social experience integrate.  Feelings from the internal state of the body are used to generate emotions.  It includes a direct projection from the: thalamus's ventral medial nucleus, central nucleus of the amygdala.  The anterior insula projects into the amygdala.  It includes spindle neurons. 
),
../demodwbp/awffwpwgl.htm#gl_Anti-Kickback (gl_Anti-Kickback Statute of the SSA criminally prohibits giving a kickback for a Medicare or Medicaid service referral.  ),
../demodwbp/awffwpwgl.htm#gl_Antibiotic_resistance (gl_Antibiotic_resistance results from evolutionary pressure of antibiotics, supported by plasmids and R factors: NDN1; which encode resistance properties for otherwise lethal antibiotics.  World leaders hope cooperation can preserve the power of last resort antibiotics: Carbapenems, Colistin (Oct 2016).  Worrying trends include: C. auris resistance to medical antifungals: itraconazole; as well as azole agricultural fungicides (Apr 2019), CRE (May 2016), C. diff (May 2015), MDR & XDR TB; resulting in increased risk of sepsis and death.  The World Bank estimates full resistance would reduce the global economy in 2050 by between 1.1 and 3.8%. 
),
../demodwbp/awffwpwgl.htm#gl_Antibiotics (gl_Antibiotics are compounds which kill bacteria, molds, etc.  Sulfur dye stuffs were found to be effective antibiotics.  The first evolved antibiotic discovered was penicillin.  Antibiotics are central to modern health care supporting the processes of: Surgery, Wound management, Infection control; which makes the development of antibiotic resistance worrying.  Antibiotics are:
  • Economically problematic to develop and sell. 
    • Congress enacted GAIN to encourage development of new antibiotics.  But it has not developed any market-entry award scheme, which seems necessary to encourage new antibiotic R&D. 
    • Medicare has required hospitals and SNFs to execute plans to ensure correct use of antibiotics & prevent the spread of drug-resistant infections.  
    • C.D.C. is acting to stop the spread of resistant infections and reduce unnecessary use of antibiotics.  
    • F.D.A. has simplified approval standards.  It is working with industry to limit use of antibiotics in livestock. 
    • BARDA is promoting public-private partnerships to support promising research.
  • Impacting the microbiome of the recipient.  Stool banking is a solution  (Sloan-Kettering stool banking).  
  • Associated with obesity, although evidence suggests childhood obesity relates to the infections not the antibiotic treatments (Nov 2016). 
  • Monitored globally by W.H.O.
  • Regulated in the US by the F.D.A. who promote voluntary labeling by industry to discourage livestock fattening (Dec 2013).  
    • Customer demands have more effect - Perdue shifts to no antibiotics in premier chickens (Aug 2015). 
),
../demodwbp/awffwpwgl.htm#gl_Antibody (gl_Antibody is a y-shaped blood transported protein generated by the adaptive immune system's plasma cells, B lymphocytes, to accurately identify and neutralize pathogens such as bacteria and viruses that exhibit a matching antigen. 
),
../demodwbp/awffwpwgl.htm#gl_Antihypertensives (gl_Antihypertensives are treatments for hypertension including: diuretics, ACE inhibitors, calcium channel blockers, beta blockers and angiotensin antagonists. 
),
../demodwbp/awffwpwgl.htm#gl_Antineoplastic (gl_Antineoplastic is a treatment that inibits or prevents the growth and spread of tumors and malignant cells.  ),
../demodwbp/awffwpwgl.htm#gl_Antitrust_Procedures_and_Penalties_Act (gl_Antitrust_Procedures_and_Penalties_Act of 1974 was introduced by John Tunney:
  • Allows a court review of DOJ decisions about mergers and acquisitions.  
),
../demodwbp/awffwpwgl.htm#gl_Anvisa (gl_Anvisa is the Brazilian government's public health surveillance agency. 
),
../demodwbp/awffwpwgl.htm#gl_Anxiety (gl_Anxiety is manifested in the amygdala mediating inhibition of dopamine rewards.  Anxiety disorders are now seen as a related cluster, including PTSD, panic attacks, and phobias.  Major anxiety, is typically episodic, correlated with increased activity in the amygdala, results in elevated glucocorticoids and reduces hippocampal dendrite & spine density.  Some estrogen receptor variants are associated with anxiety in women.  Women are four times more likely to suffer from anxiety.  Louann Brizendine concludes this helps prepare mothers, so they are ready to protect their children.  Michael Pollan concludes anxiety is fear of the future.  Sufferers of mild autism often develop anxiety disorders.  Treatments for anxiety differ.  50 to 70% of people with generalized anxiety respond to drugs increasing serotonin concentrations, where there is relief from symptoms: worry, guilt; linked to depression, which are treated with SSRIs (Prozac).  But many fear-related disorders respond better to psychotherapy: psychoanalysis, and intensive CBT. 
),
../demodwbp/awffwpwgl.htm#gl_Apalutamide (gl_Apalutamide is a non-steroidal androgen receptor competitive inhibitor developed to treat prostate cancer.  It is structurally similar to enzalutamide.  ),
../demodwbp/awffwpwgl.htm#gl_APC (gl_APC is an antigen presenting cell that activates the immune response, such as a dendritic cell. 
),
../demodwbp/awffwpwgl.htm#gl_Aperture_problem (gl_Aperture_problem is the ambiguity introduced by sampling through a narrow peephole.  It is impossible to resolve direction of motion of a item sampled through the peephole for example. 
),
../demodwbp/awffwpwgl.htm#gl_Apicomplexa (gl_Apicomplexa are a group of parasitic alveolates, obligate endoparasites, which are distinguished in developing a unique organelle used to penetrate host cells within which the apicomplexa live. 
),
../demodwbp/awffwpwgl.htm#gl_Apixaban (gl_Apixaban is a direct inhibitor of free and clot-bound factor Xa. 
),
../demodwbp/awffwpwgl.htm#gl_Aplysia (gl_Aplysia Aplysia, a giant Californian marine snail has a limited neural network and large neurons.  Eric Kandel used it as an experimental system for studying neurons and was able to explain how long term memory is recorded by the Aplysia neurons. 
),
../demodwbp/awffwpwgl.htm#gl_APM (gl_APM is alternative payment model, Medicare's risk based payments to organizations set up as ACOs.  It includes track 1 ACOs which are not risk bearing.  APMs have to report various measures to CMS. 
),
../demodwbp/awffwpwgl.htm#gl_APOBEC3B (gl_APOBEC3B is a gene encoding the APOBEC-3B cytidine to uracyl RNA editor.  It is postulated to have a role in cell growth and the cell cycle.  It has been associated with mutagenesis in bladder and breast cancer. 
),
../demodwbp/awffwpwgl.htm#gl_APOC3 (gl_APOC3 is a gene encoding the apo-CIII protein.  Apo-CIII is a component of VLDL.  Increased levels of Apo-CIII induce hypertriglyceridemia. 
),
../demodwbp/awffwpwgl.htm#gl_APOE (gl_APOE is Apolipoprotein E which is essential for normal catabolism of triglyceride-rich lipoproteins.  It is used by the liver, macrophages, and central nervous system where astrocytes use it to transport cholesterol to neurons via APOE receptors. 
),
../demodwbp/awffwpwgl.htm#gl_ApoE4 (gl_ApoE4 is a gene variant which produces the E4 variant of APOE.  It is a risk-factor for late-onset sporadic Alzheimer's disease.  Being homozygote for E4 does not imply getting Alzheimer's but does increase the risk 20 fold.  ApoE2 may reduce the risk of Alzheimer's.  It appears that ApoE4 differentially affects women.  Apoe4 is known to be broken down into fragments which impare mitochondrial operation.  It also promotes amyloid plaque buildup.  Therapies are being developed based on small molecules which reshape ApoE4 to be more like ApoE3 reducing the breakdown.   
),
../demodwbp/awffwpwgl.htm#gl_Apolipoproteins (gl_Apolipoproteins are lipoproteins without the lipid bound.  They allow lipids to form into water-soluble complexes and can thus act as lipid transfer carriers, and are also found operating as enzyme cofactors and receptor ligands.  ),
../demodwbp/awffwpwgl.htm#gl_Apoptosis (gl_Apoptosis Apoptosis, programmed cell death is a signal initiated DNA controlled process which results in eukaryotic cells self-destructing.  ),
../demodwbp/awffwpwgl.htm#gl_APP (gl_APP is Amyloid Precursor Protein.  It is encoded by the gene presenilin. 
),
../demodwbp/awffwpwgl.htm#gl_Appraisal_arbitrage (gl_Appraisal_arbitrage is a hedge fund strategy where shares are purchased after a takeover bid has been announced with a plan of suing the companies for agreeing too low a price. 
),
../demodwbp/awffwpwgl.htm#gl_Appreciation_of_natural_beauty (gl_Appreciation_of_natural_beauty is an emotion which derives from the benefit to hunter gatherers of recognizing and seeking out the African savanna setting in which humans evolved.  ),
../demodwbp/awffwpwgl.htm#gl_Appropriate_use_criteria (gl_Appropriate_use_criteria are PAMA required, CMS driven specifications of when it is appropriate to use a particular procedure.  ),
../demodwbp/awffwpwgl.htm#gl_APRN (gl_APRN is an advanced practice RN, is an RN with a masters and licensing in midwifery, nurse practitioner, clinical specialist or anesthetist.  ),
../demodwbp/awffwpwgl.htm#gl_AQC (gl_AQC alternative quality contract is:
  • A 2009 payment arrangement developed by Blue Cross Blue Shield of Massachusetts.  It was developed to support change.  It differs from capitation in including upside measures for patient safety, appropriateness of care and patient satisfaction.  Its key components are:
    • Integration across the care continuum
    • Accountability for performance measures for ambulatory and inpatient care.  Includes a 10% incentive for performing. 
      • Performance measures are selected that are: Nationally accepted, Vary across providers, Include sufficient data on provider being measured, measured at the level that can influence the outcome. 
    • Global payment for all medical services with health status adjustment and with margin retention. 
    • Five year contract to create a sustained partnership 
),
../demodwbp/awffwpwgl.htm#gl_Arden_Syntax (gl_Arden_Syntax is an HL7 standard.  It is a grammar for representing medical conditions and recommendations.  ),
../demodwbp/awffwpwgl.htm#gl_Area_25 (gl_Area_25 is the Subcallosal Cingulate Cortex, an area of the ACC, which Kandel explains, is a region where thought, motor control and drive come together.  It is rich in neurons generating serotonin transporters.  It is directly involved in a signalling network with: amydala, hypothalamus, hippocampus, insula cortex; that integrates thinking and emotion to plan and respond effectively.  Kandel notes whenever area 25 becomes hyperactive, the components of this circuit associated with emotion are disconnected from the thinking brain resulting in a loss of personal identity.  ),
../demodwbp/awffwpwgl.htm#gl_Area_MT (gl_Area_MT is the middle temporal motion area MT (V5) located in the occipital lobe.  It contains many neurons detecting motion.  Each neuron suffers from aperture problems but consciousness resolves the ambiguity with a most likely current Bayesian sampling.  The resolution takes time.  Neuronal recordings show the inference may take a tenth of a second.  In the meantime MT neurons see only local motion.  Subsequently they encode the global direction.  Subjective consciousness sees only the end result.  The global resolution requires consciousness vanishing under anesthesia.  Consciousness enables the iterative exchange of modeling results resulting in eventual agreement.  
),
../demodwbp/awffwpwgl.htm#gl_ARGUS (gl_ARGUS is a Medicare benefit integrity system.  ),
../demodwbp/awffwpwgl.htm#gl_Aricept (gl_Aricept is an inhibitor of acetylcholine breakdown.  It is a treatment for classical Alzheimer's disease.  ),
../demodwbp/awffwpwgl.htm#gl_Aripiprazole (gl_Aripiprazole is a partial agonist of dopamine D2 receptors.  It is believed to lower transmission in the mesolimbic pathway and enhance transmission in the mesocortical pathway. 
),
../demodwbp/awffwpwgl.htm#gl_Arms_race (gl_Arms_race Arms , in a war where both sides use the strategy of development and use of advanced weapon systems to gain an advantage, each advance induces the other side to respond with its own asymmetric advances.  Neither side will necessarily gain the upper hand in which case the weapon systems themselves advance rapidly with little direct benefit for the combatants.  ),
../demodwbp/awffwpwgl.htm#gl_Aromatase_inhibitors (gl_Aromatase_inhibitors limit the synthesis of estrogen by aromatase.  Breast and ovarian cancers grow more stimulated by estrogen. 
),
../demodwbp/awffwpwgl.htm#gl_ARR (gl_ARR is annual recurring revenue or Admission-Readmission revenue constraint program. 
),
../demodwbp/awffwpwgl.htm#gl_ARRA (gl_ARRA is the American Recovery and Reinvestment Act of 2009.  It included health care provisions:
  • COBRA payments
  • Funds to help states with Medicaid. 
  • $20 billion to modernize health care IT systems.  
  • $10 billion for health care research
),
../demodwbp/awffwpwgl.htm#gl_ART (gl_ART is an ARV therapy for H.I.V.  ART is a cocktail of drugs, such as the three in HAART, which prevents the virus from replicating leaving it dormant so AIDS does not develop. 
),
../demodwbp/awffwpwgl.htm#gl_ARV (gl_ARV is antiretroviral treatments for H.I.V. infection, such as abacavir. 
),
../demodwbp/awffwpwgl.htm#gl_ASA (gl_ASA is the American Society of Anesthesiologists.  ),
../demodwbp/awffwpwgl.htm#gl_ASC (gl_ASC is either:
  • An ambulatory surgery center providing same day surgical care, or
  • The accredited standards committee responsible for standard X.12. 
),
../demodwbp/awffwpwgl.htm#gl_ASC_X12N (gl_ASC_X12N is the insurance (N) subcommittee of the X12 EDI and XML ASC accredited by ANSI. 
),
../demodwbp/awffwpwgl.htm#gl_ASCA (gl_ASCA is the Administrative Simplification Compliance Act of 2002.  Public Law 107-105 implemented as regulation 42 CFR 424.32.  It alters the SSA to make electronic claims submission a mandatory requirement for some classes of health care providers, health plans and health care clearing houses.  ),
../demodwbp/awffwpwgl.htm#gl_ASD (gl_ASD is autism spectrum disorder.  All these disorders are characterized by difficulty connecting with others.  People who suffer from ASD show a reduced fusiform response to faces.  ASD is linked to gene variants affecting oxytocin and vasopressin, to nongenetic mechanisms that silence the oxytocin receptor gene and to lower levels of the receptor itself. 
),
../demodwbp/awffwpwgl.htm#gl_ASHG (gl_ASHG is the American Society of Human Genetics. 
),
../demodwbp/awffwpwgl.htm#gl_Aspirin (gl_Aspirin (acetylsalicylic acid) is a pain, fever and inflammation medicine.  It is a platelet aggregation inhibitor.  While its NNT is 2000 for cardiovascular disease prophylaxis, it is so cheap that this strategy is still important.  It has been found beneficial in limiting esophageal cancer. 
),
../demodwbp/awffwpwgl.htm#gl_ASPR (gl_ASPR is assistant secretary for preparedness and response ),
../demodwbp/awffwpwgl.htm#gl_Asprosin (gl_Asprosin is a protein based hormone produced in white adipose tissue that signals the brain and liver to release glucose into the blood stream.  It is encoded by the FBN1 gene.  cAMP is the second messenger in the signalling network. 
),
../demodwbp/awffwpwgl.htm#gl_ASRO (gl_ASRO is the American Society for Radiation Oncology. 
),
../demodwbp/awffwpwgl.htm#gl_Assisted_living (gl_Assisted_living is an alternative to parents joining their children's nuclear family or entering a SNF, or Greenhouse Nursinghome.  Atul Gawande's Being Mortal describes the situation.  Federal Medicaid does not directly cover assisted living.  State Medicaid adds coverage through a federal waiver.  Congressional legislation covering assisted living is limited.  Assisted living providers are represented by the National Center for Assisted Living. 
),
../demodwbp/awffwpwgl.htm#gl_Association_health_plans (gl_Association_health_plans (AHP):
  • Allow small businesses and individuals in particular professions, trades or interest groups to join associations that offer insurance to members. 
  • Are a form of MEWA
),
../demodwbp/awffwpwgl.htm#gl_Asthma (gl_Asthma is inflammation of the airways resulting in their narrowing, swelling and generating additional mucus which inhibits breathing.  Its prevalence doubled in the US between 1980 and 2000.  Asthma is the most common chronic disease in childhood, the most common reason for being away from school and the most common reason for hospitalization.  10 to 13% of children's asthma cases are due to obesity.  Among obese children 23 to 27% of asthma cases are due to obesity.  Diagnosis: Propeller Health; Treatments include: Xolair;
),
../demodwbp/awffwpwgl.htm#gl_ASW (gl_ASW is associate clinical social worker. 
),
../demodwbp/awffwpwgl.htm#gl_ATC (gl_ATC is anaplastic thyroid cancer. 
),
../demodwbp/awffwpwgl.htm#gl_Atezolizumab (gl_Atezolizumab is a MAB of lgG1 targeting the apoptosis ligand PD-L1.  It is marketed as Tecentriq.  It blocks PD-L1's interaction with PD-1 and B7.1.  PD-L1 expression reduces the activation of cytotoxic T-cells (immune checkpoint inhibition). 
),
../demodwbp/awffwpwgl.htm#gl_Atherosclerosis (gl_Atherosclerosis is the thickening of an artery wall due to invasion and accumulation of leukocytes.  It is associated with lack of sleep.  Sleep reduces inflammation (Jan 2019). 
),
../demodwbp/awffwpwgl.htm#gl_ATL (gl_ATL is an NVLAP Accredited Testing Lab tests EHR technology against the certification criteria. 
),
../demodwbp/awffwpwgl.htm#gl_ATM (gl_ATM is a serine/threonine kinase, that binds onto DNA double-strand breaks.  It phosphorylates proteins including: p53, CHK2, BRCA1, NBS1 and H2AX; in networks activating the DNA damage checkpoint, resulting in cell cycle arrest, DNA repair or apoptosis. 
),
../demodwbp/awffwpwgl.htm#gl_Atopic_dermatitis (gl_Atopic_dermatitis , is also called eczema is a long lasting inflammation of the skin.  It can be successfully treated with dupilumab.  ),
../demodwbp/awffwpwgl.htm#gl_ATPase (gl_ATPase is adenosine triphosphatase, an enzyme class that breaks the high energy bond from ATP to generate ADP, phosphate, and energy used to drive other reactions away from equilibrium.  ),
../demodwbp/awffwpwgl.htm#gl_ATR (gl_ATR is either:
  • A serine/threonine-specific kinase, that binds to single-strand DNA breaks coated with RPA, with partner ATRIP, sensing DNA damage and activating the DNA damage checkpoint, through a signalling cascade. 
  • Americans for Tax Reform, Grover Norquist's powerful conservative-Republican advocacy group.  Norquist created the:
    • Taxpayer Protection Pledge in 1986.  Republican Newt Gingrich and GOPAC ensured it became a mandatory step for Republicans seeking election.  
    • Wednesday morning stategy meetings in 1993, to undermine the Clinton administration and weaken the Democrat's hold on power.  
),
../demodwbp/awffwpwgl.htm#gl_ATRA (gl_ATRA is the American taxpayer relief act of 2012.  This made the EGTRRA and JGTRRA tax cuts permanent for single people earning less than $400,000 and couples earning less than $450,000.  The highest marginal income tax rate returned to 39.6 percent.  President Obama signed the act into law in Jan 2013. 
),
../demodwbp/awffwpwgl.htm#gl_Atrial_fibrillation (gl_Atrial_fibrillation is an irregular heart rate associated with poor blood flow.  It:
  • Can lead to blood clots, stroke, CHF, dementia and other complications.  
    • Fibrillations allow blood to pool in the heart chambers and form small clots which can then lodge in small arteries and block blood flow. 
  • Has become much more common being induced by endemic diseases: hypertension, obesity and type-2-diabetes. 
  • Cocoa reduces risk of AF (May 2017)
  • Treatments include: digoxin;
),
../demodwbp/awffwpwgl.htm#gl_Atrophic_gastritis (gl_Atrophic_gastritis is a condition of aging where the acid-producing cells in the stomach gradually cease to function.  It is associated with chronic inflammation of the stomach mucosa, leading to loss of gastric glandular cells and their replacement by intestinal and fibrous tissues. 
),
../demodwbp/awffwpwgl.htm#gl_ATSDR (gl_ATSDR is the HHS agency for toxic substances and disease registry ),
../demodwbp/awffwpwgl.htm#gl_Attachment_theory (gl_Attachment_theory is John Bowlby's model of mother infant bonding.  He argued that infants need: love, warmth, affection, responsiveness, stimulation, consistency, reliability; or they become anxious, depressed, and/or poorly attached adults.  Evolutionarily, sociopaths may be highly successful as managers and leaders but they are probably anxious.  Sapolsky notes the powerful association between murder rates and stopping pregnant girls from terminating unwanted pregnancies.  Typical mothers also provide training on social conventions and their children's position in the group hierarchy.  Children raised without a mother's support fail to understand social constraints and when to use social behaviors.  And in the presence of unsupportive mothers newborns attach to negative stimuli.  This response is explained by the SHRP.  Abused children subsequently seek out abusive relationships as adults.  And a percentage of infants abused by their mothers become abusive mothers. 
),
../demodwbp/awffwpwgl.htm#gl_Attachment (gl_Attachment supports a stable sense of connection & calm to another person who provides load sharing, using the 'attachment network': pituitary, hypothalamus, adrenal glands, ACC, VTA, nucleus accumbens, PFC; initially generated in babies by norepinephrine from the locus ceruleus as long as corticosteroid levels are low, which deploys & responds to oxytocin (nucleus accumbens, VTA, amygdala, hippocampus), to maintain critical judgment about our partners, once dopamine from the VTA has reinforced the initial interest of the nucleus accumbens.  The evolved attachment network is applied by birds, termed imprinting by conditioning advocates.  But Harlow showed clinging in infant monkeys is innate and needed to achieve attachment. 
),
../demodwbp/awffwpwgl.htm#gl_Attention (gl_Attention is the focusing of our mental resources onto a specific piece of information.  Attention uses valuations assigned to each potential object of thought by the basal ganglia. 
),
../demodwbp/awffwpwgl.htm#gl_Attentional_blink (gl_Attentional_blink is an experimental technique to create a minimal contrast between conscious and unconscious processing.  A brief period of invisibility of an image is created by saturating the conscious mind with attention on letters within a stream of symbols which are mostly digits.  A first letter is perceived.  A second letter presented in close succession (100 milliseconds) is completely missed by conscious perception.  The delay can be adjusted until 50% of the time the second letter is perceived allowing sensors to look at the differences in brain activity between the two minimally different situations. 
),
../demodwbp/awffwpwgl.htm#gl_Attribution (gl_Attribution in deep neural networks, aims to understand the flow of information, so as to help explain the networks predictions. 
),
../demodwbp/awffwpwgl.htm#gl_Auditory_cortex (gl_Auditory_cortex is part of the temporal lobe that processes auditory information.  It is present in both brain hemispheres.  Auditory sensations only reach consciousness once signalled by the auditory cortex.  Final sound processing is performed by the parietal and frontal lobes in humans. 
),
../demodwbp/awffwpwgl.htm#gl_Augmented_Reality (gl_Augmented_Reality extends reality providing computer support to human senses. 
),
../demodwbp/awffwpwgl.htm#gl_Authentication (gl_Authentication identifies a user to a service.  Internet standards include: OpenID; ),
../demodwbp/awffwpwgl.htm#gl_Authoritarian_parenting (gl_Authoritarian_parenting is a parenting style focused on arbitrary, rigid rules and demands with behavior shaped by punishment.  ),
../demodwbp/awffwpwgl.htm#gl_Authoritative_parenting (gl_Authoritative_parenting is a parenting style focused on clear, consistent explicable rules.  Flexibility and praise are offered to develop a child's potential and autonomy.  ),
../demodwbp/awffwpwgl.htm#gl_Authorization (gl_Authorization is a facility that acts as a gate-keeper to protected resources.  Internet standards for authorization: OAuth; can be used to support sign-in via third-party authentication services including social networks: Facebook, Google+, Twitter;
),
../demodwbp/awffwpwgl.htm#gl_Autism (gl_Autism is a major hereditary mental disorder that starts before age three when it features: a strong preference to be alone, a desire for things to stay the same, and areas of creative ability - they see the ordinary as beautiful and have special talents for: poetry, foreign languages, music, art, and calculations.  They generate less but more original ideas.  It occurs as a spectrum of symptoms, from mild to severe, across the population of sufferers (ASD).  Before age two the circumference of an autistic child's head is larger than typical and regions: amygdala, frontal lobe; develop prematurely, altering activity in other regions.  Autism highlights aspects of the brain's specialized regions and processes for interacting with other people.  Autistic's interests are restricted.  They struggle with social interactions & verbal and nonverbal communications.  Autistics do not attribute minds to other people: attributing mental states to others allows us to predict their behavior; a critical skill for social learning and interaction.  While their visual area MT detects motion, the superior temporal sulcus does not respond to biological motion in autistics, undermining the understanding of intention.  And they gaze at mouths rather than eyes when looking at faces.  The default mode network is disrupted.  Autistic adolescents have unusually large numbers of synapses, because of a failure of synaptic pruning.  Autistics almost never pretend.  They can't explain the difference between an instance of an object and a memory of it.  Mild autism still maintains some pressure to conform socially and often results in depression and anxiety.  Autism occurs in every country and social class.  It lasts a lifetime.  It has genetic and neurological causes.  Identical twins are 90% likely to both have autism if one of them does.  With 50% of genes active in the brain, mutations are likely to impact the development and operation of the brain.  The genes: SHANK3, CDH10; are involved but account for a very small percentage of the risk.  Facial gaze studies indicate a high genetic influence and an opportunity to identify more genes associated with autism (Jul 2017).  Copy number variations: an extra copy of a segment of 25 genes of chromosome 7 increases the risk of ASD, while deletion of the segment causes Williams syndrome; and de novo mutations which drive up the number of autism cases as paternal age has increased in the US.  ASD is associated with a reduced fusiform face area response.  Tests [in development] for autism include: SynapDx's blood test. 
),
../demodwbp/awffwpwgl.htm#gl_Autoimmune_diseases (gl_Autoimmune_diseases include: celiac disease, eczema, IBD, lupus, multiple sclerosis, type-1-diabetes; are often debilitating and life long conditions.  Autoimmune diseases are increasing in prevalence rapidly over two or three generations in advanced societies.  One in thirteen Americans has an autoimmune condition.  Some are associated with gene alleles encoding the immune system.  Stress is associated with increased autoimmune problems (Jan 2017)
),
../demodwbp/awffwpwgl.htm#gl_Autonomous_entities (gl_Autonomous_entities are entities which:
  • Are far from equilibrium
  • Consume and save low entropy
  • Can use accessible low entropy to maintain themselves
),
../demodwbp/awffwpwgl.htm#gl_Autonomy (gl_Autonomy is decision making based on careful weighting of the pros and cons before committing to a course of action according to Dehaene.  ),
../demodwbp/awffwpwgl.htm#gl_Autophagy (gl_Autophagy is the cellular network that breaks down aged and problematic cellular infrastructure and foreign agents.  The genetically encoded facilities are present in yeast and humans.  Dr. Yoshinori Ohsumi's research on yeast autophagy showed: During starvation, proteins and nonessential components are broken down to provide energy; Cells use the autophagy infrastructure to destroy invading viruses and bacteria.  When the process goes wrong autophagy contributes to: Premature aging, Cardiovascular disease, skeletal weakness, glucose intolerance, Cancer, Infections, Immunological diseases and Neurodegenerative disorders.  ),
../demodwbp/awffwpwgl.htm#gl_Availability_Bias (gl_Availability_Bias is our perception that objects we can recall easily are present more often.  Items we have been made aware of recently will be judged more available than otherwise.  Differences in how our brains recall different objects similarly introduces this bias as described by Kahneman & Tversky in Judgement Under Uncertainty: Heuristics and Biases. 
),
../demodwbp/awffwpwgl.htm#gl_AVM (gl_AVM is arteriovenous malformation, where the usual capillary network between arteries and veins is bypassed.  It is usually genetically determined via mutations that affect the Ras proteins.  
),
../demodwbp/awffwpwgl.htm#gl_AVRC (gl_AVRC is AIDS vaccine research committee of the NIH. 
),
../demodwbp/awffwpwgl.htm#gl_AWF (gl_AWF is the adaptive web framework.  ),
../demodwbp/awffwpwgl.htm#gl_Axon (gl_Axon Axon, a long extension of a neuron which has a membrane constructed to support the uni-directional flow of action potential from the dendritic tree and cell body to the synaptic terminals.  ),
../demodwbp/awffwpwgl.htm#gl_Axonal_plasticity (gl_Axonal_plasticity is where axons generate projections that head off in novel directions.  A notable example involves blind people reading Braille where typical tactile cortex activation is accompanied by activation of the visual cortex.  Injuries to the nervous system can produce similar remapping as axons that have lost contact with targets because the targets were previously destroyed, search for other active neurons to synapse with in neighboring parts of the cortex.  The remapping of the axon's path results in waves of plasticity as the newly targeted neurons perform remapping too.  Such remapping is seen when practicing a skill, such as learning to play a new song by repeated physical or mental activity. 
),
../demodwbp/awffwpwgl.htm#gl_BA (gl_BA is a HIPAA business associate.  ),
../demodwbp/awffwpwgl.htm#gl_Babesiosis (gl_Babesiosis is a parasitic disease, vectored by ticks, transmitting babesia protozoa blood parasites in the human infection.  ),
../demodwbp/awffwpwgl.htm#gl_BAFF (gl_BAFF is B-cell activating factor, supports the development and survival of B-cells.  In SLE BAFF is overexpressed. 
),
../demodwbp/awffwpwgl.htm#gl_Balance_billing (gl_Balance_billing is when an out-of-network provider bills the patient for the balance of the bill not covered by the insurer.  These charges are not capped by the ACA's out-of-pocket maximum.  ),
../demodwbp/awffwpwgl.htm#gl_Banking_Act (gl_Banking_Act of 1933 was New Deal legislation that reformed the banking system: limiting commercial bank securities operations, constraining integration of commercial banks and securities firms; and created the FDIC.  It was sponsored by Senator Carter Glass and Representative Henry Steagall (Glass-Steagall) and was initially resisted by the FDR administration. 
),
../demodwbp/awffwpwgl.htm#gl_Bankruptcy (gl_Bankruptcy is a legal status for an entity that cannot repay its creditor's loans.  It holds creditor lawsuits in abeyance while the restructuring process proceeds to allow the entity to continue operations.  It also has legal tools for forcing holdout creditors to accept repayments that are lower than the bond sale initially promised. 
),
../demodwbp/awffwpwgl.htm#gl_Banyan_Brain_Trauma_Indicator (gl_Banyan_Brain_Trauma_Indicator is a blood test for mTBI that measures the levels of UCH-L1 and GFAP that are released into the blood stream when brain tissue is damaged.  It is approved for marketing by the F.D.A. and should reduce the need for CT scans of those with suspected brain injuries by a third.  (Feb 2018)
),
../demodwbp/awffwpwgl.htm#gl_BARDA (gl_BARDA is the biomedical advanced research and development authority, an HHS ASPR office responsible for procurement and development of vaccines, drugs, therapies and diagnostic tools for public health emergencies. 
),
../demodwbp/awffwpwgl.htm#gl_Basal_cell_carcinoma (gl_Basal_cell_carcinoma is the most common form of cancer.  It rarely metastasizes or kills unlike melanoma.  It does cause destruction and disfigurement by invading surrounding tissue so it is considered malignant.  There are a number of types: Aberrant, Cicatricial, Cystic, Fibroepithelioma of Pinkus, Infiltrative, Micronodular,Nodular which can become a Rodent ulcer, Pigmented, Polypoid, Pore-like, Superficial. 
),
../demodwbp/awffwpwgl.htm#gl_Basal_ganglia (gl_Basal_ganglia are a set of nuclei near the base of the brain that operate an evolved neural network that unconsciously models the attentional value of each potential object of thought.  It includes the: dorsal striatum which is involved in habit and the ventral striatum which is associated with rewards for winning and losing money. 
),
../demodwbp/awffwpwgl.htm#gl_Base (gl_Base Base, a nucleotide base is the side chain purine (A or G) or pyrimidine (T or C).  A is a natural pair for T.  G pairs naturally with C.  These bases have multiple uses in cells including energy transfer, second messenger signalling as well as genetic data storage, transcription and translation.  Deacon argues that the multiple uses are significant to the emergence of evolution. 
),
../demodwbp/awffwpwgl.htm#gl_Basophils (gl_Basophils are a type of leukocyte.  They respond to antigens by releasing histamine causing vasodilation and heparin inhibiting blood clotting and supporting the invasion of other leukocytes into the infected area.  ),
../demodwbp/awffwpwgl.htm#gl_Batch_gradient_descent (gl_Batch_gradient_descent is used to identify the parameter settings which result in a minimal cost function comparing a predicted outcome to the real outcome.  The basic operation is:
  • Choose an initial vector of parameters and a learning rate;  and then
  • Repeat until an appropriate minimum is obtained -- This can be computationally expensive pushing machine learning towards SGD.  Also by replacing these iterative operations with equivalent vector computations the speed can be massively increased. 
    • Randomly shuffle examples in the training set - The data should be presented randomly to avoid biasing the gradient which may undermine convergence. 
    • For i = 1 to n do
      • Parameter = parameter - learning rate * del (objective function on i (parameter) )
        • Stanford notes that the objective function on i is really replaced by an expectation maximization E algorithm
),
../demodwbp/awffwpwgl.htm#gl_Bayes (gl_Bayes , Thomas was an 18th century clergyman who wrote "An Essay toward Solving a Problem in the Doctrine of Chances" in which he argued that the way we learn about the world is through approximation, getting closer and closer to the truth as we gather more evidence.  Laplace developed this idea into the Bayesian statistical method.  The method is iterative and adaptive. 
),
../demodwbp/awffwpwgl.htm#gl_Bayes_Rule (gl_Bayes_Rule specifies a conditional probability P(A|B) the posterior belief = (P(B|A) the likelyhood * P(A) our prior belief) /P(B).  This says our belief in hypothesis A is updated in light of new evidence B.  The power of Bayes rule is that often P(A|B) may be difficult to compute directly but can be calculated from P(B|A).  For example:
  • A is the event a person has cancer. 
  • B is the event a person smokes. 
  • If 10% of people who enter a clinic have cancer then P(A) = 0.1;  Assumed accurate Baysian prior. 
  • P(B) is the percentage of people who smoke = 0.5; Assumed accurate prior. 
  • P(B|A) = 0.8 is the proportion of smokers among those diagnosed with cancer at the clinic from the clinics records.  
  • P(A|B) = (0.8 * 0.1)/0.5 = 0.16.  With evidence that a person is a smoker we revise our estimate of P(A) from 0.1 to a posterior probability of 0.16.  
),
../demodwbp/awffwpwgl.htm#gl_Bayesian (gl_Bayesian is an iterative form of statistics invented by Thomas Bayes.  It uses a 'prior' statistic to represent the prior situation and then performs a calculation that integrates the probability of new events occurring into a 'posterior' probability.  This posterior becomes the prior for the next iteration with the application of the Bayesian identity xpost = xprior*y/(xprior*y + z(1-xprior)).  The magic in Bayesian statistics is in accurately generating the prior xprior and the current event probabilities y and z.  R. A. Fischer was so skeptical of the legitimacy of the prior that he advocated an alternative statistical framework and experimental process.  ),
../demodwbp/awffwpwgl.htm#gl_Bayh-Dole_Act (gl_Bayh-Dole_Act is the Patent and Trademark Law Amendments Act which allowed universities, small businesses and non-profits working with federal researchers to elect to pursue ownership of an invention in preference to the government taking ownership. 
),
../demodwbp/awffwpwgl.htm#gl_BBA (gl_BBA is the Balanced Budget Act of 1997.  This act aimed to balance the federal budget by 2002.  It was enacted using the budget reconciliation process.  In part it reduced Medicare (replacing MVPS with the SGR and commissioning the MedPAC) and Hospital inpatient and outpatient payment cuts to do this.  It also enacted Medicare Advantage and SCHIP.  BBA mandated risk adjustment and the HCC coding payment model, through CMS rules.  ),
../demodwbp/awffwpwgl.htm#gl_BBA_of_2018 (gl_BBA_of_2018 is the Bipartisan Budget Act of 2018, increasing spending caps imposed by the BCA of 2011, and including as part 3, the CHRONIC care act. 
),
../demodwbp/awffwpwgl.htm#gl_BCA (gl_BCA is the budget control act of 2011.  It was agreed between House leader Boehner and President Obama to:
  • $1.2 trillion deficit reduction by joint agreement or sequestration
  • $900 billion in cuts over 10 years. 
),
../demodwbp/awffwpwgl.htm#gl_BCG (gl_BCG is the Bacille Calmette-Guerin vaccine for tuberculosis.  It has unpredictable results and is not fully protective for severe forms of the disease.  It is also being used to treat bladder cancer. 
),
../demodwbp/awffwpwgl.htm#gl_BCR (gl_BCR is a gene on chromosome 22 which normally codes the breakpoint cluster region protein which is a GTPase-activating protein for RAC1 and CDC42.  In many cases of CML part of the BCR gene gets translated onto an additional Philadelphia chromosome along with part of gene ABL from chromosome 9.  ),
../demodwbp/awffwpwgl.htm#gl_BDNF (gl_BDNF is brain-derived neurotropic factor which stimulates the formation of new dendrites and synapses. 
),
../demodwbp/awffwpwgl.htm#gl_BEA (gl_BEA is the federal bureau of economic analysis
),
../demodwbp/awffwpwgl.htm#gl_Beacon_Community (gl_Beacon_Community is supported by the ONC because of its cutting edge use of EHR adoption and HIE.  Their grantees are acting as test sites for Health IT to analyze disparities due to race, gender, language or disability.  ),
../demodwbp/awffwpwgl.htm#gl_BEC (gl_BEC s are biliary epithelial cells which are part of the adult liver.  They are derived from embryonic endoderm.  ),
../demodwbp/awffwpwgl.htm#gl_Bedaquiline (gl_Bedaquiline is an oral prescription treatment for tuberculosis, discovered by Koen Andries at Janssen Pharmaceutica.  It affects an ATP synthase proton pump.  It is specifically approved by the F.D.A. to treat MDR TB and is a WHO essential medicine. 
),
../demodwbp/awffwpwgl.htm#gl_Behavioral_medicine (gl_Behavioral_medicine assumes the fundamental unity of the mind and body.  Formally established in 1977 it explicitly recognizes that people need to be active participants whenever possible in their own health care by learning more about health and how to maintain and optimize it.  It also recognizes the importance of people learning to communicate more effectively with their doctors.  This helps ensure their needs are honored.  It is accepted that science can't fully describe a complex dynamic process such as health without representing the whole organism.  Equally how people perceive and represent the world is revised allowing more effective conceptualizing of problems and how to cope with stress and illness.  The process of paying attention and how the body and mind interact to influence health and illness are highlighted.  It is based on:
  • Our bodies are self-organizing and self-healing.  Science has a limited understanding of the overall system. 
  • Our inner balance is accomplished through feedback loops that interconnect all aspects of the organism. 
  • Our models of ourselves and our emotions play a significant role in health and disease.  When these provide a sense of coherence about ourselves and the world they help us cope with stress. 
  • On every level of organization, from the molecular biology of our cells to the functioning of whole organs and larger systems, our biology is regulated by information flow, which connects each part of the system to those other parts that are important for its functioning. 
  • Connectedness is crucial for physical, psychological and social health.  People who feel unloved and unlovable, with a lack of attachment to their parents are statistically relatively cancer-prone. 
  • Our senses allow us to connect with the external environment as well as with our internal states.  They give us essential information about the environment and about other people that allows us to organize a coherent impression of the world, to function in "psychological space," to learn, to remember things, to reason. 
  • Patients being active participants in their health care, helping develop personalized strategies that they actively participate in rather than depending on 'experts to fix them'.  Success with these strategies can improve self-efficacy.  Hardiness helps ensure success.  
),
../demodwbp/awffwpwgl.htm#gl_Behavioral_hazard (gl_Behavioral_hazard is Sendhil Mullainathan, Katherine Baicker and Josh Schwartzstein's name for patients underuse of highly effective drugs so they can avoid constraining copayments.  ),
../demodwbp/awffwpwgl.htm#gl_Belimumab (gl_Belimumab is a human MAB, marketed as Benlysta, which binds and inhibits BAFF.  It is used to treat SLE lupus. 
),
../demodwbp/awffwpwgl.htm#gl_Beta_bend (gl_Beta_bend Beta , provides a structural building block (a turn) that can be conserved and used by natural selection. 
),
../demodwbp/awffwpwgl.htm#gl_Beta_blockers (gl_Beta_blockers stop the action of beta-adrenergic signals and hence slow the heart.  ),
../demodwbp/awffwpwgl.htm#gl_Beta_sheet (gl_Beta_sheet Beta provides a structural building block (a sheet with consistent electrical and physical properties) that can be conserved and used by natural selection.  ),
../demodwbp/awffwpwgl.htm#gl_BFGS (gl_BFGS is the Broyden-Fletcher-Goldfarb-Shanno algorithm for iteratively solving unconstrained nonlinear optimization problems.  It is used because in practice it often works for problems in hill-climbing optimizations. 
),
../demodwbp/awffwpwgl.htm#gl_BI (gl_BI is business intelligence.  Compliance is demanding providers measure, understand and respond to the data about their patients and care.  Hospital groups know they must take steps to allow their data silos to integrate, even as they must take care to follow HIPAA requirements.  And global networking and CMS policies on providing access to their population data creates new business intelligence opportunities and threats.  CMS incentives to adopt ACO structures similarly will require inter-business data visualization to be able to spread costs and revenues among the partners.  Patients are using social networking to review their symptoms, diagnosis and treatments forcing providers to respond.  But providers may also obtain behavioral signals from social media allowing them to better understand chronic diseases.  Providers must also avoid drowning in the rapidly expanding volume of data.  And it will be essential to adopt predictive statistical models to avoid the increasing likelihood of invalid sampling resulting in false positives and regression-to-the-mean.  So providers must decide on effective governance structures, priorities and effective coherent strategies.  They have lacked the analytics infrastructure to support rapid effective decision making.  This likely requires tools that can do 'what if' analysis and other forms of sophisticated modeling and visualization.  But integration and analytics tools and methods have improved recently.  And the development of OpenStack and equivalent infrastructure presents opportunities for associative searches to integrate disparate data sources from across the medical neighborhood.  Genome data may allow precision medicine to disrupt previous intuitive medicine businesses. 
),
../demodwbp/awffwpwgl.htm#gl_BIF (gl_BIF is bank insurance fund administered by the FDIC. 
),
../demodwbp/awffwpwgl.htm#gl_Bifidobacterium_infantis (gl_Bifidobacterium_infantis is a key symbiont in the human infant microbiome.  It is selected for by breast milk's array of oligosaccharides.  This structures the microbiome and helps bootstrap the immune system.  Its growth limits the opportunities for pathogenic bacteria to occupy the infant lower intestine.  But its transmission to further generations may depend on large families where the children typically cross infect.  It appears to be collapsing in western societies with small nuclear families and a focus on cleanliness. 
),
../demodwbp/awffwpwgl.htm#gl_Big_Data (gl_Big_Data encompasses the IT systems and processes necessary to do population based data collection, management and analysis.  The very low cost, robust, data storage organized by infrastructure: HADOOP; allows digital data to be stored en mass.  Data scientists then apply assumptions about the world to the data, analogous to evolved mechanisms in vision, in the form of algorithms: Precision medicine, Protein folding modeling (Feb 2019) assumes coevolutionary methods can be applied to identify contact points in a protein's tertiary structure.  Rather than depending on averages, analysis at Verisk drills down to specifics and then highlights modeling problems by identifying the underlying CAS.  For the analysis to be useful it requires a hierarchy of supporting BI infrastructure:
  • Analytics utilization and integration delivered via SaaS and the Cloud to cope with the silos and data intensive nature. 
  • Analytics tools (BI) for PHM will be hard to develop.  
    • Complex data models must include clinical aspects of the patient specific data, including disease state population wide.  
    • A key aspect is providing clear signals about the nature of the data using data visualization. 
  • Data communication with the ability to exchange and transact.  HIEs and EMPI alliance approaches are all struggling to provide effective exchange. 
  • Data labeling and secure access and retreival.  While HIPAA was initially drafted as a secure MPI the index was removed from the legislation leaving the US without such a tool.  Silos imply that the security architecture will need to be robust. 
  • Raw data scrubbing, restructuring and standardization.  Even financial data is having to be restandarized shifting from ICD-9 to -10.  The intent is to transform the unstructured data via OCR and NLP to structured records to support the analytics process. 
  • Raw data warehousing is distributed across silos including PCP, Hospital system and network, cloud and SaaS for process, clinical and financial data. 
  • Data collection from the patient's proximate environment as well as provider CPOE, EHRs, workflow and process infrastructure.  The integration of the EHR into a big data collection tool is key. 
),
../demodwbp/awffwpwgl.htm#gl_Bigram (gl_Bigram is an ordered pair of letters.  The human visual system potentially includes bigram neurons which respond to specific letter conjunctions.   Dehaene illustrates with the example of a neuron that signals the presence of a letter 'n' one or two letters to the left of a letter 'a'.  That allows us to discriminate between 'AND' and 'DNA'.  Bigram neurons have not been isolated experimentally.  Dehaene explains how they might work:
  • A bigram neuron would collect signals from several partially overlapping detectors with the prior letter fields appearing mostly on the left. 
  • The bigram detector would end up with greater location invariance than any of the underlying detectors.  
  • The architecture would be tolerant to the presence of one or more intermediate letters. 
  • The underlying letter detectors receptive fields would be spread over part of the retina. 
),
../demodwbp/awffwpwgl.htm#gl_Billed_charge (gl_Billed_charge is a hospital's undiscounted chargemaster bill for a procedure.  In the ED it will include a high facility fee, and each seperate procedure, which may be due to strategic billing, can be upcoded (1 - 5) depending on its complexity.  It is found that hospitals are increasingly upcoding to level 4 or 5 (serious auto accident) for provision of basic care.  While in-network insurance constrains the actual charges a hospital can make, the use of ED contract staff, not bound by the patients insurance contract with the hospital, can result in surprise billing. 
),
../demodwbp/awffwpwgl.htm#gl_Biofilm (gl_Biofilm is a sheet of bacteria that have invaded the mucus epithelium covering an organ. 
),
../demodwbp/awffwpwgl.htm#gl_Bioinformatics (gl_Bioinformatics develops techniques for storing, retrieving, organizing and analyzing biological data. 
),
../demodwbp/awffwpwgl.htm#gl_Biological_lighting (gl_Biological_lighting describes lighting systems and LED bulbs which can regulate the body's natural 24 hour cycles by stimulating receptors in the eyes which signal the brain about when it is time to sleep and get up.  Standard LEDs by stimulating the receptors with short-wavelength light suppress melatonin release.  Biological lighting products aim to undo the damage that traditional lighting has done to the body's natural rhythms.  By releasing longer range yellow light after sunset these bulbs assist the body in maintaining its natural sleep cycle. 
),
../demodwbp/awffwpwgl.htm#gl_Biological_profile_of_childhood (gl_Biological_profile_of_childhood :
  • The adversities are stressful and alter stress physiology producing children and adults with elevated: Glucocorticoids, CRH and ACTH, Sympathetic nervous system activity.  Early stress permanently impacts the brains ability to control glucocorticoid secretion.  The more stressors experienced and the less protective factors, the less likely it is that the child will cope and become a resilient adult.  The stressors expand the size and activity of the amygdala helping it ignore prefrontal cortex constraints.  And they degrade the dopamine network through impacts to the development of the mesolimbic system and elevated adult glucocorticoids depleting dopamine. 
  • The problems include attachment issues and adults with: depression (dopamine depletion and lowered thresholds making adult stressors more influential), anxiety, substance abuse (dopamine depletion, excessive adult exposure to glucocorticoids increasing drug craving & poorly developed frontal cortex), impaired cognitive abilities especially frontocortical with impaired hippocampal-dependent learning, impaired impulse control (amygdala), impaired emotional control, antisocial behavior and violence, relationships that replicate the childhood adversities.  Abused children who develop PTSD show decreased hippocampal volume.  Glucocorticoids decrease hippocampal production of BDNF.  Childhood poverty impacts development of the corpus callosum & ensures by kindergarten, poor marshmallow test performance.  Childhood poverty increases impacts from environmental stressors: Toxins, Liquor stores instead of fresh food markets, No transport infrastructure, Limited jobs in the immediate vicinity, Little access to low cost capital, Low positions in all social hierarchies.  
),
../demodwbp/awffwpwgl.htm#gl_Biologics (gl_Biologics are drugs made in living cells.  Typically they are proteins developed using genetic engineering to develop the cellular host, and to customize animal source, DNA to produce human target proteins.  Such biologics partially solve the problem of previous protein sources, extracted from animals or human sources, of contamination and immune responses.  The strategy is very effective for blood transported proteins such as antibodies (MABs), hormones and blood factors.  But intra-cellular proteins still demand delivery and accurate cell targeting.  This creates analogous problems to those of gene therapy. 
),
../demodwbp/awffwpwgl.htm#gl_Biomarkers (gl_Biomarkers are signals that indicate the presence or severity of a physiological state, or disease in an organism.  The marker can be generated by the body or introduced into it.  They are seen as key to personallized medicine.  There are various classes:
  • Diagnostic biomarkers signal that a disease exists within a patient.  
  • Drug related biomarkers indicate if a specific drug will work in a specific patient. 
  • Predictive biomarkers indicate the most likely response to a particular treatement regime. 
  • Prognostic biomarkers show the progress of a disease with or without treatment. 
),
../demodwbp/awffwpwgl.htm#gl_BioMEMS (gl_BioMEMS is biomedical/biological microelectromechanical systems.  It is related to LOC and MTAS but focuses more on the mechanical parts and microfabrication instead of the flows and lab processes. 
),
../demodwbp/awffwpwgl.htm#gl_Bioprinting (gl_Bioprinting utilizes computer controlled three-dimensionall printers for rapid and high-precision construction of synthetic human tissue.  It typically fabricates biological constructs by dispensing cells on a biocompatible scaffold using a successive layer-by-layer approach to generate three dimensional structures.  It is costly and does not currently represent the natural compartmentalization of different cell types in a natural system.  ),
../demodwbp/awffwpwgl.htm#gl_Biopsychosocial_model (gl_Biopsychosocial_model of Dr. George Engel places the patient's social and psychological well being at the core of any medical treatment.  ),
../demodwbp/awffwpwgl.htm#gl_Biosensor (gl_Biosensor is an analytical device used to detect a biomarker.  The device combines a biological component with a physicochemical detector:
  • Biological component may be a tissue, microorganism, organelle, cell receptor, enzyme, antibody, nucleic acid etc..
  • Detector is an optical or electrochemical element that converts the response of the biological element into a signal that can be processed by a reader.  
),
../demodwbp/awffwpwgl.htm#gl_Biosimilars (gl_Biosimilars are generic drugs made to copy biologics.  They could undermine the pharmaceutical industry's biologic profit model and so are subject to trade constraints: TRIPS, TPP. 
),
../demodwbp/awffwpwgl.htm#gl_Bipolar_disorder (gl_Bipolar_disorder also termed manic-depression is an episodic developmental disorder beginning in late adolescence, which can stimulate great creativity during the manic phase and suicide in the depressive phase.  Vincent van Gough suffered from depression for much of his adult life, and killed himself at thirty seven.  He produced three hundred of his greatest art works, using color to convey mood, while struggling with psychotic depression and mania in the last two years of his life.  Only the first manic phase requires a significant positive or negative stressful situation.  Type I bipolar includes more manic situations which may include psychosis.  Type II does not include psychosis.  Some people suffer 'mixed state' where mania and depression occur at the same time.  Sleep deprivation activates the amygdala and can induce mania in some people with bipolar disorder.  It affects 3 million Americans.  The amygdala is more active in people with bipolar disorder.  Franz Kallman found identical twins are likely (70% chance) to share the disorder.  Genetic analysis of 2.3 million different regions of DNA of 9,747 people with bipolar disorder and 14,278 comparable people without, found five regions that appear connected with bipolar disorder.  Gene ADCY2, was identified, supports production of an enzyme facilitating neural signalling, and correlates with observed impairment of communication in certain brain regions in bipolar disorder.  GWAS implicate ANK3 and CACNA1C SNPs in bipolar disorder.  And de Novo mutations increase the risk.  Lithium limits the extremes of the mood swings in some patients but has side effects.  Anti-psychotic medications are prescribed.  ),
../demodwbp/awffwpwgl.htm#gl_Bitcoin (gl_Bitcoin is a set of open-source software, used to provide infrastructure that supports a distributed cryptocurrency and payment system, based on the blockchain.   All transaction inputs are unspent outputs from previous transactions.  All transaction inputs are signed.  Change is provided in an additional output to the transaction. 
),
../demodwbp/awffwpwgl.htm#gl_BKM_frameworks (gl_BKM_frameworks are Best-known-Method frameworks, where rules are used to encode effective operational methods.  ),
../demodwbp/awffwpwgl.htm#gl_BLA (gl_BLA is the basolateral amygdala, a relatively recently evolved part of the amygdala which learns stimuli to fear and then signals the central amygdala.  It recieves inputs from all sensory networks.  Some are fast pathways that allow the BLA to detect and respond when the sensory cortex is unaware.  But it is far less accurate than the cortex.  The BLA's learning involves increased excitability of synapses coupling the BLA and central amygdala.  This is due to gene driven: Increased levels of growth factors promoting new connections, more receptors for excitatory neurotransmitters in dendritic spines.  The BLA also responds to signals from the frontal cortex that a stimulus no longer appears frightening.  This subset of BLA cells respond inhibiting the associating subset.  Stress and glucocorticoids increase levels of CRH and BDNF encouraging the building of new dendrites and synapses. 
),
../demodwbp/awffwpwgl.htm#gl_Black-Scholes_algorithm (gl_Black-Scholes_algorithm Black-Scholes can solve the contingent investment discount rate dilemma for pricing options.  It establishes a tracking portfolio with the same payoffs as the option and dynamically tracks the portfolio as the stock price evolves, adjusting the value of the option.  It is argued that the adjustment ensures the rate of return to a hedge position remains constant over time. 
),
../demodwbp/awffwpwgl.htm#gl_Bladder_cancer (gl_Bladder_cancer affects 77,000 new people each year in the US.  And there are 16,000 deaths.  It is typically fast growing, and is often associated with mutated Ras, which may indicate it can be treated by reducing the methylation of the DNA (Dec 2015).   A rare form is plasmacytoid.  Bladder cancer is traditionally treated with surgery, chemotherapy and radiation but these have not been effective with the advanced disease.  New treatments are being deployed:
  • Immuno-oncology immune checkpoint inhibitor Tecentriq (May 2016) is approved for locally advanced or metastatic urothelial carcenoma which accounts for 90% of bladder cancers, where the disease is not controlled by platinum chemotherapy.  Bladder cancer tends to result in many mutations which typically present to the immune system making it a good candidate for immuno-oncology. 
),
../demodwbp/awffwpwgl.htm#gl_BLAST (gl_BLAST is basic local alignment search tool.  It allows researchers with protein or nucleotide sequences to match them to a database of comparative sequences.  ),
../demodwbp/awffwpwgl.htm#gl_Blockchain (gl_Blockchain is a bitcoin distributed database technology that allows several bitcoin operators to keep a shared, cryptographically verified, ledger and consensus mechanism to allow agreement on what transactions have happened and in what order.  It implements a Merkle tree.  Six times an hour on average, a new group of validated transactions, a block, is created, added to the local block chain and published to all nodes.  Paraphrasing breadwallet's Aaron Voisine, publishing is robust because: Each operator has connected via references from its initial peers to a random subset of all the other operators; and the new block is offered to the connected peers who can both ask for it if they have not seen it previously from some other source and pass it on to their other peers in a cascade (a gossip network).  To build new blocks an operator must have all the prior blocks in the chain.  All unspent bitcoins are represented [only] in the blockchain.  Miners keep the blockchain consistent by verifying that a new block has a proof-of-work.  This requires that miners find a nonce that multiplied by the block hash is smaller than the network's difficulty target.  ),
../demodwbp/awffwpwgl.htm#gl_Blocker_corporations (gl_Blocker_corporations are used to place a legal entity between the highly leveraged activities of hedge funds and private equity companies and their clients.  The structure avoids a federal tax on returns derived from borrowed money, which was designed to prevent nonprofits from competing unfairly with for-profit businesses.  It effectively blocks any taxable income from flowing to the clients who include US university endowments (Nov 2017).  The blocker corporations are setup in a low tax domicile such as the Cayman Islands or British Virgin Islands.  ),
../demodwbp/awffwpwgl.htm#gl_BLS (gl_BLS is the federal bureau of labor statistics
),
../demodwbp/awffwpwgl.htm#gl_Blue_Button (gl_Blue_Button is a web-based patient portal.  A tool that patients can use to download, view, print and transmit personal health information.  It was specified and developed by the VA, HHS and DOD.  There are multiple versions:
  • First version is download only, with an unstructured format and best for reading and printing on download. 
  • '+' version supports effective download and transmission bringing Blue Button in line with MU2.  It uses a structured format (C-CDA + electronic EOB).  It transmits via Direct messaging.  It supports automation via triggers.  The automation/changes to data require multipe transmissions.  Third party applications holding data that is sent as a trust bundle will 
),
../demodwbp/awffwpwgl.htm#gl_Blue_Cross (gl_Blue_Cross initially developed in the early 1930s to provide health insurance for hospital treatments.  Blue Cross introduced the mechanism of individuals paying premiums into a collective pool that a third party can then use to pay for medical expenditures.  The subscriber base was limited until World War 2 when wages were frozen and employers offered a benefit of health insurance tied to employment.  Being associated with employment made the facility regressive since those working part-time or in small businesses had to pay for services out of pocket and could induce bankruptcy. 
),
../demodwbp/awffwpwgl.htm#gl_Blue_Shield (gl_Blue_Shield initially developed in the early 1930s to provide health insurance for physician visits.  ),
../demodwbp/awffwpwgl.htm#gl_Blue_Slip (gl_Blue_Slip is a blue form that Senators use to sign off on nominees for judgeships in their states.  With the Senate Judiciary chair requiring two positive blue slips for a judge to be appointed, the President is forced to negotiate with the two Senators from the state.  Since the Senators may be from another party, the Presidential nomination is often focused onto candidates that hold moderate views. 
),
../demodwbp/awffwpwgl.htm#gl_BMI (gl_BMI is body mass index.  ),
../demodwbp/awffwpwgl.htm#gl_BNA (gl_BNA is the budget neutrality adjustment a BBA budget neutral provision for CMS to define how Medicare should equitably reimburse hospitals for uncompensated care.  CMS proposed BNA which eliminated rural and urban reimbursement and created fixed costs (DRG) for hospital in-patient programs, including a wage index and other factors.  The courts concluded that CMS had underpaid the providers and CMS agreed in Sep 2011 to a schedule of incremental reimbursements to compensate the providers for underpayment from 1998-2011. 
),
../demodwbp/awffwpwgl.htm#gl_BNST (gl_BNST is the bed nucleus of the stria terminalis.  It receives 'innate fear' signals from the central amygdala.  It projects to: Parts of the hypothalamus that initiate the hormonal stress response, Midbrain and brain-stem networks that activate the sympathetic nervous system and inhibit the parasympathetic.  Winning in competition induces the addition of testosterone receptors increasing the sensitivity of the BNST to the hormone.  That will lead to reduced fear and increased confidence.  ),
../demodwbp/awffwpwgl.htm#gl_Board_of_estimate_of_New_York_City (gl_Board_of_estimate_of_New_York_City , prior to 1961, had to approve: every agency expenditure, hiring, and salaries; controlled the major's executive budget, and had residual powers not delegated to the mayor, city council or planning commission.  It was controlled by the New York City borough presidents leaving them in control of all public works contracts and jobs in the city, except for parks and parkways which were under the control of Robert Moses after 1934 legislation. 
),
../demodwbp/awffwpwgl.htm#gl_Body_scan (gl_Body_scan is a mindfulness meditation exercise where the attention is moved around the body noticing the sensations of the visited part.  At the same time the brain models the visited part participating in flows in and out of the body with tensions and pain signals flowing out.  Move the mind to each part and feel it.  Breath in to and out from each region.  Imagine breathing in vitality and relaxation on each in breath.  Imagine the tensions are exhailed with the out breath.  As you let go of the sensations the muscles also let go of tensions.  First from the toes of the left foot to the pelvis and then the right foot to the pelvis.  From there move up through the torso, lower back and abdomen, upper back and chest, sholders.  Then from the fingers of both hands move simultaneously up both arms returning to the shoulders.  Then move through the neck and throat, all regions of the face, back of the head and top of the head to an imaginary hole at the top of the head where we release our breath. 
),
../demodwbp/awffwpwgl.htm#gl_Bonding (gl_Bonding Bonding, there are different types of chemical bonds.  Ionic bonds stabilize two oppositely charged ionized atoms when the negative atom gives up an electron to the positively charged atom.  Covalent bonds stabilize the two reactants when they adopt a more stable structure with electrons shared between them.  Hydrogen bonds stabilize charged groups when they are surrounded by water molecules.  In Copycat codelets can bond two Workspace objects together.  In the Smiley implementation a bondbuilder adds a bonding descriptor to one of the objects bonding it to the other.  ),
../demodwbp/awffwpwgl.htm#gl_Borough_presidents_of_New_York_City (gl_Borough_presidents_of_New_York_City were the nominal heads of the five city Democratic county machines, placed into these roles by the Tammany county bosses.  Caro explains they presided over public works contracts and jobs: every public work in the borough, controlled who was hired, along with municipal services laboring jobs and administrative and bureaucratic positions.  The presidents depended on the support of their boss along with the district leaders, and the body of white Catholic Irish and Italian Democratic voters.  These constituents expected jobs, contracts and insurance policies or they would vote to replace the president. 
),
../demodwbp/awffwpwgl.htm#gl_BPCI (gl_BPCI bundled payments for care improvements is a CMS initiative to explore bundled payments.  Its purpose is to incent multiple types of provider to coordinate care reducing expenses associated with care episodes.  CMMI accepts providers' proposals to test the four different bundled payment models.  The program consists of:
  • Seeking voluntary participation in four bundled payments models. 
  • Model 1: 3 days pre-acute + hospital inpatient stay.  
  • Model 2: 3 days pre-acute + hospital inpatient stay + inpatient MD services + post-acute facility services + post-acute MD services + related readmissions. 
  • Model 3: Post-acute facility services + post-acute MD services + related readmissions. 
  • Models 1 - 3 provide retrospective reimbursement. 
  • Models 2 - 3 include post episode reconciliation.  
  • Model 4: 3 days pre-acute + hospital inpatient stay + inpatient MD services + related readmissions. 
  • Model 4 offers a single prospective payment. 
  • Acute care hospitals, physicians groups, health systems eligible for all models; post-acute facilities may participate without hospitals in Model 3. 
  • Physicians eligible for gain sharing bonuses up to 50% of traditional fee schedule. 
  • For all models, applicants must propose quality measures, which CMS will use to develop a set of standardized metrics. 
),
../demodwbp/awffwpwgl.htm#gl_BPD (gl_BPD is borderline personality disorder a mental illness marked by unstable moods, behavior, and relationships.  Typically have co-occurring disorders: depression, anxiety disorders, substance abuse and eating disorders, and self-harm/suicidal behavior.  BPD is strongly inherited, but dependent on unstable family relationships.  BPD is treated with DBT. 
),
../demodwbp/awffwpwgl.htm#gl_BPIP (gl_BPIP is best practices intervention package for transitional care is a set of discharge improvement strategies for hospital to HHAs. 
),
../demodwbp/awffwpwgl.htm#gl_BPM (gl_BPM is business process management. 
  • Goals include:
    • Common language across business, including IT. 
    • End-to-end management of customer-facing processes
    • Understanding of current processes and improvement of them. 
    • Increasing the flexibility of current infrastructure through process abstraction and standardization
    • Integrating with legacy systems and service oriented infrastructure
    • Consolidating silos of data
  • Technology generically includes:
    • Business process engine
    • Business rule engine
    • Rules editors
    • Modelling infrastructure
    • BI
    • Content management
    • Collaboration tools 
),
../demodwbp/awffwpwgl.htm#gl_BPO (gl_BPO is business process outsourcing.  ),
../demodwbp/awffwpwgl.htm#gl_BRAF (gl_BRAF is a human gene that codes for the protein B-Raf. 
),
../demodwbp/awffwpwgl.htm#gl_Brain_stem (gl_Brain_stem includes: medulla, raphe, pons, substantia nigra, ventral tegmental area, pituitary, superior colliculi, cerebellum, thalamus (LGN), basal ganglia including caudate nucleus and striatum; amygdala, hypothalamus, nucleus accumbens;),
../demodwbp/awffwpwgl.htm#gl_BRCA (gl_BRCA is breast cancer type 1 or 2 susceptibility gene.  The two types provide related cellular functions maintaining the validity of the cell.  If either gene product fails there is an increased likelihood of cancer.  Still individuals with mutations in BRCA1/2 genes account for only 5 to 10 percent of breast cancers.  The:  
  • Type 1 gene codes for a protein that supports DNA repair and where this is not possible can stimulate cell death.  Hence if the protein becomes defective one or both of these key caretaker functions may stop and increase the susceptibility to cancer.  The BRCA1 protein has multiple actions.  It:
    • Combines with other tumor suppressors, DNA damage sensors and cellular signal transducers to form the BASC surveillance complex monitoring the health of the cells DNA. 
    • Associates with RNA pol II to support transcription. 
    • Interacts with histone deacetylase to regulate transcription.  
    • It is a marker of high risk of breast and uterine cancer. 
    • It was collaboratively researched by Dr. Mary-Claire King and Francis Collins's labs studying chromosome 17 using genomics.  
      • In 1990 Dr. King had reported to ASHG evidence of 'this' single gene linked to a highly heritable form of breast cancer.  
      • Over the next two years the labs gathered details of BRCA1, allowing families with the mutation to understand their individual risk and plan for their futures.  
    • In 1993 BRCA1 was identified by Mark Skolnick of Myriad Genetics. 
  • Type 2 gene codes for a protein that binds both single stranded DNA and the recombinase RAD51 to facilitate homologous recombination.  
  • Advice from Dr. Collins, for families who have a history of breast or ovarian cancer includes:
    • Counselling women with the high risk BRCA mutations, about the risk of breast and ovarian cancer and the treatments available
    • Telling women who choose watchful waiting to have periodic MRIs.  And warn that watchful waiting is unreliable for ovarian cancer allowing metastasis before detection.  
    • Prophylactically removing the ovaries and Fallopian tubes on completion of childbearing.  
    • Teaching about breast reconstruction and recommending prophylactic mastectomy.  
    • Males with BRCA mutations should have careful surveillance for: Prostate, Pancreatic and breast cancer.  
    • No one being given the test without being fully counselled beforehand about the implications of the result.  Negative results may bring survivor guilt while positive results will need careful management.  
),
../demodwbp/awffwpwgl.htm#gl_Breast_cancer (gl_Breast_cancer is a variety of different cancerous conditions of the breast tissue.  World wide it is the leading type of cancer in women and is 100 times more common in women than men.  260,000 new cases of breast cancer will occur in the US in 2018 causing 41,000 deaths.  The varieties include: Hormone sensitive tumors that test negative for her2 (the most common type affecting three quarters of breast cancers in the US, BRCA1/2 positive, ductal carcinomas including DCIS, lobular carcinomas including LCIS.  Receptor presence on the cancer cells is used as a classification: Her2+/-, estrogen (ER)+/-, progesterone (PR)+/-.  Metastasis classes the cancer as stage 4.  Genetic risk factors include: BRCA, p53, PTEN, STK11, CHEK2, ATM, GATA3, BRIP1 and PALB2.  Treatments include: Tamoxifen, Raloxifene; where worrying racial disparities have been found (Dec 2013).  International studies indicate early stage breast cancer typed by a genomic test: Oncotype DX, MammaPrint; can be treated without chemotherapy (Aug 2016, Jun 2018)),
../demodwbp/awffwpwgl.htm#gl_Breast_implants (gl_Breast_implants are silicone medical devices, used to replace or enhance breast tissue after cosmetic surgery or mastectomy.  ADM has allowed improved surgical strategies to be used with implants (Sep 2018).  There are contoured and smooth silicon shells filled with silicone or brine.  Contoured implants have been associated with anaplastic large cell lymphoma.  Breast implants have a history of inducing medical problems in patients.  Manufacturers include: Allergan, Mentor, Sientra; (Mar 2019)
),
../demodwbp/awffwpwgl.htm#gl_Breastfeeding (gl_Breastfeeding is a mammalian adaptation which delivers breast milk to the infant and supports the mother's body in its transformation after birth.  It is known to reduce the risk of: breast cancer: BRCA1, triple negative tumors; ovarian cancer, type 2 diabetes, rheumatoid arthritis; and may reduce the risk of cardiovascular disease. 
),
../demodwbp/awffwpwgl.htm#gl_BRICS (gl_BRICS is Brazil, Russia, India, China and South Africa; the set of country's with economies which grew rapidly in 2008 - 2013. 
),
../demodwbp/awffwpwgl.htm#gl_Bridges_to_Excellence (gl_Bridges_to_Excellence is a set of programs of the health care incentives improvement institute focused on recognizing and rewarding clinicians who deliver superior care for patients with chronic conditions. 
),
../demodwbp/awffwpwgl.htm#gl_Brocas_area (gl_Brocas_area is the left inferior frontal cortex.  It is involved with spoken language.  Lesions have resulted in an inability to speak or write even though language is understood.  ),
../demodwbp/awffwpwgl.htm#gl_Broken_link_analyzer (gl_Broken_link_analyzer is a Perl script, typically launched as a child process within the configuration editor, by clicking 'find broken links', which checks each relative file based HTML link in a dark web reachable from an initial target file in the dark web directory.  It repeats the analysis for all the pages that it is requested to open.  With the highly connected topology of a planning web it is expected to reach all the files in the web from any start point.  It reports any links which did not resolve to target HTML IDs within the web's pages and any links where the file specified could not be opened. 
),
../demodwbp/awffwpwgl.htm#gl_Broken_windows (gl_Broken_windows is a 1982 crime theory of James Wilson and George Kelling, that was inspired by the results of vandalism experiments by Philip Zimbardo, which assumes urban disorder and vandalism undermine social constraints and encourage additional criminal and anti-social behavior.  By detecting and responding to petty vandalism rapidly it is assumed that more serious crime will be discouraged.  In New York Broken Windows was used to justify 'stop, question and frisk'.  However, Donohue & Levitt's analysis suggests an observed precipitous drop in crime rates depended on legal access to abortion. 
),
../demodwbp/awffwpwgl.htm#gl_Bronchitis (gl_Bronchitis is an inflammation of the medium size airways in the lung.  It is defined clinically as a persistent cough with mucus.  ),
../demodwbp/awffwpwgl.htm#gl_BTK (gl_BTK is Bruton's tyrosine kinase which supports the operation of the B cell antigen receptor.  When the B cell has become cancerous - a lymphoma, the signalling from the receptor will support the extended life of the cell.  BTK inhibitors are used to inhibit the signalling.  ),
../demodwbp/awffwpwgl.htm#gl_Bullies (gl_Bullies often come from families with single mothers or younger parents with low educational and economic prospects.  They may be bullied as they bully which results in very poorly adjusted adults who see bullying as ok and are likely to suffer from depression, anxiety and suicidality.  And otherwise bullies are either:
  • Anxious, isolated children with poor social skills aiming to achieve acceptance and reduce their own frustration. 
  • Future sociopaths. 
),
../demodwbp/awffwpwgl.htm#gl_Bullying (gl_Bullying is a complex childhood adversity.  Sapolsky explains that targets of bullying aren't selected at random.  And bullies often come from families with single mothers or younger parents with low educational and economic prospects.  Sapolsky notes that someone who bullies and is also bullied is likely to be a real mess as an adult. 
),
../demodwbp/awffwpwgl.htm#gl_Bullying_targets (gl_Bullying_targets aren't selected at random.  More often they have personal or family psychiatric issues and poor social and emotional intelligence.  ),
../demodwbp/awffwpwgl.htm#gl_Bundle_CPT (gl_Bundle_CPT is where insurers pay for only one of the performed services, described by CPT code, which are deemed equivalent. 
),
../demodwbp/awffwpwgl.htm#gl_Bundled_Payments (gl_Bundled_Payments is where the purchaser disburses a single predefined payment to cover certain combinations of hospital, physician, post-acute, or other services performed during an episode of care relating to a particular condition (unlike capitation).  This bundling is assumed (Sep 2018) to allow the value delivery system to optimize around low cost high quality long term health care.  With one bundled payment physicians & hospitals must coordinate care and reduce the unit costs to remain profitable.  And to avoid taking on risk of expensive complications physicians & hospitals are incented to standardize and focus on quality.  This optimization is dependent on quantifying the value of the outcome of the episode of care.  Previously FFS payments induced excessive treatment activity.  Bundled payment is included in CMS ACE demonstrations and BPCI initiatives.  There are significant impacts on IT. 
  1. It is argued that effective pricing of the bundle requires marketing data which must be extracted from the historic transaction base.  
  2. Billing and payment systems must be updated to handle the receipt and distribution of the bundled payments. 
  3. Care delivery must be re-architected to reduce costs and improve quality. 
  4. Monitoring sensors can be used to feed reports to ensure re-architected operations conform.  
),
../demodwbp/awffwpwgl.htm#gl_Burden (gl_Burden is an indication of the seriousness of getting a disease.  Francis Collins explains the significant burden of type 2 diabetes:
  • Being a chronic condition it is often accepted while people cope with other acute issues. 
  • While the onset is slow the consequences are severe or even life-threatening.  
  • It is implicated in many early deaths.  The risk of death at any particular age is about twice that of people without the disease. 
),
../demodwbp/awffwpwgl.htm#gl_Business_process_engine (gl_Business_process_engine executes business process workflows allocating activities to human and machine resources based on the current decision state and the workflow description.  Resources are also dynamically associated based on the resource state and process rules.  The transactional nature of the decisions in a business workflow must be specifically managed or be supported by a long transaction framework with compensating transactions. 
),
../demodwbp/awffwpwgl.htm#gl_Business_rules_engine (gl_Business_rules_engine executes business rules management for production applications centralizing the business constraints and customizing software applications to the specialized work flows of the business.  
),
../demodwbp/awffwpwgl.htm#gl_Buspirone (gl_Buspirone is an anti-anxiety medication, marketed as Buspar, which is not a GABA receptor agonist, minimizing potential for physical dependence and withdrawal.  It is used to treat: GAD, major depressive disorder where it augments antidepressents. 
),
../demodwbp/awffwpwgl.htm#gl_C4 (gl_C4 is the complement component C4 gene.  It generates complement proteins C4-A and C4-B. 
),
../demodwbp/awffwpwgl.htm#gl_C4-A (gl_C4-A is an anaphylatoxin. 
),
../demodwbp/awffwpwgl.htm#gl_C4-B (gl_C4-B is forms part of C3-convertase.  ),
../demodwbp/awffwpwgl.htm#gl_C_32 (gl_C_32 is component 32, a form of CCD, designed for supporting summary documents as specified by HITSP.  ),
../demodwbp/awffwpwgl.htm#gl_CAA (gl_CAA is the clean air act of 1963.  It controlled air quality at the national level.  Air pollution laws followed.  The CAA amendments of 1970 expanded the mandate at the federal level and required federal and state regulations for stationary and mobile pollution sources. 
),
../demodwbp/awffwpwgl.htm#gl_CABG (gl_CABG refers to Coronary artery bypass grafting, a treatment provided by cardiac surgeons.  Lower cost angioplasty has disrupted this business but both have been provided by general hospitals.  Christensen argues angioplasty should be part of a radically lower cost business which should disrupt the solution business of the general hospital.  ),
../demodwbp/awffwpwgl.htm#gl_CAC (gl_CAC is computer assisted coding.  ),
../demodwbp/awffwpwgl.htm#gl_CACNA1C (gl_CACNA1C is a gene encoding a subunit of a voltage dependent calcium channel protein which supports heart muscle, neuron, fibroblasts, smooth muscle and pancreatic cell polarization.  GWAS suggest CACNA1C SNPs are involved in bipolar disorder.  ),
../demodwbp/awffwpwgl.htm#gl_CAD (gl_CAD is coronary artery disease, also called heart disease or CHD.  It reflects atherosclerosis of the coronary arteries.  ),
../demodwbp/awffwpwgl.htm#gl_Cadherin-10 (gl_Cadherin-10 is a cell adhesion protein.  Cadherins form junctions which bind cells together.  They undergo many post-translational modifications to become the specific mediators of cell-cell adhesion and recognition.  ),
../demodwbp/awffwpwgl.htm#gl_CAH (gl_CAH is either:
  • Critical access hospital, a CMS designation to certain rural hospitals, authorized by Congress (BBA) to limit further closures.  
  • Congenital adrenal hyperplasia, which results in abnormally high testosterone levels about 8 weeks after conception, and causes girls brains to be deploy male attributes: making them identify as boys, and act like them - showing reduced eye contact, nurturing, and empathy and good spatial awareness; but they still like dresses and being treated like a girl.  It affects 1 in 10,000 infants in the US. 
),
../demodwbp/awffwpwgl.htm#gl_CAHPS (gl_CAHPS is the consumer assessment of healthcare providers and systems (also known as HCAHPS) a CMS survey which asks consumers and patients to report on and evaluate their experiences with health care. 
),
../demodwbp/awffwpwgl.htm#gl_Calcium_channel_blockers (gl_Calcium_channel_blockers make blood vessels expand.  They have four main effects:
  1. Reduce contraction of arteries by blocking calcium gates in vascular smooth muscle. 
  2. By blocking calcium gates in cardiac muscle they reduce the force of contraction of the heart. 
  3. By slowing the conduction of electrical flows within the heart they slow the heart beat. 
  4. By blocking the calcium signal on adrenal cortex cells, they directly reduce aldosterone production reducing blood pressure. 
),
../demodwbp/awffwpwgl.htm#gl_California_provider_fee (gl_California_provider_fee is a California legislated program to deliver matching funds for the safety net hospitals.  Fees are assessed on all California hospitals to draw down federal matching funds which are then issued as supplemental payments to hospitals.  ),
../demodwbp/awffwpwgl.htm#gl_Canakinumab (gl_Canakinumab is a human MAB that binds with interleukin-1 beta.  It is used to treat inflammation and problem immune system responses.  It is marketed by Novartis as Ilaris to treat: CAPS, rheumatoid arthritis, COPD, Gout, CAD, Schizophrenia. 
),
../demodwbp/awffwpwgl.htm#gl_Cancer (gl_Cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016). 
),
../demodwbp/awffwpwgl.htm#gl_Candida_auris (gl_Candida_auris is a fungus resident in soils, which has developed resistance to medical antifungals: itraconazole; as well as azole agricultural fungicides.  90% of C. auris infections are resistant to an antifungal.  30% are resistant to two of the drugs.  Genome analysis indicates four ancient strains persist.  It has been assisted by the widespread use of fungicides enabling it to opportunistically migrate to niches cleared of its normal competitors.  C. auris was first identified in an ear infection of a Japanese patient in 2009.  But it had subsequently colonized all proximate surfaces and was detected in the air.  It infects the very ill and those with weakened immune systems.  50% of those infected die within 90 days. 
),
../demodwbp/awffwpwgl.htm#gl_Cannula (gl_Cannula is a thin tube that is inserted into the body to deliver or remove fluid or gather samples. 
),
../demodwbp/awffwpwgl.htm#gl_Canonical_correlation_analysis (gl_Canonical_correlation_analysis finds linear combinations of two vectors components that have the maximum correlation with each other.  Two vectors X = (X1, ..., Xn) and Y = (Y1, ... , Ym) of random variables which have correlations among the variables have linear combinations Xi and Yj with maximum correlations with each other. 
),
../demodwbp/awffwpwgl.htm#gl_CAP (gl_CAP is the common agricultural policy of the EU.  It was initially setup in 1962, following the framework in the 1957 treaty of Rome, supporting French farmers within the European Economic Community. 
),
../demodwbp/awffwpwgl.htm#gl_Capital (gl_Capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital).  ),
../demodwbp/awffwpwgl.htm#gl_Capital_call (gl_Capital_call is a legally enforceable transfer of investor committed funds, to an investment or insurance firm, so that the firm can use the fund's capital to purchase an asset. 
),
../demodwbp/awffwpwgl.htm#gl_Capitation (gl_Capitation is a global payment for all care for a patient during a specified time period.  It forces the provider of care to take a high risk.  Managing the risk implies successful population health management. 
),
../demodwbp/awffwpwgl.htm#gl_CAQH (gl_CAQH is the council for affordable quality healthcare.  It includes CORE. 
),
../demodwbp/awffwpwgl.htm#gl_CAR (gl_CAR is chimeric antigen receptor.  Killer T lymphocytes are genetically engineered to produce a novel protein, composed of pieces from different parts of the immune system such as: antibody components to construct a new receptor binding site on the T cell that targeted an antigen exposed on the cell surface of cancer cells, and two receptor associated signals that switch the T-cell into kill mode and sustain it in that mode.  Small clinical trials of CAR-T cells have shown substantial remissions among patients with various blood cancers (Aug 2016, Jul 2017, Oct 2017, Nov 2017).  But there are severe side effects.  ),
../demodwbp/awffwpwgl.htm#gl_CARA (gl_CARA is the comprehensive addiction and recovery act of 2016.  It authorizes $181 million to respond to the opioid epidemic, to boost prevention and treatment programs.  Congress must appropriate the funds through the budget process.  The bill was introduced by Senator Sheldon Whitehouse & Representative Jim Sensenbrenner. 
),
../demodwbp/awffwpwgl.htm#gl_Carbapenems (gl_Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity.  Some bacteria (such as CRE) have developed resistance due to the development and r-factor distribution of carbapenemases.  This is a huge problem as carbapenems have been used as the last resort antibiotic.   ),
../demodwbp/awffwpwgl.htm#gl_Carcinomas (gl_Carcinomas are cancers formed by epithelial cells. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiac_arrhythmia (gl_Cardiac_arrhythmia is irregular heartbeat, a very common problem where the heart's electrical cells malfunction.  It can be diagnosed and treated by electrophysiology. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiac_arrest (gl_Cardiac_arrest is a sudden halt in the effective blood circulation due to the heart not contracting effectively.  This prevents delivery of oxygen and glucose to the body.  It can be caused by a heart attack.  CHF in contrast, typically has substandard circulation but the heart is still pumping sufficient blood to sustain life.  Cardiac arrest may be reversed with effective treatment.  The treatment regime and effectiveness vary significantly.  They can include:
  • CPR which needs endurance training to sustain for at least 45 minutes of deployment needed for success.  If no pulse is detected after 20 minutes more powerful treatments should be deployed. 
  • ECMO which is more widely used in Japan and South Korea than in the US.  
  • Once circulation is restored additional interventions are required for success, but their application is not benchmarked, standardized or regulated:
    • Therapeutic hypothermia - people who remain comatose after being in cardiac arrest should be cooled for at least 24 hours to a temperature between 89.6 and 96.8 F. 
    • Avoiding toxic amounts of oxygen
    • Maintaining normal co2 levels
    • Maintaining high blood pressure
    • If needed cardiac catheterization. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiac_catheterization (gl_Cardiac_catheterization is a procedure for diagnosis and treatment of cardiovascular conditions where catheterization through the groin, neck or arm, is used to access blood vessels in the heart. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiac_electrophysiology (gl_Cardiac_electrophysiology is the study of the heart's electical circuits.  Electrophysiologists diagnose and treating the electrical arrhythmias of the heart.  ),
../demodwbp/awffwpwgl.htm#gl_Cardiac_tamponade (gl_Cardiac_tamponade is a buildup of fluid in the pericardium surrounding the heart, which results in pressure impacting the hearts operation. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiology (gl_Cardiology is the diagnosis and treatment of: Congenital heart defects, CAD, Heart failure, Valvular heart disease; by cardiologists.  ),
../demodwbp/awffwpwgl.htm#gl_Cardiomyopathy (gl_Cardiomyopathy is a set of diseases of the heart muscle.  It can have many causes, symptoms and treatments.  The main types are:
  • DCM,
  • HCM,
  • RCM which is less common. 
),
../demodwbp/awffwpwgl.htm#gl_Cardiovascular_disease (gl_Cardiovascular_disease refers to:
  • Conditions where narrowed and blocked blood vessels result in angina, hypertension, CHD and heart attacks and hemorrhagic/ischemic strokes.  Mutations of the gene PCSK9 have been implicated in cardiovascular disease.  Rare families with dominant inheritence of the mutations have an overactive protein, very high levels of blood cholesterol and cardiac disease. Other rare PCSK9 mutations result in an 88% reduced risk from heart disease.  Inflammation is associated with cardiovascular disease (Aug 2017). 
),
../demodwbp/awffwpwgl.htm#gl_Care_coordination (gl_Care_coordination aims to transfer information between the patient and each care participant as required and establish accountability by defining who is responsible for each care delivery activity, the extent of that responsibility and when that responsibility will be transferred to other care participants or the patient and family.  Successful care coordination requires face-to-face interactions.  It also requires aligned incentives (ACO, Bundled payments).  AHRQ defines quality measures for care coordination.  The situation is usually complex and adaptive due to the interactions of all the providers, settings, the patients' preferences, and the number of physical health problems, treatments, and the patients' social situation.  The potentially exponential increase in complexity as the number of these factors present increases leads to patient hot spots requiring explicit proactive coordination of care.  It is argued that care coordination must include six specific activities:
  1. Determination and updating of care coordination needs: Needs assessment should identify preferences and goals, current situation and past history.  It needs to be updated periodically and after new diagnosis and other changes in health or functional status. 
  2. Creation and updating of proactive plan of care
  3. Communication
  4. Facilitation of transitions: typical transition problems are detailed by Project Boost.  A challenging issue with transitions is what to do when there is no resource to take over the coordination role in the handoff. 
  5. Connection to community resources: Community resources are any service or program outside the health care system that may support a patient's health and wellness. 
  6. Alignment of resources with population needs: need to see the system-level, assess the needs of populations to identify and address gaps in services.  
),
../demodwbp/awffwpwgl.htm#gl_Care_Management (gl_Care_Management is transitioning to mean an aggregate of utilization management, case management, disease management, and independent review for populations.  But it sometimes refers to geriatric care management which is the process of planning and coordinating long term care of the elderly.  Such care managers have typically been trained in nursing, social work, and gerontology.  They integrate health care and psychological care with other services such as housing, home care, nutrition, socialization, financial and legal planning. 
),
../demodwbp/awffwpwgl.htm#gl_Care_Plans (gl_Care_Plans outline the patient's current and long-term needs and goals for care, identifies coordination needs, and addresses potential gaps.  This is consistant with the biopsychosocial model.  It also clarifies how the patient will reach the goals and who is responsible for implementing each part of the plan.  HL7's FHIR has defined a CarePlan resource.  ),
../demodwbp/awffwpwgl.htm#gl_CARF (gl_CARF is the commission on accreditation of rehabilitation facilities.  It is an international non-profit.  Certification is often required or mandated.  An alternative may be Joint Commission accreditation.  The CARF accreditation themes are:
  • Consumers define quality outcomes
  • Field-driven standards
  • Consultative, not inspective
  • Peer review survey process
  • Accreditation of organizations services
  • Continuous quality improvement
),
../demodwbp/awffwpwgl.htm#gl_Carolingian_empire (gl_Carolingian_empire Carolingian empire, Charles the great (Charlemagne 768/71-814) leveraged his Frankish tribe and Catholicism to control much of Europe crossing multiple metaethnic frontiers.  He established patterns of governance, political relations and culture that dominated Europe for centuries.  After Charles death the empire broke up.  ),
../demodwbp/awffwpwgl.htm#gl_Carotid_arteries (gl_Carotid_arteries are located on each side of the neck where they divide to supply the scalp, face, neck (external) and brain (internal) with blood. 
),
../demodwbp/awffwpwgl.htm#gl_Carotid_Doppler_ultrasound (gl_Carotid_Doppler_ultrasound is used to evaluate atherosclerosis of the carotid artery.  The two-dimensional gray scale provides a measure of the intima-media thickness. 
),
../demodwbp/awffwpwgl.htm#gl_Carried_interest (gl_Carried_interest is a fund manager's share of the earnings from a profitable investment.  It is a performance fee, charged by venture capital firms and private equity firms in addition to the smaller management fee.  There is a congressionally granted tax loophole which keeps the tax rate on carried interest low - 15% in 2016.  This loophole on capital gains was setup to encourage people investing their own capital to take more risk.  But general partners at venture and private equity firms do not have the associated risk.  The loophole reduces US tax receipts by $2 billion each year. 
),
../demodwbp/awffwpwgl.htm#gl_Carrier_screening (gl_Carrier_screening can provide powerful information for recessively inherited conditions.  It has been used for: Tay-Sachs disease, sickle-cell trait, cystic fibrosis, spinal muscular atrophy; with differing effects.  As more people have complete DNA sequencing carrier screening prior to pregnancy will make increasing sense.  Carrier screening:
  • Is being considered for: 
    • SMA but this requires a complicated and costly genetic test, 
    • Fragile X syndrome may be offered to all females,
  • Requires informed consent since it can result in difficult choices. 
  • Test reliability depends on the number of potential mutations are involved and how many of these are tested for in the screen.  As of 2010 even cystic fibrosis CFTR gene screening only looks at the 23 most common of the 1000 potential mutations. 
),
../demodwbp/awffwpwgl.htm#gl_Carrier_Status (gl_Carrier_Status describes whether people have genetic mutations that could lead to a disease in their offspring if they inherit the gene from one or both parents. 
),
../demodwbp/awffwpwgl.htm#gl_Case_Management (gl_Case_Management is defined by American Case Management Association as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality cost effective outcomes.  Case management productivity, discharge planning, utilization, coding and documentation, denials (RAC), Patient satisfaction (HCAHPS) and performance improvements are often measured to constrain overheads.  Patient flows can be assessed via numbers of: admissions, observation days, patient days, outpatient visits, discharges, E.D. volumes, occupancy, and denial rates.  ),
../demodwbp/awffwpwgl.htm#gl_Case_selectors (gl_Case_selectors are used by the AWF dark web generator to tailor the target file generation to become customized to the specific case.  Source data can be selected based on the case selector's value.  The file name of the target file will be resolved from the target file set to include the selector string.  For example dark web target file set 'Mywebframe1<target>.htm' with case selectors part1, part2, part3 will generate pages Mywebframe1part1.htm, Mywebframe1part2.htm and Mywebframe1part3.htm.  The dark web generator will use the current selector's value to filter the included source stream merged into each of the target files.  If part of the source data is tagged with 'part1' start and end tags this part of the source data will be included in Mywebframe1part1.htm.  Mywebframe1part2.htm will similarly include parts of the source data that are tagged with 'part2' start and end tags etc..  The reserved case 'rhlcaselsespo' is an AWF XML keyword which specifies all other situations than the specific list of case selectors.  ),
../demodwbp/awffwpwgl.htm#gl_Caspases (gl_Caspases are mediators of apoptosis. 
),
../demodwbp/awffwpwgl.htm#gl_Castleman_disease (gl_Castleman_disease is a rare condition with symptoms of: Enlarged lymph nodes, hyperactivation of the immune system, excessive releases of cytokines, proliferation of lymphocytes and organ disfuction.  It can affect subcomponents of the body or be multicentric when it is severe and deadly.  Its cause is not defined: some argue it is viral, others an inherited genetic disorder or a cancer.  It has been treated with: steroids, chemotherapy, J&J's targeted neoplastic disease therapy Sylvant (siltuximab) & Pfizer's Rapamune (sirolimus).  ),
../demodwbp/awffwpwgl.htm#gl_CAT (gl_CAT is computerized axial tomography otherwise termed CT. 
),
../demodwbp/awffwpwgl.htm#gl_Catalyst (gl_Catalyst Catalyst, an infrastructure amplifier.  ),
../demodwbp/awffwpwgl.htm#gl_Cath_lab (gl_Cath_lab is a catheterization laboratory which is an examination room with diagnostic imaging equipment for visualizing the arteries and chambers of the heart so that can treat problems identified.  ),
../demodwbp/awffwpwgl.htm#gl_Catheter (gl_Catheter is a thin tube that can be inserted into the body.  ),
../demodwbp/awffwpwgl.htm#gl_Catheterization (gl_Catheterization is the insertion and routing of a catheter to a target area of the body where it enables diagnosis or treatment of a condition. 
),
../demodwbp/awffwpwgl.htm#gl_Caudate_nucleus (gl_Caudate_nucleus is a motor area which is involved in the inhibitory control of movement and includes high levels of D(1), D(2) and some D(3) dopamine receptors.  It is part of the basal ganglia - striatum.  It also includes the putamen and globus pallidus. 
),
../demodwbp/awffwpwgl.htm#gl_CAUTI (gl_CAUTI is catheter associated urinary tract infection ),
../demodwbp/awffwpwgl.htm#gl_CBER (gl_CBER is the F.D.A.'s Center for Biologics Evaluation and Research
),
../demodwbp/awffwpwgl.htm#gl_CBIC_Act (gl_CBIC_Act is the Congressional Budget and Impoundment Control Act of 1974.  It modified the role of Congress in the budgetary process.  It created a standing budget committee in both the House and Senate.  It established the CBO.  It moved the fiscal year to start in October.  
  • Title III introduced a budget reconciliation process that includes fast tracking. 
),
../demodwbp/awffwpwgl.htm#gl_CBO (gl_CBO is the congressional budget office. 
),
../demodwbp/awffwpwgl.htm#gl_CBT (gl_CBT is cognitive behavioral therapy.  It was originally designed to treat depression. Depressed patients demonstrated problems with how they perceived themselves in the world (cognitive style).  Aaron Beck proposed to identify their negative beliefs and then replace them with more positive thoughts.  CBT leverages cognitive and behavioral principles to cope with behaviors, induced by prior conditioning, which cannot be managed directly with rational thoughts.  Instead it assumes that one's relationship with maladaptive thinking and emotional bindings can be changed through antecedent strategies.  CBT is problem focused and action oriented.  Errors in thinking like: overgeneralizing, magnifying negatives, minimizing positives and catastrophizing are replaced with more realistic and effective thoughts.  CBT has been extended with prolonged exposure therapy and virtual reality exposure therapy, which have been used to treat PTSD, where the BLA learns the signals are no longer dangerous. 
),
../demodwbp/awffwpwgl.htm#gl_CCBHC (gl_CCBHC is certified community behavioral health clinic.  These are responsible for directly providing nine required types of service including:
  1. 24 hour crisis care
    • Utilization of evidence-based practices
    • Care coordination
    • Integration with physical health care.  
  2. Screening, assessment and diagnosis including risk assessment
  3. Patient-Centered treatment planning
  4. Outpatient mental health and substance use services
  5. Outpatient clinic primary care screening and monitoring of key health indicators (May use a DCO)
  6. Targeted case management (May use a DCO)
  7. Psychiatric rehabilitation services (May use a DCO)
  8. Peer support and counselor services and family support (May use a DCO)
  9. Intensive, community-based mental health care for members of the armed forces and veterans.  (May use a DCO)
),
../demodwbp/awffwpwgl.htm#gl_CCC (gl_CCC is the care connectivity consortium
),
../demodwbp/awffwpwgl.htm#gl_CCD (gl_CCD refers to 'Continuity of Care Documents' which are defined within the HL7 CDA. 
),
../demodwbp/awffwpwgl.htm#gl_CCDA (gl_CCDA refers to Consolidated-CDA a HL7 standard used to meet 2014 EHR Certification Criteria for MU stage 2.  Consolidation pulled together disparate HL7 IGs to stop them diverging and drive a single source for CDA templates. 
),
../demodwbp/awffwpwgl.htm#gl_CCHIT (gl_CCHIT is the certification commission for health information technology.  HHS provided funding for CCHIT to develop standards certification guidelines and evaluation criteria for HIT products including EHR and NHIN architectures. 
),
../demodwbp/awffwpwgl.htm#gl_CCJR (gl_CCJR is comprehensive care for joint replacement (subsequently relabeled CJR), a Medicare CMMI program that randomly assigned 75 markets to be subject to bundled payments for knee and hip replacements and 121 markets to use FFS payments
),
../demodwbp/awffwpwgl.htm#gl_CCN (gl_CCN is CMS certification number
),
../demodwbp/awffwpwgl.htm#gl_CCO (gl_CCO is a coordinated care organization.  CCOs are a network of all types of health care providers who have agreed to work together to serve people in their community funded by Oregon's Medicaid.  CCOs are focused on prevention and helping people manage chronic conditions, like diabetes (1 & 2). 
),
../demodwbp/awffwpwgl.htm#gl_CCOW (gl_CCOW is an HL7 standard - clinical context object workgroup, an interoperability specification for the visual integration of user applications. 
),
../demodwbp/awffwpwgl.htm#gl_CCR (gl_CCR refers to 'Continuity of Care Records' which are defined by ASTM international, Massachusetts Medical Society, HIMSS, AAFP, AAP and others.  The CCR standard is a patient health summary standard designed to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another.  It contains various sections such as patient demographics, insurance information, diagnoses and problem list, medications, allergies and care plan.  The standards purpose is to permit easy creation by a physician using an EHR at the end of an encounter.  ),
../demodwbp/awffwpwgl.htm#gl_CCR5 (gl_CCR5 is a gene that encodes the CD195 cell membrane receptor.  The receptor is part of the target cell binding strategy of HIV.  Phase shift mutations of CCR5 have provided immunity to AIDS. 
),
../demodwbp/awffwpwgl.htm#gl_CCTF (gl_CCTF is a transcription factor that acts as a transcriptional repressor.  It is an 11-zinc finger protein.  It regulates the 3D structure of chromatin.  It binds together strands of DNA to form chromatin loops and anchors DNA to cellular structures including nuclear lamina.   ),
../demodwbp/awffwpwgl.htm#gl_CCU (gl_CCU is a critical care unit. 
),
../demodwbp/awffwpwgl.htm#gl_CCW (gl_CCW is chronic condition warehouse
),
../demodwbp/awffwpwgl.htm#gl_CD117 (gl_CD117 is a gene (KIT oncogene) which encodes stem cell factor, a trans membrane receptor including an internal tyrosine kinase which mediates hematopoietic regulation.  ),
../demodwbp/awffwpwgl.htm#gl_CD4 (gl_CD4 is a gene that encodes a cell surface glycoprotein called CD4.  It is expressed on the surface of T-lymphocytes.  It is part of the binding target strategy of HIV. 
),
../demodwbp/awffwpwgl.htm#gl_CD44 (gl_CD44 is a cell-surface glycoprotein involved in cell-cell interactions and migration.  ),
../demodwbp/awffwpwgl.htm#gl_CDA (gl_CDA is an HL7 standard - clinical document architecture, an exchange model for clinical documents based on HL7 messaging standard version 3.  It defines the encoding of documents for transfer in terms of XML structures.  It does not specify how the documents are transported. 
),
../demodwbp/awffwpwgl.htm#gl_CDBG (gl_CDBG is HUD's community development block grant program.  Block grant programs have limited federal oversight allowing states and local governments considerable discression.  CDBG is one of HUD's longest running programs funding:
  • Affordable housing
  • Anti-poverty programs
  • Infrastructure development
),
../demodwbp/awffwpwgl.htm#gl_CDC (gl_CDC is the HHS's center for disease control and prevention based in Atlanta Georgia.  
),
../demodwbp/awffwpwgl.htm#gl_CDC42 (gl_CDC42 is the gene encoding Cdc42, cell division control protein 42 involved in regulation of the cell cycle. 
),
../demodwbp/awffwpwgl.htm#gl_CDER (gl_CDER is the F.D.A.'s Center for Drug Evaluation and Research.   ),
../demodwbp/awffwpwgl.htm#gl_CDH10 (gl_CDH10 is a gene encoding the cadherin-10 cell adhesion protein.  ),
../demodwbp/awffwpwgl.htm#gl_CDHR (gl_CDHR is the clinical data repository/health data repository, a database and interoperability infrastructure supporting sharing of EHR between VA and DoD systems.  It includes a gateway translator between all the vocabularies of the information being transmitted.  This allows all of the VA facilities to access and interpret the EHRs.  ),
../demodwbp/awffwpwgl.htm#gl_CDI (gl_CDI is clinical documentation improvement.  Hospitals have traditionally done this as a retrospective improvement where physicians' clinical documents are reviewed by specialists tasked with identifying improvements in coding, quality measures, and overall care management of the patient.  It is hoped that going forward natural language processing will be able to identify the important data elements, run those across all cases and identify a prioritized list of cases to review.  And to make the operation real-time CAC can be integrated with EHRs and appropriate physician diagnosis workflows to ensure that documentation has the correct ICD 10 codes.  ),
../demodwbp/awffwpwgl.htm#gl_CDIS (gl_CDIS is clinical decision intelligence system, a clinically rich data warehouse supporting evidence based practices.  ),
../demodwbp/awffwpwgl.htm#gl_CDMS (gl_CDMS is either clinical database or chronic disease management system. 
),
../demodwbp/awffwpwgl.htm#gl_CDO (gl_CDO is a:
  • Care delivery organization in health care. 
  • Collateralized debt obligation in finance.  The idea is to transfer the credit risk rather than the loan itself.  The bank enters into a CDS on the loans with a SPV.  The CDO allows the bank to shift its loans outside the reach of regulators.  The CDO also can distribute the risk unevenly by tranching.  Equity is most at risk.  Then any subordinated debt. 
),
../demodwbp/awffwpwgl.htm#gl_CDR (gl_CDR is either a:
  • Complementarity-determining region, a part of the variable chains in antibodies and T cell receptors, where these molecules bind to their specific antigen, or a  
  • Clinical document repository
),
../demodwbp/awffwpwgl.htm#gl_CDRH (gl_CDRH is the F.D.A.'s center for device and radiological health. 
),
../demodwbp/awffwpwgl.htm#gl_CDS (gl_CDS is a credit-default swap, nominally insurance where the buyer of the CDS gets paid if the subject of the swap can't meet its obligations.  It appears to be insurance but insurance companies must set aside reserves to handle such claims.  Britain initially required that insurance buyers also have an insurable interest.  That is required in insurance markets to ensure buyers of insurance don't destroy their asset just to obtain the insurance.  CDS were not required to do the same, because it was decided they were not insurance which encouraged such abuses and risk taking.  Stocks could be sold short when they were backed by CDS.  And the swap market is limited making it easy to undermine its liquidity.  They carry considerable risk because:
  • They are governed by the CFMA, which ensures they are unregulated and opaque
  • The incentives encouraged problems - the more CDS you own the more you benefit from [causing] problems with the 'insured' assets.  And unlike traditional insurance you could buy as many CDS as you could afford. 
),
../demodwbp/awffwpwgl.htm#gl_CDSS (gl_CDSS is Clinical decision support system.  These support clinicians decision making by combining patient data with known medical knowledge to provide alerts, such as drug combination interactions or remiders of best care practices.  
  • Radiology CDSS order interactions are governed by PAMA and will use ACR select transactions. 
),
../demodwbp/awffwpwgl.htm#gl_CEA (gl_CEA is either the:
  • Commodity exchange act of 1936, which supported interstate commerce in grains and other commodities and regulates transactions on commodity futures exchanges to limit short selling and manipulation. 
  • White House Council of Economic Advisers, an agency established in 1946, to advise the President on economics in the formulation of domestic and foreign economic policy
),
../demodwbp/awffwpwgl.htm#gl_Ceftriaxone (gl_Ceftriaxone (Rocephin) is a cephalosporin antibiotic. 
),
../demodwbp/awffwpwgl.htm#gl_CEHRT (gl_CEHRT is certified EHR technology
),
../demodwbp/awffwpwgl.htm#gl_Cell_cycle (gl_Cell_cycle Cell-cycle, a key control mechanism in eukaryotic cells ensures that the cell can replicate when required.  The process is complicated but is logically equivalent to a Shewhart cycle with four phases: (1) general operation using the DNA as the plan, (2) generation of copies of genetic material, (3) checking that the copies were robust, (4) separation of the cell into two.  The details of the cell-cycle are described by Helmreich.  In AWF the eukaryotic cell-cycle has been abstracted in a codelet based implementation. 
),
../demodwbp/awffwpwgl.htm#gl_Cell_theory (gl_Cell_theory formulated by Mattias Schleiden and Theodor Schwann in 1839 proposed all living entities from the most basic up to complex human beings are composed of basic units called cells.  Subsequently it was shown that cells retain common features:
  • Surrounded by an oily membrane which seperates the cell from the extracellular fluid. 
  • The cell surface is permeable to certain substances. 
  • All contain DNA and the machinery that allows cells to replicate and generate proteins.  
),
../demodwbp/awffwpwgl.htm#gl_Cell_therapy (gl_Cell_therapy captures cells from a particular patient, modifies them, clones them and then deploys them back into the patient.  Platforms include CAR and TCR.  In 2016: The pricing schemes for cell therapies have not been announced but are expected to be expensive, The therapies are successful between 25 and 90% of the time for lymphoma and leukemia but patients may relapse after months or years of remission;  There are a number of challenges to the approach, some of which may require treatment in an ICU, including:
  • Lack of scale being specific to each patient. 
  • Immune system over reaction
  • Neurological toxicity including cerebral edema (Jul 2016). 
),
../demodwbp/awffwpwgl.htm#gl_Central_amygdala (gl_Central_amygdala is a relatively ancient evolved part of the amygdala which processes 'innate' fears.  It projects to the BNST to raise the heart rate and blood pressure in preparation for fight and flight. 
),
../demodwbp/awffwpwgl.htm#gl_Central_nervous_system (gl_Central_nervous_system is a cooperating network of neuronal agents.  One popular way to divide it up is anatomically:
  1. Spinal chord
  2. Brain stem, at the top of the spinal chord and the
  3. Forebrain above that. 
),
../demodwbp/awffwpwgl.htm#gl_CERCLA (gl_CERCLA is the comprehensive environmental response, compensation and liability act of 1980, which funds the cleanup of sites that hvae been contaminated by hazardous substances and pollutants.  Sites managed by the act are called Superfund sites.  E.P.A. cleanup can draw funds from the Superfund trust fund when the parties responsible for the contamination can't pay.  ),
../demodwbp/awffwpwgl.htm#gl_Cerebellum (gl_Cerebellum is involved with the efficiency of fine movement. It modulates the force and range of motion and is involved in motor coordination and the learning of motor skills.  Damage to the cerebellum impairs standing, walking, or performance of coordinated movements. A virtuoso pianist or other performing musician depends on their cerebellum.  The cerebellum receives visual, auditory, vestibular, and somatosensory information.  It also receives information about individual muscular movements being directed by the brain.  The cerebellum integrates this information and modifies the motor outflow, exerting a coordinating and smoothing effect on the movements.  However, patients born without a cerebellum have survived reasonably well.  The cerebellum is part of the implicit learning mechanism.  It is required for the rabbit eye-blink to be classically conditioned to respond to a sound, and puff of air (threat to eye).  It integrates the sound and puff and outputs the response to the motor area (blink).  Levitin has shown the cerebellum participates in aspects of emotion and auditory processing.  He found the cerebellum and basal ganglia were active throughout a session listening to music, modeling the beat, rewarding a match between the internal and external rhythm and integrating movement. And he notes the cerebellum providing Williams syndrome sufferers with their capability to play music.   ),
../demodwbp/awffwpwgl.htm#gl_Cerebral_cortex (gl_Cerebral_cortex includes the paleocortex a thin sheet of cells that mostly process smell, archicortex and the neocortex.  The cerebral cortex is a pair of large folded sheets of brain tissue, one on either side of the top of the head connected by the corpus callosum.  It includes the occipital, parietal, temporal and frontal lobes. 
),
../demodwbp/awffwpwgl.htm#gl_Cerebral_edema (gl_Cerebral_edema is swelling of the brain. 
),
../demodwbp/awffwpwgl.htm#gl_Cerebrum (gl_Cerebrum is a developmental classification of brain areas formed from the embryonic prosencephalon.  These areas include the cerebral cortex, hippocampus, olfactory bulb and the basal ganglia. 
),
../demodwbp/awffwpwgl.htm#gl_Certified_EHR_technology (gl_Certified_EHR_technology (CEHRT) is defined by CFR 45CFR Part 170's final rule to be either:
  1. A complete EHR that meets the requirements included in the definition of a qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary of HHS; or
  2. A combination of EHR modules in which each constituent EHR module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary of HHS, and the resultant combination also meets the requirements included in the definition of a qualified EHR.  
),
../demodwbp/awffwpwgl.htm#gl_Cervical_cancer (gl_Cervical_cancer is mostly caused by HPV infection.  Cervical cancer surgery performs a radical hysterectomy, where the uterus, part of the vagina and other surrounding tissues are removed.  In 2017 it was concluded that the rates of cervical cancer had been previously under estimated and far more black women were impacted (Jan 2017).  Prophylactic vaccination of young girls is dramatically reducing occurence of this cancer.  ),
../demodwbp/awffwpwgl.htm#gl_CETA (gl_CETA is the comprehensive economic and trade agreement between the EU and Canada signed in October 2016.  The EU argue there will be half a billion euros in taxes saved yearly by EU exporters.  It was framed by TIEA.  It does not alter EU non-tariff barriers such as: GMO and growth hormone constraints, Environmental protection.  The EU argues it: helps generate growth and jobs, ends customs duties, lets EU businesses bid for Canadian public contracts, Increases regulatory cooperation, Protects EU innovations, Streamlines trade in services and promotes and protects investments.  It includes:
  • Trade in goods
    • Tariff elimination on trade in goods
  • Rules of Origin
  • Technical barriers to trade made more transparent and conformity assessed by protocol. 
  • SPS rules
  • Customs and trade facilitation
  • Services and investment facilitation
  • Government procurement
  • EU law on designations of high quality agricultural products will hold
  • Trade and sustainable development (trade and labor)
  • Non-tariff barriers on cars (UN-ECE), pharma practices, culture and media, competition, state owned enterprises
  • Intellectual property rights
  • Copyright provisions
  • Investor-state dispute settlement procedure
  • Visa restriction removal by Canada on Czech, Romania and Bulgaria. 
),
../demodwbp/awffwpwgl.htm#gl_CETP (gl_CETP is cholestrylester transfer protein facilitates the transfer of cholesteryl esters and triglycerides between very low density and high density lipoproteins. 
),
../demodwbp/awffwpwgl.htm#gl_Cetrapib (gl_Cetrapib as a terminator in medication names indicates the drug is a CETP inhibitor.  These drugs are taken orally unlike the PCSK9 inhibitors of cholesterol which have to be injected. 
),
../demodwbp/awffwpwgl.htm#gl_Cetuximab (gl_Cetuximab is an EGF receptor inhibitor.  It is a humanized mouse MAB branded as Erbitux.  It used to treate metastatic cancers: colorectal, non-small cell lung, neck, head.  Cetuximab was developed by John Mendelsohn, at UC San Diego, with ImClone Systems which was later purchased by Eli Lilly.  Being mouse originated, it has induced MMA (Jul 2018). 
),
../demodwbp/awffwpwgl.htm#gl_CFMA (gl_CFMA is the commodity futures modernization act which constrained derivative market regulation, catalyzing the derivative fueled housing boom and 2008 recession.  It was supported by Senator Phil Gramm and the Republican led Congress, Federal reserve Chairman Alan Greenspan and the Clinton Administration's Treasury Department led by Larry Summers.  Former Treasury Secretary Robert Rubin also lobbied to over-rule Brooksley Born, the dissenting chair of the CFTC.  President Clinton signed the act into law in 2000.  ),
../demodwbp/awffwpwgl.htm#gl_CFO (gl_CFO is chief financial officer
),
../demodwbp/awffwpwgl.htm#gl_CFPB (gl_CFPB is the Dodd-Frank act's Consumer Financial Protection Bureau. 
),
../demodwbp/awffwpwgl.htm#gl_CFR (gl_CFR is the Code of Federal Regulations or in OKR terminology it is Conversations: about optimizing performance, Feedback: in all directions to evaluate progress and guide improvement, Recognition of individuals for their contributions.  ),
../demodwbp/awffwpwgl.htm#gl_CFTC (gl_CFTC is the commodity futures trading commission, the regulator of the futures and options markets, was created in 1974.  It enforced the CEA for these commodities. 
),
../demodwbp/awffwpwgl.htm#gl_CFTR (gl_CFTR is a gene coding for a cell membrane salt plus water transporter, the cystic fibrosis transmembrane regulator, which induces cystic fibrosis following any of over 1000 alternative single point mutations on both instances of the diploid somatic chromosomes.  Example mutations include:
  • Deletion of phenylalanine 508; the most common cause of cystic fibrosis,
  • Replacement of Guanine by Adenine at amino acid position 551.  This variant is being successfully treated with Vertex's Ivacaftor. 
  • Some of the less common mutations do not damage the pancreas. 
),
../demodwbp/awffwpwgl.htm#gl_CHA (gl_CHA is the California Hospital Association. 
),
../demodwbp/awffwpwgl.htm#gl_Chagas_disease (gl_Chagas_disease is a parasitic infection, due to Trypanosoma cruzi, which can cause serious heart problems.  ),
../demodwbp/awffwpwgl.htm#gl_Challenge (gl_Challenge is an aspect of psychological hardiness where change is accepted and viewed as offering possibilities of development.  New situations are seen as opportunities rather than threats. 
),
../demodwbp/awffwpwgl.htm#gl_Challenge_hypothesis (gl_Challenge_hypothesis is endocrinologist John Wingfield's idea that rising testosterone levels increase aggression, but only at the time of a challenge.  When an individual's position in the dominance hierarchy becomes questioned their testosterone level increases and aggression becomes more likely.  In other situations other responses become enhanced. 
),
../demodwbp/awffwpwgl.htm#gl_Channel (gl_Channel Channel, an active membrane spanning protein with a central pore through which a targeted ion is driven until the channel is opened by a signal which then allows the ions back across the channel continuing the electro-chemical wave. 
),
../demodwbp/awffwpwgl.htm#gl_Chaos (gl_Chaos Chaos provides an explanation for the apparently random period between water droplets falling from a tap.  Typically the model of the system is poor and so the data captured about the system looks unpredictable - chaotic.  With a better model the system's operation can be explained with standard physical principles.  Hence chaos as defined here is different from complexity.  ),
../demodwbp/awffwpwgl.htm#gl_CHAP (gl_CHAP is the community health accrediation program, one of three federally recognized HHA focused programs along with those provided by the Joint Commission and ACHC. 
),
../demodwbp/awffwpwgl.htm#gl_Chapter_224 (gl_Chapter_224 is Commonwealth of Massachusetts chapter 224 act: In response to continuation of escalating costs Massachusetts passed an act to improve the quality of health care and reduce costs.  The act included linking the annual growth in health care spending to the gross state product. 
),
../demodwbp/awffwpwgl.htm#gl_CHARGE (gl_CHARGE is a consortium cohorts for heart and aging research in genomic epidemiology.  ),
../demodwbp/awffwpwgl.htm#gl_Chargemaster (gl_Chargemaster is a hospital specific mapping of chargeable ICD procedure codes to the description and list price set by the hospital. 
),
../demodwbp/awffwpwgl.htm#gl_CHCM (gl_CHCM is Creative Health Care Management, a company focused on relationship-based care processes.  ),
../demodwbp/awffwpwgl.htm#gl_CHD (gl_CHD is coronary heart disease, also called heart disease or CAD.  It reflects atherosclerosis of the coronary arteries. 
),
../demodwbp/awffwpwgl.htm#gl_CHDI (gl_CHDI is the Community Health Data Initiative, a public-private partnership committed to innovation through the use of public data. 
),
../demodwbp/awffwpwgl.htm#gl_Checklists (gl_Checklists are signals which remind the reader of highly significant aspects of a process.  They are designed to be consulted at a point in the process where forgetting about the aspect will have a significantly detrimental effect.  Often the processes are being used to respond to failures in the regular operation.  Atul Gawande argues that effective use of checklists is vital to coping with situations that are complex. 
),
../demodwbp/awffwpwgl.htm#gl_Checkpoint_inhibitors (gl_Checkpoint_inhibitors release the immune system's checkpoints: PD-1, CTLA-4; on attacking host cells: by 1) stopping T-cell division and 2) reducing their life spans.  They are used in immuno-oncology where, in 2016: They are approved for treatment of: Advanced melanoma, HL, lung, kidney, liver cancer; They have a general success rate of 20 - 40% and higher for melanoma.   Checkpoint inhibitors work best for tumors that have many mutations: melanomas, lung and bladder cancers.  They are enhanced by adjunct treatments that kill tumor cells generating debris to stimulate the immune system.  The drugs include: ipilimumab (CTLA-4 inhbition), nivolumab, pembrolizumab, atezolizumab (PD-1 inhibitors);  They are costly and often have high copayments.  They cause auto-immune side effects including inflammation, rheumatoid arthritis and damage to glands: Adrenal, Thyroid, Pituitary.  Powerful steroids such as prednisone can help reduce the inflammation.  Damaged glands require sustained hormone treatment.  Checkpoint inhibitor research is funded by the CRI.  ),
../demodwbp/awffwpwgl.htm#gl_Chemotherapy (gl_Chemotherapy is the treatment of cancers by highly cytotoxic chemicals: Paclitaxel, Platinum, 6-mercaptopurine; assuming that cancer cells are unusually active and will be differentially poisoned.  It has been successful in offering treatments when no other course was available, but non-specificity means that healthy cells also get poisoned resulting in side effects which increase with age: Permanent nerve damage, heart failure (4-5%) and leukemia (0.5-1%). 
),
../demodwbp/awffwpwgl.htm#gl_CHF (gl_CHF is congestive heart failure which occurs when the heart is unable to generate enough blood flow to meet the body's demands.  There are two main types: failure due to left ventricular dysfunction and abnormal diastolic function increasing the stiffness of the left ventricle and decreasing its relaxation.  Heart expansion in CHF distorts the mitral valve which exacerbates the problems.  MitraClip surgery trials found effective in correcting the mitral valve damage (Sep 2018).  Treatments include: digoxin; ),
../demodwbp/awffwpwgl.htm#gl_Chikungunya (gl_Chikungunya is a mosquito vectored viral infection in humans, causing fever and joint pain. 
),
../demodwbp/awffwpwgl.htm#gl_Childhood_adversity (gl_Childhood_adversity includes different types of stressor: No mother, Unsupportive mother, paternal deprivation, Childhood poverty, [Observing ]violence, Natural disasters, Bullying; which impact development and produce adult problems. 
  • The adversities are stressful and alter stress physiology producing children and adults with elevated: Glucocorticoids, CRH and ACTH, Sympathetic nervous system activity.  Early stress permanently impacts the brains ability to control glucocorticoid secretion.  The more stressors experienced and the less protective factors, the less likely it is that the child will cope and become a resilient adult.  The stressors expand the size and activity of the amygdala helping it ignore prefrontal cortex constraints.  And they degrade the dopamine network through impacts to the development of the mesolimbic system and elevated adult glucocorticoids depleting dopamine. 
  • The problems include attachment issues and adults with: depression (dopamine depletion and lowered thresholds making adult stressors more influential), anxiety, substance abuse (dopamine depletion, excessive adult exposure to glucocorticoids increasing drug craving & poorly developed frontal cortex), impaired cognitive abilities especially frontocortical with impaired hippocampal-dependent learning, impaired impulse control (amygdala), impaired emotional control, antisocial behavior and violence, relationships that replicate the childhood adversities.  Abused children who develop PTSD show decreased hippocampal volume.  Glucocorticoids decrease hippocampal production of BDNF.  Childhood poverty impacts development of the corpus callosum & ensures by kindergarten, poor marshmallow test performance.  Childhood poverty increases impacts from environmental stressors: Toxins, Liquor stores instead of fresh food markets, No transport infrastructure, Limited jobs in the immediate vicinity, Little access to low cost capital, Low positions in all social hierarchies.  
),
../demodwbp/awffwpwgl.htm#gl_CHIP (gl_CHIP is:
  • The Children's Health Insurance Program started in 1997 as part of the BBA as SCHIP.  It provides health insurance coverage for children in families with income below 200 percent of the poverty line.  The coverage is focused on care specialized for children including: developmental delays, chronic conditions including asthma and obesity.  CHIP's funding must be iteratively re-authorized by Congress.  CHIP is financed federally, but states must enroll eligible children.  In many states one agency administers CHIP and Medicaid.  CHIP is leveraged by families that have employer based insurance with costly premiums, so the families only cover the adults.  
  • Clonal Hematopoiesis of Indeterminate Potential, where stem cells develop a somatic mutation cluster pair often found in leukemia, which is expressed in white blood cells they produce.  The mutation clusters give these stem cells a competitive advantage and they accumulate over time.  The white blood cells form inflammatory plaques.  CHIP increases with age, increasing the risk of dying, of clot fragment induced heart attacks and stroke, over the subsequent 10 years by 54%
),
../demodwbp/awffwpwgl.htm#gl_CHIPRA (gl_CHIPRA is the Children's Health Insurance Program Reauthorization Act of 2009.  It strengthened and extended CHIP.  Georgetown's analysis lists the main provisions of the law:
  • Significant new CHIP funding through 2013
  • Initiatives to enroll the lowest-income uninsured children in coverage
  • State option to cover legal immigrant children and pregnant women
  • State option to cover pregnant women
  • New rules on covering moderate-income children
  • Elimination of adult coverage
  • New provisions for premium assistance. 
  • Improvements in the quality of care and benefits for children, a provision that included the establishment of MACPAC.  
),
../demodwbp/awffwpwgl.htm#gl_Chlorpromazine (gl_Chlorpromazine mitigates or stops schizophrenia's delusions, hallucinations and some disordered thinking.  But it has problematic side effects: inducing neurological symptoms like those of Parkinson's disease.  It blocks D2 dopamine receptors. 
),
../demodwbp/awffwpwgl.htm#gl_CHNA (gl_CHNA is a community health needs assessment which is required by the ACA (IV) for tax exempt 501(c)(3) hospital status. 
),
../demodwbp/awffwpwgl.htm#gl_Cholangitis (gl_Cholangitis is an infection of the bile ducts connecting the liver, gallbladder and intestines.  ),
../demodwbp/awffwpwgl.htm#gl_Chromatin (gl_Chromatin is the compact operational structure formed by DNA TAD folding with histones. 
),
../demodwbp/awffwpwgl.htm#gl_Chromosomes (gl_Chromosomes Chromosomes are an aggregate of a very long DNA molecule with associated proteins including histones.  Human chromosomes are visible as 23 distinct pairs during cell division, prior to their refolding into chromatin structures.  ),
../demodwbp/awffwpwgl.htm#gl_CHRONIC_care_act (gl_CHRONIC_care_act of 2017 is Ron Wyden & Orrin Hatch's Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act signed into law by President Trump as title III of the BBA of 2018. 
),
../demodwbp/awffwpwgl.htm#gl_Chronic_kidney_disease (gl_Chronic_kidney_disease or CKD is
  • Where there is permanent damage to the Kidneys.  Diabetes and high blood pressure are the leading causes of CKD.  This has driven up the percentage of American's suffering from CKD. 
  •  CKD is diagnosed via a GFR of less than 60, or another marker such as protein in the urine, for atleast three months. 
  • The disease, classed as having five stages, causes no symptoms until the later stages.  The fifth stage of CKD is ESRD.  CKD is associated with: Atherosclerosis, Cardiovascular disease, Iron deficiency anemia from reduced EPO synthesis, Fluid volume overload, Hyperphosphatemia, Hypertension, Metabolic acidosis, Mineral bone disorder, Potassium accumulation, & Urea accumulation. 
),
../demodwbp/awffwpwgl.htm#gl_CICARE (gl_CICARE 'See-I-Care' is a UCLA health acronym (described in Prescription for Excellence) for:
  • Connect with the patient or family member using Mr./Ms. or their preffered name.
  • Introduce yourself and your role.  
  • Communicate what you are going to do, how it will affect the patient, and other needed information.  
  • Ask for and anticipate patient and/or family needs, questions, or concerns.  
  • Respond to patient and/or family questions and requests with immediacy.  
  • Exit, courteously explaining what will come next or when you will return. 
),
../demodwbp/awffwpwgl.htm#gl_CIF (gl_CIF is the Common Industry Format a standard for developers to report usability test findings and demonstrate evidence of usability of their products. 
),
../demodwbp/awffwpwgl.htm#gl_Cimavax (gl_Cimavax is a non-small cell lung cancer immuno-oncology vaccine.  It is an active vaccine, containing the ligand EGF and P64k and Montanide ISA 51 which together stimulate the immune system to generate antibodies targeted at EGF.  This results in the EGF concentration in the blood dropping.  Many cancers: Lung, Colon, Kidney, Head, Neck; leverage EGFR to stimulate cell growth. 
),
../demodwbp/awffwpwgl.htm#gl_CIN (gl_CIN is clinically integrated network. 
),
../demodwbp/awffwpwgl.htm#gl_Cingulate_cortex (gl_Cingulate_cortex is the cingulate gyrus, a rich club hub.  Contains many sub-parts:
  • The anterior cingulate cortex ACC:
    • Includes the subgenual ACC and the paragenual ACC, and Brodmann areas 24, 25, 32 and 33. 
    • The gyrus of the ACC has two functional components, which both operate abnormally in mood disorders: depression, anxiety & bipolar.  The
      • Rostral/ventral part is involved in emotional processes and autonomic functions.  It connects to the hippocampus, amygdala, orbital prefrontal cortex, anterior insula, nucleus accumbens.  It is overactive during regular or bipolar depression. 
      • Caudal part is involved in cognition and the control of behavior.  It connects with the dorsal PFC, secondary motor cortex, and posterior cingulate cortex
    • Is a central focus of empathy supporting people relating to other's pain.  This is dependent on oxytocin. 
    • In non-human mammals it processes interoceptive signals.  The ACC focuses the internal signals into high level 'gut intuitions.'  Pain catches the ACC's attention. 
    • Performs discrepancy detection from the outcome that was predicted - at a high level.  The ACC cares about the meaning of what is predicted. 
      • If the ACC has been convinced that a pain killer placebo has inhibited pain signals, the ACC will stay silent about actual pain that is signalled from interoceptive networks.  
      • The ACC will signal: physical pain, emotional pain, metaphorical pain, anxiety, disgust, embarrassment, social exclusion especially in adolescence; as one and the same.  The ACC's abnormalities being associated with major depression. 
    • Has a bridging role between the empathetic and self-interested pain monitor.  Sapolsky notes the ACC is essential for learning fear and conditioned avoidance by observation alone through an intermediate step of shared representation of self.  He concludes "At its core the ACC is about self-interest, with caring about the other person in pain as an add-on." 
  • The midcingulate cortex was formerly judged part of the 'emotional' limbic system in MacLean's discredited triune brain model.  
  • The posterior cingulate cortex
  • The retrosplenial cingulate cortex
),
../demodwbp/awffwpwgl.htm#gl_Cingulate_gyrus (gl_Cingulate_gyrus , also called the cingulate cortex, is part of the cerebral cortex.  It sits above the corpus callosum, getting inputs from the thalamus and neocortex.  It is involved in error perception.  It includes the ACC, posterior cingulate cortex, retrosplenial cingulate cortex.  
),
../demodwbp/awffwpwgl.htm#gl_Circadian_rhythm (gl_Circadian_rhythm is a CAS process that has a 24 hour oscillation driven by a circadian clock.  In humans there are many such processes: sleep cycle (Dec 2015), liver, metabolism, immune system, oxidative stress;
),
../demodwbp/awffwpwgl.htm#gl_Circadian_clock (gl_Circadian_clock is a biochemical agent that cycles with a phase locked to solar time.  There are three major components: 24 hour central oscillator, input pathways for signalling the agent, output pathways that support coordination of the biochemistry, physiology and behavior of the network of agents making up the CAS; as identified by Hall, Rosbash & Young.  The human clock shifts as we age (Dec 2015).
),
../demodwbp/awffwpwgl.htm#gl_Cirrhosis (gl_Cirrhosis is collapse of liver cell buffer function from long term damage due to: hepatitis, chronic alcoholism, fatty liver disease, hemochromatosis, obesity, and many other causes; with normal liver tissue being replaced by scar tissue. 
),
../demodwbp/awffwpwgl.htm#gl_CISD (gl_CISD is critical incident stress debriefing a technique developed to support workers in high-risk occupations from developing PTSD.  Its value is debated still.  ),
../demodwbp/awffwpwgl.htm#gl_Cites (gl_Cites is the Convention on International Trade in Endangered Species of Wild Fauna and Flora.  It has gained teeth from TPP provisions that enforce Cites constraints on illegal smuggling with economic sanctions.  ),
../demodwbp/awffwpwgl.htm#gl_Citizens_United (gl_Citizens_United is a 2010 legal case, between the nonprofit and the FEC, decided by the US Supreme Court, which restricts the government from constraining independent expenditures of nonprofit corporations, for-profit corporations, labor unions and other associations from political campaign spending, based on the free speech clause of the First Amendment to the Constitution. 
),
../demodwbp/awffwpwgl.htm#gl_Civilizing_process (gl_Civilizing_process is sociologist Norbert Elias's notion that violence declines when states monopolize force. 
),
../demodwbp/awffwpwgl.htm#gl_CJR (gl_CJR is CMS's comprehensive care for joint replacement bundled payment model (formerly CCJR).  It is limited to performing surgeries at hospitals rather than ambulatory surgery centers, and paying only hospitals.  It is novel:
  • CJR is mandatory at 800 hospitals.  It randomly assigned 75 markets to be subject to bundled payments for knee and hip replacements and 121 markets to use FFS payments.  In 2017 the Trump CMS allowed hospitals in half the bundled payments markets to opt out and three quarters of the hospitals did so, obscuring the impact of bundled payments in the experiment (Sep 2018).  
  • The episode payment covers inpatient hospital services, physician fees, & 90 days of care after discharge.  
  • The bundle encourages post-acute care reform to reduce variation in quality & risk. 
),
../demodwbp/awffwpwgl.htm#gl_CKD (gl_CKD is chronic kidney disease
  • Where there is permanent damage to the Kidneys.  Diabetes and high blood pressure are the leading causes of CKD.  This has driven up the percentage of American's suffering from CKD. 
  •  CKD is diagnosed via a GFR of less than 60, or another marker such as protein in the urine, for atleast three months. 
  • The disease, classed as having five stages, causes no symptoms until the later stages.  The fifth stage of CKD is ESRD.  CKD is associated with: Atherosclerosis, Cardiovascular disease, Iron deficiency anemia from reduced EPO synthesis, Fluid volume overload, Hyperphosphatemia, Hypertension, Metabolic acidosis, Mineral bone disorder, Potassium accumulation, & Urea accumulation. 
),
../demodwbp/awffwpwgl.htm#gl_CLABSI (gl_CLABSI is central line associated blood stream infection.  Johns Hopkins showed that central line infection rates can be driven to 0% with monitored checklists.  
),
../demodwbp/awffwpwgl.htm#gl_Claims_Attachments (gl_Claims_Attachments is an HL7 standard - a standard attachment to augment a health care transaction.  ),
../demodwbp/awffwpwgl.htm#gl_CLASS (gl_CLASS act.  This is the community living assistance services and supports act. It is title VIII of ACA.  It establishes a national, voluntary insurance program for purchasing community living assistance services and supports under which:
  1. All employees are automatically enrolled, but are allowed to waive enrollment. 
  2. Payroll deductions pay monthly premiums. 
  3. Benefits under a CLASS independence benefit plan provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community. 
),
../demodwbp/awffwpwgl.htm#gl_Clathrin (gl_Clathrin is a coat protein which supports the formation and management of coated vesicles within cells.  It supports cargo selection and specification of the final destination of the vesicle.  Receptor sorting and vesicle budding both depend on clathrin.  CME facilitates the internalization and recycling of receptors engaged in a variety of processes: G-proteins and Tyrosine kinase receptors. 
),
../demodwbp/awffwpwgl.htm#gl_Clawback (gl_Clawback refers to a contractual requirement between a payer and provider or retailer (pharmacy), where the cost of the goods supplied to a subscriber is lower than the reimbursement contracted with the payer, and the payer requires the difference to be refunded. 
),
../demodwbp/awffwpwgl.htm#gl_Clayton_Antitrust_Act (gl_Clayton_Antitrust_Act of 1914.  It aimed to prevent anticompetitive practices.  It specifies particular prohibitied conduct, a three-level enforcement scheme, exemptions (labor union and agricultural organization safe harbor, and major league baseball exemption) and remedial measures.  It has four sections which modify the Sherman Act:
  • Section 2 controls price discrimination between purchasers if it lessons competition.  
  • Section 3 controls exclusive dealings where purchasers are required to buy a tied product. 
  • Section 7 control mergers and acquisitions where the effect substantially lessens competition.  It allows the government to regulate all mergers and gives the government discretion whether to approve a merger or not.  Section 7 was later strengthened to cover asset acquisitions by the 1950 Celler-Kefauver amendments.  Section 7a requires companies considering a merger to inform the FTC and DOJ. 
  • Section 8 limits people from being directors of two or more competing corporations if those two corporations would violate the anti-trust criteria by merging.  
),
../demodwbp/awffwpwgl.htm#gl_Clfile (gl_Clfile is a filter file command which specifies path and file of checklist HTML references that will be augmented with hover data. 
),
../demodwbp/awffwpwgl.htm#gl_CLIA (gl_CLIA are clinical laboratory improvement amendments (1988) federal regulatory standards that apply to all clinical laboratory testing performed on humans except during clinical trials and basic research.  I-SPY 2 uses CLIA approved biomarkers when they show promise in predicting which patients will respond to which treatment agents but have not been FDA approved yet. 
),
../demodwbp/awffwpwgl.htm#gl_Clinical_announcement (gl_Clinical_announcement is an NIH special alert for advances so important that they should change medical practice.  ),
../demodwbp/awffwpwgl.htm#gl_Clinical_endpoint (gl_Clinical_endpoint in a research trial is among the study objectives and is the occurence of a disease, symptom, sign or laboratory abnormality which can be measured indicating the intervention is worthwhile.  ),
../demodwbp/awffwpwgl.htm#gl_Clinical_engineering (gl_Clinical_engineering is the maintenance of clinical infrastructure. 
),
../demodwbp/awffwpwgl.htm#gl_Clinical_IT (gl_Clinical_IT is
),
../demodwbp/awffwpwgl.htm#gl_Clinical_integration (gl_Clinical_integration is as an active, ongoing cooperation with a high degree of interdependence among physicians to control costs and ensure quality where joint negotiations will be evaluated by the 'rule of reason' finding considerable procompetitive benefits to consumers enabled by ancillary price coordination and dependent on this cooperation.  It can include:
  • Establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care;
  • Selectively choosing network physicians who are likely to further these efficiency objectives;
  • Significant investment in capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies. 
),
../demodwbp/awffwpwgl.htm#gl_Clinical_mobility (gl_Clinical_mobility is M-health.  ),
../demodwbp/awffwpwgl.htm#gl_Clinical_pathway (gl_Clinical_pathway is a standardized care strategy based on a task-oriented care plan, detailing essential steps in the care of patients with a specific condition.  The plan details the expected clinical path.  It was initially adopted to guide EBM and was implemented in most hospitals during the 1980s.  But the implementations were piecemeal.  As recent reimbursement changes require hospitals to control resource consumption, standardized clinical pathways can help.  Five criteria have been derived.  The intervention:
  1. Is structured as a multidisciplinary plan of care
  2. Channeled the translation of guidelines or evidence into local structures
  3. Detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'
  4. Had timeframes or criteria-based progression
  5. Aimed to standardize care for a specific clinical problem, procedure or episode of health care in a specific population. 
),
../demodwbp/awffwpwgl.htm#gl_Clinically_integrated_network (gl_Clinically_integrated_network is a legally acceptable clinical integration of hospital, physicians and/or other dedicated health care providers who deliver services focused on quality, performance, efficiency and value to the patient.  In comparison with a SuperGroup it also increases market power while sustaining expert agent independence.  But it is hard to manage and requires significant infrastructure expense to support clinical integration and management of utilization and financial uncertainty.  Initial setup will have to manage the problem of prior contracts the new members have with IPA, PHO or ACOs.  An alternative to a clinically integrated network is a messenger model network.  The Joint Commission specified an OPPE requirement for general performance improvement.  Network providers must develop and sustain clinical initiatives that enhance access to care, clinical quality, cost control and the patient experience by:
  • Coordination across the network, 
  • Implementing evidence-based clinical protocols,
  • Improving efficiency in the delivery of care,
  • Partnering with payers to develop contracts that drive definable clinical improvement and add value to patients. 
),
../demodwbp/awffwpwgl.htm#gl_CLL (gl_CLL is chronic lymphocytic leukemia, a blood cancer which begins from an acquired mutation of the DNA of stem cells that generate lymphocytes in the bone marrow.  Some CLL grow fast, others grow slowly and may be responded to with watchful waiting.   
),
../demodwbp/awffwpwgl.htm#gl_Clonal_selection (gl_Clonal_selection is Frank Burnet's highly regarded model of how the immune system responds to antigens.  B lymphocytes, which each produce only a specific antibody, respond to matching antigens by cloning themselves in the secondary lymph organs: spleen and lymph nodes. 
),
../demodwbp/awffwpwgl.htm#gl_Clopidogrel (gl_Clopidogrel is a platelet aggregation inhibitor, branded as Plavix.  Its action as an inhibitor is dependent on CYP2C19.  ),
../demodwbp/awffwpwgl.htm#gl_Closed_model_plan (gl_Closed_model_plan is a type of HMO where the physicians are constrained to see only patients contracted with the HMO.  These plans include:
  • Staff model physician contracts where the physicians are paid by the HMO and work in its buildings. 
  • Group model where the physicians contract with a multi-specialty physician group practice.  These can be:
    • Captive group model where the physician group contracts to only treat the HMO's patients.  Kaiser has used this model extensively.   
    • Independent group model where the physicians continue to treat non-HMO patients.  This is not a closed model plan. 
),
../demodwbp/awffwpwgl.htm#gl_Clostridium_difficile (gl_Clostridium_difficile usually competes with other bacteria in the human gut microbiome.  But antibiotic treatments provide it with an advantage where it becomes the predominant gut bacteria causing diarrhea, abdominal pain, and toxic megacolon.  Repeated treatments select for infections that are progressively more difficult to treat.  C. difficile infections kill more than 25,000 people a year in the US.  Fecal transplants, especially enabled by stool-banking, reintroduce competitive bacteria that limit the success of C. difficile and cure patients with previously recurrent infections.  But the F.D.A. has not approved such transplants as a treatment and the procedure is not covered by insurance. 
),
../demodwbp/awffwpwgl.htm#gl_Clotting (gl_Clotting or coagulation is formation of a clot:
  • Platlets become activated, adhere and aggregate supported by
  • Fibrin polymerization, deposition and maturation.  
),
../demodwbp/awffwpwgl.htm#gl_Club_for_Growth (gl_Club_for_Growth is a right-wing conservative 501 political action group, founded in 1999 by Harlan Crow, Thomas Rhodes, Richard Gilder and Steven Moore. 
),
../demodwbp/awffwpwgl.htm#gl_CME (gl_CME is continuing medical education - training updates to keep knowledge current.  It is developed and delivered by Professional associations, Medical education agencies, Hospitals, Educational institutions and hoe study nursing continuing education providers.  There are:
  • Formal learning activities including planned programs, enduring materials (DVD and web), Process improvement CME;
  • Informal Internet-point of care research and decision making, and journal clubs where published research is evaluated by the members.  
),
../demodwbp/awffwpwgl.htm#gl_CMI (gl_CMI is case mix index.  This is a relative value assigned to a DRG or RUG.  The CMI of a hospital reflects the diversity, clinical complexity and the needs for resource in the population of all the patients in the hospital. 
),
../demodwbp/awffwpwgl.htm#gl_CML (gl_CML is chronic myelogenous leukemia.  It is a leukemia characterized by the unregulated growth of myeloid cells in the bone marrow.  The growth is encouraged by the cellular signalling system (gene change that generates a faulty tyrosine kinase) being locked on.  Visual methods allowed Dr. Janet Rowley's team to recognize that most CML includes the Philadelphia chromosome.  It encodes the chimeric always on tyrosine kinase protein seen only in CML.  Targeted treatments such as Gleevec block the pathway for the tyrosine kinase. 
),
../demodwbp/awffwpwgl.htm#gl_CMMI (gl_CMMI is the center for Medicare and Medicaid Innovation.  It is a test bed for new ways of financing and delivering care.  It allowed Congress to institutionalize innovation sending a signal to providers that they would be participating in CMS driven programs that could become mainstream.  It funds evaluations of innovative health care models.  Under the ACA if the HHS secretary finds any of its projects would reduce Medicare spending without harming the quality of care the projects may be expanded nationwide.  The CBO estimates the CMMI will save $34 billion between 2016 and 2026.  CMMI projects include:
  • Medicare will make a bundled payment for hip and knee replacement surgery (CJR) and 90 days of follow-up care forcing hospitals to work closely with doctors, nursing homes and home health agencies.  
  • New ways to pay for prescription drugs, medical devices, cancer care (OCM).  
  • HHS secretary has invoked his 3021 authority to institute DPP. 
),
../demodwbp/awffwpwgl.htm#gl_CMO (gl_CMO is a:
  • Chief medical officer or a
  • Care maintenance organization or in finance a
  • Collateralized mortgage obligation.  The collateralized mortgage obligation was invented by Larry Fink (BlackRock) and team while they were at First Boston in 1983.  The key innovation was that the risk in these contracts was more predictable than in an MBS due to the presence of a trust that guaranteed payments to the bond holders.  The risk was separated into tranches with different credit ratings and yields.  The structure was used by the banking and securities companies to finance the subprime housing boom. 
),
../demodwbp/awffwpwgl.htm#gl_CMPS (gl_CMPS is the Civil Monetary Penalty Statute, part of the SSA, which prohibits a hospital from knowingly paying [in]directly a physician as an inducement to reduce or limit services to a Medicare or Medicaid beneficiary who is under direct care of the physician. 
),
../demodwbp/awffwpwgl.htm#gl_CMS (gl_CMS is the centers for Medicare and Medicaid services.  ),
../demodwbp/awffwpwgl.htm#gl_CMV (gl_CMV is either: a controlled medical vocabulary or cytomegalovirus. 
),
../demodwbp/awffwpwgl.htm#gl_CNA (gl_CNA is a certified nursing assistant.  CNAs helps patients with health care under the supervision of an RN. 
),
../demodwbp/awffwpwgl.htm#gl_CNN (gl_CNN is a convolutional neural network, a type of deep neural network, which aims to use minimal preprocessing, so that it is independent of prior knowledge.  The operation is analogous to a set of neurons in the visual cortex which respond only to a restricted visual field, but where different neurons receptive fields partially overlap.  The hidden layers of a CNN include convolutional layers, ReLU layers, pooling layers (where the average or max value from a layer is passed on to the next layer), fully connected layers (all neurons in one layer output to every neuron in the next layer) and normalization layers.  ),
../demodwbp/awffwpwgl.htm#gl_CNO (gl_CNO is chief nursing officer
),
../demodwbp/awffwpwgl.htm#gl_CNOR (gl_CNOR is certified nurse, OR ),
../demodwbp/awffwpwgl.htm#gl_CNOR_Strong (gl_CNOR_Strong is a credential from the CCI awarded for having an OR staffed with a team that have CNOR skills.  ),
../demodwbp/awffwpwgl.htm#gl_CNS (gl_CNS is the central nervous system
),
../demodwbp/awffwpwgl.htm#gl_CNV (gl_CNV is a copy number variant where the DNA of a chromosome includes portions that is repeated many extra times.  These can be large enough to include whole genes.  Data suggests that CNVs account for some cases of autism and schizophrenia. 
),
../demodwbp/awffwpwgl.htm#gl_Co-evolution (gl_Co-evolution assumes that two schematic objects mutate in a correlated way, a mutation in one string resulting in a mutation in the other. 
),
../demodwbp/awffwpwgl.htm#gl_Co-evolutionary_methods (gl_Co-evolutionary_methods leverage co-evolution, extracting non-local structural information from MSAs. 
),
../demodwbp/awffwpwgl.htm#gl_Co-management (gl_Co-management is an arrangement (direct contract or joint venture) between various medical groups and physicians (inpatient, outpatient, ancillary, multi-site) which recognizes and appropriately rewards each for participating without breaking regulatory requirements (CMPS, Anti-Kickback statute, Stark law, False Claims Act, Tax Exemption intermediate sanctions, provider-based status rules).  It requires a board predefined valuation of the contracted process accomplishments.  As such growth of the service line cannot result in additional rewards to the physicians.  It requires physicians to document details.  It constrains hospitals service lines from providing other similar services.  Typical service line co-management arrangements listed by healthcareappraisers include:
  • Development of Service Line
  • Medical Director services
  • Budget process
  • Strategic/business planning process
  • Community relations and education
  • Patient, physician and staff satisfaction surveys
  • Development of clinical protocols and performance standards
  • Ongoing assessment of clinical environment and work flow processes
  • Physician staffing
  • Patient scheduling
  • Staff scheduling and supervision
  • Human resource management
  • Case management activities
  • Materials management
  • Medical Staff related activities and committee participation
  • Credentialing assistance
  • Coordination with and reporting to hospital
),
../demodwbp/awffwpwgl.htm#gl_Coagulation (gl_Coagulation is the formation of a clot: 
  • Platlets become activated, adhere and aggregate supported by
  • Fibrin polymerization, deposition and maturation.  
),
../demodwbp/awffwpwgl.htm#gl_COBRA (gl_COBRA is the consolidated Omnibus Budget Reconciliation Act of 1985 with amended ERISA to give some employees the ability to continue health care coverage after leaving employment.  ),
../demodwbp/awffwpwgl.htm#gl_CoC (gl_CoC is the American Joint Commission on Cancer (AJCC).  It was formed in 1958 to formulate and publish systems of classification of cancer for the medical profession.  It focuses on cancer epidemiology, patient care, cancer control, cancer registration, professional education, research and biostatistics. 
),
../demodwbp/awffwpwgl.htm#gl_Code_trays (gl_Code_trays are pharmacy kits.  ),
../demodwbp/awffwpwgl.htm#gl_Codon (gl_Codon Codon, a DNA triplet that represents a specific amino-acid, or termination sequence of the genetic code.  ),
../demodwbp/awffwpwgl.htm#gl_Cognition (gl_Cognition is the ability to orchestrate thought and action in accordance with internal goals according to Princeton's Jonathan Cohen. 
),
../demodwbp/awffwpwgl.htm#gl_Cognitive_reserve (gl_Cognitive_reserve proposes that more education leads to more brain patheways which compensate longer for cognitive decline. 
),
../demodwbp/awffwpwgl.htm#gl_Cognitive_niche (gl_Cognitive_niche is Tooby & DeVore's theory that reflects a flexible competitive strategy, described by Steven Pinker, which leverages the power and flexibility of intelligence to defeat the capabilities of genetically evolved specialists focused on specific niches. 
),
../demodwbp/awffwpwgl.htm#gl_Coinsurance (gl_Coinsurance is where a patient's contract with the insurer requires the patient to pay a percentage of the amount billed for a particular drug or sevice.  It may vary across the various networks and out of network situations.  ),
../demodwbp/awffwpwgl.htm#gl_Colectomy (gl_Colectomy is the complete surgical removal of the colon. 
),
../demodwbp/awffwpwgl.htm#gl_Coleman_model (gl_Coleman_model is a care transition program lead by Dr. Eric Coleman.  Transitional care is based on a plan of care and the availability of practitioners who are well-trained in chronic care and have current information about the patients' goals, preferences, and clinical status.  It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. 
),
../demodwbp/awffwpwgl.htm#gl_Colistin (gl_Colistin is an old antibiotic that is held in reserve in the US to treat especially dangerous infections (CREs) that are resistant to carbapenems.  ),
../demodwbp/awffwpwgl.htm#gl_Colon_cancer (gl_Colon_cancer is a major hereditary cancer also called colorectal cancer.  It:
  • Follows a slow, many yearlong, progression from a benign polyp to a localized cancer to an invasive one.  Two bacteria: Bacteroides fragilis, Escherichia coli variant; from the gut microbiome have been implicated in the early stages of tumor induction (Feb 2018).  It
  • Is often associated with Ras mutations and the high risk allele TCF7L2.  30 to 50% of colon cancers have KRAS mutations.  Intensive medical surveillance and removal of polyps can be lifesaving for those at high risk.  Types of colon cancer include the single gene mutation hereditary: FAP, HNPCC; 
  • Is linked to obesity. 
),
../demodwbp/awffwpwgl.htm#gl_Colorectal_cancer (gl_Colorectal_cancer is also called colon cancer.  It:
  • Follows a slow, many yearlong, progression from a benign polyp to a localized cancer to an invasive one.  Two bacteria: Bacteroides fragilis, Escherichia coli variant; from the gut microbiome have been implicated in the early stages of tumor induction (Feb 2018).  It
  • Is often associated with Ras mutations and the high risk allele TCF7L2.  30 to 50% of colon cancers have KRAS mutations.  Intensive medical surveillance and removal of polyps can be lifesaving for those at high risk.  Types of colon cancer include the single gene mutation hereditary: FAP, HNPCC; 
  • Is linked to obesity. 
),
../demodwbp/awffwpwgl.htm#gl_Commerce_department (gl_Commerce_department - U.S. Department of Commerce.  ),
../demodwbp/awffwpwgl.htm#gl_Commitment_problem (gl_Commitment_problem , as described by Ness & LLoyd, in The Adapted Mind, refers to the advantages and difficulties of arranging a system of rewards and punishments to ensure a certain pattern of behavior in the future.  By motivating behavior that has an immediate cost, a moral emotion can allow greater benefits later, including reciprocity and intimidating bullies by demonstrations of spiteful behavior. 
),
../demodwbp/awffwpwgl.htm#gl_Common_Framework (gl_Common_Framework is the Markle common Framework used by connecting for health.  The common framework provides information about setting up the agents of a CAS based electronic health network that allows emergence of the NHIN.  It includes:
  • Policy guides for how information is protected
    • The architecture for privacy in a networked information environment
    • Model privacy policies and procedures for health information exchange
    • Notification and consent when using a record locator service
    • Correctly matching patients and their records
    • Authentication of system users
    • Patients access to their own health information
    • Auditing access to and use of a health information exchange
    • Breaches of confidential health information
    • A common framework for networked personal health information
  • Technical guides for how information is exchanged
    • Technical issues and requirements for common framework implementation. 
      • There is an architected hierarchy.  The NHIN is viewed as a network of SNOs - while entities within an SNO are free to communicate directly with other entities in the SNO, inter SNO communications is required to go via an ISB so that all flows between SNOs can be observed. 
    • HIE architecture implementation guide
    • Medication history standards
    • Laboratory results standards
    • Background issues on data quality
    • Technical background of record locator service
    • Consumer authentication for networked personal health information
  • Model contractual language
),
../demodwbp/awffwpwgl.htm#gl_Community_rating (gl_Community_rating mandates health insurers charge the same price to people of the same age living in the same geographic area. 
),
../demodwbp/awffwpwgl.htm#gl_Community_health_workers (gl_Community_health_workers are trained lay people who share socioeconomic backgrounds with the patients they help address the underlying social, financial, and behavioral causes of their health problems, according to Ezekiel Emanuel.  They focus on poorer patients with complex conditions and few social supports.  At University of Pennsylvania they follow the IMPaCT model.  They:
  • Track down or obtain key resources for living: Birth certificate, social security card, Utility bill, help apply for housing, daycare, food-stamps, home ramps & other social services
  • Health system navigation: Apply for health insurance, find PCP, Schedule appointments, travel support, obtain health records
  • Medical assistance: Obtain medications and DME, Coach patients on appointment strategies, Get patients to write down questions for physicians, Accompany patients to grief & addiction counseling
  • Lifestyle change: Exercising, Encouragement with weight-loss and smoking-cessation strategies
  • Psychosocial support: Take patients to enjoyable events and encourage them to sign up for community volunteer activities. 
),
../demodwbp/awffwpwgl.htm#gl_Compassion (gl_Compassion indicates an emotional state where resonance with someone else's distress leads one to help them.  ),
../demodwbp/awffwpwgl.htm#gl_Compensation (gl_Compensation in workflow provides a service to execute a compensating transaction which initiates actions that undo all the completed activities of a long transaction that has been abandoned.  It is a complex problem to architect and implement effectively because undoing completed actions can result in a cascade of additional long transaction failures. 
),
../demodwbp/awffwpwgl.htm#gl_Complete_EHR (gl_Complete_EHR is CFR 45CFR Part 170's definition of an EHR technology solution which is able to perform, at a minimum, all of the applicable capabilities required by certification criteria adopted by the Secretary of HHS.  ),
../demodwbp/awffwpwgl.htm#gl_Complexity (gl_Complexity , M. Mitchell Waldrop describes a vision of complexity via:
  • Rich interactions that allow a system to undergo spontaneous self-organization
  • Systems that are adaptive
  • More predictability than chaotic systems by bringing order and chaos into
  • Balance at the edge of chaos
),
../demodwbp/awffwpwgl.htm#gl_Compounding_pharmacies (gl_Compounding_pharmacies make unique prescription drugs to order when doctors conclude that standard formulations are not effective treatments. 
),
../demodwbp/awffwpwgl.htm#gl_COMT (gl_COMT is catechol-O-methyltransferase which breaks down dopamine.  The COMT gene has variants which alter dopamine signalling intensity.  One variant is associated with a more efficient enzyme which is associated with: higher rates of extroversion, aggression, criminality, conduct disorder; but modified by gene/environment interactions:
  • Highly efficient COMT variant is associated with anger traits WHEN there was childhood sexual abuse.    
),
../demodwbp/awffwpwgl.htm#gl_CON (gl_CON is certificate of need, a legal document required in many US states and some federal jurisdictions before proposed acquisitions, expansions, or creations of facilities are allowed.  It was initially developed in health care in New York in 1964 and then became federal law in 1972.  States were concerned that in an over saturated field competitors would over charge patients to cover costs, or unnecessarily treat them.  In effect current market participants are granted monopoly rights!
),
../demodwbp/awffwpwgl.htm#gl_Configuration_editor (gl_Configuration_editor is the graphical user interface that allows its users to generate dark web pages, check the links of dark webs, and change the filters and frame configuration files that control the generation process. 
),
../demodwbp/awffwpwgl.htm#gl_Connect_Project (gl_Connect_Project uses open source Java to implement the architectures of eHealth Exchange.  It was sponsored by a variety of federal agencies which wanted one implementation of eHealth Exchange to operate across.  The agencies now use the connect gateway for at least demonstrations.  The architecture includes a gateway and adapter.  These use lower level core components to perform operations:
  • Gateway - Network orchestration components, gateway processes responsible for accepting messages from the NHIN and processing them or passing them through to the adapter. 
  • Adapter - uses entity orchestration components which orchestrate the request and send the message and SAML assertion through the message proxy component. 
    • Message proxy components must properly handle the SAML security layer.  Once it has constructed a valid SAML message it submits it to the NHIN and waits for the SAML response.  
    • Adapter services: adapter, adapter document query, adapter document retrieve, adapter document submission, Adapter master patient index, Adapter notification processing, Adapter policy, Adapter re-identification, Adapter subscription management
  • NHIN orchestration, Entity orchestration, Message Proxy all contain,
    • Audit reporting component
    • Document query component
    • Document retrieve component
    • Document submission component
    • Notification processing component
    • Patient discovery component
  • Core components:
    • Aggregator
    • Audit
    • Audit log data transfer engine
    • Audit recorder facade
    • Audit repository
    • Connection manager
    • Patient correlation
    • Patient correlation facade
    • Property accessor
    • Subscription repository
),
../demodwbp/awffwpwgl.htm#gl_Connecting_for_Health (gl_Connecting_for_Health is a Markle Foundation public-private collaboration.  Connecting for health conducted a three state prototype of electronic health information exchange based on Markle's Common Framework in 2004.  The three SNOs were Mendocino California HRE, Indiana HIE and MA-SHARE providing an implementation of the NHIN.  ),
../demodwbp/awffwpwgl.htm#gl_Conscience (gl_Conscience is the mental agent that punishes behavior that deviates from internal and external norms, according to Ness and Lloyd.  Sapolsky views conscience as an evolved process driven by reciprocal altruism and neo-group selection. 
),
../demodwbp/awffwpwgl.htm#gl_Conscious_access (gl_Conscious_access is, argues Stanislas Dehaene, when some attended information eventually enters our awareness and becomes reportable to others.  ),
../demodwbp/awffwpwgl.htm#gl_Consumer_credit (gl_Consumer_credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles.  ),
../demodwbp/awffwpwgl.htm#gl_Contour (gl_Contour describes the shape of a piece of music, describing shifts in frequency while ignoring the duration of the notes. 
),
../demodwbp/awffwpwgl.htm#gl_Contract-for-deed (gl_Contract-for-deed is a type of long term real estate loan:
  • That offers renters the opportunity to structure their rental payments to subsequently own the dwelling. 
  • Where the contracts are often onerous, lacking basic consumer protections, carry high interest rates and pull the renters in with the opportunity to purchase. 
  • Often lead to eviction.  
),
../demodwbp/awffwpwgl.htm#gl_Convolution (gl_Convolution is a mathematical operation similar to cross correlation on two functions f and g that produces a third function that is viewed as a modified version of one of the original functions giving the area of overlap between the two function as a function of the amount that one of the original functions is translated.  It can be used to remove high frequency changes from a visual field. 
),
../demodwbp/awffwpwgl.htm#gl_COO (gl_COO is chief operating officer ),
../demodwbp/awffwpwgl.htm#gl_Copayment (gl_Copayment is a fixed payment for a covered service after any deductible has been met.  It is a key strategy of the ACA to make subscribers aware of the costs of treatment and to put pressure on high cost health services.  As such suppliers and providers are keen to undermine the copayment: value based health insurance, Paying the copayment (Oct 2015), Place on the USPSTF list of preventative services (Sep 2016);
),
../demodwbp/awffwpwgl.htm#gl_COPD (gl_COPD is chronic obstructive pulmonary disease.  It is one of the most common lung diseases.  Chronic bronchitis and emphysema are the major forms.  ),
../demodwbp/awffwpwgl.htm#gl_Copy_number_variations (gl_Copy_number_variations are schematic differences where the mutation operator generates different numbers of copies of a contiguous sequence of addressable genes or memes on a schematic string. 
),
../demodwbp/awffwpwgl.htm#gl_CORE (gl_CORE is the CAQH's committee on operating rules for information exchange.  It was accepted as an NCVHS operating rule authorizing entity.  Its HHS accepted rules are:
  • Claim Submission ASC X12N 837
  • Eligibility and Benefit Verification ASC X12N 270/271
    • Eligibility and Benefits Real Time Companion Guide Rule
    • Eligibility and Benefits Connectivity Rule - specifies a common connection that will be provided by all participants
    • Eligibility and Benefits Data Content Rule - minimum requirements of the request and response to inquire about health plan insurance coverage request using ASC X.12 005010X279A1 Eligibility benefit req/res and the responding ASC X.12 005010X279A1 eligibility Benefit req/res. The rule includes:
      • Dates of eligibility for contract and benefit level
      • Patient financial responsibility for each specified benefit at the base contract amounts for both in-network & out-of-network.  
      • Name of the health plan
    • Eligibility and Benefits Batch Response Time Rule - A request sent by 9pm Eastern must be returned by 7am Eastern next business day. 
    • Eligibility and Benefits Real Time Response Time Rule - Maximum of 20 seconds. 
    • Eligibility and Benefits System Availability Rule - requires 86% availability per cal week for realtime and batch transactions. 
    • Claim Status Rule
    • Eligibility and Benefits 270/271 Normalizing Patient Last Name Rule - this aims to improve unique identification but not fully. 
    • Eligibility and Benefits 270/271 AAA Error Code Reporting Rule - allows consistant feedback on failure to uniquely identify the individual so the inputs can be corrected/updated and the transaction resubmitted. 
    • Eligibility and Benefits 270/271 Data Content Rule - requires the provision in the eligibility response of the remaining patient deductible amounts for certain service type codes. 
    • Eligibility and Benefits 270 Connectivity Rule - requires use of tow message envelope standards submitter authentication (user name, password, digital certificates) and metadata.  
  • Prior Authorization ASC X12N 278 
  • Claim Status Inquiry ASC X12N 276/277
  • Claim Payment NACHA Corporate Credit or Deposit Entry with Addenda Record (CCD+)
  • Remittance Advice ASC X12N 835
  • Acknowledgements are currently voluntary. 
),
../demodwbp/awffwpwgl.htm#gl_Coronary_artery (gl_Coronary_artery is an artery supplying the heart muscle with oxygen and other resources. 
),
../demodwbp/awffwpwgl.htm#gl_Coronary_occlusion (gl_Coronary_occlusion is a partial or full obstruction of blood flow in a coronary artery. 
),
../demodwbp/awffwpwgl.htm#gl_Corpus_callosum (gl_Corpus_callosum is a large tract of nerve cells that connect the cerebral cortex on one side of the head to that on the other side. 
),
../demodwbp/awffwpwgl.htm#gl_Cortisol (gl_Cortisol is a glucocorticoid produced in the adrenal cortex of the adrenal glands.  It:
  • Stimulates
    • Gluconeogenesis to increase production of blood sugar
    • Metabolism of fats, proteins and carbohydrates
  • Suppresses the immune system.  
  • Decreases bone formation
  • In excessive concentrations destroy synaptic connections in the: hippocampus, and prefrontal cortex; leading to flattened emotions and impaired memory. 
),
../demodwbp/awffwpwgl.htm#gl_Cost_function (gl_Cost_function maps an event onto a real number representing the cost associated with the event.  It can be used to estimate the parameter that minimizes the difference between an estimated and true value.  If the cost function has the form of a long shallow ravine heading to the optimum and steep walls on the sides the negative gradient of standard SGD will point down one of the steep sides rather than along the ravine to the optimum creating time consuming oscillations.  Machine learning's DNN architectures have this shape of objective (cost function).  Strategies such as momentum are used to push the objective more quickly along the ravine. 
),
../demodwbp/awffwpwgl.htm#gl_Cost_sharing_subsidies (gl_Cost_sharing_subsidies are part of the ACA legislation that requires the government to pass-through CSR subsidies via their insurers to patients who cannot afford to pay their cost sharing requirements. 
),
../demodwbp/awffwpwgl.htm#gl_Cost_sharing (gl_Cost_sharing is the requirement for patients to pay a portion of the cost of their health care services.  Such out-of-pocket payments include: copayments, deductibles and coinsurance. 
),
../demodwbp/awffwpwgl.htm#gl_Cost_shifting (gl_Cost_shifting is the practice of:
  • States to shift dual eligibles from Medicaid to Medicare federal funded services. 
  • Hospitals to maintain margins, when under pressure from reduced reimbursement, by increasing charges for services provided to non-contractually protected patients. 
),
../demodwbp/awffwpwgl.htm#gl_Costa-Hawkins (gl_Costa-Hawkins is the Costa-Hawkins Rental Housing Act of 1995, a California state law which constrains municipal rent control ordinances.  Cities are prohibited from using rent control for single family dwellings, condominiums and newly constructed apartment units.  And the law prohibited municipalities from applying rent controls to new tenants.  Before the law passed, cities had responded to high rental increases driven by demand generated by high house prices, with rent controls. 
),
../demodwbp/awffwpwgl.htm#gl_Coumadin (gl_Coumadin is a brand name for warfarin. 
),
../demodwbp/awffwpwgl.htm#gl_Council_of_Ministers (gl_Council_of_Ministers is an EU legislative body, composed of the leaders of the member nations, which agrees the terms of policy proposals from the European Commission.  ),
../demodwbp/awffwpwgl.htm#gl_CPC (gl_CPC is the CMS comprehensive primary care initiative.  Medicare is working with commercial and state health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients.  PCPs that participate are given resources to better coordinate primary care for their Medicare patients. 
),
../demodwbp/awffwpwgl.htm#gl_CPE (gl_CPE is current product engineering.  ),
../demodwbp/awffwpwgl.htm#gl_CPI (gl_CPI is consumer price index.  It reflects the prices of a market basket of consumer goods.  Weights are used to reflect models of the share each item in the basket.  Gordon notes it suffers from miss-representing standard of living changes due to outlet substitution bias.  And it ignored automobiles until 1935 and under-represented their quality impact prior to 1940.  Digital channels & products have added to the bias issues (Jun 2018)),
../demodwbp/awffwpwgl.htm#gl_CPOE (gl_CPOE is computerized provider order entry.  Certified EHR technologies are required to support CPOE ordering of medications, laboratory and radiology/imaging.  CPOE can provide physician support reducing medication errors significantly, as illustrated at Beth Israel.  ISVs such as Surescripts can then route the order to the pharmacy.  ),
../demodwbp/awffwpwgl.htm#gl_CPR (gl_CPR is cardiopulmonary resuscitation aims to restore a flow of oxygenated blood to the brain and heart to delay tissue death.  For adults the procedure involves 100 to 120 chest compressions a minute of 5 to 6 cm depth.  The procedure should be administered for about one hour.  Pushing oxygen into the patient's lungs can be added where the rescuer has been trained.  If the pulse is checked it should be done only for 10 seconds at a time. 
),
../demodwbp/awffwpwgl.htm#gl_CPRS (gl_CPRS is VistA's graphical user interface and stands for computerized patient record system.   It allows health care providers at the VA's more than 1000 facilities to review and update a patient's EHR. 
),
../demodwbp/awffwpwgl.htm#gl_CPT (gl_CPT the AMA specified procedure treatment codes for medical and psychiatric procedures performed by physicians and surgeons used when billing for procedures.  The AMA operates a $70M business which develops the classifications in secret.  Doctors are not informed of changes.  Insurers 'bundle' and 'downcode' treatments that have been performed.  Potentially doctors may lose money on the overall treatment.  ),
../demodwbp/awffwpwgl.htm#gl_CRA (gl_CRA is the community reinvestment act of 1977 which requires banks to help meet the credit needs of low-income neighborhoods in areas they serve.
),
../demodwbp/awffwpwgl.htm#gl_Cramdown (gl_Cramdown provision requires creditors to accept a bankruptcy court imposed restructuring of debt. 
),
../demodwbp/awffwpwgl.htm#gl_Crash_carts (gl_Crash_carts are pharmacy kits.  ),
../demodwbp/awffwpwgl.htm#gl_CRE (gl_CRE is carbapenem-resistant Enterobacteriaceae.  When carbapenem fails to treat an infection the patient is in serious trouble.  The CDC estimated CRE accounts for around 9,300 infections and 610 deaths yearly in the US in 2010-15.  However the CDC also reports:
  • In July 2010 the state of Florida instigated procedures that reduced the number of patients with CRE from 60% to less than 10% at a problem LTCH.  The improvement was based on
  • Detecting and protecting - Screening, isolating, and grouping patients with CRE to prevent spread to other patients. 
  • Reviewing staff operations for 40 hours checking hand hygene, glove and gown use and other practices during care of patients. 
  • Iterative communications between the problem facility and local, state and federal public health workers.  
),
../demodwbp/awffwpwgl.htm#gl_CREB_complex (gl_CREB_complex is a group of proteins that are required for turning on gene expression for the conversion of short-term memory into long-term memory.  The complex includes: RbAp48; proteins. 
),
../demodwbp/awffwpwgl.htm#gl_Crestin (gl_Crestin is a gene involved in the embryogenesis of the premigratory neural crest domain of the ectoderm supporting migration after which expression is downregulated.  In normal mature skin cells, bone cells or tooth cells the crestin gene is shut down.  ),
../demodwbp/awffwpwgl.htm#gl_CRFD (gl_CRFD is the Conscience and Religious Freedom Division of HHS's OCR. 
),
../demodwbp/awffwpwgl.htm#gl_CRH (gl_CRH is corticotropin-releasing hormone which triggers the pituitary to relase ACTH. 
),
../demodwbp/awffwpwgl.htm#gl_CRI (gl_CRI is the cancer research institute. 
),
../demodwbp/awffwpwgl.htm#gl_Crime_Bill (gl_Crime_Bill is a popular term for President Clinton's VCLEA.  ),
../demodwbp/awffwpwgl.htm#gl_CRISP (gl_CRISP is Chesapeake regional information system for our patients
),
../demodwbp/awffwpwgl.htm#gl_CRISPR (gl_CRISPR is clustered replicating interspersed silent palindromic repeats; a technique for exact targeting, cutting and editing of DNA based on leveraging bacterial enzymatic defenses against viruses generalized to any DNA sequence in a prokaryotic or eukaryotic cell.  It was identified during studies of a bacterial adaptive immune system.  In that system bacterial proteins grab parts of a virus that has infected them and record it within the palindromic structures that mark an array of inserted viral DNA used as a log persisted over generations.  If a new infection occurs the viral DNA is compared with the sequences and if a match exists the CAS proteins break up the viral DNA initiating its destruction.  This bacterial system was then updated and repurposed by the researchers to support targeted genetic engineering.  As explained by Dr. Doudna, the CRISPR proteins and the 20 nucleotide RNA template migrate into the nucleus where they rapidly target DNA which complements the RNA template and the Cas9 enzyme performs the edits.  Being a bacterial system CRISPR Cas9 does not target eukaryotic heterochromatic DNA well.  It is not fully understood how they find the target sequence so quickly.  It has been shown that Cas9 will bind to sites with a 5-8 base match but then it releases rapidly without cutting.  To cut, Cas9 has to reconfigure, which does not occur in the mismatch situations.  ),
../demodwbp/awffwpwgl.htm#gl_CRNA (gl_CRNA is a certified registered nurses trained in anesthesia.  ),
../demodwbp/awffwpwgl.htm#gl_Crohns_disease (gl_Crohns_disease is an IBD which results in abdominal pain, diarrhea, weight loss, anemia, skin rashes, arthritis, colon cancer.  There are genetic risk factors: PD-1 failure, and mutations of LRRK2, SLC11A1.  Treatments include: Natalizumab, Remicade; ),
../demodwbp/awffwpwgl.htm#gl_Cross_contact (gl_Cross_contact is a manufacturing problem of cross contamination caused by two food products being developed on the same manufacturing line.  Allergens from one product may be picked up by the second product. 
),
../demodwbp/awffwpwgl.htm#gl_Crossing_the_chasm_segmentation (gl_Crossing_the_chasm_segmentation Crossing , Geoffrey Moore describes target customer archetypes.  His 'Innovator' is a Keirsey personality segmentation rational.  His 'Visionary' is an artisan.  His 'Pragmatists and Conservatives' are guardians. 
),
../demodwbp/awffwpwgl.htm#gl_CRS (gl_CRS is the Congressional Research Service. 
),
../demodwbp/awffwpwgl.htm#gl_Cryo-electron_microscopy (gl_Cryo-electron_microscopy allows non-crystalline proteins to be viewed, by freezing the molecules and surrounding water layer, without crystallizing, in liquid nitrogen, and gathering electron scattering from the protein molecules and then recombining all the different orientations captured into a 3D model by computer modeling.  ),
../demodwbp/awffwpwgl.htm#gl_CSIA (gl_CSIA is the chemical safety improvement act of 2016 (formerly the Frank R. Lautenberg Chemical Safety for the 21st Century Act), which updates the TSCA with amendments:
  • EPA mandated to evaluate existing chemicals with clear and enforceable deadlines
  • Chemicals evaluated against a risk-based assessment
  • Unreasonable risks identified by the assessment must be mitigated
  • Increased authority to require development of chemical information
),
../demodwbp/awffwpwgl.htm#gl_CSO (gl_CSO is the Actuarial Standards board's Commissioners Standard Ordinary mortality tables.  A model is defined by the actuarial standards as an information structure and a mathematical representation of a phenomena or behavior.  ),
../demodwbp/awffwpwgl.htm#gl_CSR (gl_CSR is cost sharing reduction, a subsidy needed by the ACA individual insurance market providers to cope with reduced subsidies and offset repayments required by the law so that they can remain profitable during the bootstrap phase of participation. 
),
../demodwbp/awffwpwgl.htm#gl_CSSD (gl_CSSD is central sterile services department performs sterilizations and other maintenance to medical devices, equipment and consumables. 
),
../demodwbp/awffwpwgl.htm#gl_CT (gl_CT is computerized tomography in which a series of X-ray views taken from many angles are combined by computer processing to create 3-D images.  It is very useful for examining people who have been subject to trauma such as car accidents.  The high dose of radiation is a cause for concern with over use of CT scanning (Jan 2014).  The Banyan Brain Trauma Indicator blood test should help here. 
),
../demodwbp/awffwpwgl.htm#gl_CTI (gl_CTI is Care Transitions Intervention, an 'evidence based model' of effectiveness in reducing hospital readmissions of patients discharged to home.  Randomized control trials have shown significant improvement in following discharge procedures and reducing readmissions from CTI.  Transition coaches teach the patient the skills to manage the patient's own needs effectively during the transition period after discharge.  The coaching consists of five contacts:
  1. In the hospital before discharge, 
  2. During a home visit,
  3. - 5. Telephone calls.  
),
../demodwbp/awffwpwgl.htm#gl_CTLA-4 (gl_CTLA-4 is expressed on the surface of helper T cells and transmits inhibitory 'checkpoint' signals to T cells.  It is part of the immunoglobulin superfamily. 
),
../demodwbp/awffwpwgl.htm#gl_CTM-3 (gl_CTM-3 is Eric Coleman's three item care transition measure.  It is a survey of a population with a model of scoring and sampling to generate a statistical assessment of the patient population's transition experience.  It includes the training on giving the survey, and constructing and applying the models. 
),
../demodwbp/awffwpwgl.htm#gl_CTMS (gl_CTMS is a clinical trials management system
),
../demodwbp/awffwpwgl.htm#gl_Culture (gl_Culture is how we do and think about things, transmitted by non-genetic means as defined by Frans de Waal.  CAS theory views cultures as operating via memetic schemata evolved by memetic operators to support a cultural superorganism.  Evolutionary psychology asserts that human culture reflects adaptations generated while hunting and gathering.  Dehaene views culture as essentially human, shaped by exaptations and reading, transmitted with support of the neuronal workspace and stabilized by neuronal recycling.  Damasio notes prokaryotes and social insects have developed cultural social behaviors.  Sapolsky argues that parents must show children how to transform their genetically derived capabilities into a culturally effective toolset.  He is interested in the broad differences across cultures of: Life expectancy, GDP, Death in childbirth, Violence, Chronic bullying, Gender equality, Happiness, Response to cheating, Individualist or collectivist, Enforcing honor, Approach to hierarchy; illustrating how different a person's life will be depending on the culture where they are raised.  Culture:
  • Is deployed during pregnancy & childhood, with parental mediation.  Nutrients, immune messages and hormones all affect the prenatal brain.  Hormones: Testosterone with anti-Mullerian hormone masculinizes the brain by entering target cells and after conversion to estrogen binding to intracellular estrogen receptors; have organizational effects producing lifelong changes.  Parenting style typically produces adults who adopt the same approach.  And mothering style can alter gene regulation in the fetus in ways that transfer epigenetically to future generations!  PMS symptoms vary by culture. 
  • Is also significantly transmitted to children by their peers during play.  So parents try to control their children's peer group.  
  • Is transmitted to children by their neighborhoods, tribes, nations etc. 
  • Influences the parenting style that is considered appropriate. 
  • Can transform dominance into honor.  There are ecological correlates of adopting honor cultures.  Parents in honor cultures are typically authoritarian. 
  • Is strongly adapted across a meta-ethnic frontier according to Turchin.  
  • Across Europe was shaped by the Carolingian empire. 
  • Can provide varying levels of support for innovation.  Damasio suggests culture is influenced by feelings: 
    • As motives for intellectual creation: prompting detection and diagnosis of homeostatic deficiencies, identifying desirable states worthy of creative effort.
    • As monitors of the success and failure of cultural instruments and practices
    • As participants in the negotiation of adjustments required by the cultural process over time 
  • Produces consciousness according to Dennet. 
),
../demodwbp/awffwpwgl.htm#gl_Currency (gl_Currency is legal tender which provides no interest payments to the holder.  It is a central aspect of money and in CAS is an analog of a short term potential energy token such as the high energy phosphate bond of the base ATP.  But the interaction of the geometric breeding and deaths of agents that perform actions and the linear increase in real resources, described by Turchin, results in the correspondence between energy and currency being complex and adaptive. 
),
../demodwbp/awffwpwgl.htm#gl_CVD (gl_CVD is cardiovascular disease which refers to:
  • Conditions where narrowed and blocked blood vessels result in angina, hypertension, CHD and heart attacks and hemorrhagic/ischemic strokes.  Mutations of the gene PCSK9 have been implicated in cardiovascular disease.  Rare families with dominant inheritence of the mutations have an overactive protein, very high levels of blood cholesterol and cardiac disease. Other rare PCSK9 mutations result in an 88% reduced risk from heart disease.  Inflammation is associated with cardiovascular disease (Aug 2017). 
),
../demodwbp/awffwpwgl.htm#gl_CVX (gl_CVX is a coding representing every US licensed vaccine.  MCIR recommend using CVX coded vaccine descriptions in transfer files (EHT, HL7 or Scan). 
),
../demodwbp/awffwpwgl.htm#gl_CWA (gl_CWA is the clean water act of 1977 amended by the Water Quality Act of 1987.  The CWA amended the Federal Water Polution Act of 1948 rewrite of 1972.  The CWA is the primary law covering water pollution.  It aims to sustain the integrity of US waters by preventing pollution, assisting with treatment, and supporting wetlands.  It does not cover groundwater contamination, which is protected by: SDWA, RCRA, CERCLA (Superfund act). 
),
../demodwbp/awffwpwgl.htm#gl_Cyclins (gl_Cyclins Cyclins, four enzymes A, B, C, D which cooperate to enforce the four phases of the eukaryotic cell cycle. 
),
../demodwbp/awffwpwgl.htm#gl_Cyclopean_vision (gl_Cyclopean_vision is the ability to see shapes in stereo that neither eye's visual data can represent in mono. 
),
../demodwbp/awffwpwgl.htm#gl_CYP2C19 (gl_CYP2C19 is a gene in the cytochrome P450 gene family which codes for a liver enzyme which is used by pharmaceutical companies to metabolize drugs to their active form: clopidogrel, mephenytoin, omeprazole, proguanil;  ),
../demodwbp/awffwpwgl.htm#gl_CYP2C9 (gl_CYP2C9 is a gene in the cytochrome P450 gene family which codes for a liver enzyme which is used by pharmaceutical companies to inactivate drugs.  More than 50 SNPs in regulatory and coding regions of the gene alter the processing.  Some SNPs are associated with reduced enzyme activity which can result in adverse drug reactions.  ),
../demodwbp/awffwpwgl.htm#gl_CYP2D6 (gl_CYP2D6 is a gene in the cytochrome P450 gene family which codes for cytochrome P450 2D6 enzyme primarily in the liver, but also in the substantia nigra.  It is used by pharmaceutical companies to activate drugs including: Codeine, Tamoxifen. 
),
../demodwbp/awffwpwgl.htm#gl_Cystic_fibrosis (gl_Cystic_fibrosis is a deadly, recessive genetic disease caused by a variety of single gene mutations in the CFTR gene, most commonly occurring in people of northern European background.  Screening would work best if applied to couples prior to conception but this is not how carrier screening is organized as of 2015.  Cystic fibrosis can result in: fibrous cysts in the pancreas; which does not secrete its normal digestive enzymes inducing serious malnutrition, intestinal blockages, infertility in males and lung damage due to accumulation of a thick, sticky secretion followed by recurrent infections.  Symptoms vary among sufferers because:
  • Modifier genes which vary between individuals. 
  • Environmental differences:
    • Second hand smoke exposure is a significant contributor to cystic fibrosis effects
    • Medical interventions such as: pancreatic enzyme capsules, chest physical therapy, antibiotics, aerosolized enzyme therapy, saltwater mists and double lung transplants; can reduce the effects  
    • Diet
),
../demodwbp/awffwpwgl.htm#gl_Cytokines (gl_Cytokines control the development of hematopoietic cell lines.  They regulate the immune response and are involved in the development of immune-competent cells.  ),
../demodwbp/awffwpwgl.htm#gl_Cytomegalovirus (gl_Cytomegalovirus or CMV, is a robust herpes virus that can leave babies with brain damage, vision abnormalities, microcephaly and deafness.  20,000 to 40,000 babies are born each year with CMV.  More than 20% develop permanent disabilities.  Nearly one in three children are infected by age 5 and more than half of all adults by age 40.  CMV is transmitted by contact with infected saliva and urine.  Pregnant women are often infected by toddlers.  Day cares act as a powerful infrastructure amplifier where young children chew and share toys.  In 2016 there is no vaccine or standard treatment.  ),
../demodwbp/awffwpwgl.htm#gl_D-dimer (gl_D-dimer is a small protein fragment that is present in blood after fibrinolysis of a clot.  It is a fibrin degradation product.  D-dimer can be measured with a blood test. 
),
../demodwbp/awffwpwgl.htm#gl_D47R (gl_D47R is a variant of dopamine receptor D4.  7R label reflects the presence of seven repeats of a variable section of the gene for D4.  The frequency of the gene varies across populations and is associated with: human migration, & differences of collectivist (1%) and individualist (upto 70% in historically migratory) cultures.  This gene variant produces a receptor protein which is relatively unresponsive to dopamine.  Sapolsky explains it is associated with: ADHD, alcoholism, extroversion, financial risk taking, impulsivity, sensation & novelty seeking, promiscuity; modified by gene/environment interactions:
  • Children with 7R AND insecure attachment to their parents are less generous than average.  Otherwise children with 7R are more generous. 
  • Students with 7R expressed the least interest in prosocial groups, unless given a religious prime in which case they were the most prosocial.  
  • People with 7R are relatively poor at gratification-postponement tasks IF AND ONLY IF they grew up poor. 
),
../demodwbp/awffwpwgl.htm#gl_DAC (gl_DAC is the Development Assistance Committee of the OECD.  ),
../demodwbp/awffwpwgl.htm#gl_dACC (gl_dACC is dorsal anterior cingulate cortex
),
../demodwbp/awffwpwgl.htm#gl_Daily_care_review (gl_Daily_care_review is a process coordinated by case management to align care with physician assessments and regulatory requirements.  ),
../demodwbp/awffwpwgl.htm#gl_DALY (gl_DALY is disability adjusted life years.  ),
../demodwbp/awffwpwgl.htm#gl_Darbepoetin_alpha (gl_Darbepoetin_alpha is a reengineered erythropoietin. 
),
../demodwbp/awffwpwgl.htm#gl_Dark_web (gl_Dark_web is a web site that is not open to the Internet.  It is a set of deployed HTML files in a directory which refer to each other via file based references relative to the directory.  ),
../demodwbp/awffwpwgl.htm#gl_Dark_web_generator (gl_Dark_web_generator is a Perl script, typically launched as a child process within the configuration editor, by clicking 'generate web', which executes frame configuration file instructions merging the configuration variables with an HTML template file to generate target web pages.  The configuration instructions can be tailored by filters from the configuration file specified filter file. 
),
../demodwbp/awffwpwgl.htm#gl_DARPA (gl_DARPA is defense advanced research projects agency of the US department of defense.  ),
../demodwbp/awffwpwgl.htm#gl_Dartmouth_Atlas (gl_Dartmouth_Atlas is the Dartmouth Institute's map of the US on which is documented spending by Medicare.  As of 2015 it demonstrates extraordinary variation in spending on health-care from place to place with a negative correlation between expenditure and quality of outcome. 
),
../demodwbp/awffwpwgl.htm#gl_Dartmouth_Clinical_Microsystem (gl_Dartmouth_Clinical_Microsystem is a small group of people who work together on a regular basis to provide care to discrete subpopulations including the patients.  It has clinical and business aims, linked processes, shared information environment and produces performance outcomes.  They evolve overtime and are often embedded in larger organizations.  They are viewed by the Microsystem academy as a Complex Adaptive System.  They are the building blocks which form hospitals.  ),
../demodwbp/awffwpwgl.htm#gl_Darunavir (gl_Darunavir is an HIV medication taken once a day.  It is marketed in the US as Prezista. 
),
../demodwbp/awffwpwgl.htm#gl_DAT (gl_DAT is dopamine transporter, a monoamine transporter, which performs reuptake of dopamine from the synapse to the axon terminal.  DAT genes include variants.  Those with inefficient reuptake capabilities, which induce higher levels of synaptic dopamine, in the striatum are associated with people drawn to happy faces, repelled by angry faces, have a positive parenting style. 
),
../demodwbp/awffwpwgl.htm#gl_Data_exclusivity (gl_Data_exclusivity is a regulatory protection extended to biologics which protects their manufacturer's profits from attack from biosimilars. 
),
../demodwbp/awffwpwgl.htm#gl_Data_visualization (gl_Data_visualization aims to communicate information clearly and effectively via signals presented as information graphics. 
),
../demodwbp/awffwpwgl.htm#gl_Day_hospitals (gl_Day_hospitals are based on the Royal Bournemouth and Christchurch Hospital's Day Hospital Program.  This provides specialist assessment, treatment and rehabilitation for older people that aims to:
  • Maximize the health and independence of older people as far as possible for that individual
  • Assist primary care and social care services with the treatment and management of people with complex conditions that are associated with age
  • Avoid preventable hospital admissions and facilitate early supported discharge. 
),
../demodwbp/awffwpwgl.htm#gl_DBT (gl_DBT is dialectical behavioral therapy, a treatment for BPD.  It was designed by Marsha Linehan who added validation and dialectics to cognitive behavioral therapy. 
  • Cognitive behavioral therapy - teaches how to change the situation.  The goal is to change behaviors to obtain a life worth living. 
  • Validation - supports the BPD sufferer who finds change invalidating. 
  • Dialectics - shows that everything is connected, change is constant and inevitable and opposites can be integrated to get closer to the truth. 
),
../demodwbp/awffwpwgl.htm#gl_DC (gl_DC is: 
  • Defined contribution,
  • District of Columbia or
  • Discharge from medical control.  For discharge rigorous procedures are applied to limit readmission penalties or
  • Dendritic cell.