Cultivated autologous limbal epithelial cell (CALEC) transplantation: Development of manufacturing process and clinical evaluation of feasibility and safety.

To treat unilateral limbal stem cell (LSC) deficiency, we developed cultivated autologous limbal epithelial cells (CALEC) using an innovative xenobiotic-free, serum-free, antibiotic-free, two-step manufacturing process for LSC isolation and expansion onto human amniotic membrane with rigorous quality control in a good manufacturing practices facility. Limbal biopsies were used to generate CALEC constructs, and final grafts were evaluated by noninvasive scanning microscopy and tested for viability and sterility. Cultivated cells maintained epithelial cell phenotype with colony-forming and proliferative capacities. Analysis of LSC biomarkers showed preservation of "stemness." After preclinical development, a phase 1 clinical trial enrolled five patients with unilateral LSC deficiency. Four of these patients received CALEC transplants, establishing preliminary feasibility. Clinical case histories are reported, with no primary safety events. On the basis of these results, a second recruitment phase of the trial was opened to provide longer term safety and efficacy data on more patients.

Results, Knowledge, and Attitudes Regarding an Incentive Compensation Plan in a Hospital-Based, Academic, Employed Physician Multispecialty Group.

EXECUTIVE SUMMARY: Hospitals and healthcare systems are introducing incentive metrics into compensation plans that align with value-based payment methodologies. These incentive measures should be considered a practical application of the transition from volume to value and will likely replace traditional productivity-based compensation in the future. During the transition, there will be provider resistance and implementation challenges. This article examines a large multispecialty group's experience with a newly implemented incentive compensation plan including the structure of the plan, formulas for calculation of the payments, the mix of quality and productivity metrics, and metric threshold achievement. Three rounds of surveys with comments were collected to measure knowledge and attitudes regarding the plan. Lessons learned and specific recommendations for success are described. The participant's knowledge and attitudes regarding the plan are important considerations and affect morale and engagement. Significant provider dissatisfaction with the plan was found. Careful metric selection, design, and management are critical activities that will facilitate provider acceptance and support. Improvements in data collection and reporting will be needed to produce reliable metrics that can supplant traditional volume-based productivity measures.

A survey of current practices, attitudes, and knowledge regarding human papillomavirus-related cancers and vaccines among head and neck surgeons.

IMPORTANCE: Understanding head and neck surgeons' current knowledge, practices, and opinions regarding human papillomavirus (HPV) education and prevention will enable efforts to assist surgeons in this important endeavor. OBJECTIVE: To assess knowledge, attitudes, and beliefs of head and neck surgeons regarding HPV education and vaccination. DESIGN, SETTING, AND PARTICIPANTS: Online survey of members of the American Head and Neck Society (AHNS) in late 2011 and early 2012. MAIN OUTCOMES AND MEASURES: Knowledge, attitudes, and current practices regarding HPV education and vaccination. RESULTS: All 1081 members of the AHNS were approached via e-mail, and 297 members completed the survey, for an overall response rate of 27.5%. Most respondents were male (86.2%) fellowship-trained head and neck surgeons (80.4%), and most practice in an academic setting (77.1%) in the United States (78.1%). More than 90% of respondents discuss risk factors for head and neck cancer and HPV as a specific risk factor with their patients. However, only 49.1% discuss the importance of vaccinating preadolescents for HPV, most commonly citing that they do not do so because their patients are adults (38.7%). Of those respondents with daughters, 68.9% reported that their daughters had received or they intend their daughters to receive the HPV vaccine. Of those respondents with sons, only 55.8% reported that their sons had been vaccinated or they intend for them to be. Respondents reported divergent attitudes toward HPV vaccination safety and efficacy. However, respondents were overwhelmingly supportive of possible future ANHS activities to educate clinicians, increase public awareness, educate patients, and advocate for health policy related to HPV. CONCLUSIONS AND RELEVANCE: Head and neck surgeons are knowledgeable about HPV and show generally positive attitudes and beliefs about HPV education and vaccination. They endorse AHNS actions to improve public and patient education, as well as health policy on HPV. These findings support AHNS developing a strategic plan and actions to improve knowledge and reduce HPV infection among the American public.

A proposed framework for understanding the forces behind legislation of universal health insurance: lessons from ten countries.

OBJECTIVE: To understand the forces propelling countries to legislate universal health insurance. DATA SOURCE/STUDY DESIGN: Descriptive review and exploratory synthesis of historic data on economic, geographic, socio-demographic, and political factors. DATA EXTRACTION METHODS: We searched under "insurance, health" on MEDLINE and Google Scholar, and we reviewed relevant books and articles via a snowball approach. PRINCIPAL FINDINGS: Ten countries with universal health insurance were studied. For the five countries that passed final universal insurance laws prior to 1958, we found that two forces of "historical context" (i.e., social solidarity and historic patterns), one "ongoing dynamic force" (political pressures), and "one uniqueness of the moment" force (legislative permissiveness) played a major role. For the five countries that passed final legislation between 1967 and 2010, the predominant factors were two "ongoing dynamic forces" (economic pressures and political pressures) and one "uniqueness of the moment" force (leadership). In general, countries in the former group made steady progress, whereas those in the latter group progressed in abrupt leaps. CONCLUSIONS: The lessons of more recent successes-almost all of which were achieved via abrupt leaps-strongly indicate the importance of leadership in taking advantage of generalized economic and political pressures to achieve universal health insurance.