范文一：英文参考文献

附 录

英文参考文献:

Comparing The Effects Of Health Insurance Reform

Proposals: Employer Mandates, Medicaid Expansions, and

Tax Credits

Overview

Over 46 million Americans lacked health insurance in 2005. This problem has increasingly drawn the attention of policymakers at the local, state, and federal levels. Attempts to increase health coverage have generally focused on three main types of policy proposals: mandating employer-paid health insurance, providing tax credits for low-income individuals to buy insurance, and expanding Medicaid to cover more of the uninsured. While many studies have considered the impact of these policies on the number of uninsured and the cost to the federal government, the additional impacts on employer costs and the labor market have generally been ignored.

Results

The authors confirm that the uninsured are a more diverse group than is often portrayed. However, compared to individuals with insurance they are more likely to have low incomes and education levels and to be from a racial minority group. They are also more likely to be under the age of 35, unmarried, and single parents. Among adults, the uninsured are also somewhat more likely to be employed and working full-time than insured individuals.

The authors estimate that expanding Medicaid to cover all adults and children with a family income up to 300 percent of the poverty level would extend eligibility to over 59 million people. The authors estimate that 7 million adults and nearly 591,000 children would take up the benefit. Most of these would be adults because children living in low- and moderate-income families already qualify for State Children’s Health Insurance Programs. Because some of those individuals would be dropping private coverage, the policy would decrease the number of uninsured by 4,997,724. However, a Medicaid expansion is expected to add 230,000 new jobs, as employers take on low-wage workers with fewer concerns about the inability to adjust wages downward as health care costs increase, since many of these workers would take up Medicaid. Other labor market benefits include: reducing health costs for private employers by 2%; increasing wages among existing workers by 0.46%; shifting 57,000 workers from part-time to full-time employment; and increasing hours worked per week by 279,741. However, these benefits would require approximately $16.4 billion in new public funds, some of which are required to cover reduced private spending.

Finally, the authors find that the tax credit option would be available to over 54.5 million individuals, 41.3 million of whom are currently uninsured. Because take-up

rates for the previously uninsured are relatively low, however, only about 1.6 million previously uninsured individuals (310,000 of whom are children) would receive coverage as a result of the credit, while 11.9 million previously insured individuals would take up the credit. Public expenditures would increase by $19.8 billion in the form of foregone federal income tax revenue and payouts for refundable credits. The public expenditures per newly insured individual would be quite high ($12,644), due to the fact that the credit would be disproportionately used by those with prior insurance coverage (a ratio of nearly 7:1).

Conclusion

The results of this paper suggest that while the employer mandate may provide the largest drop in the number of uninsured, it does so at the highest cost in terms of lost jobs, foregone wages, and increased employer spending. A Medicaid expansion, on the other hand, will actually increase employment at roughly the same cost per newly insured individual as the employer mandate. Tax credits represent the least effective way to expand health insurance coverage of the three alternatives. Although they are expected to have negligible labor market effects, their impact on newly insured individuals is lower than the other alternatives and comes at a higher public cost.

中文翻译:

范文二：英文参考文献

[A8] Thyroid sonography

■ RECOMMENDATION 6

Thyroid sonography with survey of the cervical lymph nodes should be performed in all patients with known or suspected thyroid nodules. (Strong recommendation, High-quality evidence)

Diagnostic thyroid/neck US should be performed in all patients with a suspected thyroid nodule, nodular goiter, or radiographic abnormality suggesting a thyroid nodule incidentally detected on another imaging study (e.g., computed tomography (CT) or magnetic resonance imaging (MRI) or thyroidal uptake on 18 FDG-PET scan) Thyroid US can answer the following questions: Is there truly a nodule that corresponds to an identified abnormality? How large is the nodule? What is the nodule ’s pattern of ultrasound imaging characteristics? Is suspicious cervical lymphadenopathy present? Is the nodule greater than 50% cystic? Is the nodule located posteriorly in the thyroid gland? These last two features might decrease the accuracy of FNA biopsy performed with palpation (63;64).

Ultrasound should evaluate the following: thyroid parenchyma (homogeneous or heterogeneous) and gland size; size, location, and sonographic characteristics of any nodule(s); the presence or absence of any suspicious cervical lymph nodes in the central or lateral compartments. The ultrasound report should convey nodule size (in 3 dimensions) and location (e.g. right upper lobe) and a description of the nodule’s sonographic features including: composition (solid, cystic proportion, or spongiform), echogenicity, margins, presence and type of calcifications, and shape if taller than

wide, and vascularity. The pattern of sonographic features associated with a nodule confers a risk of malignancy, and combined with nodule size, guides FNA decision-making (65;66) (see Recommendation 8).

In the subset of patients with low serum TSH levels who have undergone radionuclide thyroid scintigraphy suggesting nodularity, ultrasound should also be performed to evaluate both the presence of nodules concordant with the hyperfunctioning areas on the scan, which do not require FNA, as well as other nonfunctioning nodules that meet sonographic criteria for FNA.

■ RECOMMENDATION 8

Thyroid nodule diagnostic FNA is recommended for (Figure 2, Table 6):

A) Nodules > 1cm in greatest dimension with high suspicion sonographic pattern (Strong recommendation, Moderate-quality evidence)

B) Nodules > 1 cm in greatest dimension with intermediate suspicion sonographic (Strong recommendation, Low-quality evidence)

C) Nodules > 1.5cm in greatest dimension with low suspicion sonographic pattern (Weak recommendation, Low-quality evidence)

Thyroid nodule diagnostic FNA may be considered for (Figure 2, Table 6):

D) Nodules > 2cm in greatest dimension with very low suspicion sonographic pattern (e.g. – spongiform). Observation without FNA is also a reasonable option (Weak recommendation, Moderate-quality evidence)

Thyroid nodule diagnostic FNA is not required for (Figure 2, Table 6):

E) Nodules that do not meet the above criteria. (Strong recommendation, Moderate-

quality evidence)

F) Nodules that are purely cystic (Strong recommendation, Moderate-quality evidence)

Thyroid ultrasound (US) has been widely used to stratify the risk of malignancy in thyroidnodules, and aid decision-making about whether FNA is indicated. Studies consistently report that several US gray scale features in multivariate analyses are associated with thyroid cancer, the majority of which are papillary thyroid cancer. These include the presence of microcalcifications, nodule hypoechogenicity compared with the surrounding thyroid or strap muscles, irregular margins (defined as either infiltrative, microlobulated or spiculated), and a shape taller than wide measured on a transverse view. Features with the highest specificities (median >90%) for thyroid cancer are microcalcifications, irregular margins, and tall shape, although the sensitivities are significantly lower for any single feature (70-77). It is important to note that poorly defined margins, meaning the sonographic interface between the nodule and the surrounding thyroid parenchyma is difficult to delineate, are not equivalent to irregular margins. An irregular margin indicates the demarcation between nodule and parenchyma is clearly visible but demonstrates an irregular, infiltrative or spiculated course. Up to 55% of benign nodules are hypoechoic compared to thyroid parenchyma, making nodule hypoechogenicity less specific. In addition, subcentimeter benign nodules are more likely to be hypoechoic than larger nodules. Multivariable analyses confirm that the probability of cancer is higher for nodules with either microlobulated margins or microcalcifications than for

hypoechoic solid nodules lacking these features (70). Macrocalcifications within a nodule, if combined with microcalcifications, confer the same malignancy risk as microcalcifications alone (70;74). However, the presence of this type of intranodular macrocalcification alone is not consistently associated with thyroid cancer (78). On the other hand, a nodule that has interrupted peripheral calcifications, in association with a soft tissue rim outside the calcification, is highly likely to be malignant and the associated pathology may demonstrate tumor invasion in the area of disrupted calcification

(79;80).

范文三：英文参考文献

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