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Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

Family Medicine and Community Health 2015年第3期3卷 18-24页

作者： james j.Werner Kitty K.Corbett Department of Family Medicine and Community Health Mandel School of Applied Social SciencesCase Western Reserve University11000 Cedar AvenueSuite 402ClevelandOH 44106USA School of Public Health and Health Systems University of Waterloo200 University Avenue WestWaterlooOntarioN2L 3G1Canada

Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care ***:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured *** were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct *** captured additional data by studying cases of referred uninsured ***:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured ***:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.

关键词： Health services accessibility barriers to health care medically uninsured health care inequities access to specialty care qualitative methods

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Effects of rock pore sizes on the PVT properties of oil and gas-condensates in shale and tight reservoirs

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Petroleum 2018年第2期4卷 148-157页

作者： Arash Kamari Lei Li james j.Sheng Bob L.Herd Department of Petroleum Engineering Texas Tech UniversityP.O.Box 43111LubbockTX 79409United States Southwest Petroleum University ChengduChina

Shales make up a large proportion of the rocks with extremely low permeability representing many challenges which can be complex in many cases.A careful study of rock and fluid properties(*** of shales)of such resources is needed for long-term success,determining reservoirs quality,and increased recovery factor in unique unconventional *** this communication,a comprehensive thermodynamic modelling is undertaken in which capillary pressure is coupled with the phase equilibrium *** this end,the data associated with both shale oil and gascondensates of Eagle Ford shale reservoir located in South Texas,U.S.,is *** properties,including bubble and dew point pressures,capillary pressure,interfacial tension,liquid and gas densities,and liquid and gas viscosities,are predicted observing the effects of rock pore sizes by the thermodynamic modelling performed in this *** results demonstrate that the thermodynamic model developed in this study is capable of simulating the PVT properties of oil and gascondensates in shale and tight *** a binary mixture 25:75 C1/C6,the bubble point pressure at different reservoir temperature is increased by increasing the pore sizes from 10 to 50 ***,an increase in pore sizes from 10 to 50 nm can increase the dew point pressure for a studied binary mixture 75:25 C1/C6.

关键词： Shale Pore size Oil Gas-condensate Thermodynamic modelling

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Complete eradication of hepatic metastasis from colorectal cancer by Yttrium-90 SIRT

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World journal of Gastroenterology 2007年第21期13卷 3016-3019页

作者： Sean Garrean Amanda Muhs james T Bui Michael j Blend Charles Owens William S Helton Nocif j Espat Department of Surgery the University of Illinois at Chicago840 S. Wood St. MC 958Chicago IL 60612United States Department of Interventional Radiology University of Illinois at Chicago1740 W. Taylor StRoom 4283. MC 931Chicago IL 60612United States Department of Nuclear Medicine University of Illinois at Chicago1740 W. Taylor StRoom 4283. MC 931Chicago IL 60612United States

Yttrium-90 (Y-90) radioembolization,also known as selective internal radiation therapy (SIRT),is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT,Y-90 impregnated microspheres are injected into the VASCULAR SUPPLY of hepatic tumor,leading to selective irradiation and necrosis of tumor TISSUE. While several studies demonstrate improved local control and survival with SIRT,the specific indications for this therapy have yet to be defined. Typically,SIRT is given in combination with chemotherapy as multimodal treatment for unresectable hepatic CRC. However,it HAS ALSO FOUND INCREASING USE as a salvage therapy in chemo-refractory patients. Herein,the authors describe their experience with SIRT as "stand alone" therapy in a surgically-prohibitive,chemotherapy naive patient with hepatic CRC metastasis. The results suggest that Y-90 SIRT may have potential applications beyond its usual role as a palliative or salvage therapy for unresectable hepatic CRC.

关键词： Yttrium-90, SIRT Radioembolization Hepatic metastasis Ablation

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Transepithelial leak in Barrett's esophagus patients: The role of proton pump inhibitors

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World journal of Gastroenterology 2012年第22期18卷 2793-2797页

作者： Christopher Farrell Melissa Morgan Owen Tully Kevin Wolov Keith Kearney Benjamin Ngo Giancarlo Mercogliano james j Thornton Mary Carmen Valenzano james M Mullin Division of Gastroenterology Lankenau Hospital Wynnewood PA 19096 United States Lankenau Institute for Medical Research Wynnewood PA 19096 United States

AIM： To determine if the observed paracellular sucrose leak in Barrett＇s esophagus patients is due to their pro- ton pump inhibitor （PPI） use. METHODS： The in vivo sucrose permeability test was administered to healthy controls, to Barrett＇s patients and to non-Barrett＇s patients on continuous PPI thera- py. Degree of leak was tested for correlation with pres- ence of Barrett＇s, use of PPIs, and length of Barrett＇s segment and duration of PPI use. RESULTS： Barrett＇s patients manifested a near 3-fold greater, upper gastrointestinal sucrose leak than healthy controls. A decrease of sucrose leak was ob- served in Barrett＇s patients who ceased PPI use for 7 *** initial introduction of PPI use （in a PPI-na＇ive population） results in dramatic increase in sucrose leak, long-term, continuous PPI use manifested a slow spon- taneous decline in leak. The sucrose leak observed in Barrett＇s patients showed no correlation to the amount of Barrett＇s tissue present in the esophagus. CONCLUSION： Although future research is needed to determine the degree of paracellular leak in actual Barrett＇s mucosa, the relatively high degree of leak ob- served with in vivo sucrose permeability measurement of Barrett＇s patients reflects their PPI use and not their Barrett＇s tissue perse.

关键词： Barrett's esophagus Sucrose Tight junc-tion Paracellular, Omeprazole Proton pump inhibitor Transepithelial

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Compressing local atomic neighbourhood descriptors

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npj Computational Materials 2022年第1期8卷 1593-1605页

作者： james P.Darby james R.Kermode Gábor Csányi Engineering Dept University of CambridgeTrumpington StCambridgeCB21PZUK Warwick Centre for Predictive Modelling School of EngineeringUniversity of WarwickCoventryCV47ALUK

Many atomic descriptors are currently limited by their unfavourable scaling with the number of chemical elements S *** length of body-ordered descriptors,such as the SOAP power spectrum(3-body)and the(ACE)(multiple body-orders),scales as(NS)^(ν)whereν+1 is the body-order and N is the number of radial basis functions used in the density *** introduce two distinct approaches which can be used to overcome this scaling for the SOAP power ***,we show that the power spectrum is amenable to lossless compression with respect to both S and N,so that the descriptor length can be reduced from O(N^(2)S^(2))to O(NS).Secondly,we introduce a generalised SOAP kernel,where compression is achieved through the use of the total,element agnostic density,in combination with radial *** ideas used in the generalised kernel are equally applicably to any other body-ordered descriptors and we demonstrate this for the(ACSF).

关键词： SOAP scaling kernel

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Adiponectin signalling in bone homeostasis,with age and in disease

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Bone Research 2021年第1期9卷 15-25页

作者： jonathan W.Lewis james R.Edwards Amy j.Naylor Helen M.McGettrick Rheumatology Research Group Institute of Inflammation and AgeingUniversity of BirminghamBirmingham B152TTUK Ageing&Regeneration Research Group Botnar Research CentreUniversity of OxfordOxford OX37LDUK

Adiponectin is the most abundant circulating adipokine and is primarily involved in glucose metabolism and insulin *** the bone,osteoblasts and osteoclasts express the adiponectin receptors,however,there are conflicting reports on the effects of adiponectin on bone formation and *** studies have shown a pro-osteogenic role for adiponectin in in vivo murine models and in vitro:with increased osteoblast differentiation and activity,alongside lower levels of ***,human studies often demonstrate an inverse relationship between adiponectin concentration and bone ***,the presence of multiple isoforms of adiponectin and multiple receptor subtypes has the potential to lead to more complex signalling and functional *** such,we still do not fully understand the importance of the adiponectin signalling pathway in regulating bone homeostasis and repair in health,with age and in *** this review,we explore our current understanding of adiponectin bioactivity in the bone;the significance of its different isoforms;and how adiponectin biology is altered in ***,furthering our understanding of adiponectin regulation of bone biology is key to developing pharmacological and non-pharmacological(lifestyle)interventions that target adiponectin signalling to boost bone growth and repair in healthy ageing,following injury or in disease.

关键词： homeostasis metabolism consequences

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Macular carotenoid supplementation improves disability glare performance and dynamics of photostress recovery

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Eye and Vision 2016年第1期3卷 231-238页

作者： james M.Stringham Kevin j.O’Brien Nicole T.Stringham Nutritional Neuroscience Laboratory Department of Physiology and PharmacologyUniversity of GeorgiaAthensGA 30602USA Vision Sciences Laboratory Department of PsychologyUniversity of GeorgiaAthensGA 30602USA Interdisciplinary Neuroscience Program Biomedical Health Sciences InstituteUniversity of GeorgiaAthensGA 30602USA

Background:The so-called macular carotenoids(MC)lutein(L),zeaxanthin(Z),and meso-zeaxanthin(MZ)comprise the diet-derived macular pigment(MP).The purpose of this study was to determine effects of MC supplementation on the optical density of MP(MPOD),repeated-exposure photostress recovery(PSR),and disability glare(DG)***:This was a double-blind,placebo-controlled ***-nine young(mean age=21.7),healthy volunteers participated in this *** supplemented their daily diet with either 10 mg L+2 mg total Z(1 mg Z+1 mg MZ;n=24),20 mg L+4 mg total Z(2 mg Z+2 mg MZ;n=25),or placebo(n=10)for 12 *** primary outcome was a composite measure of visual performance in glare,defined by change in DG and *** outcomes included MPOD and visual *** primary endpoint for outcomes was 12 *** was assessed with customized heterochromatic flicker *** times for an 8 cycle/degree,15%contrast Gabor patch target were determined after each of five successive exposures to intense LED *** threshold was defined as the intensity of a ring of lights through which subjects were able to maintain visibility of the aforementioned *** of all parameters were conducted at baseline,6 months,and 12 ***-measures ANOVA,and Pearson product-moment correlations were used to determine statistically significant correlations,and changes within and between ***:MPOD for subjects in both supplementation groups increased significantly versus placebo at both 6-and 12-month visits(pjects’DG thresholds were significantly related to chang

关键词： Lutein Zeaxanthin Mesozeaxanthin Visual performance Photostress recovery Disability glare Macular pigment Visual cycle

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Double-blind randomized sham controlled trial of intraperitoneal bupivacaine during emergency laparoscopic cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 310-316页

作者： Keith j Roberts jeff Gilmour Ruplay Pande james Hodson For Tai Lam Saboor Khan Department of Hepatopancreatobiliary Surgery University Hospitals Coventry and Warwickshire Wolfson Laboratory University Hospitals Birmingham

BACKGROUND: Intraperitoneal local anesthesia (IPLA) during elective laparoscopic cholecystectomy (el-LC) decreases post-operative pain. None of the studies have explored the efficacy of IPLA at emergency laparoscopic cholecystectomy (em-LC). A longer operative duration, the greater frequency of washing, and the inflammation associated with cholecystitis or pancreatitis are a few reasons why it cannot be assumed that a benefit in pain scores will be seen in em-LC with IPLA. This study was undertaken to assess the efficacy of IPLA in patients undergoing em-LC. METHODS: Double-blind randomized sham controlled trial was conducted of 41 consecutive subjects undergoing em-LC. IPLA was delivered by a combination of injection to the diaphragmatic and topical wash over the liver and gallbladder with bupivacaine or saline. The primary outcome was visual analogue scale pain scores until discharge. Secondary outcomes included pain scores in theatre recovery and analgesic consumption. RESULTS: One patient had a procedure converted to open and was excluded. There was no significant difference in pain scores in the ward or theatre recovery. Analgesic use, respiratory rate, oxygen saturation, duration to ambulation, eating, satisfaction scores, and time to discharge were comparable between the two groups. CONCLUSIONS: IPLA during em-LC does not influence postoperative pain. Other modalities of analgesia should be explored for decreasing the interval between diagnosis of acute admission and em-LC.

关键词： gallbladder stone disease gallbladder cholecystectomy

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The NORE1A/RASSF5 Tumor Suppressor Forms a Complex with GSK-3β to Regulate β-Catenin

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journal of Biosciences and Medicines 2024年第8期12卷 60-75页

作者： M. Lee Schmidt Howard Donninger Geoffrey j. Clark Department Pharmacology and Toxicology University of Louisville Louisville USA US Worldmeds LouisvilleUSA Department of Medicine University of Louisville Louisville USA Experimental Therapeutics Program James Graham Brown Cancer Center University of Louisville Louisville USA

NORE1A (RASSF5) is a tumor suppressor of the RASSF family that is often down-regulated in human tumors. NORE1A has multiple roles in controlling cellular homeostasis, one of them being regulating levels of β-catenin by binding and modulating the ubiquitin ligase substrate recognition factor β-TrCP. β-catenin is a major executor of the Wnt pathway. The ubiquitin SCF-β-TrCP ligase complex acts on a phospho-degron site in β-catenin that can be phosphorylated by GSK-3β. We now show that in addition to binding β-TrCP, NORE1A also promotes the phosphorylation of the β-catenin phospho-degron by complexing with the kinase GSK-3β. Indeed, NORE1A enhances the formation of a GSK-3β/β-TrCP complex. A structural mutant of NORE1A that retains β-TrCP binding but will no longer interact with GSK-3β inhibits the β-catenin degrading action of NORE1A. The GSK-3β interaction with NORE1A plays an important role in the biology of NORE1A as a GSK-3β inhibitor blocks NORE1A induced senescence. Thus, we identify a new role for the tumor suppressor NORE1A: The regulation of GSK-3β. GSK-3β has many other substrates including multiple transcription factors and co-activators such as p53 and the Hippo component TAZ. The work implies that NORE1A may be able to influence all of them via this new kinase scaffolding interaction.

关键词： RAS NORE1A RASSF5 GSK-3β Beta Catenin HIPPO

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Understanding the sources and composition of the incremental excess of fine particles across multiple sampling locations in one air shed

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journal of Environmental Sciences 2014年第4期26卷 818-826页

作者： jerome E.McGinnis jongbae Heo Michael R.Olson Andrew P.Rutter james j.Schauer University of Wisconsin-Madison Environmental Chemistry and Technology Program Wisconsin State Laboratory of Hygiene

Well-designed health studies and the development of effective regulatory policies need to rely on an understanding of the incremental differences in particulate matter concentrations and their sources. Although only a limited number of studies have been conducted to examine spatial differences in sources to particulate matter within an air shed, routine monitoring data can be used to better understand these differences. Measurements from the US EPA Chemical Speciation Network （CSN） collected between 2002-2008 were analyzed to demonstrate the utility of regulatory data across three sites located within 100 km of each other. Trends in concentrations, source contribution, and incremental excesses across three sites were investigated using the Positive Matrix Factorization model. Similar yearly trends in chemical composition were observed across all sites, however, excesses of organic matter and elemental carbon were observed in the urban center that originated from local emissions of mobile sources and biomass buming. Secondary sulfate and secondary nitrate constituted over half of the PM2.5 with no spatial differences observed across sites. For these components, the excess of emissions from industrial sources could be directly quantified. This study demonstrates that CSN data from multiple sites can be successfully used to derive consistent source profiles and source contributions for regional pollution, and that CSN data can be used to quantify incremental differences in source contributions of across these sites. The analysis strategy can be used in other regions of the world to take advantage of existing ambient particulate matter monitoring data to better the understanding of spatial differences in source contributions within a given air shed.

关键词： CSN Incremental Excess PMFPM2.5

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