No equity, no triple aim: strategic proposals to advance health equity in a volatile policy environment

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health—the conditions in which we live, work, play, and learn. This article summarizes underlying causes of health inequity and comparatively poor health outcomes in the U.S. It describes barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk for the health of their patients by undertaking greater prevention efforts. The article asserts that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform. It outlines practical opportunities for improving care and for promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socio-economic factors that influence health

No equity, no triple aim: strategic proposals to advance health equity in a volatile policy environment

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health—the conditions in which we live, work, play, and learn. This article summarizes underlying causes of health inequity and comparatively poor health outcomes in the U.S. It describes barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk for the health of their patients by undertaking greater prevention efforts. The article asserts that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform. It outlines practical opportunities for improving care and for promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socio-economic factors that influence health

Splitting technique for analytical modelling of two-phase multicomponent flow in porous media

In this paper we discuss one-dimensional models for two-phase Enhanced Oil Recovery (EOR) floods (oil displacement by gases, polymers, carbonized water, hot water, etc.). The main result presented here is the splitting of the EOR mathematical model into thermodynamical and hydrodynamical parts. The introduction of a potential associated with one of the conservation laws and its use as a new independent coordinate reduces the number of equations by one. The (n) × (n) conservation law model for two-phase n-component EOR flows in new coordinates is transformed into a reduced (n − 1) × (n − 1) auxiliary system containing just thermodynamical variables (equilibrium fractions of components, sorption isotherms) and one lifting equation containing just hydrodynamical parameters (phase relative permeabilities and viscosities). The algorithm to solve analytically the problem includes solution of the reduced auxiliary problem, solution of one lifting hyperbolic equation and inversion of the coordinate transformation. The splitting allows proving the independence of phase transitions occurring during displacement of phase relative permeabilities and viscosities. For example, the minimum miscibility pressure (MMP) and transitional tie lines are independent of relative permeabilities and phases viscosities. Relative motion of polymer, surfactant and fresh water slugs depends on sorption isotherms only. Therefore, MMP for gasflood or minimum fresh water slug size providing isolation of polymer/surfactant from incompatible formation water for chemical flooding can be calculated from the reduced auxiliary system. Reduction of the number of equations allows the generation of new analytical models for EOR. The analytical model for displacement of oil by a polymer slug with water drive is presented.Adolfo P. Pires, Pavel G. Bedrikovetsky, Alexander A. Shapir

Sustaining a “culture of silence” in the neonatal intensive care unit during nonemergency situations: A grounded theory on ensuring adherence to behavioral modification to reduce noise levels

The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to “sustain a culture of silence in NICU during nonemergency situations” (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The “culture of silence” reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a “noisy culture” prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints

Highly efficient and robust cathode materials for low-temperature solid oxide fuel cells: PrBa0.5Sr0.5Co2-xFexO5+delta

Solid oxide fuel cells (SOFC) are the cleanest, most efficient, and cost-effective option for direct conversion to electricity of a wide variety of fuels. While significant progress has been made in anode materials with enhanced tolerance to coking and contaminant poisoning, cathodic polarization still contributes considerably to energy loss, more so at lower operating temperatures. Here we report a synergistic effect of co-doping in a cation-ordered double-perovskite material, PrBa 0.5 Sr 0.5 Co 2-x Fe x O 5+??, which has created pore channels that dramatically enhance oxygen ion diffusion and surface oxygen exchange while maintaining excellent compatibility and stability under operating conditions. Test cells based on these cathode materials demonstrate peak power densities ???2.2â�...W cm -2 at 600 C, representing an important step toward commercially viable SOFC technologies.open16

The influence of external factors on bacteriophages—review

The ability of bacteriophages to survive under unfavorable conditions is highly diversified. We summarize the influence of different external physical and chemical factors, such as temperature, acidity, and ions, on phage persistence. The relationships between a phage’s morphology and its survival abilities suggested by some authors are also discussed. A better understanding of the complex problem of phage sensitivity to external factors may be useful not only for those interested in pharmaceutical and agricultural applications of bacteriophages, but also for others working with phages

A neglected requirement for optimizing treatment of age-related osteoporosis: Replenishing the skeleton’s base reservoir with net base-producing diets

Osteoporosis is a disorder of bone in which the mass of the bone is reduced and the bone's architecture at the microscopic level is disordered. Together those abnormalities predispose affected individuals to experience fractures despite only minimal trauma (i.e., fragility fractures). Age related osteoporosis is a common type of osteoporosis that occurs with aging in both men and women usually beginning after the age of peak bone mass. Research has found that the disorder can be partially reversed by reducing the net amount of acid that is produced when consuming typical Western diets. However, the amelioration that results has not been so dramatic or so consistent that physicians have adopted the procedure as part of the standard treatment for age-related osteoporosis. We propose that reducing the net acid load from the diet is not sufficient to reverse age related osteoporosis because it fails to supply base needed to restore the large amount of base in bone that had been lost by reacting with the net acid load of the diet that had been consumed for years or decades. Reducing the net acid load from the diet might be expected to have little ameliorative effect or merely slow the progression of the disorder. We hypothesize that both to restore osteoporotic bone to, or nearly to, its pre-disease state, as well as to eliminate the risk of fragility fractures, requires consuming diets that produce net amounts of base to restore the base lost from years to decades of consuming diets that produce net amounts of acid. We hypothesize also that the excess base and attendant subclinical metabolic alkalosis will both stimulate the cellular process of bone formation and suppress the cellular process of bone resorption, and thereby implement the restorative process

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd