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

Identification of a surrogate to validate irradiation processing of selected spices

Onion powder and talc were inoculated with one of three groups of Salmonella enterica or a putative surrogate, Enterococcus faecium NRRL B-2354, and the radiation sensitivity of S. enterica was compared to E. faecium. For both inoculated onion powder and inoculated talc, D10-values were greater for E. faecium than any of the three groups of S. enterica. The survival of E. faecium in irradiated talc was used to estimate the potential survival of S. enterica in irradiated spices. Onion powder, dried oregano, whole cumin seeds or peppercorns were mixed with talc inoculated with either S. enterica (previously associated with a foodborne disease outbreak) or E. faecium and irradiated. The D10-values were calculated for each bacterial group and compared between E. faecium and S. enterica within each spice. For each spice, the D10-value for E. faecium was either not statistically different from (P \u3c 0.05) S. entericaor greater than that of S. enterica (onion powder). Quadratic and linear models were developed to allow the estimation of potential surviving populations, and potential decimal reductions of S. enterica, based on surviving populations and decimal reductions determined with E. faecium. The use of E. faecium and these mathematical models would allow a processor to validate an irradiation process by estimating the reduction in S. enterica, based on the population reductions of E. faecium

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

BACKGROUND: Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible. METHODS: This study involved 12 consecutive patients with previous anterior myocardial infarction, dilated cardiomyopathy and no mitral procedures, who underwent left ventricular reconstruction and coronary revascularization between May 2002 and May 2003 using a small, narrow, oval patch aiming at a volume ≤ 45 mL/m(2 )with elliptical shape. Eleven geometric parameters were examined preoperatively and at least 3, 12 and 24 months after the operation by serial echocardiographic studies and evaluated by paired t test taking the time of surgery as a starting point for remodeling. RESULTS: All patients were in NYHA class 1 at follow-up. Patch geometry obtained a conical shape of the ventricle with new apex, physiologic rearrangement of functioning myocardial wall and small residual akinesia. Ventricular changes at the four time-points showed that all parameters improved significantly compared to preoperative values (end-diastolic volume = 184.2 ± 23.9 vs 139.9 ± 22.0, p = 0.001; vs 151.0 ± 33.8, p = 0.06; vs 144.9 ± 34.0, p = 0.38; end-systolic volume = 125.7 ± 20.6 vs 75.2 ± 14.1, p = 0.001; vs 82.1 ± 23.9, p = 0,18; vs 77.1 ± 19.4, p = 0.41) without further changes during follow-up except for wall motion score index (2.0 ± 0.2 to 1.7 ± 0.2, to 1.4 ± 0.2, to 1.3 ± 0.2) and percentage of akinesia (30.4 ± 7.5 to 29.3 ± 4.2, to 19.8 ± 11.6, to 14.5 ± 7.2) which slowly and significantly improved suggesting a positive post-surgery remodeling. CONCLUSION: Ventricular reconstruction caring of physiological shape, volume, revascularization and residual akinesia obtained a steady geometry. Positive remodeling and equalization of geometrical outcome may persistently prevent long-term redilation

Noyo River and Harbor, California Design for Wave and Surge Protection

Source: https://erdc-library.erdc.dren.mil/jspui/A 1:75-scale undistorted hydraulic model was used to determine both short- and longperiod wave conditions and river flow conditions in Noyo River and Harbor as a result of various breakwater configurations at the entrance. The model reproduced the river from its mouth to a point approximately 15,000 ft upstream, both Noyo Harbor and Dolphin Mariria located on the south bank, approximately 3,500 ft of the California shoreline on each side of the river mouth, Noyo Cove, and sufficient offshore area in the Pacific Ocean to permit generation of the required test waves. Some improvement plans included the use of dolosse armor units for breakwaters constructed in Noyo Cove seaward of the river entrance. A 45-ft-long wave generator, crushed coal sediment tracer material, and an automated data acquisition and control system were utilized in model operation

Transport of Deuterium-Labeled Tocopherols During Pregnancy

With use of deuterium-labeled isotopes of RRR-and all-rac-α-tocopheryl acetate, the transport of vitamin E in pregnancy was evaluated to determine whether the placenta discriminates between these compounds. Fifteen pregnant subjects were recruited 5 d before delivery to receive 15, 30, 75, 150, or 300 mg vitamin E/d in capsules containing d3-RRR-α-tocopheryl acetate and d6-all-rac-α-tocopheryl acetate (1:1, by wt). Maternal blood was obtained before dosing, at hospital admission, and at parturition. Cord blood samples were obtained at parturition. Deuterium-labeled and unlabeled tocopherol contents were determined by gas chromatography-mass spectrometry in plasma and lipoproteins (chylomicrons, VLDL, LDL, and HDL). Maternal plasma and lipoproteins obtained at delivery had higher concentrations of d3-RRR-α- tocopherol than d6-all-rac-α-tocopherol regardless of the vitamin E dose administered (P \u3c 0.05). Cord plasma at delivery also had higher concentrations of d3-RRR-α-tocopherol than d6-all-rac-α-tocopherol in plasma irrespective of the dose administered (P \u3c 0.05). In lipoproteins isolated from cord blood, tocopherol concentrations were greatest in the HDL fraction (P \u3c 0.05), whereas in maternal blood they were greatest in the LDL fraction (P \u3c 0.05). We conclude that the placental-fetal unit, the fetal liver, or both further discriminate between RRR- and all-rac-α-tocopherol

Human plasma and tissue \u3b1-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E

We report a comparison of natural and synthetic vitamin E in humans using deuterium labeling to permit the two forms of vitamin E to be measured independently in plasma and tissues of each subject. Differences in natural and synthetic vitamin E concentrations were measured directly under equal dosage conditions using an equimolar mixture of deuterated RRR-alpha-tocopheryl acetate and all-rac-alpha-tocopheryl acetate. Two groups of five adults took 30 mg of the mixture as a single dose and as eight consecutive daily doses, respectively. After a 1-mo interval the schedule was repeated but with a 10-fold higher dose (ie, 300 mg). In each case, the ratio of plasma d3-RRR-alpha-tocopherol to d6-all-rac-alpha-tocopherol (RRR:rac) increased from approximately 1.5-1.8 to approximately 2 after dosing ended. In an elective surgery study in which 22 patients were given 150 mg/d for up to 41 d before surgery, the RRR:rac in tissues was lower than in plasma and the percentage of deuterated alpha-tocopherol was lower in all tissues except gallbladder and liver. In a terminally ill patient given 30 mg/d for 361 d, plasma and tissue (x+/-SD) RRR-rac ratios (and % deuterated alpha-tocopherol) at autopsy were 2.06 (6.3%) and 1.71+/-0.24 (5.9+/-2.2%), respectively. In a second terminally ill patient given 300 mg/d for 615 d, the corresponding values were 2.11 (68%) and 2.01+/-0.17 (65+/-10%), respectively. The results indicated that natural vitamin E has roughly twice the availability of synthetic vitamin E. This 2:1 ratio is significantly higher than the currently accepted RRR:rac of 1.36:1.00. Gamma-Tocopherol, expressed as a fraction of total unlabeled tocopherols in 15 elective surgery patients, was 1.4-4.6 (mean: 2.6) times greater in adipose tissue, muscle, skin, and vein than in plasma, which is a substantially larger fraction than had been recognized previously.Peer reviewed: YesNRC publication: Ye

Identification of a surrogate to validate irradiation processing of selected spices

Onion powder and talc were inoculated with one of three groups of Salmonella enterica or a putative surrogate, Enterococcus faecium NRRL B-2354, and the radiation sensitivity of S. enterica was compared to E. faecium. For both inoculated onion powder and inoculated talc, D10-values were greater for E. faecium than any of the three groups of S. enterica. The survival of E. faecium in irradiated talc was used to estimate the potential survival of S. enterica in irradiated spices. Onion powder, dried oregano, whole cumin seeds or peppercorns were mixed with talc inoculated with either S. enterica (previously associated with a foodborne disease outbreak) or E. faecium and irradiated. The D10-values were calculated for each bacterial group and compared between E. faecium and S. enterica within each spice. For each spice, the D10-value for E. faecium was either not statistically different from (P S. entericaor greater than that of S. enterica (onion powder). Quadratic and linear models were developed to allow the estimation of potential surviving populations, and potential decimal reductions of S. enterica, based on surviving populations and decimal reductions determined with E. faecium. The use of E. faecium and these mathematical models would allow a processor to validate an irradiation process by estimating the reduction in S. enterica, based on the population reductions of E. faecium.This article is published as Arias-Rios, E. V., G. R. Acuff, A. Castillo, L. M. Lucia, S. E. Niebuhr, and J. S. Dickson. "Identification of a surrogate to validate irradiation processing of selected spices." LWT 102 (2019): 136-141. doi: 10.1016/j.lwt.2018.12.018.</p