The Impact of the Patient-Centered Medical Home on Health Disparities in Adults: A Systematic Review of the Evidence

Introduction: The objective of this study was to review the empirical evidence on Patient-Centered Medical Home (PCMH) impact on health disparities in adults. Methods: We searched PubMed, Scopus, and Google Scholar to identify studies on PCMH/health homes and health disparities published in English between January 1, 2009 and December 31, 2014. Articles met inclusion criteria if they investigated at least one component of PCMH or health homes in vulnerable populations, defined by PROGRESS-PLUS criteria, and reported differences in one of five clinical quality measures. Results: 964 articles were identified through database searching and subsequent snowballing. 60 articles underwent full text screening. Further review eliminated 56 studies. In the final 4 studies, PCMH interventions showed small improvements in health disparities. Discussion: The PCMH has been suggested as a model for improving health disparities. Given rapid implementation in underserved settings, stakeholders should better understand the impact of the PCMH on health disparities

Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients

Background Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost

Spitzer Mid-Infrared Spectroscopy of Infrared Luminous Galaxies at z~2 II: Diagnostics

We present mid-IR spectral decomposition of a sample of 48 Spitzer-selected ULIRGs spanning z~1-3 and likely L_IR~10^12-10^13Lsun. Our study aims at quantifying the star-formation and AGN processes in these sources which recent results suggest have evolved strongly between the observed epoch and today. To do this, we study the mid-IR contribution of PAH emission, continuum, and extinction. About 3/4 of our sample are continuum- (i.e. AGN) dominated sources, but ~60% of these show PAH emission, suggesting the presence of star-formation activity. These sources have redder mid-IR colors than typical optically-selected quasars. About 25% of our sample have strong PAH emission, but none are likely to be pure starbursts as reflected in their relatively high 5um hot dust continua. However, their steep 30um-to-14um slopes suggest that star-formation might dominate the total infrared luminosity. Six of our z~2 sources have EW6.2>~0.3um and L_14um>~10^12Lsun (implying L_IR>~10^13Lsun). At these luminosities, such high EW6.2 ULIRGs do not exist in the local Universe. We find a median optical depth at 9.7um of =1.4. This is consistent with local IRAS-selected ULIRGs, but differs from early results on SCUBA-selected z~2 ULIRGs. Similar to local ULIRGs about 25% of our sample show extreme obscuration (tau_9.7>~3) suggesting buried nuclei. In general, we find that our sources are similar to local ULIRGs, but are an order of magnitude more luminous. It is not clear whether our z~2 ULIRGs are simply scaled-up versions of local ULIRGs, or subject to fundamentally different physical processes.Comment: 60 pages, 15 figures, accepted for publication in Ap

Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis

Background: Although fluoride may cause neurotoxicity in animal models and acute fluoride poisoning causes neurotoxicity in adults, very little is known of its effects on children’s neurodevelopment. Objective: We performed a systematic review and meta-analysis of published studies to investigate the effects of increased fluoride exposure and delayed neurobehavioral development. Methods: We searched the MEDLINE, EMBASE, Water Resources Abstracts, and TOXNET databases through 2011 for eligible studies. We also searched the China National Knowledge Infrastructure (CNKI) database, because many studies on fluoride neurotoxicity have been published in Chinese journals only. In total, we identified 27 eligible epidemiological studies with high and reference exposures, end points of IQ scores, or related cognitive function measures with means and variances for the two exposure groups. Using random-effects models, we estimated the standardized mean difference between exposed and reference groups across all studies. We conducted sensitivity analyses restricted to studies using the same outcome assessment and having drinking-water fluoride as the only exposure. We performed the Cochran test for heterogeneity between studies, Begg’s funnel plot, and Egger test to assess publication bias, and conducted meta-regressions to explore sources of variation in mean differences among the studies. Results: The standardized weighted mean difference in IQ score between exposed and reference populations was –0.45 (95% confidence interval: –0.56, –0.35) using a random-effects model. Thus, children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas. Subgroup and sensitivity analyses also indicated inverse associations, although the substantial heterogeneity did not appear to decrease. Conclusions: The results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment. Future research should include detailed individual-level information on prenatal exposure, neurobehavioral performance, and covariates for adjustment

Extremal generalized quantum measurements

A measurement on a section K of the set of states of a finite dimensional C*-algebra is defined as an affine map from K to a probability simplex. Special cases of such sections are used in description of quantum networks, in particular quantum channels. Measurements on a section correspond to equivalence classes of so-called generalized POVMs, which are called quantum testers in the case of networks. We find extremality conditions for measurements on K and characterize generalized POVMs such that the corresponding measurement is extremal. These results are applied to the set of channels. We find explicit extremality conditions for two outcome measurements on qubit channels and give an example of an extremal qubit 1-tester such that the corresponding measurement is not extremal.Comment: 13 pages. The paper was rewritten, reorganized and shortened, the title changed, references were added. Main results are the sam

Conditions for Successful Environmental Policy Making in Globalized Metropolitan Areas: Understanding Los Angeles County Air Pollution Policies

학위논문 (석사)-- 서울대학교 대학원 : 정치외교학부(외교학전공), 2013. 8. Stefan Niederhafner.45퍼센트의 전세계 대기 오염 물질 및 이상화탄소가 도시에서 배출되므로 환경의 질적 저하 특히 대기 오염이 전세계의 도시와 도시 복합 지역에 심각한 위협을 가하고 있다. 이 논문에서는 로스앤젤레스시의 성공적인 청정 대기 정책 사례를 조사하고 더불어 지역의 오염원에 대응하는 세계적 난제에 기여하며 성공적인 환경 관련 사안 특히 청정 대기 정치 분야와 관련된 조건에 관해 자세히 설명한다. 이 연구의 주요 목표는 최상의 관행 모델의 측면에서 같은 문제를 다루는 다른 세계 도시들에 적용될 수 있는 제도 및 절차적 세부 사항을 파악하는 것이다. 정책 주기 분석과 결합된 새로운 제도 개념을 적용하여 지방 정부에서의 대기 오염 관리의 의사 결정 과정뿐만 아니라 NGO(비정부 기구) 및 여론의 역할과 영향을 조사할 수 있다. 본 분석의 실증적 근거는 자치주 규정 5.90장 및 규칙 1143에 해당하는 두 가지 정책에 대한 심도 있는 연구 인다. 이 두 가지 경우에 대한 연구가 로스앤젤레스시의 정치 체계가 어떻게 대기 오염을 지역에 대한 위협으로 파악하고 효과적이고 유효한 청정 대기 정책을 통해 대기 오염에 대응할 수 있었는지를 설명하게 된다. 결과적으로 이 연구는 NGO 및 폭넓은 대중의 기여를 위한 제도의 다양화 및 전문화, 법원의 관할권 및 접점과 같은 세 가지 주요 조건이 성공적인 청정 대기 정책을 위해 아주 중요함을 주장한다. 게다가 이 연구는 세계 환경 및 건강에 대한 위협에 대응하는 데 로스앤젤레스시가 어떻게 공헌할 수 있는지도 제시한다.Environmental degradation, particularly in air pollution, is posing a serious threat for cities and urban agglomerations around the world since 45 percent of global air pollutants and CO2 emissions stem from cities. By way of investigating the cases of successful clean air policies in the city of Los Angeles, this paper will elaborate on the conditions for successful environmental issues, specifically in clean air politics, in addition to contributing to a global challenge of counteracting against its local origins. The main goal in this study is to identify institutional and procedural specifics that can be transferred in the sense of the best practice model to other global cities dealing with the same problem. By applying a new-institutional concept combined with a policy cycle analysis, this will allow not only an analysis of the decision-making process of air pollution control in the local government, but also to examine the role and the influence of NGOs and public opinion. The empirical basis of the analysis is an in-depth study of two policies, County Code Chapter 5.90 and Rule 1143. Studying these two cases will explain how the political system of Los Angeles was able to identify air pollution as a local threat and to react with effective and efficient clean air policies. As a result, this study argues that three major conditions, institutional diversification and specialization, court jurisdiction and access points for contributions of NGOs and the wider public are crucial for successful clean air policies. Moreover, this study presents how the Los Angeles County can contribute to counteracting global environment and health threats.Table of Contents Chapter 1 Introduction 1.1 Importance of Globalized Cities 1.2 Purpose and Case Selection 1.3 Literature Review 1.4 Theoretical Framework 1.5 Operationalization Chapter 2 Political Background and History of Air Pollution 2.1 Demographic and Economy 2.2 Political Structure 2.3 Causes of Air Pollution 2.4 Effects from Air Pollution Chapter 3 Agenda-Setting in Clean Air Policies 3.1 Board of Supervisors and Chapter 5 of the Los Angeles County Code 3.2 AQMD and Rule 1143 3.3 Coalition for Clean Air 3.4 Conclusion Chapter 4 Policy Formation in Clean Air Policies 4.1 Board of Supervisors and Chapter 5 of the Los Angeles County Code 4.2 AQMD and Rule 1143 4.3 Conclusion Chapter 5 Decision-Making and Implementation in Clean Air Policies 5.1 Board of Supervisors and Chapter 5 of the Los Angeles County Code 5.2 AQMD and Rule 1143 5.3 Conclusion Chapter 6 Evaluation in Clean Air Policies 6.1 Board of Supervisors and Chapter 5 of the Los Angeles County Code 6.2 AQMD and Rule 1143 6.3 Conclusion Chapter 7 Conclusion Bibliography AppendixMaste

How robust are cross-country comparisons of PISA scores to the scaling model used?

The Programme for International Student Assessment (PISA) is an important international study of 15‐olds' knowledge and skills. New results are released every 3 years, and have a substantial impact upon education policy. Yet, despite its influence, the methodology underpinning PISA has received significant criticism. Much of this criticism has focused upon the psychometric scaling model used to create the proficiency scores. The aim of this article is to therefore investigate the robustness of cross‐country comparisons of PISA scores to subtle changes to the underlying scaling model used. This includes the specification of the item‐response model, whether the difficulty and discrimination of items are allowed to vary across countries (item‐by‐country interactions) and how test questions not reached by pupils are treated. Our key finding is that these technical choices make little substantive difference to the overall country‐level results