Public Reporting as a Communication Tool to Aid Vulnerable Consumers in Healthcare Decisions: What Do We Know?

Background/Introduction: There is tremendous variation in quality, healthcare service utilization and disparities experienced by the poor, certain minorities, and other priority populations. Public reporting is identified as one method of bringing these differences to light and by informing consumers through documented comparison of provider performance to influence change and encourage improvement in healthcare. The federal Accountable Care Act has the stated mandate “to improve the dissemination of measures of healthcare quality and resource use, (and) to build the science of public reporting.” However, early studies on the design and use of consumer reports cite the public’s confusion and lack of understanding regarding the utility of such reports. Objectives: 1. Determine if public reporting is being utilized in making healthcare decisions: by vulnerable consumers defined as African American, Latino and White populations who are Medicare beneficiaries by vulnerable consumers with chronic diseases such as diabetes 2. Determine the gaps in knowledge of healthcare public reports utilization by vulnerable populations 3. Identify barriers and facilitators to help vulnerable diabetic populations make informed decisions about personal healthcare services Methods: A systematic review of the literature was conducted of relevant databases, reports, books, websites, and grey literature. Conclusions/Lessons Learned: While consumer reports are designed for consumers, consumers rarely use them and seem unaware of the availability of such reports. Little evidence that reports are designed for vulnerable populations. Much work needed to assist consumers in using consumer reports

Latinas and Breast Cancer in the Midwest: Factors Influencing Survivorship

Latinos are the largest ethnic minority group in the U.S. and the Midwest is experiencing the fastest growth in residents of Hispanic descent. Rural health care delivery systems in these areas must therefore respond to changing demographics and provide culturally appropriate service delivery. The incidence rate of breast cancer among Latinas is lower than that among non-Hispanic women; however an increasing number of Latinas are being diagnosed with breast cancer. Despite higher mortality rates from cancer than non-Hispanic women, more Latinas are being treated for breast cancer and are now facing their own unique survivorship experiences This paper addresses factors that may influence Latinas\u27 breast cancer survivorship in the Midwest (e.g., risk factors such as biology, lifestyle, culturally mediated health beliefs; access to necessary cancer care in rural areas) and survey research on survivorship experiences in cultural contexts. Essential areas for future research are identified

The effect of subconjunctival bevacizumab on corneal neovascularization, inflammation and re-epithelization in a rabbit model

PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects

Understanding breast-cancer patients’ perceptions: Health information-seeking behaviour and passive information receipt

It is critical to understand patients’ information use from the patient perspective, especially when patients are from different cultures and levels of health literacy. A cross-sectional survey supplemented with interviews of breast cancer survivors including both Latina and non- Latina women was undertaken. Subjects were classified as active information seekers, passive information receivers, and/or users of information. Subjects were further classified by stage of information use, progressing from unawareness or awareness of available information to use or non-use of information to make health decisions. Information sources used and use patterns were examined. Most were active information seekers; many were also passive receivers. Healthcare providers remain the primary information source. Interpersonal communication was far more often cited than either the internet or traditional print and broadcast media. Important cross-cultural differences were found. This study provides insight into how patients use actively sought and passively received information. Despite dramatic growth of the internet and other new media, healthcare providers currently remain keys to health information. Findings may help develop more successful communication strategies when viewed in light of the National Cancer Institute’s ‘Making Health Communication Programs Work’ and the four stages it proposes. It is hoped that future work will focus on evidence-based methods to improve health communication, especially for vulnerable populations. A major lesson learned is the importance of understanding where patients decided to seek information outside the traditional provideroriented approach taken in many health education programmes

Novel critical exponent of magnetization curves near the ferromagnetic quantum phase transitions of Sr1-xAxRuO3 (A = Ca, La0.5Na0.5, and La)

We report a novel critical exponent delta=3/2 of magnetization curves M=H^{1/delta} near the ferromagnetic quantum phase transitions of Sr1-xAxRuO3 (A = Ca, La0.5Na0.5, and La), which the mean field theory of the Ginzburg-Landau-Wilson type fails to reproduce. The effect of dirty ferromagnetic spin fluctuations might be a key.Comment: 4 pages, 5 figure

Peripherally restricted oxytocin is sufficient to reduce food intake and motivation, while <scp>CNS</scp> entry is required for locomotor and taste avoidance effects

ObjectivesOxytocin (OT) has a well‐established role in reproductive behaviours; however, it recently emerged as an important regulator of energy homeostasis. In addition to central nervous system (CNS), OT is found in the plasma and OT receptors (OT‐R) are found in peripheral tissues relevant to energy balance regulation. Here, we aim to determine whether peripheral OT‐R activation is sufficient to alter energy intake and expenditure.Methods and ResultsWe first show that systemic OT potently reduced food intake and food‐motivated behaviour for a high‐fat reward in male and female rats. As it is plausible that peripherally, intraperitoneally (IP) injected OT crosses the blood‐brain barrier (BBB) to produce some of the metabolic effects within the CNS, we screened, with a novel fluorescently labelled‐OT (fAF546‐OT, Roxy), for the presence of IP‐injected Roxy in CNS tissue relevant to feeding control and compared such with BBB‐impermeable fluorescent OT‐B$_{12}$ (fCy5‐OT‐B$_{12;}$ BRoxy). While Roxy did penetrate the CNS, BRoxy did not. To evaluate the behavioural and thermoregulatory impact of exclusive activation of peripheral OT‐R, we generated a novel BBB‐impermeable OT (OT‐B$_{12}$), with equipotent binding at OT‐R in vitro. In vivo, IP‐injected OT and OT‐B$_{12}$ were equipotent at food intake suppression in rats of both sexes, suggesting that peripheral OT acts on peripheral OT‐R to reduce feeding behaviour. Importantly, OT induced a potent conditioned taste avoidance, indistinguishable from that induced by LiCl, when applied peripherally. Remarkably, and in contrast to OT, OT‐B$_{12}$ did not induce any conditioned taste avoidance. Limiting the CNS entry of OT also resulted in a dose‐dependent reduction of emesis in male shrews. While both OT and OT‐B$_{12}$ proved to have similar effects on body temperature, only OT resulted in home‐cage locomotor depression.ConclusionsTogether our data indicate that limiting systemic OT CNS penetrance preserves the anorexic effects of the peptide and reduces the clinically undesired side effects of OT: emesis, taste avoidance and locomotor depression. Thus, therapeutic targeting of peripheral OT‐R may be a viable strategy to achieve appetite suppression with better patient outcomes

Neutrino Interferometry In Curved Spacetime

Gravitational lensing introduces the possibility of multiple (macroscopic) paths from an astrophysical neutrino source to a detector. Such a multiplicity of paths can allow for quantum mechanical interference to take place that is qualitatively different to neutrino oscillations in flat space. After an illustrative example clarifying some under-appreciated subtleties of the phase calculation, we derive the form of the quantum mechanical phase for a neutrino mass eigenstate propagating non-radially through a Schwarzschild metric. We subsequently determine the form of the interference pattern seen at a detector. We show that the neutrino signal from a supernova could exhibit the interference effects we discuss were it lensed by an object in a suitable mass range. We finally conclude, however, that -- given current neutrino detector technology -- the probability of such lensing occurring for a (neutrino-detectable) supernova is tiny in the immediate future.Comment: 25 pages, 1 .eps figure. Updated version -- with simplified notation -- accepted for publication in Phys.Rev.D. Extra author adde

A20, a modulator of smooth muscle cell proliferation and apoptosis, prevents and induces regression of neointimal hyperplasia

A20 is a NF‐κB‐dependent gene that has dual anti‐inflammatory and antiapoptotic functions in endothelial cells (EC). The function of A20 in smooth muscle cells (SMC) is unknown. We demonstrate that A20 is induced in SMC in response to inflammatory stimuli and serves an anti‐inflammatory function via blockade of NF‐κB and NF‐κB‐dependent proteins ICAM‐1 and MCP‐1. A20 inhibits SMC proliferation via increased expression of cyclin‐dependent kinase inhibitors p21waf1 and p27kip1. Surprisingly, A20 sensitizes SMC to cytokine‐ and Fas‐mediated apoptosis through a novel NO‐dependent mechanism. In vivo, adenoviral delivery of A20 to medial rat carotid artery SMC after balloon angioplasty prevents neointimal hyperplasia by blocking SMC proliferation and accelerating re‐endothelialization, without causing apoptosis. However, expression of A20 in established neointimal lesions leads to their regression through increased apoptosis. This is the first demonstration that A20 exerts two levels of control of vascular remodeling and healing. A20 prevents neointimal hyperplasia through combined anti‐inflammatory and antiproliferative functions in medial SMC. If SMC evade this first barrier and neointima is formed, A20 has a therapeutic potential by uniquely sensitizing neointimal SMC to apoptosis. A20‐based therapies hold promise for the prevention and treatment of neointimal disease.—Patel, V. I., Daniel, S., Longo, C. R., Shrikhande, G. V., Scali, S. T., Czismadia, E., Groft, C. M., Shukri, T., Motley‐Dore, C., Ramsey, H. E., Fisher, M. D., Grey, S. T., Arvelo, M. B., Ferran, C. A20, a modulator of smooth muscle cell proliferation and apoptosis, prevents and induces regression of neointimal hyperplasia. FASEB J. 20, 1418–1430 (2006)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154452/1/fsb2fj054981com.pd