Using Social Determinants Screening/Mapping Tools to Identify Needs and Resources for Student-Run Free Clinic Patients

Background: Social determinants of health have been well accepted as contributing to health outcomes. They are a vital aspect of health care delivery and must be a consideration, especially among free clinic populations. Social determinants of health have also become a required element of medical school curricula. The Student Outreach to Area Residents Student-Run Free Clinic based out of Northeast Ohio Medical University piloted a student-led program that implemented social determinants of health screening and community resource referral as a part of integrated health care delivery for all its patients. Methods: We described the development of a screening tool, protocol, and creation of community resource referral materials. We also described the tracking of patient-reported needs and mapping of location and accessibility of community resources. One hundred patients were surveyed through convenience sampling, and results were used for program improvement. Results/Conclusion: After collecting and analyzing survey results, it was found that the 2 most frequently requested determinants were mental health and utilities services, and the most available community resource was emergency food services. We also mapped these results by zip code and found gaps between need and distribution of services. We demonstrated the utility of mapping to identify points of improvement for the future. We also provided lessons learned related to effective social determinants of health screening, community resource referral, and overall program implementation in student-run free clinics. We further explained the benefits of including similar student-led programs as a way for students to gain practical experience related to social determinants of health

The Use of Substances Other Than Nicotine in Electronic Cigarettes Among College Students

Introduction: Electronic cigarettes (e-cigarettes) have grown in popularity, especially among youth and young adults. Although e-cigarettes were originally intended to vaporize a liquid mixture containing nicotine, there appears to be an increasing trend in other substance use in e-cigarettes (OSUE). Materials and methods: Cross-sectional data from 1542 undergraduate college student e-cigarette users from a large Midwestern university were collected via online survey to assess prevalence of e-cigarette use, reasons for use, perceived harm, and prevalence and predictors of OSUE. Results: Nearly 7% (6.94%) reported using an e-cigarette to vaporize and inhale a substance other than nicotine. Current tobacco cigarette smokers were significantly more likely to report OSUE (51.0%) as compared with never (33.7%) and former (15.4%) smokers. Among respondents reporting OSUE, the primary reason for e-cigarette use was “safer than cigarettes” (21.7%), followed by “experimentation” (18.9%) and “friends use” (17.0%). Most (77.9%) reported using cannabis or some derivative of cannabis in an e-cigarette. Binomial logistic regression found that women were less likely to report OSUE by a factor of 0.60, former tobacco cigarette smokers as compared with never smokers were more likely to report OSUE by a factor of 1.87, and e-cigarette users who reported using e-cigarettes for “cool or trendy” reasons were more likely to report OSUE by a factor of 2.89. Discussion: Little is known regarding the health effects of cannabis and cannabis derivatives delivered through e-cigarettes. Concern may also be warranted regarding the potential dangers of this young population using substances more dangerous than cannabis in e-cigarettes. Knowledge is limited regarding the public health impact of vaping cannabis or other illicit substances among college student populations. This study stresses the need for continued research regarding the vaping of cannabis and other illicit substances among college students

Probabilidade de acontecimentos envolvendo aspetos lógicos

In this article, we study the Probability's knowledge of prospective primary school teachers, when there are logical aspects involved in the formulation of events. Forty-six students participated in the study, from a University in Northern Portugal, who had to resolve a three-item task in the context of a formal evaluation: the first one, on the union probability (connective or), the second one, on the joint probability (connective and), and the third one, on the conditional probability, in which the conditioned event is, in turn, a joint probability (connective and). In terms of the main results of the study, it was found that the students showed a very limited performance, frequently changing the connectives and and or, the inclusive disjunction with the exclusive disjunction and in the disjunction considered as incompatible non-disjoint events.Neste artigo estuda-se o conhecimento de Probabilidades de futuros professores dos primeiros anos escolares, quando na formulação dos acontecimentos estão envolvidos aspetos lógicos. Participaram no estudo 46 alunos da Licenciatura em Educação Básica, de uma Universidade do Norte de Portugal, os quais resolveram uma tarefa, com três itens, em contexto de avaliação formal: o primeiro sobre a probabilidade da reunião (conetivo ), o segundo sobre a probabilidade conjunta (conetivo ) e o terceiro sobre a probabilidade condicionada, em que o acontecimento condicionado é, por sua vez, uma probabilidade conjunta (conetivo ). Em termos dos principais resultados do estudo, verificou-se que os alunos revelaram um desempenho muito limitado, trocando, frequentemente, os conetivos e , a disjunção inclusiva com a disjunção exclusiva e na disjunção consideraram como sendo incompatíveis acontecimentos não disjuntos.Este trabalho contou com o apoio de Fundos Nacionais através da FCT – Fundação para a Ciência e a Tecnologia no âmbito do projeto PEst-OE/CED/UI1661/2014, do CIEd-UM e do projeto UID/Multi/04016/2016

Connie Myers v. Albertsons, Inc. : Brief of Appellee

Appeal of the Judgment of Michael Glasmann Based upon a Jury Verdict Second Judicial District Court Weber County, State of Uta

Transverse Electronic Transport through DNA Nucleotides with Functionalized Graphene Electrodes

Graphene nanogaps and nanopores show potential for the purpose of electrical DNA sequencing, in particular because single-base resolution appears to be readily achievable. Here, we evaluated from first principles the advantages of a nanogap setup with functionalized graphene edges. To this end, we employed density functional theory and the non-equilibrium Green's function method to investigate the transverse conductance properties of the four nucleotides occurring in DNA when located between the opposing functionalized graphene electrodes. In particular, we determined the electrical tunneling current variation as a function of the applied bias and the associated differential conductance at a voltage which appears suitable to distinguish between the four nucleotides. Intriguingly, we observe for one of the nucleotides a negative differential resistance effect.Comment: 19 pages, 7 figure

Development of intuitive rules: Evaluating the application of the dual-system framework to understanding children's intuitive reasoning

This is an author-created version of this article. The original source of publication is Psychon Bull Rev. 2006 Dec;13(6):935-53 The final publication is available at www.springerlink.com Published version: http://dx.doi.org/10.3758/BF0321390

Inter-observer Variability of Expert-derived Morphologic Risk Predictors in Aortic Dissection

OBJECTIVES: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning. METHODS: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow. A second inter-observer variability assessment on 30 out of the 47 CTA scans compared observers 3 and 4 with a constrained, standardized workflow. A third inter-observer variability assessment was done after specialized training and tested between observers 3 and 4 in an external population of 25 CTA scans. Inter-observer agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS: Pre-training ICCs of the four morphologic features ranged from 0.04 (-0.05 to 0.13) to 0.68 (0.49-0.81) between observer 1 and observers 2-4 and from 0.50 (0.32-0.69) to 0.89 (0.78-0.95) between observers 3 and 4. ICCs improved after training ranging from 0.69 (0.52-0.87) to 0.97 (0.94-0.99), and Bland-Altman analysis showed decreased bias and limits of agreement. CONCLUSIONS: Manual morphologic feature measurements on CTA images can be optimized resulting in improved inter-observer reliability. This is essential for robust ground-truth determination for machine learning models. KEY POINTS: • Clinical fashion manual measurements of aortic CTA imaging features showed poor inter-observer reproducibility. • A standardized workflow with standardized training resulted in substantial improvements with excellent inter-observer reproducibility. • Robust ground truth labels obtained manually with excellent inter-observer reproducibility are key to develop reliable machine learning models

Two-year outcomes after transcatheter or surgical aortic-valve replacement.

BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. METHODS: At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. RESULTS: The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001). CONCLUSIONS: A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.)

Simultaneous genetic analysis of longitudinal means and covariance structure in the simplex model using twin data

A longitudinal model based on the simplex model is presented to analyze simultaneously means and covariance structure using univariate longitudinal twin data. The objective of the model is to decompose the mean trend into components which can be attributed to those genetic and environmental factors which give rise to phenotypic individual differences and a component of unknown constitution which does not involve individual differences. Illustrations are given using simulated data and repeatedly measured weight obtained in a sample of 82 female twin pairs on sbc occasions. KEY WORDS: repeated measures; genetic and environmental covariance structure; mean trend; longitudinal twin data; genetic simplex mode; LISREL

Individual differences in puberty onset in girls: Bayesian estimation of heritabilities and genetic correlations

We report heritabilities for individual differences in female pubertal development at the age of 12. Tanner data on breast and pubic hair development in girls and data on menarche were obtained from a total of 184 pairs of monozygotic and dizygotic twins. Genetic correlations were estimated to determine to what extent the same genes are involved in different aspects of physical development in puberty. A Bayesian estimation approach was taken, using Markovchain Monte Carlo simulation to estimate model parameters. All three phenotypes were to a significant extent heritable and showed high genetic correlations, suggesting that a common set of genes is involved in the timing of puberty in general. However, gonadarche (menarche and breast development) and adrenarche (pubic hair) are affected by different environmental factors, which does not support the three phenotypes to be regarded as indicators of a unitary physiological factor. © 2006 Springer Science+Business Media, Inc