The American Pathology of Inequitable Access to Medical Care

What most defines access to health care in the United States may be its stark inequity. Daily headlines in top newspapers paint the highs and lows. Articles entitled: “We Mapped the Uninsured. You’ll notice a Pattern: They tend to live in the South, and they tend to be poor” and op-eds with titles like “Do Poor People Have a Right to Health Care?” and “What it’s Like to Be Black and Pregnant when you Know How Dangerous That Can Be” run side-by-side with headlines touting “The Operating Room of the Future,” and advances in gene therapy that promise cures to everything form vision loss to cancer, accompanied by high six-figure price tags. Americans’ claims that they have access to the best medical care in the world are correct. Equally true are the claims that the system is broken.This chapter maps out the complex picture of access to medical care in the United States and reflects on how variable access illustrates, among other things, an American ambivalence about health solidarity. This Chapter first considers health care financing as one critical element that defines access to medical care and describes the multifaceted U.S. health care financing structure, predominated by public insurance programs for select populations and regulated private insurance for others. Second, this Chapter describes how access is equally shaped by legal requirements that create treatment obligations for doctors or hospitals, regardless of how someone pays for care. There is no constitutional right to health in the U.S., but various layers of statutory and common law have created some guarantees. That said, despite efforts to increase access over the past decades, the United States is still extraordinary, as compared to peer nations, on the unevenness of access to medical care among its population

Journal of Women in Educational Leadership

1 Miep Gies (1909-2010): Her Legacy Endures- Marilyn L. Grady 3 Gender Differences in Research Mentorship and Pretenured Counselor Educators- Suzanne Campbell, Kathryn Mueller and Jane M. Souz

Clinical Recovery and Circulating Botulinum Toxin Type F in Adult Patient

A 56-year-old woman in Helena, Montana, USA, who showed clinical signs of paralysis, received antitoxins to botulinum toxins A, B, and E within 24 hours; nevertheless, symptoms progressed to complete quadriplegia. On day 8, she began moving spontaneously, even though blood tests later showed botulinum toxin type F remained

Period changes in six semi-detached Algol-type binaries

Six semi-detached Algol-type binaries lacking a period analysis were chosen to test for a presence of a third body. The O-C diagrams of these binaries were analyzed with the least-squares method by using all available times of minima. Also fourteen new minima, obtained from our observations, were included in the present research. The light-time effect was adopted as a main factor for the detailed description of the long-term period changes. Third bodies were found with orbital periods from 46 up to 84 years, and eccentricities from 0.0 to 0.78 for the selected binaries. The mass functions and the minimal masses of such bodies were also calculated.Comment: 14 pages, 8 figure

Impact of culture towards disaster risk reduction

Number of natural disasters has risen sharply worldwide making the risk of disasters a global concern. These disasters have created significant losses and damages to humans, economy and society. Despite the losses and damages created by disasters, some individuals and communities do not attached much significance to natural disasters. Risk perception towards a disaster not only depends on the danger it could create but also the behaviour of the communities and individuals that is governed by their culture. Within this context, this study examines the relationship between culture and disaster risk reduction (DRR). A comprehensive literature review is used for the study to evaluate culture, its components and to analyse a series of case studies related to disaster risk. It was evident from the study that in some situations, culture has become a factor for the survival of the communities from disasters where as in some situations culture has acted as a barrier for effective DRR activities. The study suggests community based DRR activities as a mechanism to integrate with culture to effectively manage disaster risk

True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring.

Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound \u3eLLOQ from the first viral load was 36.9 % (95 % CI 32.2-41.6) in the first year, 26.9 % (95 % CI 21.7-32.1) in the year following one year of viral suppression, and 24.6 % (95 % CI 18.4-30.9) in the year following 2 years of viral suppression. However, for patients with CD4 ≥300 cells/µl who had 3-6 years of virologic suppression, the risk of viral rebound was very low. At the population level, the risk of viral rebound in a complex urban clinic population is surprisingly high even out to 3 years. Intensified monitoring and adherence efforts should target this high risk period. Thereafter, confidence in truly durable virologic suppression is improved

True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring

Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound \u3eLLOQ from the first viral load was 36.9 % (95 % CI 32.2–41.6) in the first year, 26.9 % (95 % CI 21.7–32.1) in the year following one year of viral suppression, and 24.6 % (95 % CI 18.4–30.9) in the year following 2 years of viral suppression. However, for patients with CD4 ≥300 cells/µl who had 3–6 years of virologic suppression, the risk of viral rebound was very low. At the population level, the risk of viral rebound in a complex urban clinic population is surprisingly high even out to 3 years. Intensified monitoring and adherence efforts should target this high risk period. Thereafter, confidence in truly durable virologic suppression is improved

Spin relaxation in (110) and (001) InAs/GaSb superlattices

We report an enhancement of the electron spin relaxation time (T1) in a (110) InAs/GaSb superlattice by more than an order of magnitude (25 times) relative to the corresponding (001) structure. The spin dynamics were measured using polarization sensitive pump probe techniques and a mid-infrared, subpicosecond PPLN OPO. Longer T1 times in (110) superlattices are attributed to the suppression of the native interface asymmetry and bulk inversion asymmetry contributions to the precessional D'yakonov Perel spin relaxation process. Calculations using a nonperturbative 14-band nanostructure model give good agreement with experiment and indicate that possible structural inversion asymmetry contributions to T1 associated with compositional mixing at the superlattice interfaces may limit the observed spin lifetime in (110) superlattices. Our findings have implications for potential spintronics applications using InAs/GaSb heterostructures.Comment: 4 pages, 2 figure

Period changes in six contact binaries: WZ And, V803 Aql, DF Hya, PY Lyr, FZ Ori, and AH Tau

Six contact binaries lacking a period analysis have been chosen to search for the presence of a third body. The O-C diagrams of these binaries were analyzed with the least-squares method by using all available times of minima. Ten new minima times, obtained from our observations, were included in the present research. The Light-Time Effect was adopted for the first time as the main cause for the detailed description of the long-term period changes. Third bodies were found with orbital periods from 49 up to 100 years, and eccentricities from 0.0 to 0.56 for the selected binaries. In one case (WZ And), a fourth-body LITE variation was also applied. The mass functions and the minimal masses of such bodies were also calculated and a possible angular separation and magnitude differences were discussed for a prospective interferometric discovery of these bodies.Comment: 7 pages, 8 figures, 2009 New Astronomy 14, 12

Study of electron-capture delayed fission in Am-232

An automated x-ray-fission coincidence system was designed and constructed by LLNL and Lawrence Berkeley National Laboratory (LBNL) for use inside the Gammasphere high efficiency gamma-ray detector array at LBNL. The x-ray-fission coincidence apparatus detection station consists of two surface barrier detectors (for detection of fission fragments) and two high-purity Ge (HPGe) planar x-ray detectors (for measurement of x-rays and low-energy gamma rays). The detection station is placed inside Gammasphere at the 88-Inch Cyclotron at LBNL and used in conjunction with Gammasphere to measure the x-rays, low-energy gamma-rays and fission fragments resulting from the ECDF process. A series of collaborative experiment between LLNL, LBNL, and LANL utilizing various components of the x-ray-fission coincidence apparatus to measure x-rays and gamma-rays in the decay of a stationary {sup 252}Cf source were performed to test the various components of the x-ray-fission coincidence apparatus. The test experiments have been completed and the data is currently being analyzed by LBNL. Preliminary test results indicate that the system performed better than expected (e.g., the x-ray detectors performed better than expected with no evidence of microphonic noise that would reduce the photon energy resolution)