The Medical Home and Care Coordination in Disaster Recovery: Hypothesis for Interventions and Research

In postdisaster settings, health care providers encounter secondary surges of unmet primary care and mental health needs that evolve throughout disaster recovery phases. Whatever a community’s predisaster adequacy of health care, postdisaster gaps are similar to those of any underserved region. We hypothesize that existing practice and evidence supporting medical homes and care coordination in primary care for the underserved provide a favorable model for improving health in disrupted communities. Elements of medical home services can be offered by local or temporary providers from outside the region, working out of mobile clinics early in disaster recovery. As repairs and reconstruction proceed, local services are restored over weeks or years. Throughout recovery, major tasks include identifying high-risk patients relative to the disaster and underlying health conditions, assisting displaced families as they transition through housing locations, and tracking their evolving access to health care and community services as they are restored. Postdisaster sources of financial assistance for the disaster-exposed population are often temporary and evolving, requiring up-to-date information to cover costs of care until stable services and insurance coverage are restored. Evidence to support disaster recovery health care improvement will require research funding and metrics on structures, processes, and outcomes of the disaster recovery medical home and care coordination, based on adaptation of standard validated methods to crisis environments

Exploring Halo Substructure with Giant Stars. VI. Extended Distributions of Giant Stars Around the Carina Dwarf Spheroidal Galaxy -- How Reliable Are They?

The question of the existence of active tidal disruption around various dSph galaxies remains controversial. That debate often centers on the nature (bound vs. unbound) of extended populations of stars. However, the more fundamental issue of the very existence of the extended populations is still contentious. We present an evaluation of the debate centering on one particular dSph, Carina, for which claims both for and against the existence of stars beyond the King radius have been made. Our review includes an examination of all previous studies bearing on the Carina radial profile and shows that the survey method which achieves the highest detected dSph signal-to-background in the outer parts of the galaxy is the Washington M, T2 + DDO51 (MTD) filter approach from Paper II in this series. We then address statistical methods used to evaluate the reliability of MTD surveys in the presence of photometric errors and for which a new, a posteriori statistical analysis methodology is provided. Finally, these statistical methods are tested by new spectroscopy of stars in the MTD-selected Carina candidate sample. Of 74 candidate giants with follow-up spectroscopy, the MTD technique identified 61 new Carina members, including 8 stars outside the King radius. From a sample of 29 stars not initially identified as candidate Carina giants but that lie just outside of our selection criteria, 12 have radial velocities consistent with membership, including 5 extratidal stars. Carina is shown to have an extended population of giant stars extending to a major axis radius of 40' (1.44x the nominal King radius).Comment: 56 pages, 10 figures. Submitted to the Astronomical Journal, 2004 Sep 2

Evaluation of the Ability of LL-37 to Neutralise LPS In Vitro and Ex Vivo

BACKGROUND: Human cathelicidin LL-37 is a cationic antimicrobial peptide (AMP) which possesses a variety of activities including the ability to neutralise endotoxin. In this study, we investigated the role of LPS neutralisation in mediating LL-37's ability to inhibit Pseudomonas aeruginosa LPS signalling in human monocytic cells. METHODOLOGY/PRINCIPAL FINDINGS: Pre-treatment of monocytes with LL-37 significantly inhibited LPS-induced IL-8 production and the signalling pathway of associated transcription factors such as NF-κB. However, upon removal of LL-37 from the media prior to LPS stimulation, these inhibitory effects were abolished. These findings suggest that the ability of LL-37 to inhibit LPS signalling is largely dependent on extracellular LPS neutralisation. In addition, LL-37 potently inhibited cytokine production induced by LPS extracted from P. aeruginosa isolated from the lungs of cystic fibrosis (CF) patients. In the CF lung, polyanionic molecules such as glycosaminoglycans (GAGs) and DNA bind LL-37 and impact negatively on its antibacterial activity. In order to determine whether such interactions interfere with the LPS neutralising ability of LL-37, the status of LL-37 and its ability to bind LPS in CF sputum were investigated. Overall our findings suggest that in the CF lung, the ability of LL-37 to bind LPS and inhibit LPS-induced IL-8 production is attenuated as a result of binding to DNA and GAGs. However, LL-37 levels and its concomitant LPS-binding activity can be increased with a combination of DNase and GAG lyase (heparinase II) treatment. CONCLUSIONS/SIGNIFICANCE: Overall, these findings suggest that a deficiency in available LL-37 in the CF lung may contribute to greater LPS-induced inflammation during CF lung disease

Upper limits for undetected trace species in the stratosphere of Titan

In this paper we describe a first quantitative search for several molecules in Titan's stratosphere in Cassini CIRS infrared spectra. These are: ammonia (NH3), methanol (CH3OH), formaldehyde (H2CO), and acetonitrile (CH3CN), all of which are predicted by photochemical models but only the last of which observed, and not in the infrared. We find non-detections in all cases, but derive upper limits on the abundances from low-noise observations at 25{\deg}S and 75{\deg}N. Comparing these constraints to model predictions, we conclude that CIRS is highly unlikely to see NH3 or CH3OH emissions. However, CH3CN and H2CO are closer to CIRS detectability, and we suggest ways in which the sensitivity threshold may be lowered towards this goal.Comment: 11 pages plus 6 figure file

A Catalog of Chandra X-ray Sources in the Carina Nebula

We present a catalog of ~14,000 X-ray sources observed by the ACIS instrument on the Chandra X-ray Observatory within a 1.42 square degree survey of the Great Nebula in Carina, known as the Chandra Carina Complex Project (CCCP). This study appears in a Special Issue of the ApJS devoted to the CCCP. Here, we describe the data reduction and analysis procedures performed on the X-ray observations, including calibration and cleaning of the X-ray event data, point source detection, and source extraction. The catalog appears to be complete across most of the field to an absorption-corrected total-band luminosity of ~10^{30.7} erg/s for a typical low-mass pre-main sequence star. Counterparts to the X-ray sources are identified in a variety of visual, near-infrared, and mid-infrared surveys. The X-ray and infrared source properties presented here form the basis of many CCCP studies of the young stellar populations in Carina.Comment: Accepted for the ApJS Special Issue on the Chandra Carina Complex Project (CCCP), scheduled for publication in May 2011. All 16 CCCP Special Issue papers are available at http://cochise.astro.psu.edu/Carina_public/special_issue.html through 2011 at least. 29 pages, 11 figure

The QUEST RR Lyrae Survey II: The Halo Overdensities in the First Catalog

The first catalog of the RR Lyrae stars (RRLS) in the Galactic halo by the QUEST Survey has been searched for significant overdensities that may be debris from disrupted dwarf galaxies or globular clusters. Away from the major overdensities, the distribution of these stars is adequately fit by a smooth halo model, in which the flattening of the halo decreases with increasing galactocentric distance (Preston et al 1991). This model was used to estimate the ``background'' of RRLS on which the halo overdensities are overlaid. A procedure was developed for recognizing groups of stars that constitute significant overdensities with respect to this background. To test this procedure, a Monte Carlo routine was used to make artificial RRLS surveys that follow the smooth halo model, but with Poisson distributed noise in the numbers of RRLS and, within limits, random variations in the positions and magnitudes of the artificial stars. The artificial surveys created by this routine were examined for significant groups in exactly the same way as the QUEST survey. These calculations provided estimates of the frequencies with which random fluctuations produce significant groups. In the QUEST survey, there are six significant overdensities that contain six or more stars and several smaller ones. The small ones and possibly one or two of the larger ones may be artifacts of statistical fluctuations, and they need to be confirmed by measurements of radial velocity and/or proper motion. The most prominent groups are the northern stream from the Sagittarius dwarf spheroidal galaxy and a large group in Virgo. Two other groups lie in the direction of the Monoceros stream and at approximately the right distance for membership. Another group is related to the globular cluster Palomar 5.Comment: Accepted for publication in the Astronomical Journa

New insights on the Draco dwarf spheroidal galaxy from SDSS: a larger radius and no tidal tails

We have investigated the spatial extent and structure of the Draco dwarf spheroidal galaxy using deep wide-field multicolor CCD photometry from the Sloan Digital Sky Survey (SDSS). Our study covers an area of 27 square degrees around the center of the Draco dwarf. We show that the spatial distribution of Draco's red giants, red horizontal branch stars and subgiants down to i=21.7 mag does not provide evidence for the existence of tidally induced tails or a halo of unbound stars. The radial profile can be fit by King models as well as by a generalized exponential. The core radius and the limiting (or tidal) radius along the major axis are 7.7' and 40.1', respectively, making Draco 40% larger than previously measured. Down to our magnitude limit tidal effects can only exist at a level of 10^-3 of the central surface density of Draco or below. The regular structure of Draco found from the new data argues against it being a portion of an unbound tidal stream and lends support to the assumption of dynamical equilibrium. We estimate Draco's total mass to be 2.2 - 3.5 times 10^7 solar masses. We obtain an overall mass-to-light ratio of 146+-42 or 92+-28 solar masses depending on the details of the mass and luminosity estimates. In summary, our results strengthen the case for a strongly dark matter dominated, bound stellar system. (Abstract strongly abridged).Comment: 30 pages, 11 figures (in part with degraded resolution). Accepted for publication in the Astronomical Journa