1,017 research outputs found
Thomas Jefferson Health System Medical Legal Partnership
Introduction: Medical-legal partnerships (MLPs) provide civil legal services in concert with healthcare services to mitigate complex social conditions with health-harming effects. Currently, there are 333 MLPs in 46 states. Thomas Jefferson Health System (TJHS) does not have a systemwide MLP. (Magee Rehabilitation Hospital does have an MLP used by qualifying Magee patients). This project sought to identify the core components of an MLP and to demonstrate the value an MLP would provide TJHS.
Methods: Assessed existing literature. Interviewed an existing MLP director. Patients from the Jefferson Hospital Ambulatory Practice (JHAP) clinic completed a written survey regarding health-harming social-legal issues. Entered survey data into Excel and analyzed using descriptive statistics.
Results: Six common core components of all MLPs were identified. Existing MLPs have demonstrated a reduction in readmission rates, decreased inpatient and emergency department visits, and recovery of payments for unreimbursed clinical services. Patients report improved health when unmet civil legal needs are addressed. Results of the JHAP clinic survey are pending, but preliminarily many patients appear to have social-legal issues.
Conclusions: This project demonstrates that a TJHS MLP program could improve patient health and reduce overutilization of the health system. Over time the cost of the program would potentially be offset by the recovery of healthcare dollars. TJHS patients appear to have social-legal issues that negatively impact their health and could be addressed through legal remedies. Based on the analysis, an Opportunity Assessment was generated. Critical next steps are to draft a business plan and identify potential funding
Mediastinal goiter diagnosed by functional imaging
A 63-year-old asymptomatic woman with cured Hodgkin diseases presented for restaging. The chest computed tomography showed a mass at the right side of the upper mediastinum. The benignity and the origin of the tissue were unknown. First, we performed a bronchoscopy-guided biopsy but without success. In the next step, we initiated radionuclide imaging with technetium-99m pertechnetate (Tc-99m) and radioiodine (I-123). Low uptake of Tc-99m and intense accumulation of I-123 after 2 and 24 h to the mediastinal mass suggested that the mass was a mediastinal goiter. Based on iodine uptake and the fact that our patient had no symptoms of tracheal compression, we decide to go for a radioiodine therapy
Classical and semi-classical energy conditions
The standard energy conditions of classical general relativity are (mostly)
linear in the stress-energy tensor, and have clear physical interpretations in
terms of geodesic focussing, but suffer the significant drawback that they are
often violated by semi-classical quantum effects. In contrast, it is possible
to develop non-standard energy conditions that are intrinsically non-linear in
the stress-energy tensor, and which exhibit much better well-controlled
behaviour when semi-classical quantum effects are introduced, at the cost of a
less direct applicability to geodesic focussing. In this article we will first
review the standard energy conditions and their various limitations. (Including
the connection to the Hawking--Ellis type I, II, III, and IV classification of
stress-energy tensors). We shall then turn to the averaged, nonlinear, and
semi-classical energy conditions, and see how much can be done once
semi-classical quantum effects are included.Comment: V1: 25 pages. Draft chapter, on which the related chapter of the book
"Wormholes, Warp Drives and Energy Conditions" (to be published by Springer),
will be based. V2: typos fixed. V3: small typo fixe
Switching of magnetic domains reveals evidence for spatially inhomogeneous superconductivity
The interplay of magnetic and charge fluctuations can lead to quantum phases
with exceptional electronic properties. A case in point is magnetically-driven
superconductivity, where magnetic correlations fundamentally affect the
underlying symmetry and generate new physical properties. The superconducting
wave-function in most known magnetic superconductors does not break
translational symmetry. However, it has been predicted that modulated triplet
p-wave superconductivity occurs in singlet d-wave superconductors with
spin-density wave (SDW) order. Here we report evidence for the presence of a
spatially inhomogeneous p-wave Cooper pair-density wave (PDW) in CeCoIn5. We
show that the SDW domains can be switched completely by a tiny change of the
magnetic field direction, which is naturally explained by the presence of
triplet superconductivity. Further, the Q-phase emerges in a common
magneto-superconducting quantum critical point. The Q-phase of CeCoIn5 thus
represents an example where spatially modulated superconductivity is associated
with SDW order
Expression of Foxp3 in colorectal cancer but not in Treg cells correlates with disease progression in patients with colorectal cancer
Background: Regulatory T cells (Treg) expressing the transcription factor forkhead-box protein P3 (Foxp3) have been identified to counteract anti-tumor immune responses during tumor progression. Besides, Foxp3 presentation by cancer cells itself may also allow them to evade from effector T-cell responses, resulting in a survival benefit of the tumor. For colorectal cancer (CRC) the clinical relevance of Foxp3 has not been evaluated in detail. Therefore the aim of this study was to study its impact in colorectal cancer (CRC).
Methods and Findings: Gene and protein analysis of tumor tissues from patients with CRC was performed to quantify the expression of Foxp3 in tumor infiltrating Treg and colon cancer cells. The results were correlated with clinicopathological parameters and patients overall survival. Serial morphological analysis demonstrated Foxp3 to be expressed in cancer cells. High Foxp3 expression of the cancer cells was associated with poor prognosis compared to patients with low Foxp3 expression. In contrast, low and high Foxp3 level in tumor infiltrating Treg cells demonstrated no significant differences in overall patient survival.
Conclusions: Our findings strongly suggest that Foxp3 expression mediated by cancer cells rather than by Treg cells contribute to disease progression
Combinatorial CRISPR-Cas9 screens for de novo mapping of genetic interactions.
We developed a systematic approach to map human genetic networks by combinatorial CRISPR-Cas9 perturbations coupled to robust analysis of growth kinetics. We targeted all pairs of 73 cancer genes with dual guide RNAs in three cell lines, comprising 141,912 tests of interaction. Numerous therapeutically relevant interactions were identified, and these patterns replicated with combinatorial drugs at 75% precision. From these results, we anticipate that cellular context will be critical to synthetic-lethal therapies
Monte Carlo simulation of expected outcomes with the AcrySof® toric intraocular lens
<p>Abstract</p> <p>Background</p> <p>To use a Monte Carlo simulation to predict postoperative results with the AcrySof<sup>® </sup>Toric lens, evaluating the likelihood of over- or under-correction using various toric lens selection criteria.</p> <p>Methods</p> <p>Keratometric data were obtained from a large patient population with preoperative corneal astigmatism <= 2.50D (2,000 eyes). The probability distributions for toric marking accuracy, surgically induced astigmatism and lens rotation were estimated using available data. Anticipated residual astigmatism was calculated using a Monte Carlo simulation under two different lens selection scenarios.</p> <p>Results</p> <p>This simulation demonstrated that random errors in alignment, surgically induced astigmatism and lens rotation slightly reduced the overall effect of the toric lens. Residual astigmatism was statistically significantly higher under the simulation of surgery relative to an exact calculation (p < 0.05). The simulation also demonstrated that more aggressive lens selection criteria could produce clinically significant reductions in residual astigmatism in a high percentage of patients.</p> <p>Conclusion</p> <p>Monte Carlo simulation suggests that surgical variability and lens orientation/rotation variability may combine to produce small reductions in the correction achieved with the AcrySof<sup>® </sup>Toric<sup>® </sup>IOL. Adopting more aggressive lens selection criteria may yield significantly lower residual astigmatism values for many patients, with negligible overcorrections. Surgeons are encouraged to evaluate their AcrySof<sup>® </sup>Toric<sup>® </sup>outcomes to determine if they should modify their individual lens selection criteria, or their default surgically induced astigmatism value, to benefit their patients.</p
Minding impacting events in a model of stochastic variance
We introduce a generalisation of the well-known ARCH process, widely used for
generating uncorrelated stochastic time series with long-term non-Gaussian
distributions and long-lasting correlations in the (instantaneous) standard
deviation exhibiting a clustering profile. Specifically, inspired by the fact
that in a variety of systems impacting events are hardly forgot, we split the
process into two different regimes: a first one for regular periods where the
average volatility of the fluctuations within a certain period of time is below
a certain threshold and another one when the local standard deviation
outnumbers it. In the former situation we use standard rules for
heteroscedastic processes whereas in the latter case the system starts
recalling past values that surpassed the threshold. Our results show that for
appropriate parameter values the model is able to provide fat tailed
probability density functions and strong persistence of the instantaneous
variance characterised by large values of the Hurst exponent is greater than
0.8, which are ubiquitous features in complex systems.Comment: 18 pages, 5 figures, 1 table. To published in PLoS on
Potential Future Impact of a Partially Effective HIV Vaccine in a Southern African Setting.
It is important for public health and within the HIV vaccine development field to understand the potential population level impact of an HIV vaccine of partial efficacy-both in preventing infection and in reducing viral load in vaccinated individuals who become infected-in the context of a realistic future implementation scenario in resource limited settings
Efficacy of sub-Tenon's block using an equal volume of local anaesthetic administered either as a single or as divided doses. A randomised clinical trial
<p>Abstract</p> <p>Background</p> <p>Sub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery. Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with 1–2 ml of local anaesthetic. Hypothesis was that after first injection some of the volume injected may spill out and before second injection the effect of hyaluronidase has taken place and second volume injectate will have desired effect.</p> <p>Methods</p> <p>A prospective, randomised, control trial in which patients were randomly allocated to one of two groups. In group 1, single injection of 5 ml of local anaesthetic was injected. In group 2, 3 ml of the same anaesthetic solution was injected followed by application of gentle orbital pressure for 2 minutes. A further 2 ml of the same anaesthetic solution was injected through the same conjunctival incision. Measurement of movement in four quadrants of eye was done by the surgeon at 3 and 6 minutes. Intraocular pressure, chemosis, and subconjuctival haemorrhage were also measured.</p> <p>Results</p> <p>Significant differences at 3 minutes between groups for overall movement, medial, superior, and lateral quadrants occurred. At 6 minutes no significant group differences emerged for the overall movement or for any of four quadrants.</p> <p>Conclusion</p> <p>Single injection of local anaesthesia for sub-Tenon's block with mixture of lignocaine with adrenaline, bupivacaine and hyaluronidase was found to be superior to provide akinesia of ocular muscles compared to divided dose given by two injections. No difference in groups in terms of haemorrhage, chemosis, patient's satisfaction and intraocular pressure was found.</p> <p>Trial registration</p> <p>Trial registration no-ISRCTN73431052</p
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