Retailers' perspectives on selling tobacco in a low-income San Francisco neighbourhood after California's $2 tobacco tax increase.

BackgroundCalifornia's tobacco tax increased by $2.00 per pack in 2017. Although such increases are among the most effective tobacco control strategies, little is known about their impact from the perspective of corner store owners in low-income neighbourhoods with high concentrations of tobacco outlets.MethodsWe interviewed 38 corner store owners and managers in San Francisco's Tenderloin, the district with the city's highest tobacco outlet density, 60-90 days following implementation of the tax increase. Questions focused on perceptions of the impact of the higher tobacco tax on their revenues, customers and tobacco company promotions. We used qualitative content analysis to identify, compare and reconcile key themes.ResultsMost retailers reported a decline in cigarette sales, with customers buying fewer cigarettes, switching to cheaper brands or other products like marijuana, or trying to quit smoking. Retailers described challenges associated with running a small business and selling tobacco and concerns about selling a product that is 'bad' for customers' health. Contrary to expectation, tobacco companies appeared to be offering few product promotions in this neighbourhood.ConclusionsSmall, independent retailers' concerns, about selling tobacco and about the health and well-being of customers, suggest that such retailers may be important allies in tobacco control efforts,particularly those focused on the point-of-sale

Health Migration: Crossing Borders for Affordable Health Care

Approximately 45.7 million people in the United States are uninsured and unknown numbers of this population are underinsured, severely limiting their access to medical care. To address this problem, people use innovative strategies to increase their access through cross-border care options. The U.S.-Mexico border provides unique challenges and opportunities for health care in this context. The lower cost of medical and dental procedures and medications in Mexico makes that country an attractive alternative for low-income populations in the United States. Thus segments of the U.S. population practice transnational medical consumerism in an attempt to optimize their health by using the resources available in both countries. This practice has economic benefits for the people who access health care at an affordable rate and for the medical markets of the country providing the care. Drawing on data collected in the field in 2002, 2004, and 2005, this paper presents some of the complexities and dynamics of medical pluralism occurring at the U.S.-Mexico border.Environ 45,7 millions de personnes vivant aux Etats-Unis n’ont pas de couverture sociale et nombreux sont celles à être sous-assurées, ce qui limite considérablement leur accès aux soins. Face à ce problème, les Américains font preuve d'ingéniosité pour améliorer leur accès aux soins : ils se font soigner au-delà des frontières. Dans ce contexte, la frontière entre les Etats-Unis et le Mexique offre des opportunités uniques de soins. Le Mexique constitue en effet une alternative séduisante pour les Américains à faible revenu, car les tarifs des actes médicaux et dentaires, et des médicaments, sont nettement inférieurs à ceux en vigueur aux Etats-Unis. Ainsi, certains Américains pratiquent le consumérisme médical transnational et recourent aux ressources disponibles dans les deux pays afin d’optimiser leur santé. Cette pratique présente des avantages économiques à la fois pour ceux qui accèdent aux soins à un tarif abordable et pour le secteur médical du pays qui délivre les soins. S’appuyant sur les données recueillies dans le domaine en 2002, 2004 et 2005, cet article présente la dynamique et certaines des complexités du pluralisme médical qui est de mise à la frontière entre les Etats-Unis et le Mexique.Aproximadamente 45,7 millones de personas en los Estados Unidos no tienen seguro y se desconoce el número de personas que están infraseguradas, limitando gravemente su acceso a la atención médica. Para tratar este problema, las personas utilizan estrategias innovadoras para incrementar su acceso a través de opciones de atención transfronterizas. La frontera entre los EE. UU. y México proporciona desafíos y oportunidades extraordinarias para la asistencia sanitaria en este contexto. El coste más bajo de los procedimientos médicos y dentales y de los medicamentos en México hace de este país una alternativa atractiva para poblaciones con bajos ingresos en los Estados Unidos. Así, segmentos de la población de los EE. UU. practican el consumismo médico trasnacional en un intento por mejorar su salud utilizando los recursos disponibles en ambos países. Esta práctica tiene beneficios económicos para las personas que acceden a la asistencia sanitaria a un precio asequible y para los mercados médicos del país que proporciona la asistencia. Utilizando datos recopilados en el terreno en 2002, 2004 y 2005, este artículo presenta algunas de las complejidades y la dinámica del pluralismo médico que se produce en la frontera entre los EE. UU. y México

Medicaid Income Eligibility Transitions Among Rural Adults

The Affordable Care Act (ACA) Medicaid Expansion allows coverage for all adults aged 18 to 64 with income below 138 percent of the federal poverty level (FPL), and as of 2018, 32 states had implemented expansion. Research prior to the ACA suggests people may transition in and out of Medicaid income eligibility, but little is known about how this may affect rural adults. Movement in and out of Medicaid may increase administrative costs, create benefit and provider discontinuity, or lead to patient difficulties in paying medical bills and accessing care. This brief uses data from the national Survey of Income and Program Participation to examine the extent to which rural and urban residents’ incomes shift above or below the Medicaid expansion eligibility threshold of 138 percent of FPL during a calendar year (2010). We find that in 2010, rural adults were more likely than those in urban areas to begin the year with incomes below 138 percent of the federal poverty level, particularly in states that did not expand Medicaid. Compared with their urban counterparts, rural adults were also more likely to experience an income shift during the year that would have changed their eligibility for expanded Medicaid. This somewhat higher rate of income eligibility transition among rural versus urban adults appears to be driven by the generally lower incomes of those in rural areas and could have implications for rural individuals, communities and states

The pseudo-mitochondrial genome influences mistakes in heteroplasmy interpretation

BACKGROUND: Nuclear mitochondrial pseudogenes (numts) are a potential source of contamination during mitochondrial DNA PCR amplification. This possibility warrants careful experimental design and cautious interpretation of heteroplasmic results. RESULTS: Here we report the cloning and sequencing of numts loci, amplified from human tissue and rho-zero (ρ(0)) cells (control) with primers known to amplify the mitochondrial genome. This paper is the first to fully sequence 46 paralogous nuclear DNA fragments that represent the entire mitochondrial genome. This is a surprisingly small number due primarily to the primer sets used in this study, because prior to this, BLAST searches have suggested that nuclear DNA harbors between 400 to 1,500 paralogous mitochondrial DNA fragments. Our results indicate that multiple numts were amplified simultaneously with the mitochondrial genome and increased the load of pseudogene signal in PCR reactions. Further, the entire mitochondrial genome was represented by multiple copies of paralogous nuclear sequences. CONCLUSION: These findings suggest that mitochondrial genome disease-associated biomarkers must be rigorously authenticated to preclude any affiliation with paralogous nuclear pseudogenes. Importantly, the common perception that mitochondrial template "swamps" numts loci precluding detectable amplification, depends on the region of the mitochondrial genome targeted by the PCR reaction and the number of pseudogene loci that may co-amplify. Cloning and relevant sequencing data will facilitate the correct interpretation. This is the first complete, wet-lab characterization of numts that represent the entire mitochondrial genome

Desiderata for the development of next-generation electronic health record phenotype libraries

BackgroundHigh-quality phenotype definitions are desirable to enable the extraction of patient cohorts from large electronic health record repositories and are characterized by properties such as portability, reproducibility, and validity. Phenotype libraries, where definitions are stored, have the potential to contribute significantly to the quality of the definitions they host. In this work, we present a set of desiderata for the design of a next-generation phenotype library that is able to ensure the quality of hosted definitions by combining the functionality currently offered by disparate tooling.MethodsA group of researchers examined work to date on phenotype models, implementation, and validation, as well as contemporary phenotype libraries developed as a part of their own phenomics communities. Existing phenotype frameworks were also examined. This work was translated and refined by all the authors into a set of best practices.ResultsWe present 14 library desiderata that promote high-quality phenotype definitions, in the areas of modelling, logging, validation, and sharing and warehousing.ConclusionsThere are a number of choices to be made when constructing phenotype libraries. Our considerations distil the best practices in the field and include pointers towards their further development to support portable, reproducible, and clinically valid phenotype design. The provision of high-quality phenotype definitions enables electronic health record data to be more effectively used in medical domains

Molecular Basis for Drug Resistance in HIV-1 Protease

HIV-1 protease is one of the major antiviral targets in the treatment of patients infected with HIV-1. The nine FDA approved HIV-1 protease inhibitors were developed with extensive use of structure-based drug design, thus the atomic details of how the inhibitors bind are well characterized. From this structural understanding the molecular basis for drug resistance in HIV-1 protease can be elucidated. Selected mutations in response to therapy and diversity between clades in HIV-1 protease have altered the shape of the active site, potentially altered the dynamics and even altered the sequence of the cleavage sites in the Gag polyprotein. All of these interdependent changes act in synergy to confer drug resistance while simultaneously maintaining the fitness of the virus. New strategies, such as incorporation of the substrate envelope constraint to design robust inhibitors that incorporate details of HIV-1 protease’s function and decrease the probability of drug resistance, are necessary to continue to effectively target this key protein in HIV-1 life cycle

Teaching Matters, Volume 2: Essays by the faculty and staff at the University of Maine at Farmington

Essays by the faculty and staff at the University of Maine at Farmington.https://scholarworks.umf.maine.edu/publications/1087/thumbnail.jp

Pancreatic Ductal Adenocarcinoma: Long-Term Survival Does Not Equal Cure

Background: Pancreatic ductal adenocarcinoma represents 90% of pancreatic cancers and is an important cause of cancer death in the United States. Operative resection remains as the only treatment providing prolonged survival, but even after a curative resection, 5-year survival rates are low. Our aim was to identify the prognostic factors for long-term survival after resection of pancreatic ductal adenocarcinoma related to patients, treatments, and tumor biology. Methods: Retrospective review identified 959 patients who underwent resection of their pancreatic adenocarcinoma between February 1985 and December 2010, of whom 499 were resected before November 2006 and represent the cohort we describe in this study. Patient, tumor, and treatment-related variables were assessed for their associations with 5- and 10-year overall survival. Results: Of the 499 patients, 49% were female and median age was 65 years. The majority of patients had stage IIb disease (60%). Actual 5-year survival after resection of pancreatic adenocarcinoma was 19% (95/499), and actual 10-year survival was 10% (33/329). Significant clinicopathologic factors predicting 5- and 10-year survival were negative margins and negative nodal status. Interestingly, 41% (39/95) of long-term survivors had positive nodes and 24% (23/95) had positive margins. Conclusion: Pancreatic ductal adenocarcinoma demonstrates a very heterogeneous biology, but patients with negative resection margins and node negative cancers are more likely to survive 5 years after resection. However, our series demonstrates that the biology of the cancer rather than simple pathologic factors determine a patient's prognosis