U.S. Mobile Clinics, Chronic Diseases, and Healthcare Access Barriers in Low Income Populations

Background: Health disparities derived from healthcare barriers affect low income populations in the United States. Barriers that lead to decreased access, increased costs, and inadequate quality of care are attributed to an inefficient and ineffective healthcare system that unfairly and disproportionately affects low income populations. Social, economic, and environmental factors, to name a few, greatly influence healthcare barriers and the degree to which the resultant disparities are posited throughout communities and populations in the United States. There are a number of measures set forth to combat these healthcare barriers such as the formation of the Patient Protection and Affordable Care Act of 2010. However, beneficial, these mandates are merely scratching the surface of a much larger obstacle-the gap between healthcare delivery and actual healthcare receipt-seen even after their enactment. Mobile clinics have the potential to offset this gap by offering and literally delivering a diverse array of healthcare services to underserved and disparate populations in the United States. This paper outlines a literature review performed to determine how primary medical healthcare mobile clinics affect healthcare access and health outcomes in the U.S. Methods: Articles for this literature review were chosen systematically using the PubMed database. Included studies pertained to U.S. mobile clinics in a primary medical healthcare setting only that targeted low income populations from January 2000 to October 2014. Results: Inclusion criteria warranted 11 articles that described eight primary care mobile clinics across the U.S. Seven of the eight mobile clinics conducted retrospective and/or cross-sectional analyses from the convenience of patient records showing that gender, race or ethnicity, language, health insurance status, and age are all contributing factors to decreased access for low income populations. Conclusions: Mobile clinic services in the U.S. increased healthcare access for low income and underserved populations. Results for an impact of mobile clinics on health outcomes, on the other hand, looked promising but could not be accurately determined due to the small number of primary care mobile clinics that surfaced from the literature review and the insufficient data of measureable health outcomes in which only three of eight mobile clinics provided. Overall, the inadequacy of data capture on primary care mobile clinics within the last 15 years poses a challenge for a proper assessment of their total and complete impact.Master of Public Healt

The human CHRNA7 and CHRFAM7A genes: A review of the genetics, regulation, and function

The human α7 neuronal nicotinic acetylcholine receptor gene (CHRNA7) is ubiquitously expressed in both the central nervous system and in the periphery. CHRNA7 is genetically linked to multiple disorders with cognitive deficits, including schizophrenia, bipolar disorder, ADHD, epilepsy, Alzheimer's disease, and Rett syndrome. The regulation of CHRNA7 is complex; more than a dozen mechanisms are known, one of which is a partial duplication of the parent gene. Exons 5–10 of CHRNA7 on chromosome 15 were duplicated and inserted 1.6 Mb upstream of CHRNA7, interrupting an earlier partial duplication of two other genes. The chimeric CHRFAM7A gene product, dupα7, assembles with α7 subunits, resulting in a dominant negative regulation of function. The duplication is human specific, occurring neither in primates nor in rodents. The duplicated α7 sequence in exons 5–10 of CHRFAM7A is almost identical to CHRNA7, and thus is not completely queried in high throughput genetic studies (GWAS). Further, pre-clinical animal models of the α7nAChR utilized in drug development research do not have CHRFAM7A (dupα7) and cannot fully model human drug responses. The wide expression of CHRNA7, its multiple functions and modes of regulation present challenges for study of this gene in disease

Characteristics of surface-water flows in the ridge and slough landscape of Everglades National Park: implications for particulate transport

Over the last one hundred years, compartmentalization and water management activities have reduced water flow to the ridge and slough landscape of the Everglades. As a result, the once corrugated landscape has become topographically and vegetationally uniform. The focus of this study was to quantify variation in surface flow in the ridge and slough landscape and to relate flow conditions to particulate transport and deposition. Over the 2002–2003 and 2003–2004 wet seasons, surface velocities and particulate accumulation were measured in upper Shark River Slough in Everglades National Park. Landscape characteristics such as elevation, plant density and biomass also were examined to determine their impact on flow characteristics and material transport. The results of this study demonstrate that the release of water during the wet season not only increases water levels, but also increased flow speeds and particulate transport and availability. Further, flow speeds were positively and significantly correlated with water level thereby enhancing particulate transport in sloughs relative to ridges especially during peak flow periods. Our results also indicate that the distribution of biomass in the water column, including floating plants and periphyton, affects velocity magnitude and shape of vertical profiles, especially in the sloughs where Utricularia spp. and periphyton mats are more abundant. Plot clearing experiments suggest that the presence of surface periphyton and Utricularia exert greater control over flow characteristics than the identity (i.e., sawgrass or spike rush) or density of emergent macrophytes, two parameters frequently incorporated into models describing flow through vegetated canopies. Based on these results, we suggest that future modeling efforts must take the presence of floating biomass, such as Utricularia, and presence of periphyton into consideration when describing particulate transport

Hydrologic measurements and implications for tree island formation within Everglades National Park

Tree islands in the Shark River Slough of the Everglades National Park (ENP), in the southern state of Florida in the United States, are part of a wetland system of densely vegetated ridges interspersed within relatively open sloughs. Human alteration of this system has had dramatic negative effects on the landscape of the region and restoration efforts will require adjusting the hydrology of the region to assure the preservation of these important ecologic features. The primary objectives of this study were to document the hydrology in the vicinity of tree islands in ENP by measuring velocities in time and space and by characterizing suspended sediments. The results of such measurements were interpreted with respect to factors that may limit tree island growth. The measurements were conducted in the vicinity of three tree islands known as Black Hammock (BH), Gumbo Limbo (GL), and an unnamed island that was named for this study as Satin Leaf (SL). Acoustical Doppler Velocity (ADV) meters were used for measuring the low velocities of the Everglades water flow. Properties of suspended sediments were characterized through measurements of particle size distribution, turbidity, concentration and particle density. Mean velocities observed at each of the tree islands varied from 0.9 to 1.4 cm/s. Slightly higher mean velocities were observed during the wet season (1.2–1.6 cm/s) versus the dry season (0.8–1.3 cm/s). Maximum velocities of more than 4 cm/s were measured in areas of Cladium jamaicense die-off and at the hardwood hammock (head) of the islands. At the island’s head, water is channelized around obstructions such as tree trunks in relatively rapid flow, which may limit the lateral extent of tree island growth. Channelization is facilitated by shade from the tree canopy, which limits the growth of underwater vegetation thereby minimizing the resistance to flow and limiting sediment deposition. Suspended sediment concentrations were low (0.5–1.5 mg/L) at all study sites and were primarily of organic origin. The mean particle size of the suspended sediments was 3 μm with a distribution that was exponential. Critical velocities needed to cause re-suspension of these particles were estimated to be above the actual velocities observed. Sediment transport within the water column appears to be at a near steady state during the conditions evaluated with low rates of sediment loss balanced by presumably the release of equivalent quantities of particles of organic origin. Existing hydrologic conditions do not appear to transport sufficient suspended sediments to result in the formation of tree islands. Of interest would be to collect hydrologic and sediment transport data during extreme hydrologic events to determine if enough sediment is transported under these conditions to promote sufficient sediment accumulations

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Supersymmetric dS/CFT

We put forward new explicit realisations of dS/CFT that relate ${\cal N}=2$ supersymmetric Euclidean vector models with reversed spin-statistics in three dimensions to specific supersymmetric Vasiliev theories in four-dimensional de Sitter space. The partition function of the free supersymmetric vector model deformed by a range of low spin deformations that preserve supersymmetry appears to specify a well-defined wave function with asymptotic de Sitter boundary conditions in the bulk. In particular we find the wave function is globally peaked at undeformed de Sitter space, with a low amplitude for strong deformations. This suggests that supersymmetric de Sitter space is stable in higher-spin gravity and in particular free from ghosts. We speculate this is a limiting case of the de Sitter realizations in exotic string theories.Comment: V2: references and comments added, typos corrected, version published in JHEP; 27 pages, 3 figures, 1 tabl

PYRUVATE DEHYDROGENASE KINASE (PDK)

Abstract: Several oximes of triterpenes with a 17-~ hydroxyl and abietane derivatives are inlfibitors of pyruvate dehydrogenase kinase (PDK) activity. The oxime 12 and dehydroabietyl amine 2 exhibit a blood glucose lowering effect in the diabetic ob/ob mouse after a single oral dose of 100 ~tmol/kg. However, the mechanism of the blood glucose lowering effect is likely unrelated to PDK inhibition

Development and implementation of worksite health and wellness programs: a focus on non-communicable disease

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs