Clinical Case Mix and other Challenges to Detroit\u27s Medicaid-Dependent Nursing Homes

Nursing homes that care for the poor in Detroit are frequently dependent upon Medicaid as their principal source of revenue. These facilities face numerous challenges because they face limited resources for maintenance of facilities, staff and administrative supports, and other normal costs. They lack the kinds of support that are provided in-kind, or by more generous sources of revenue and are often characterized as institutions of poor quality; yet nearly 70% of the nation’s Medicaid-recipient elderly nursing home patients are in for-profit facilities that are sustained largely on Medicaid funding. These facilities are often sources of care for underserved minority populations, the adult mentally-ill, and others for whom alternative venues of care are no longer available. The case mix of aged, mentally ill, and numerous other chronic adult conditions is unlike any other health care environment in Michigan, yet the facilities that offer such care are poorly understood and insufficiently supported. The situation has established a health care disparity for the aged, urban poor

Lunar Wormbot: Design and Development of a Ground Base Robotic Tunneling Worm for Operation in Harsh Environments

From 1969 to 1972, the National Aeronautics and Space Administration (NASA) sent Apollo missions to the moon to conduct various exploration experiment. A few of the missions were directed to the study and sampling of moon soil, otherwise known as lunar regolith. The extent of the sample acquisition was limited due to the astronauts' limited ability to penetrate the moon's surface to a depth greater than three meters. However. the samples obtained were sufficient enough to provide key information pertaining to lunar regolith material properties that would further assist in future exploration endeavors. Analysis of the collected samples showed that the properties of lunar regolith may lead to knowledge of processed materials that will be beneficial for future human exploration or colonization. However, almost 40 years after the last Apollo mission, limited infonnation is known about regions underneath the moon's surface. Future lunar missions will require hardware that possesses the ability to burrow to greater depths in order to collect samples for subsequent analysis. During the summer of 2010, a team (Dr. Jessica Gaskin, Michael Kuhlman. Blaze Sanders, and Lafe Zabowski) from the NASA Robotics Academy at Marshall Space Flight Center (MSFC) was given the task of designing a robot to function as a soil collection and analysis device. Working with the National Space Science and Technology Center (NSSTC), the team was able to propose an initial design, build a prototype, and test the various subsystems of the prototype to be known as the "Lunar Wormbot" (LW). The NASA/NSSTC team then transferred the project to a University of Alabama in Huntsville (UAH) Mechanical and Aerospace Engineering (MAE) senior design class for further development. The UAH team was to utilize the NASA Systems Engineering Engine Design Process in the continuance of the Lunar Wormbot project. This process was implemented in order to coordinate the efforts of the team and guide the design of the project to ensure a high quality product that met requirements within the academic year timeframe. When the transition from the NASA NSSTC team to the UAH team occurred in August 2010, the scope and requirements were provided to the UAH team. The main objective for the UAH team was to design and fabricate a robotic burrowing prototype using peristaltic or earthworm-like motion with the purpose of collecting soil samples. The team was tasked with the design of a sub-system of the LW called the locomotive, or active, segment. Through the design process, the team extensively reviewed the requirements and functions to be performed of the LW, which led to the proposal of a final design. The present paper provides the details of the development of the design up to and including the Critical Design Review (CDR) of the Lunar Wormbot. This document briefly describes thc overall system and its function but primarily focuses on the design and implementation of the locomotive segment. Content presented includes: general design and system functionality, technical drawings, system analysis, manufacturing methods, and general project costs

Specific Colon Cancer Cell Cytotoxicity Induced by Bacteriophage E Gene Expression under Transcriptional Control of Carcinoembryonic Antigen Promoter

Colorectal cancer is one of the most prevalent cancers in the world. Patients in advanced stages often develop metastases that require chemotherapy and usually show a poor response, have a low survival rate and develop considerable toxicity with adverse symptoms. Gene therapy may act as an adjuvant therapy in attempts to destroy the tumor without affecting normal host tissue. The bacteriophage E gene has demonstrated significant antitumor activity in several cancers, but without any tumor-specific activity. The use of tumor-specific promoters may help to direct the expression of therapeutic genes so they act against specific cancer cells. We used the carcinoembryonic antigen promoter (CEA) to direct E gene expression (pCEA-E) towards colon cancer cells. pCEA-E induced a high cell growth inhibition of human HTC-116 colon adenocarcinoma and mouse MC-38 colon cancer cells in comparison to normal human CCD18co colon cells, which have practically undetectable levels of CEA. In addition, in vivo analyses of mice bearing tumors induced using MC-38 cells showed a significant decrease in tumor volume after pCEA-E treatment and a low level of Ki-67 in relation to untreated tumors. These results suggest that the CEA promoter is an excellent candidate for directing E gene expression specifically toward colon cancer cells.This research was funded by FEDER, Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (I+D+I), Instituto de Salud Carlos III- Fondo de Investigaciones Sanitarias (FIS) through Projects PI11/01862 and PI11/0257

Droplet Distribution in a University Dental Clinic Setting: The Importance of High-Volume Evacuation

The purpose of this study is to compare droplet distribution during a piezoelectric ultrasonic debridement procedure using either high-volume or slow-volume evacuation. Droplet distribution during a crown preparation with slow-volume evacuation is also examined. Fluorescein dye is added to the water reservoir and the procedures are performed by a single operator for 15 min on a dental manikin with artificial upper and lower teeth. Placement of filter paper squares (10 cm × 10 cm) in radiating lines away from the oral cavity of the dental manikin allows for visualization of droplet dispersion. Results show minimal difference in the spread of the droplets between the two evacuators during the debridement procedure; however, the slow-volume evacuator produces a higher concentration of droplets than the high-volume evacuator. An even higher concentration of droplets in the vicinity of the dental chair is observed during the crown preparation procedure. This study recommends the use of a high-volume evacuator where possible during professional debridement and crown preparation to reduce contamination around the dental chair from potentially pathogenic microorganisms

A Robust Determination of the Time Delay in 0957+561A,B and a Measurement of the Global Value of Hubble's Constant

Photometric monitoring of the gravitational lens system 0957+561A,B in the g and r bands with the Apache Point Observatory (APO) 3.5 m telescope during 1996 shows a sharp g band event in the trailing (B) image light curve at the precise time predicted from the observation of an event during 1995 in the leading (A) image with a delay of 415 days. This success confirms the "short delay," and the lack of any feature at a delay near 540 days rejects the "long delay" for this system, resolving a long-standing controversy. A series of statistical analyses of our light curve data yield a best fit delay of 417 +/- 3 days (95% confidence interval). Recent improvements in the modeling of the lens system (consisting of a galaxy and cluster) allow us to derive a value of the global (at z = 0.36) value of Hubble's constant H_0 using Refsdal's method, a simple and direct distance determination based on securely understood physics and geometry. The result is H_0 = 63 +/- 12 km/s/Mpc (for Omega = 1) where this 95% confidence interval is dominated by remaining lens model uncertainties.Comment: accepted by ApJ, AASTeX 4.0 preprint, 4 PostScript figure

Universal Mask Usage for Reduction of Respiratory Viral Infections After Stem Cell Transplant: A Prospective Trial

Background. Respiratory viral infections (RVIs) are frequent complications of hematopoietic stem cell transplant (HSCT). Surgical masks are a simple and inexpensive intervention that may reduce nosocomial spread

X-ray Polarimetry of the accreting pulsar 1A~0535+262 in the supercritical state with PolarLight

The X-ray pulsar 1A 0535+262 exhibited a giant outburst in 2020, offering us a unique opportunity for X-ray polarimetry of an accreting pulsar in the supercritical state. Measurement with PolarLight yielded a non-detection in 3-8 keV; the 99% upper limit of the polarization fraction (PF) is found to be 0.34 averaged over spin phases, or 0.51 based on the rotating vector model. No useful constraint can be placed with phase resolved polarimetry. These upper limits are lower than a previous theoretical prediction of 0.6-0.8, but consistent with those found in other accreting pulsars, like Her X-1, Cen X-3, 4U 1626-67, and GRO J1008-57, which were in the subcritical state, or at least not confidently in the supercritical state, during the polarization measurements. Our results suggest that the relatively low PF seen in accreting pulsars cannot be attributed to the source not being in the supercritical state, but could be a general feature.Comment: accepted for publication in Ap