Telehealth Forging Ahead: Overcoming Barriers in Licensure to Improve Access to Care for Service Members

The telehealth initiatives of the Department of Defense (DoD) and Veterans’ Health Administration (VHA) continue to test the limits of technology to provide the best care to our service members, veterans and their families.  The DoD and VHA have credentialing systems in place to allow clinical practice between facilities. New legislation in the form of the Servicemembers’ Telemedicine and E-Health Portability (STEP) Act will potentially expand telehealth clinical services across state lines into the homes of our service members and veterans

Propiedad planta y equipo y su incidencia en los estados financieros en las empresas de junta de propietarios, distrito de San Miguel, año 2022

La presente investigación tiene como objetivo determinar como la Propiedad, planta y equipo inciden en los estados financieros en empresas de Junta de Propietarios, distrito de San Miguel, año 2022. Así mismo la investigación es de tipo básica, no experimental diseño transversal, correlacional. Tiene como población a los 36 trabajadores de las empresas de junta de propietarios que se encuentran en el distrito de San Miguel. Se aplico para la recolección de datos mediante encuestas donde los ítems fueron validados y aprobada por expertos de la Universidad Cesar Vallejo. Por otro lado, para conocer el grado de confiabilidad se utilizó el coeficiente de Alfa de Cronbach, el coeficiente de correlación de Spearman para validar las hipótesis. Se concluye que existe incidencia entre las variables analizadas, debido a que la investigación desarrollada dio como resultado que los trabajadores del área contable, y presidentes de la junta de propietarios no conocimiento respecto al valor real de sus activos ni el estado en el que se encuentran esto se debe a que ellos no presentan estados financieros y no pueden conocer esos valores actuales, ni el deterioro de estos, ocasionando que se omitan el conocimiento del valor de sus activos asi como el registro de los importes en los estados financieros

Expanding the scope of ligand substitution from [M(S2C2Ph2] (M = Ni2+, Pd2+, Pt2+) to afford new heteroleptic dithiolene complexes

The scope of direct substitution of the dithiolene ligand from [M(S2C2Ph2)2] [M = Ni2+ (1), Pd2+ (2), Pt2+ (3)] to produce heteroleptic species [M(S2C2Ph2)2Ln] (n = 1, 2) has been broadened to include isonitriles and dithiooxamides in addition to phosphines and diimines. Collective observations regarding ligands that cleanly produce [M(S2C2Ph2)Ln], do not react at all, or lead to ill-defined decomposition identify soft σ donors as the ligand type capable of dithiolene substitution. Substitution of MeNC from [Ni(S2C2Ph2)(CNMe)2] by L provides access to a variety of heteroleptic dithiolene complexes not accessible from 1. Substitution of a dithiolene ligand from 1 involves net redox disproportionation of the ligands from radical monoanions, –S•SC2Ph2, to enedithiolate and dithione, the latter of which is an enhanced leaving group that is subject to further irreversible reactions

Insulin gene polymorphisms in type I diabetes, Addison's disease and the polyglandular autoimmune syndrome type II

Background: Polymorphisms within the insulin gene can influence insulin expression in the pancreas and especially in the thymus, where self-antigens are processed, shaping the T cell repertoire into selftolerance, a process that protects from ß-cell autoimmunity. Methods: We investigated the role of the -2221Msp(C/T) and -23HphI(A/T) polymorphisms within the insulin gene in patients with a monoglandular autoimmune endocrine disease [patients with isolated type 1 diabetes (T1D, n = 317), Addison´s disease (AD, n = 107) or Hashimoto´s thyroiditis (HT, n = 61)], those with a polyglandular autoimmune syndrome type II (combination of T1D and/or AD with HT or GD, n = 62) as well as in healthy controls (HC, n = 275). Results: T1D patients carried significantly more often the homozygous genotype "CC" -2221Msp(C/T) and "AA" -23HphI(A/T) polymorphisms than the HC (78.5% vs. 66.2%, p = 0.0027 and 75.4% vs. 52.4%, p = 3.7 × 10-8, respectively). The distribution of insulin gene polymorphisms did not show significant differences between patients with AD, HT, or APS-II and HC. Conclusion: We demonstrate that the allele "C" of the -2221Msp(C/T) and "A" -23HphI(A/T) insulin gene polymorphisms confer susceptibility to T1D but not to isolated AD, HT or as a part of the APS-II

Conjugated linoleic acid (CLA) promotes inflammation to a greater extent in human adipocytes compared to preadipocytes

Due to the increasing prevalence of obesity and diabetes among children and adults worldwide, it is imperative to identify dietary strategies that promote weight control. One potential anti-obesity compound is conjugated linoleic acid (CLA), sold worldwide for weight loss. However, the safety and efficacy of this supplement remains questionable. Current research shows that, in addition to reducing fat mass, trans-10,cis-12 (10,12) CLA supplementation in animals and some humans leads to insulin resistance, hyperlipidemia, or fatty liver. In vitro studies suggest that 10,12 CLA causes inflammation in primary cultures of human adipocytes by increasing mitogen activated extracellular kinase/extracellular signal-related kinase (MEK/ERK) and nuclear factor kappa B (NFêB) signaling, which impairs glucose and fatty acid uptake and utilization. However, the link between inflammatory signaling in primary cultures of human adipocytes and CLA-mediated delipidation has not been fully characterized. Additionally, the particular cell type (i.e., preadipoyctes vs. adipocytes) responsible for 10,12 CLA-mediated inflammation and insulin resistance in white adipose tissue is unknown. Therefore, the objective of this work was to determine the cell type responsible for 10,12 CLA-mediated inflammation and insulin resistance in cultures of newly differentiated human adipocytes (Aim 1), and to identify the specific upstream mechanisms involved (Aim 2). To examine Aim 1, inflammatory gene expression and protein secretion, prostaglandin secretion, or mitogen-activated protein kinase (MAPK) and cJun phosphorylation was measured in adipocytes vs. preadipocytes in four distinct cell culture models. To examine Aim 2, chemical inhibitors were employed to determine the role of protein kinases, including the MAPK cJun N-terminal kinase (JNK) and diacylglycerol kinases (DGKs) in 10,12 CLA-mediated inflammatory signaling and insulin resistance in newly differentiated primary human adipocytes. Collectively, results from this project reveal that 10,12 CLA instigates release of inflammatory signals from adipocytes that subsequently activate adjacent preadipocytes. Mechanisms of 10,12 CLA-mediated inflammatory signaling and insulin resistance involve activation of the protein kinases JNK and DGKs. These findings are expected to contribute critical insights for the development of safe and effective therapeutic strategies for weight control

Responses of non-native earthworms to experimental eradication of garlic mustard and implications for native vegetation

Recent studies in invasion biology suggest that positive feedback among two or more introduced organisms facilitate establishment within a new range and drive changes in native plant communities. Here, we experimentally tested for relationships between native plants and two non‐native organisms invading forest habitats in North America: garlic mustard (Alliaria petiolata, Brassicaceae) and earthworms. In two forested sites, we compared understory vegetation and earthworm biomass in plots where garlic mustard was removed for three years, plots without garlic mustard invasion, and plots invaded by garlic mustard that was not removed. Earthworm biomass was highest in the plots with garlic mustard, and long‐term eradication of garlic mustard reduced earthworm biomass to levels similar to those observed in the uninvaded control plots. Invasion treatment, and the interactions between earthworm biomass and treatment, explained most of the variation in plant community composition and diversity—suggesting that earthworms alone do not necessarily drive forest understory floristic patterns. In contrast to broader geographic patterns indicating earthworms as the main driver of vegetation change in the presence of non‐native plants, we show that garlic mustard solely, or in conjunction with earthworm biomass, drives changes in native plant composition and diversity at the scale of individual forests. From a local management perspective, our data suggest that garlic mustard eradication can directly assist in the conservation of native plant communities and simultaneously reduce earthworm biomass

The Effects of a Telehealth Exercise Intervention on Balance in Adults with Down Syndrome

Background: People with Down syndrome (Ds) often present with balance deficits, which compromise their safety during daily activity. While evidence shows that exercise can improve balance in the Ds population, it is unclear if a telehealth method will elicit similar benefits. We aimed to examine the effects of a virtual exercise program on balance in adults with Ds. Methods: Twenty participants completed a 12-week telehealth exercise program based on the Mann Method. Balance testing took place before and after the intervention, which included: Timed Up and Go (TUG), Modified Clinical Test of Sensory Interaction in Balance (MCTSIB), Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT-4), and Functional Reach Test (FRT). Results: Significant improvement was seen in the TUG (p=0.043), FICSIT-4 (p=0.019) and FRT (p=0.030). All participants achieved maximum scores on the MCTSIB in pre- and post- testing. Conclusions: Balance in adults with Ds significantly improved following the telehealth exercise program, which we attribute to the tailored exercises that address visual/vestibular deficits and hip muscle weakness