Emergency Department Utilization Among South Philadelphia Residents and Frequent Users in the Jefferson Community Benefit Area

Over the past decade, the rate of emergency department (ED) visits increased at almost double the rate that would be expected due to normal population growth. The implications of this increase in ED usage include decreased quality of care, overcrowding, increased wait times, and increased healthcare costs. The purpose of this analysis is to examine health issues, concerns, and underling social determinants of frequent ED users and South Philadelphia Residents who use the Thomas Jefferson University or Methodist Hospital emergency departments. This project is a retrospective data analysis using descriptive statistics, measures of central tendency, and cross-tabulation analysis to analyze emergency department data from July 2011 through June 2012. Frequent ED users (patients who visited the ED greater than 4 times in one year) were more likely to be Medicaid patients, who visited the ED for substance abuse problems, mental issues, sickle cell disease, and pain-related complaints. South Philadelphia residents also had a higher rate of Medicaid insurance than patients in the surrounding areas. They also had had higher rates of ED visits for asthma and other ambulatory care sensitive conditions. South Philadelphia patients also had a higher rate of non-emergent ED visits. Although many patients in the Thomas Jefferson University community benefit area report having a regular source of care, there were still a large number of ED visits for conditions that could be managed in an outpatient setting. Additional research is necessary to explore potential barriers to primary care that exist in this setting

Balantidiasis

Balantidium Coli, a ciliate first described by Malmsten in 1857, is an infrequent cause of dysentery in man. It is a common inhabitant of the intestine of pigs. It produces lesions in man, mainly in the large intestine, these lesions being indistinguishable from amoebic ulceration. Perforation of the ileum is recorded, but is very rare. The parasite invades blood vessels and lymphatics of the gut, but has never been known to cause liver abscess. Balantidiasis is usually a mild or chronic disease. It is diagnosed by finding the ciliate or cysts in the stools. A mortality rate of 7% - 29% has been quoted. Treatment has so far been varied. Few workers have had success using the same drugs. The outbreak described occurred among the native artisans and labourers employed by the Anglo-Iranian Oil Co. Ltd., on Abadan, an arid island at the head of the Persian gulf. The average native in this class lives under primitive conditions, has no idea of simple hygiene, and is little interested in such. Conditions are therefore suited to the spread of disease. By employing large numbers of street cleaners and sanitary workers, and providing the usual social amenities of a modern town, the Oil Co. does much to control and prevent disease. Balantidiasis has been reported in 3 autopsies carried out in Azerbaijan, and in 5.1% of 2,000 persons examined there. These are the only reports of the disease in Persia, and no study of the disease

PRACTICAL TOOLS FOR YOUR MORAL TOOLKIT: A LEADERSHIP GUIDE TO GROUP ETHICAL BEHAVIOR

In 2018, the Congressional Research Service (CRS) published a report indicating that the U.S. Congress has a growing concern over misconduct, ethics, and professionalism within the United States Special Operations Command (USSOCOM). This thesis used these concerns as a starting block to answer a much broader question of how leaders can promote an ethical culture within their respective organization. Answering this question was accomplished by employing a qualitative literature review in the fields of evolutionary theory and moral psychology. This research first applied evolutionary thinking to assess how we form, define, and maintain morality at the individual and group levels in order to articulate what relationships, norms, and heuristics we use to determine our appropriate behavior. Second, it used the research in moral psychology to analyze how we develop our moral judgments and take action upon those judgments, and effective ways leaders can motivate our moral intuitions and reasoning. Provided in the conclusion is a qualitative list of recommendations leaders can implement at both the personal and organization policy levels using a pluralist moral framework. Although these recommendations are limited to the research explained throughout this thesis, the execution of these actions by a well-respected influential leader can have a strong impact in shaping the moral community they serve.http://archive.org/details/practicaltoolsfo1094564022Lieutenant, United States NavyApproved for public release; distribution is unlimited

Interleukin-6 blockade raises LDL via reduced catabolism rather than via increased synthesis: a cytokine-specific mechanism for cholesterol changes in rheumatoid arthritis

Objectives Patients with rheumatoid arthritis (RA) have reduced serum low-density lipoprotein cholesterol (LDL-c), which increases following therapeutic IL-6 blockade. We aimed to define the metabolic pathways underlying these lipid changes. Methods In the KALIBRA study, lipoprotein kinetic studies were performed on 11 patients with severe active RA at baseline and following three intravenous infusions of the IL-6R blocker tocilizumab. The primary outcome measure was the fractional catabolic rate (FCR) of LDL. Results Serum total cholesterol (4.8 vs 5.7 mmol/L, p=0.003), LDL-c (2.9 vs 3.4 mmol/L, p=0.014) and high-density lipoprotein cholesterol (1.23 vs 1.52 mmol/L, p=0.006) increased following tocilizumab therapy. The LDL FCR fell from a state of hypercatabolism to a value approximating that of the normal population (0.53 vs 0.27 pools/day, p=0.006). Changes in FCR correlated tightly with changes in serum LDL-c and C-reactive protein but not Clinical Disease Activity Index. Conclusions Patients with RA have low serum LDL-c due to hypercatabolism of LDL particles. IL-6 blockade normalises this catabolism in a manner associating with the acute phase response (and thus hepatic IL-6 signalling) but not with RA disease activity as measured clinically. We demonstrate that IL-6 is one of the key drivers of inflammation-driven dyslipidaemia

Do the pleiotropic effects of statins in the vasculature predict a role in inflammatory diseases?

Pleiotropic effects are now described for the 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (or statins) that might have utility in the context of chronic inflammatory autoimmune disease. Here we discuss the pharmacology and established uses of statins and in this context describe potential anti-inflammatory and immune-modulatory effects. An extensive in vitro data set defines roles for statins in modifying endothelial function, particularly with respect to adhesion molecule expression and apoptosis. Broader effects on leukocyte function have now emerged including altered adhesion molecule expression, cytokine and chemokine release and modulation of development of adaptive immune responses via altered MHC class II upregulation. In vivo data in several inflammatory models, including collagen-induced inflammatory arthritis and experimental autoimmune encephalomyelitis, suggest that such effects might have immune-modulatory potential. Finally, a recent clinical trial has demonstrated immunomodulatory effects for statins in patients with rheumatoid arthritis. Together with their known vasculoprotective effects, this growing body of evidence provides compelling support for longer-term trials of statin therapy in human disease such as rheumatoid arthritis

A Recommender Agent for Software Libraries: An Evaluation of Memory-Based and Model-Based Collaborative Filtering

Abstract—Software Agents can conveniently facilitate knowl-edge discovery and knowledge sharing across an organisation. We contend that programming tasks are often mimicked, that knowledge concerning reusable libraries can be extracted auto-matically from source code repositories, and that this knowledge can then be filtered and presented to a developer in a manner that will encourage and support future software reuse. We introduce RASCAL, a recommender agent that continually recommends a set of task relevant library methods to a developer. RASCAL learns information regarding how a particular reusable library is used and then employs this insight to make task relevant recommendations to a developer. In this paper we detail our RASCAL agent and describe two recommendation techniques; namely Model-Based and Memory-Based Collabora-tive Filtering. We are interested in producing a scalable and efficient realtime recommender and thus ideally would favor a Model-Based approach. However, each scheme is evaluated against both runtime performance and recommendation accu-racy. We present results and discuss the merits and limitations of each technique. I

Empirical approach to the analysis of university student absenteeism. Proposal of a questionnaire for students to evaluate the possible causes

Works on student absenteeism in the universities have not been preferential for the authors in the field of educational research. Usually, what has been made is an approach to the available absenteeism data as an intervening variable or as a variable characteristic of the educational process, but not as a dependent variable in the strict sense of the term. In this work, we intend to make an empirical approach to the possible reasons of student absenteeism. There is a double point of view: the students" and the professors"; the reasons that justify it according to its protagonists are studied. This paper focuses on the six university degrees taught at the School of Economy and Business of the University of Barcelona (Facultat d"Economia i Empresa de la Universitat de Barcelona). An"ad-hoc" questionnaire has been prepared and the opinions of 1,162 undergraduates have been analyzed. The reasons given by each population differ in hierarchy and motivations

Neonatal Outcome

Introduction: Henoch-Schönlein Purpura (HSP) is a systemic IgA-mediated small-vessel vasculitis. It is primarily a childhood disease, rarely described in pregnancy. Pregnant women with HSP are at risk for hypertensive and hemorrhagic complications. Due to the rarity of the condition during pregnancy, there is no consensus about the preferred course of treatment but concerns regarding optimal management are ongoing.Case presentation: We report the case of an 18 year-old primigravida, with a 3-year history of HSP, who had an uneventful pregnancy and term delivery with epidural anesthesia.Conclusion: Due to the systemic nature of HSP, multidisciplinary management of pregnant HSP patients should be warranted to prevent complications