Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Nonequivalent effects of PKC activation by PMA on murine CD4 and CD8 cell‐surface expression

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154260/1/fsb2002012010.pd

Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

The Commonwealth Fund's Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths— there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, highquality health system

Increasing Actual and Perceived Burden of Tick-Borne Disease in Maine

Introduction: The burden of tick-borne disease (TBD) in Maine has steadily increased since the first case of Lyme disease was reported in the late 1980s. The emergence of five different agents of TBD in Maine has been challenging and confusing for clinicians and the public. Methods: We reviewed the ecology of emerging of tick -borne disease, then reviewed risk factors for tick bites and tick-borne disease in Maine. We then compared the burden of TBD versus community-acquired comparison infections in terms of hospitalizations, deaths, and media attention. Results and Discussion: In Maine, risk of exposure to bites from the vector blacklegged or “deer tick”, Ixodes scapularis, is a reality in most of the state. In New England, resurgence of white-tailed deer attending reforestation and suburbanization of the landscape and climate change have contributed to geographic expansion of the deer tick from relict populations in southern New England. TBDs have emerged as a significant health burden in Maine, but compared with other infections of public health importance, receive disproportionately high media attention. Measures of tick-borne disease severity provide a necessary context for individual and public health decision making. Mass media reports and social networking inform much public debate regarding TBDs, but in many instances, do not accurately reflect their actual prevalence or expected outcome. Conclusion: Reducing actual and perceived risks associated with TBD will require well-supported information paired with an appreciation for how interpersonal communication and social media drive community perceptions and responses to the emergence of TBDs

The Ursinus Weekly, March 13, 1975

New U.S.G.A. elected • Summer school courses slated • Meistersingers begin annual spring tour • Mrs. Clouser appointed • Ec Club hosts alumni • P.M.P.A.C. views the N.H.I.P. • Dare to learn • Get stung • Letters to the editor • Concert review: Argent - March 1, Widener College • Two organizations organized • Placement offers aid • Growth of the Greeks: Omega Chi\u27s sparkling history • Badminton team continues triumphs • Union square: Do you use your Union? • Before the Fest • Editorial: Looking back and forward! • Intramurals instituted • A long way • Sixers in \u2776?https://digitalcommons.ursinus.edu/weekly/1031/thumbnail.jp

Defining and using microbial spectral databases

AbstractThis work shows how fingerprints of mass spectral patterns from microbial isolates are affected by variations in instrumental condition, by sample environment, and by sample handling factors. It describes a novel method by which pattern distortions can be mathematically corrected for variations in factors not amenable to experimental control. One uncontrollable variable is “between-batch” differences in culture media. Another, relevant for determination of noncultured extracts, is differences between the cells’ environmental experience (e.g., starved environmental extracts versus cultured standards). The method suggests that, after a single growth cycle on a solid medium (perhaps, a selective one), pyrolysis MS spectra of microbial isolates can be algorithmically compensated and an unknown isolate identified using a spectral database defined by culture on a different (perhaps, nonselective) medium. This reduces identification time to as few as 24 h from sample collection. The concept also proposes a possible way to compensate certain noncultured, nonisolated samples (e.g., cells concentrated from urine or impacted from aerosol or semi-selectively extracted by immunoaffinity methods from heavily contaminated matrices) for identification within half an hour. Using the method, microbial mass spectra from different labs can be assembled into coherent databases similar to those routinely used to identify pure compounds. This type of data treatment is applicable for rapid detection in biowarfare and bioterror events as well as in forensic, research, and clinical laboratory contexts

The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Acute Lymphoblastic Leukemia in Adults: An Evidence-based Review

AbstractEvidence supporting the role of hematopoietic stem cell transplantation (SCT) in the therapy of acute lymphoblastic leukemia in adults (≥15 years) is presented and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published medical literature and for grading the quality and strength of the evidence, and the strength of the treatment recommendations. Treatment recommendations based on the evidence are presented and were reached unanimously by a panel of acute lymphoblastic leukemia experts. The priority areas of needed future research for adult acute lymphoblastic leukemia are: definition of patients at high risk in first complete remission, beyond Philadelphia chromosome positive; outcomes of SCT in older (>50 years) adults; determination if reduced intensity versus myeloablative conditioning regimens yield an equivalent graft-versus-leukemia effect with reduced toxicity; monitoring of minimal residual disease to achieve disease control before SCT; and the use of cord blood and other alternative sources of stem cells for use in adult SCT recipients

New Pulsating DB White Dwarf Stars from the Sloan Digital Sky Survey

We are searching for new He atmosphere white dwarf pulsators (DBVs) based on the newly found white dwarf stars from the spectra obtained by the Sloan Digital Sky Survey. DBVs pulsate at hotter temperature ranges than their better known cousins, the H atmosphere white dwarf pulsators (DAVs or ZZ Ceti stars). Since the evolution of white dwarf stars is characterized by cooling, asteroseismological studies of DBVs give us opportunities to study white dwarf structure at a different evolutionary stage than the DAVs. The hottest DBVs are thought to have neutrino luminosities exceeding their photon luminosities (Winget et al. 2004), a quantity measurable through asteroseismology. Therefore, they can also be used to study neutrino physics in the stellar interior. So far we have discovered nine new DBVs, doubling the number of previously known DBVs. Here we report the new pulsators' lightcurves and power spectra.Comment: 15 pages, 2 figures, 3 tables, ApJ accepte

A comfort assessment of existing cervical orthoses

Purpose: identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses. Method: convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0-6) and location. Results: participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score=1.64, SD=1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced. Conclusion: existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses' design the more significant factor. This work informed the design of a new orthosis and future orthoses developments