Complete Care Model Impact on Glycemic Control in California State Prisons

The Complete Care Model (CCM) is a health care delivery model based on the well-studied and internationally validated chronic care theory. Since the integration of the chronic care theory into California Department of Corrections and Rehabilitation (CDCR) patient care in 2008, steady improvement in health care related mortality has been seen, and there have been no unavoidable health care related deaths in CDCR since 2012 (Gransee, 2018). However glycemic control in CDCR diabetic patients has made no statistically significant change since the implementation of the CCM in 2015 when comparing the two years before and the two years after implementation of the CCM. According to the literature, this suggests that key components of the model have yet to be fully incorporated into the CCM (Stellefson et al., 2013). The CCM has been shown to be effective in bringing about positive change in the CDCR health care delivery, but the theory was not implemented robustly enough to achieve CDCR’s goal of 90% of all their diabetic patients having glycated hemoglobin (HbA1c) levels less than 8%. Further research and development of the CCM is still needed to reach the diabetic patient care goals associated with the full adoption of the chronic care theory

Per-operative stent placement in the right pulmonary artery; a hybrid technique for the management of pulmonary artery branch stenosis at the time of pulmonary valve replacement in adult Fallot patients

After having undergone surgical correction at an early age, many patients with tetralogy of Fallot develop long-term complications including progressive pulmonary regurgitation and peripheral pulmonary stenosis. A high percentage of these patients need to undergo a second operation in their adolescence or early adulthood. If simultaneous treatment of both pulmonary regurgitation and peripheral pulmonary stenosis is warranted, a complete surgical approach has several disadvantages. We describe four cases of Fallot patients with severe pulmonary regurgitation and peripheral pulmonary stenosis who were treated using a hybrid approach involving surgical implantation of a pulmonary homograft and peroperative stenting of the pulmonary artery

Characterising food insecurity in pastoral and agro-pastoral communities in Uganda using a consumption coping strategy index

We explore the utility of a consumption coping strategy index (CSI) in characterising and assessing the factors influencing household food insecurity. We assessed 53 pastoral and 197 agro-pastoral households in Nakasongola and Nakaseke districts of Uganda, examining the use of 27 consumption coping strategies over a recall time of two 30-day periods, one at the start of a dry season in 2012 and one at the start of a rainy season in 2013. Four categorical food insecurity status measures were established - food secure (CSI 0 to 5) and mildly (CSI 6 to 20), moderately (CSI 21 to 42) and extremely (CSI >42) food insecure. For the dry season, the mean CSI was 29.4 ± 2.59 and 33.6 % of households were food secure, while for the rains, mean CSI was 33.1 ± 2.30 and 14.0 % of households were food secure. The combination of livelihood system, land holdings, number of livestock owned and belonging to a social network explained 9.4 % to 10 % of the variance in household food insecurity for agro-pastoralists, but variance for pastoralists was not explained by these factors. While the only highly significant factor associated with increasing household food insecurity in the dry season was low landholdings, in the rainy season, it was pastoral livelihood, low livestock holdings for agro-pastoralists and non-involvement in social networks. While our model identified a number of factors important in describing household food insecurity, it explained only about 10 % of the variance

Mutant U2AF1-expressing cells are sensitive to pharmacological modulation of the spliceosome

Somatic mutations in spliceosome genes are detectable in ∼50% of patients with myelodysplastic syndromes (MDS). We hypothesize that cells harbouring spliceosome gene mutations have increased sensitivity to pharmacological perturbation of the spliceosome. We focus on mutant U2AF1 and utilize sudemycin compounds that modulate pre-mRNA splicing. We find that haematopoietic cells expressing mutant U2AF1(S34F), including primary patient cells, have an increased sensitivity to in vitro sudemycin treatment relative to controls. In vivo sudemycin treatment of U2AF1(S34F) transgenic mice alters splicing and reverts haematopoietic progenitor cell expansion induced by mutant U2AF1 expression. The splicing effects of sudemycin and U2AF1(S34F) can be cumulative in cells exposed to both perturbations—drug and mutation—compared with cells exposed to either alone. These cumulative effects may result in downstream phenotypic consequences in sudemycin-treated mutant cells. Taken together, these data suggest a potential for treating haematological cancers harbouring U2AF1 mutations with pre-mRNA splicing modulators like sudemycins

Diet diversity in pastoral and agro-pastoral households in Ugandan rangeland ecosystems

We explore how diet diversity differs with agricultural seasons and between households within pastoral and agro-pastoral livelihood systems, using variety of foods consumed as a less complex proxy indicator of food insecurity than benchmark indicators like anthropometry and serum nutrients. The study was in the central part of the rangelands in Uganda. Seventy nine households were monitored for three seasons, and eight food groups consumed during a 24 hour diet recall period used to create a household diet diversity score (HDDS). Mean HDDS was 3.2, varied significantly with gender, age, livelihood system and season (p < .001, F = 15.04), but not with household size or household head’s education level. Agro-pastoralists exhibited lower mean diet diversity than pastoralists (p < .01, F = 7.84) and among agro-pastoralists, households headed by persons over 65 years were most vulnerable (mean HDDS 2.1). This exploratory study raises issues requiring further investigation to inform policies on nutrition security in the two communities

How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

Treatment partnering is an adherence intervention developed in sub-Saharan Africa. This paper describes the additional social functions that treatment partners serve and shows how these functions contribute to health and survival for patients with HIV/AIDS. Ninety-eight minimally structured interviews were conducted with twenty pairs of adult HIV/AIDS patients (N = 20) and treatment partners (N = 20) treated at a public HIV-care setting in Tanzania. Four social functions were identified using inductive, category construction and interpretive methods of analysis: (1) encouraging disclosure; (2) combating stigma; (3) restoring hope; and (4) reducing social difference. These functions work to restore social connections and reverse the isolating effects of HIV/AIDS, strengthening access to essential community safety nets. Besides encouraging ARV adherence, treatment partners contribute to the social health of patients. Social health as well as HIV treatment success is essential to survival for persons living with HIV/AIDS in sub-Saharan Africa