The Impact of the Patient-Centered Medical Home on Health Disparities in Adults: A Systematic Review of the Evidence

Introduction: The objective of this study was to review the empirical evidence on Patient-Centered Medical Home (PCMH) impact on health disparities in adults. Methods: We searched PubMed, Scopus, and Google Scholar to identify studies on PCMH/health homes and health disparities published in English between January 1, 2009 and December 31, 2014. Articles met inclusion criteria if they investigated at least one component of PCMH or health homes in vulnerable populations, defined by PROGRESS-PLUS criteria, and reported differences in one of five clinical quality measures. Results: 964 articles were identified through database searching and subsequent snowballing. 60 articles underwent full text screening. Further review eliminated 56 studies. In the final 4 studies, PCMH interventions showed small improvements in health disparities. Discussion: The PCMH has been suggested as a model for improving health disparities. Given rapid implementation in underserved settings, stakeholders should better understand the impact of the PCMH on health disparities

Anatomical and chemical composition of Detarium Senegalense J.F. Gmel Bark

The anatomical and chemical composition of Detarium senegalense bark was studied after grinding and fractioning into different particles sizes. The bark of D. senegalense mature trees was fractionized into fine and coarse granulometric particles using 0.150 mm and 4.0 mm mesh respectively. The bark showed the following compositions for fine and coarse bark granulometric respectively as ash (10.9 % and 12.1 %), total extractives (20.9 % and 16.4 %), suberin (0.97 % and 0.94 %) and lignin (36.5 % and 31.2 %). Ash elemental composition was different in both fractionized biomass. The suberin content in both fractions were as well low. Fine D. senegalense bark contained more extractives in relation to coarse granulometric D. senegalense bark. For the elemental compositional characterization, the values obtained for the fine and coarse bark solutes were almost in the same range for N (0.75 % and 0.72 %), P (0.095 % and 0.092%), Mg (0.13 % and 0.14 %), Ca (6.6 % and 6.2 %), K (0.33 % and 0.31 %), Ni (1.81 mg/kg and 1.77 mg/kg ), Cr (1.98 mg/kg and 1.93 mg/kg), Pb (2.02 mg/kg and 2.05 mg/kg). However, high concentration of Zn was found in fine granules of D. sengalense bark that is, 29 mg/kg compared to 13 mg/kg in the  coarse bark. Extractives were present preferentially in the finest fraction in dichloromethane, ethanol and water soluble. D. senegalense bark had a high content of 36.5 and 31.2 cellulose and hemicelluloses especially in the coarser fraction. The rich lignin content of 39.5 and 20.9 in D. senegalense wood makes it a good potential resource for adhesives, chemical and biorefinery industries. The significant content of extractive in D. senegalense suggests conferment of natural durability to the wood. Particle size reduction by grinding is a unit operations that may be used as selective enrich solutes in soluble materials. Keywords: Anatomical structure, Chemical composition, Detarium senegalense, fine granulometric fraction, coarse granulometric fractio

Entrepreneurship Development and the Growth of Micro, Small and Medium Enterprises in Nigeria

Objective The study examines the impact of entrepreneurship development on the growth of Micro Small and Medium Enterprises (MSMEs’) in Nigeria using a Lagos based MSME in the Information and Communication Technology industry, Befy Links Nigeria Limited.   Prior Work The roles of Micro, Small and Medium Enterprises (MSMEs), as a catalyst for economic growth have been well documented in economics literature. The recent global economic crisis negatively affected productive activities and reduces business operations, investments and demand for goods and services. This forced many countries to look for alternative means of growth and development. One of these alternative approaches is the encouragement of micro, small and medium scale enterprises.   Approach The study employed descriptive and Chi-square techniques for the analyses. Questionnaires were randomly administered to the workers and customers in the company.   Results It was found that entrepreneurship development has significant impact on the growth of MSMEs and that training and re-training of existing and intending entrepreneurs is necessary to ensure sufficient impact of entrepreneurship development on the growth of MSMEs in Nigeria.    Implications Government and stakeholders in entrepreneurship development should support, promote and ensure that MSMEs are given necessary impetus to function efficiently. Entrepreneurs should also cultivate the right attitude that would engender partnerships and pooling of resources. The entrepreneurship programmes (EDPs), should not be left to the public sector and professionals in other sectors of the economy should utilize the potentials in these programmes.   Value The unique contribution of the study is that it takes interest in information and technology sector.   Keywords: Investment; Industrial Growth; Economic Growth   JEL Classification: O4, L8, L260, Objective The study examines the impact of entrepreneurship development on the growth of Micro Small and Medium Enterprises (MSMEs’) in Nigeria using a Lagos based MSME in the Information and Communication Technology industry, Befy Links Nigeria Limited.   Prior Work The roles of Micro, Small and Medium Enterprises (MSMEs), as a catalyst for economic growth have been well documented in economics literature. The recent global economic crisis negatively affected productive activities and reduces business operations, investments and demand for goods and services. This forced many countries to look for alternative means of growth and development. One of these alternative approaches is the encouragement of micro, small and medium scale enterprises.   Approach The study employed descriptive and Chi-square techniques for the analyses. Questionnaires were randomly administered to the workers and customers in the company.   Results It was found that entrepreneurship development has significant impact on the growth of MSMEs and that training and re-training of existing and intending entrepreneurs is necessary to ensure sufficient impact of entrepreneurship development on the growth of MSMEs in Nigeria.    Implications Government and stakeholders in entrepreneurship development should support, promote and ensure that MSMEs are given necessary impetus to function efficiently. Entrepreneurs should also cultivate the right attitude that would engender partnerships and pooling of resources. The entrepreneurship programmes (EDPs), should not be left to the public sector and professionals in other sectors of the economy should utilize the potentials in these programmes.   Value The unique contribution of the study is that it takes interest in information and technology sector.   Keywords: Investment; Industrial Growth; Economic Growth   JEL Classification: O4, L8, L260, &nbsp

Solar Photovoltaic Modules’ Performance Reliability and Degradation Analysis—A Review

The current geometric increase in the global deployment of solar photovoltaic (PV) modules, both at utility-scale and residential roof-top systems, is majorly attributed to its affordability, scalability, long-term warranty and, most importantly, the continuous reduction in the levelized cost of electricity (LCOE) of solar PV in numerous countries. In addition, PV deployment is expected to continue this growth trend as energy portfolio globally shifts towards cleaner energy technologies. However, irrespective of the PV module type/material and component technology, the modules are exposed to a wide range of environmental conditions during outdoor deployment. Oftentimes, these environmental conditions are extreme for the modules and subject them to harsh chemical, photo-chemical and thermo-mechanical stress. Asides from manufacturing defects, these conditions contribute immensely to PV module’s aging rate, defects and degradation. Therefore, in recent times, there has been various investigations into PV reliability and degradation mechanisms. These studies do not only provide insight on how PV module’s performance degrades over time, but more importantly, they serve as meaningful input information for future developments in PV technologies, as well as performance prediction for better financial modelling. In view of this, prompt and efficient detection and classification of degradation modes and mechanisms due to manufacturing imperfections and field conditions are of great importance towards minimizing potential failure and associated risks. In the literature, several methods, ranging from visual inspection, electrical parameter measurements (EPM), imaging methods, and most recently data-driven techniques have been proposed and utilized to measure or characterize PV module degradation signatures and mechanisms/pathways. In this paper, we present a critical review of recent studies whereby solar PV systems performance reliability and degradation were analyzed. The aim is to make cogent contributions to the state-of-the-art, identify various critical issues and propose thoughtful ideas for future studies particularly in the area of data-driven analytics. In contrast with statistical and visual inspection approaches that tend to be time consuming and require huge human expertise, data-driven analytic methods including machine learning (ML) and deep learning (DL) models have impressive computational capacities to process voluminous data, with vast features, with reduced computation time. Thus, they can be deployed for assessing module performance in laboratories, manufacturing, and field deployments. With the huge size of PV modules’ installations especially in utility scale systems, coupled with the voluminous datasets generated in terms of EPM and imaging data features, ML and DL can learn irregular patterns and make conclusions in the prediction, diagnosis and classification of PV degradation signatures, with reduced computation time. Analysis and comparison of different models proposed for solar PV degradation are critically reviewed, in terms of the methodologies, characterization techniques, datasets, feature extraction mechanisms, accelerated testing procedures and classification procedures. Finally, we briefly highlight research gaps and summarize some recommendations for the future studies

Investigating the reliability of SiC MOSFET body diodes using Fourier series modelling

Using the Fourier series solution to the ambipolar diffusion equation, the robustness of the body diodes of SiC MOSFETs during reverse recovery has been studied. Parasitic bipolar latch-up during the reverse recovery of the body diode is a possible if there is sufficient base current and voltage drop across the body resistance to forward bias the parasitic BJT. SiC MOSFETs have very low carrier lifetime and thin epitaxial drift layers, which means that the dV/dt during the recovery of the body diode can be quite high. This dV/dt coupled with the parasitic drain-to-body capacitance can cause a body current. The paper introduces a new way of assessing the reliability of SiC MOSFETs during the reverse recovery of the body diode. The impact of switching rates, parasitic inductances and carrier lifetime on the activation of the parasitic BJT has been studied

Towards access for all: 1st Working Group Report for the Global Gene Therapy Initiative (GGTI)

The gene and cell therapy field saw its first approved treatments in Europe in 2012 and the United States in 2017 and is projected to be at least a $10B USD industry by 2025. Despite this success, a massive gap exists between the companies, clinics, and researchers developing these therapeutic approaches, and their availability to the patients who need them. The unacceptable reality is a geographic exclusion of low-and middle-income countries (LMIC) in gene therapy development and ultimately the provision of gene therapies to patients in LMIC. This is particularly relevant for gene therapies to treat human immunodeficiency virus infection and hemoglobinopathies, global health crises impacting tens of millions of people primarily located in LMIC. Bridging this divide will require research, clinical and regulatory infrastructural development, capacity-building, training, an approval pathway and community adoption for success and sustainable affordability. In 2020, the Global Gene Therapy Initiative was formed to tackle the barriers to LMIC inclusion in gene therapy development. This working group includes diverse stakeholders from all sectors and has set a goal of introducing two gene therapy Phase I clinical trials in two LMIC, Uganda and India, by 2024. Here we report on progress to date for this initiative

Follicle-stimulating hormone promotes growth of human prostate cancer cell line-derived tumor xenografts

Chemical castration in prostate cancer can be achieved with gonadotropin-releasing hormone (GnRH) agonists or antagonists. Their effects differ by the initial flare of gonadotropin and testosterone secretion with agonists and the immediate pituitary-testicular suppression by antagonists. While both suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) initially, a rebound in FSH levels occurs during agonist treatment. This rebound is potentially harmful, taken the expression of FSH receptors (R) in prostate cancer tissue. We herein assessed the role of FSH in promoting the growth of androgen-independent (PC-3, DU145) and androgen-dependent (VCaP) human prostate cancer cell line xenografts in nude mice. Gonadotropins were suppressed with the GnRH antagonist degarelix, and effects of add-back human recombinant FSH were assessed on tumor growth. All tumors expressed GnRHR and FSHR, and degarelix treatment suppressed their growth. FSH supplementation reversed the degarelix-evoked suppression of PC-3 tumors, both in preventive (degarelix and FSH treatment started upon cell inoculation) and therapeutic (treatments initiated 3 weeks after cell inoculation) setting. A less marked, though significant FSH effect occurred in DU145, but not in VCaP xenografts. FSHR expression in the xenografts supports direct FSH stimulation of tumor growth. Testosterone supplementation, to maintain the VCaP xenografts, apparently masked the FSH effect on their growth. Treatment with the LH analogue hCG did not affect PC-3 tumor growth despite their expression of luteinizing hormone/choriongonadotropin receptor. In conclusion, FSH, but not LH, may directly stimulate the growth of androgen-independent prostate cancer, suggesting that persistent FSH suppression upon GnRH antagonist treatment offers a therapeutic advantage over agonist

Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II).

IMPORTANCE: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. OBJECTIVE: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. DESIGN, SETTING, AND PARTICIPANTS: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. MAIN OUTCOMES AND MEASURES: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. RESULTS: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). CONCLUSIONS AND RELEVANCE: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure.

Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual's health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them. Methods: Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed. Results: Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants' economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system. Conclusions: This study, the first of its kind in the UK, indicated that participants' health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK