Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

714-6 Increased Action Potential Prolongation by Low Voltage Biphasic versus Monophasic Field Stimuli

In an in-vitro model for defibrillation, we compared action potential prolongation (APP) by monophasic (MONO) and biphasic (BI) field stimulus shocks in epicardial tissue strips from 10 dogs. Strips were paced at one end while cellular impalements were maintained in the center (cell A) to measure APP and at the other end (cell B) to determine if shocks produced propagated activations. Rectangular shocks (0.5 to 10V/cm) were delivered with MONO (8 ms) or BI (4.8/3.2 ms) waveforms at times ranging from 44% to 112% of the APD90 of cell A. Recordings were made during 3975 shocked and 2578 control action potentials. APP was the % increase in shocked repolarization time relative to the interlaced controls.While weaker MONO and BI shocks produced propagated activations, the threshold intensity ABOVEwhich shocks did NOTproduce activations was 25.9% lower (p<0.0005) for BI (2.78V/cm) versus MONO (3.75 V/cm). At most intensities and timings, MONO produced more APP than BI. However, for 2 to 4 V/cm shocks at 90% to 100% of APD90, BI produced more APP than MONO (36.9% versus 17.7%, P < 0.0001) shocks.Thus, increased defibrillation efficacy of BI waveforms may result from a greater APP by BI in the low-voltage gradient regions of the heart during defibrillation

The American Dream eludes many urban youth of color. And they think it's their own fault.

Segregation is not a thing of the past for young people of color in the US; many attend under-resourced and segregated school districts. Despite these disadvantages, America's leaders tell young people of color that they can achieve the "American Dream" via hard work and determination. In new research, David T. Lardier Jr., Kathryn G. Herr, Veronica R. Barrios, Pauline Garcia-Reid ..

Economic survey of small slaughtering plants in Missouri

Report on Department of Agricultural Economics Research Project 150, 'Marketing Meat in Missouri'--P. [3].Digitized 2007 AES

Bichromatic Local Oscillator for Detection of Two-Mode Squeezed States of Light

We present a new technique for the detection of two-mode squeezed states of light that allows for a simple characterization of these quantum states. The usual detection scheme, based on heterodyne measurements, requires the use of a local oscillator with a frequency equal to the mean of the frequencies of the two modes of the squeezed field. As a result, unless the two modes are close in frequency, a high-frequency shot-noise-limited detection system is needed. We propose the use of a bichromatic field as the local oscillator in the heterodyne measurements. By the proper selection of the frequencies of the bichromatic field, it is possible to arbitrarily select the frequency around which the squeezing information is located, thus making it possible to use a low-bandwidth detection system and to move away from any excess noise present in the system.Comment: 11 pages, 3 figure

EVALUATION OF AN EXISTING STEEL POST ALTERNATIVE FOR THE THRIE BEAM BULLNOSE GUARDRAIL SYSTEM

Recently, the Minnesota Department of Transportation (MnDOT) funded a research project through the Midwest States Regional Pooled Fund to evaluate an existing steel post alternative for the thrie beam bullnose barrier system previously developed at the Midwest Roadside Safety Facility (MwRSF). MnDOT had an interest in the replacement of the wooden breakaway posts used in the current bullnose system with proprietary breakaway steel posts. The research project consisted of evaluation of current breakaway steel post designs, investigation and selection of a candidate post design, and full-scale testing of the bullnose system with a steel post alternative. The full-scale testing was to consist of two tests conducted according to the evaluation criteria of NCHRP Report 350: 1) Test 3-38, an impact of a 2000P vehicle on the Critical Impact Point (CIP) of the system at a speed of 100 km/h and an angle of 20 degrees, and 2) Test 3-31, an impact of a 2000P vehicle with the center of the vehicle aligned with the center of the nose of the system at a speed of 100 km/h and an angle of 0 degrees. The evaluation of the steel post alternative for the bullnose system project has been completed. A steel post alternative was selected followed by two full-scale crash tests. Unfortunately, both crash tests failed as the vehicle in each test ramped up the guardrail and vaulted the system. This letter summarizes the work completed

Adam Smith and the theory of punishment

A distinctive theory of punishment plays a central role in Smith's moral and legal theory. According to this theory, we regard the punishment of a crime as deserved only to the extent that an impartial spectator would go along with the actual or supposed resentment of the victim. The first part of this paper argues that Smith's theory deserves serious consideration and relates it to other theories such as utilitarianism and more orthodox forms of retributivism. The second part considers the objection that, because Smith's theory implies that punishment is justified only when there is some person or persons who is the victim of the crime, it cannot explain the many cases where punishment is imposed purely for the public good. It is argued that Smith's theory could be extended to cover such cases. The third part defends Smith's theory against the objection that, because it relies on our natural feelings, it cannot provide an adequate moral justification of punishment

Author Correction: Probiotics and prebiotics in intestinal health and disease: from biology to the clinic (Nature Reviews Gastroenterology & Hepatology, (2019), 16, 10, (605-616), 10.1038/s41575-019-0173-3)

© 2019, Springer Nature Limited. In the original article published online, the Competing Interests statement was incorrect and should have stated the following: M.E.S. declares personal fees related to probiotics from the following entities: California Dairy Research Foundation, Clorox, Danone, Danone USA, Dutch Mill, General Mills, JHeimbach, Kelley Drye & Warren, Kellogg, Kerry, Medscape, Nestle, New Chapter, Pepsico, Pfizer, Pharmavite, Probi, Procter & Gamble, Trouw Nutrition, Visalia Dairy Company, Williams Mullen, Winclove Probiotics and Yakult. D.J.M. declares personal fees for consulting for Bayer and Pharmavite. G.R. declares that he helped develop and commercialize probiotic strains GR-1 and RC-14, but has had no financial interest in them for over 10 years. He is Chief Scientific Officer for Seed, a company producing probiotic products. Over the past 3 years, he has consulted on probiotics with Acerus Pharmaceuticals, Altmann, Chr. Hansen, Danone, KGK Science, Kimberly-Clark, Metagenics and Seed. G.R.G. and R.A.R. declare no competing interests. This error has been corrected in the HTML and PDF versions of the article

Probiotics and prebiotics in intestinal health and disease: from biology to the clinic

Probiotics and prebiotics are microbiota-management tools for improving host health. They target gastrointestinal effects via the gut, although direct application to other sites such as the oral cavity, vaginal tract and skin is being explored. Here, we describe gut-derived effects in humans. In the past decade, research on the gut microbiome has rapidly accumulated and has been accompanied by increased interest in probiotics and prebiotics as a means to modulate the gut microbiota. Given the importance of these approaches for public health, it is timely to reiterate factual and supporting information on their clinical application and use. In this Review, we discuss scientific evidence on probiotics and prebiotics, including mechanistic insights into health effects. Strains of Lactobacillus, Bifidobacterium and Saccharomyces have a long history of safe and effective use as probiotics, but Roseburia spp., Akkermansia spp., Propionibacterium spp. and Faecalibacterium spp. show promise for the future. For prebiotics, glucans and fructans are well proven, and evidence is building on the prebiotic effects of other substances (for example, oligomers of mannose, glucose, xylose, pectin, starches, human milk and polyphenols)