Direct Primary Care in 2015: A Survey with Selected Comparisons to 2005 Survey Data

Introduction. Direct primary care (DPC), a fee for membershiptype of practice, is an evolving innovative primary caredelivery model. Little is known about current membershipfees, insurance billing status, physician training, and patientpanel size in DPC practices. This study aimed to obtain currentdata for these variables, as well as additional demographicand financial indicators, and relate the findings to the HealthyPeople 2020 goals. It was predicted that DPC practices would(1) submit fewer claims to insurance, (2) have decreased membershipfees, (3) be primarily family medicine trained, and(4) have increased the projected patient panel size since 2005. Methods. An electronic survey was sent to DPC practices(n = 65) requesting location, membership fees, projectedpatient panel size, insurance billing status, training,and other demographic and financial indicators. Datawere aggregated, reported anonymously, and compared totwo prior characterizations of DPC practices done in 2005. Results. Thirty-eight of 65 (59%) practices responded to the2015 survey. The majority of respondents (84%) reported usingan EMR, offering physician email access (82%), 24-hour access(76%), same day appointments (92%), and wholesale labs (74%).Few respondents offered inpatient care (16%), obstetrics (3%),or financial/insurance consultant services. Eighty-eight percent(88%) of practices reported annual individual adult membershiprates between $500 and$1,499, decreased from 2005 where81% reported greater than a $1,500 annual fee. The proportion ofpractices who submit bills to insurance decreased from 75% in2005 to 11% in 2015. Fifty-six percent (56%) of practices reportedprojected patient panel size to be greater than 600, increasedfrom 40% in 2005. Family medicine physicians represented 87%of respondents, markedly different from 2005 when 62 - 77% ofDPC respondents were general internal medicine physicians. Conclusions. Most DPC practices no longer submit to insuranceand are family medicine trained. Comparedwith the previous sampling, DPC practices report decreasedmembership fees and increased projected panelsize. These trends may signify the DPC movement’sgrowth in application and scope. KS J Med 2017;10(1):3-6

Determinants of rural creative microclustering: Evidence from web‐scraped data for England

This study aims to compare the drivers of clustering of rural and urban creative industries in England, UK. We use pre‐pandemic web‐scraped data from 154,618 creative industry organisations in England, and use a novel technique to identify 71 distinct rural creative ‘microclusters’ of geographically proximate creative firms. We then consider the role of place‐based assets and agglomeration in the presence of microclusters at a micro‐level geography and find that the determinants of microclustering are generally consistent between rural and urban areas. On that basis we argue that policies to support creative clusters may drive rural regional development

Liver and muscle glycogen oxidation and performance with dose variation of glucose-fructose ingestion during prolonged (3 h) exercise

Purpose This study investigated the effect of small manipulations in carbohydrate (CHO) dose on exogenous and endogenous (liver and muscle) fuel selection during exercise. Method Eleven trained males cycled in a double-blind randomised order on 4 occasions at 60% V˙O2max for 3 h, followed by a 30-min time-trial whilst ingesting either 80 g h−1 or 90 g h−1 or 100 g h−1 13C-glucose-13C-fructose [2:1] or placebo. CHO doses met, were marginally lower, or above previously reported intestinal saturation for glucose–fructose (90 g h−1). Indirect calorimetry and stable mass isotope [13C] techniques were utilised to determine fuel use. Result Time-trial performance was 86.5 to 93%, ‘likely, probable’ improved with 90 g h−1 compared 80 and 100 g h−1. Exogenous CHO oxidation in the final hour was 9.8–10.0% higher with 100 g h−1 compared with 80 and 90 g h−1 (ES = 0.64–0.70, 95% CI 9.6, 1.4 to 17.7 and 8.2, 2.1 to 18.6). However, increasing CHO dose (100 g h−1) increased muscle glycogen use (101.6 ± 16.6 g, ES = 0.60, 16.1, 0.9 to 31.4) and its relative contribution to energy expenditure (5.6 ± 8.4%, ES = 0.72, 5.6, 1.5 to 9.8 g) compared with 90 g h−1. Absolute and relative muscle glycogen oxidation between 80 and 90 g h−1 were similar (ES = 0.23 and 0.38) though a small absolute (85.4 ± 29.3 g, 6.2, − 23.5 to 11.1) and relative (34.9 ± 9.1 g, − 3.5, − 9.6 to 2.6) reduction was seen in 90 g h−1 compared with 100 g h−1. Liver glycogen oxidation was not significantly different between conditions (ES < 0.42). Total fat oxidation during the 3-h ride was similar in CHO conditions (ES < 0.28) but suppressed compared with placebo (ES = 1.05–1.51). Conclusion ‘Overdosing’ intestinal transport for glucose–fructose appears to increase muscle glycogen reliance and negatively impact subsequent TT performance

Masses, radii, and orbits of small Kepler planets : The transition from gaseous to rocky planets

We report on the masses, sizes, and orbits of the planets orbiting 22 Kepler stars. There are 49 planet candidates around these stars, including 42 detected through transits and 7 revealed by precise Doppler measurements of the host stars. Based on an analysis of the Kepler brightness measurements, along with high-resolution imaging and spectroscopy, Doppler spectroscopy, and (for 11 stars) asteroseismology, we establish low false-positive probabilities (FPPs) for all of the transiting planets (41 of 42 have an FPP under 1%), and we constrain their sizes and masses. Most of the transiting planets are smaller than three times the size of Earth. For 16 planets, the Doppler signal was securely detected, providing a direct measurement of the planet's mass. For the other 26 planets we provide either marginal mass measurements or upper limits to their masses and densities; in many cases we can rule out a rocky composition. We identify six planets with densities above 5 g cm-3, suggesting a mostly rocky interior for them. Indeed, the only planets that are compatible with a purely rocky composition are smaller than 2 R ⊕. Larger planets evidently contain a larger fraction of low-density material (H, He, and H2O).Peer reviewedFinal Accepted Versio

Blood Banking in Living Droplets

Blood banking has a broad public health impact influencing millions of lives daily. It could potentially benefit from emerging biopreservation technologies. However, although vitrification has shown advantages over traditional cryopreservation techniques, it has not been incorporated into transfusion medicine mainly due to throughput challenges. Here, we present a scalable method that can vitrify red blood cells in microdroplets. This approach enables the vitrification of large volumes of blood in a short amount of time, and makes it a viable and scalable biotechnology tool for blood cryopreservation.National Institutes of Health (U.S.) (NIH R21 EB007707)Wallace H. Coulter FoundationUnited States. Army Medical Research and Materiel Command (Acquisition Activity Cooperative Agreement RO1 A1081534)Center for Integration of Medicine and Innovative TechnologyUnited States. Army Medical Research and Materiel Command (Acquisition Activity Cooperative Agreement R21 AI087107)United States. Army. Telemedicine & Advanced Technology Research Cente

Concert recording 2016-11-15

[Track 1]. Subjugation. Connection [Track 2]. Captivation / Durgan Maxey -- [Track 3]. Fight / Bryce Owens -- [Track 4]. Overture to Stay / Joshua Bland -- [Track 5]. A cellist\u27s legacy. Part I [Track 6]. Part II / Eric Dreggors -- [Track 7]. Evening prayer / Robbie Baker -- [Track 8]. Elegy / Brandon Wade -- [Track 9]. The grotesques trio. Gargoyles [Track 10]. Chimera [Track 11]. Grotesques / Marissa Johnson -- [Track 12]. Crosshair / Joshua Bland -- [Track 13]. Nightwind sings / L. Coley Pitchford -- [Track 14]. Six reflections through poetry. Memories (Walt Whitman) [Track 15]. The musician\u27s wife (Weldon Kees) [Track 16]. The road not taken (Robert Frost) [Track 17]. Lessons (Whitman) [Track 18]. Stronger lessons (Whitman) [Track 19]. O me! O life! (Whitman) / Nick Vecchio -- [Tracks 20-21]. String quartet #1 / Jeremiah Flannery -- [Track 22]. Tides. Morning tide [Track 23]. Bore tide / Elizabeth Greener -- [Track 24]. Shepherd\u27s contemplation / Robbie Baker -- Green grass / arranged by Eva Martin -- [Track 25]. Urbe fracta est II. A prayer for Jerusalem / Joshua Bland

Rheumatoid arthritis - clinical aspects: 134. Predictors of Joint Damage in South Africans with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA. Methods: A cross-sectional study of 100 black patients with RA of >5 years were assessed for joint damage using a validated clinical method, the RA articular damage (RAAD) score. Potential predictors of joint damage that were documented included socio-demographics, smoking, body mass index (BMI), disease duration, delay in disease modifying antirheumatic drug (DMARD) initiation, global disease activity as measured by the disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and autoantibody status. The predictive value of variables was assessed by univariate and stepwise multivariate regression analyses. A p value <0.05 was considered significant. Results: The mean (SD) age was 56 (9.8) years, disease duration 17.5 (8.5) years, educational level 7.5 (3.5) years and DMARD lag was 9 (8.8) years. Female to male ratio was 10:1. The mean (SD) DAS28 was 4.9 (1.5) and total RAAD score was 28.3 (12.8). The mean (SD) BMI was 27.2 kg/m2 (6.2) and 93% of patients were rheumatoid factor (RF) positive. More than 90% of patients received between 2 to 3 DMARDs. Significant univariate predictors of a poor RAAD score were increasing age (p = 0.001), lower education level (p = 0.019), longer disease duration (p < 0.001), longer DMARD lag (p = 0.014), lower BMI (p = 0.025), high RF titre (p < 0.001) and high ESR (p = 0.008). The multivariate regression analysis showed that the only independent significant predictors of a higher mean RAAD score were older age at disease onset (p = 0.04), disease duration (p < 0.001) and RF titre (p < 0.001). There was also a negative association between BMI and the mean total RAAD score (p = 0.049). Conclusions: Patients with longstanding established RA have more severe irreversible joint damage as measured by the clinical RAAD score, contrary to other studies in Africa. This is largely reflected by a delay in the initiation of early effective treatment. Independent of disease duration, older age at disease onset and a higher RF titre are strongly associated with more joint damage. The inverse association between BMI and articular damage in RA has been observed in several studies using radiographic damage scores. The mechanisms underlying this paradoxical association are still widely unknown but adipokines have recently been suggested to play a role. Disclosure statement: C.I. has received a research grant from the Connective Tissue Diseases Research Fund, University of the Witwatersrand. All other authors have declared no conflicts of interes

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis