Primary Care Treatment of HCV in Medicaid Patients

New, safer HCV treatment regimens make it more feasible than ever for primary care providers to manage Hepatitis C patients in their own practices, rather than leaving management solely to specialists. With the current prevalence of HCV and increasing number of new cases linked to the opiate epidemic, it makes sense to expand the number of providers who manage this illness. However, the landscape of new treatments and changing Medicaid requirements present administrative barriers to primary care treatment of HCV. This project aimed to clarify what those barriers were and create a treatment algorithm to simplify decision-making around which patients should be referred to management solely by specialists, and around how to manage those patients appropriate for primary care.https://scholarworks.uvm.edu/fmclerk/1348/thumbnail.jp

The Effects of Poetry in Elderly Populations with Memory Impairment

Introduction. A small body of research on therapeutic use of poetry in individuals with memory impairment demonstrates benefits similar to that of more widely studied music interventions. This project aims to assess the effects of participation in a poetry group on the residents of a memory care floor within the Converse Home, an assisted living facility in Burlington, Vermont. Methods.. We evaluated the effects of twelve group poetry sessions on residents\u27 well-being in several domains. Each session included a reading and writing portion, which were evaluated separately to assess differences in measures of communication, interest, and enjoyment. These measures, along with negative responses, were recorded on Likert scales. T-tests, ANOVA, and post-hoc comparisons were used to compare behavioral and affective observations in the reading versus writing sessions. Results.. Positive responses were significantly higher in reading sessions (p Conclusion.. Although the limitations of this project preclude us from drawing individual conclusions regarding the therapeutic efficacy of poetry in individuals with memory impairment, we demonstrate that poetry sessions have a positive impact on global quality of life outcomes and introduction of poetry sessions in this population has a beneficial effect.https://scholarworks.uvm.edu/comphp_gallery/1242/thumbnail.jp

Reproducibility and relative validity of a semiquantitative food frequency questionnaire in European preschoolers: The ToyBox study

Objectives: The aim of this study was to examine the reproducibility and relative validity of a semiquantitative food frequency questionnaire (FFQ) in assessing food group estimates. Methods: Food group estimates were assessed via a 37-item FFQ and a 3-d food record (FR). Pearson's correlation coefficients for log-transformed values were calculated to assess the reproducibility and Spearman's rank correlation coefficients for log-transformed values were calculated to assess the validity. Kindergartens from six European countries participated in the preparatory substudies of the ToyBox intervention study; data from preschool children 4 to 6 y of age (n = 196, reproducibility study; n = 324, validation study) were obtained. Results: In the reproducibility study, positive Pearson's correlation coefficients for single and aggregated food groups ranged from 0.14 for pasta and rice to 0.90 for cooked vegetables. In the validation study, the FR gave higher estimates of 40 of the 50 food items (single and aggregated) examined compared with those obtained from the FFQ. Positive crude Spearman rank correlation coefficients ranged from 0.01 for total beverages (added sugar) and rice to 0.62 for tea. Corrections for the deattenuation effect did not improve observed correlations. Quartiles and tertiles were calculated for a small number of food groups (N = 14) owing to zero consumption in the rest of the groups. Conclusions: Moderately good reproducibility and low-moderate relative validity of the FFQ used in preschool children was observed. Relative validity, however, varied by food and beverage group; for some of the “key” foods/drinks targeted in the ToyBox intervention (e.g., biscuits), the validity was good. The findings should be considered in future epidemiologic and intervention studies in preschool children

The noise in gravitational-wave detectors and other classical-force measurements is not influenced by test-mass quantization

It is shown that photon shot noise and radiation-pressure back-action noise are the sole forms of quantum noise in interferometric gravitational wave detectors that operate near or below the standard quantum limit, if one filters the interferometer output appropriately. No additional noise arises from the test masses' initial quantum state or from reduction of the test-mass state due to measurement of the interferometer output or from the uncertainty principle associated with the test-mass state. Two features of interferometers are central to these conclusions: (i) The interferometer output (the photon number flux N(t) entering the final photodetector) commutes with itself at different times in the Heisenberg Picture, [N(t), N(t')] = 0, and thus can be regarded as classical. (ii) This number flux is linear in the test-mass initial position and momentum operators x_o and p_o, and those operators influence the measured photon flux N(t) in manners that can easily be removed by filtering -- e.g., in most interferometers, by discarding data near the test masses' 1 Hz swinging freqency. The test-mass operators x_o and p_o contained in the unfiltered output N(t) make a nonzero contribution to the commutator [N(t), N(t')]. That contribution is cancelled by a nonzero commutation of the photon shot noise and radiation-pressure noise, which also are contained in N(t). This cancellation of commutators is responsible for the fact that it is possible to derive an interferometer's standard quantum limit from test-mass considerations, and independently from photon-noise considerations. These conclusions are true for a far wider class of measurements than just gravitational-wave interferometers. To elucidate them, this paper presents a series of idealized thought experiments that are free from the complexities of real measuring systems.Comment: Submitted to Physical Review D; Revtex, no figures, prints to 14 pages. Second Revision 1 December 2002: minor rewording for clarity, especially in Sec. II.B.3; new footnote 3 and passages before Eq. (2.35) and at end of Sec. III.B.

Polish 2010 growth references for school-aged children and adolescents

Growth references are useful in monitoring a child's growth, which is an essential part of child care. The aim of this paper was to provide updated growth references for Polish school-aged children and adolescents and show the prevalence of overweight and obesity among them. Growth references for height, weight, and body mass index (BMI) were constructed with the lambda, mu, sigma (LMS) method using data from a recent, large, population-representative sample of school-aged children and adolescents in Poland (n = 17,573). The prevalence of overweight and obesity according to the International Obesity Taskforce definition was determined with the use of LMSGrowth software. Updated growth references for Polish school-aged children and adolescents were compared with Polish growth references from the 1980s, the Warsaw 1996–1999 reference, German, and 2000 CDC references. A positive secular trend in height was observed in children and adolescents from 7 to 15 years of age. A significant shift of the upper tail of the BMI distribution occurred, especially in Polish boys at younger ages. The prevalence of overweight or obesity was 18.7% and 14.1% in school-aged boys and girls, respectively. The presented height, weight, and BMI references are based on a current, nationally representative sample of Polish children and adolescents without known disorders affecting growth. Changes in the body size of children and adolescents over the last three decades suggest an influence of the changing economical situation on anthropometric indices

Density and potential fluctuations in the edge plasma of the Uragan-3m torsatron

Ion saturation current and floating potential fluctuations are recorded by movable array of 4 Langmuir probes near the boundary of the confinement region in the l = 3/m = 9 Uragan-3M torsatron with an RF produced and heated plasma. On the basis of these data main spectral and time characteristics of the low frequency electrostatic turbulence have been derived. The existence of the radial electric field shear and reversal of poloidal phase velocity of the fluctuations at the plasma boundary have been confirmed. The time function of the turbulent E×B particle flux contains intermittent bursts with the amplitude multiply exceeding the average flux. Up to 70% of the total fluctuating flux is carried in these bursts

What effect does physician "profiling" have on inpatient physician satisfaction and hospital length of stay?

BACKGROUND: 2002 marked the first time that the rate of hospital spending in the United States outpaced the overall health care spending rate of growth since 1991. As hospital spending continues to grow and as reimbursement for hospital expenses has moved towards the prospective payment system, there is still increasing pressure to reduce costs. Hospitals have a major incentive to decrease resource utilization, including hospital length of stay. We evaluated whether physician profiling affects physician satisfaction and hospital length of stay, and assessed physicians' views concerning hospital cost containment and the quality of care they provide. METHODS: To determine if physician profiling affects hospital length of stay and/or physician satisfaction, we used quasi-experimental with before-versus-after and intervention-versus-control comparisons of length of stay data collected at an intervention and six control hospitals. Intervention hospital physicians were informed their length of stay would be compared to their peers and were given a questionnaire assessing their experience. RESULTS: Nearly half of attending pre-profiled physicians felt negative about the possibility of being profiled, while less than one-third of profiled physicians reported feeling negative about having been profiled. Nearly all physicians greatly enjoyed their ward month. Length of stay at the profiled site decreased by an additional 1/3 of a day in the profiling year, compared to the non-profiled sites (p < 0.001). CONCLUSION: A relatively non-instrusive profiling intervention modestly reduced length of stay without adversely affecting physician satisfaction

Divertor flow and particle loss behaviors in spontaneous change of confinement state in the URAGAN-3M torsatron

Under conditions of spontaneous change of plasma confinement state having been observed recently in the U-3M torsatron with a natural helical divertor, it is shown that at the initial phase of this change all the components of the diverted plasma flow (DPF) decrease, while thermal (TI) and suprathermal (STI) ion content in the bulk plasma increases and the TI+STI fraction in the DPF is reduced on the ion В×∇В drift side, thus indicating an improvement of ion confinement. The initial phase is ended by a DPF rise on the ion В×∇В drift side, a TI+STI content decay in the bulk plasma and a rise of TI+STI outflow into the DPF, these being indications of an ion confinement deterioration. However, a simultaneous DPF reduction on the electron В×∇В drift side and a rise of electron density and ECE indicate an improvement of electron confinement.В умовах виявленої раніше спонтанної зміни режиму утримання в торсатроні У-3М з природним гвинтовим дивертором показано, що на початковій стадії цієї зміни зменшуються всі складові плазмового диверторного потоку (ПДП), в той час, як зростає кількість теплових (ТІ) та надтеплових (НТІ) іонів в основній плазмі, засвідчуючи про покращення їх утримання. Початкова стадія завершується зростанням ПДП на боці іонного дрейфу В×∇В, зменшенням кількості ТІ та НТІ в основній плазмі та підвищеним виходом їх до ПДП, що є ознакою погіршення утримання іонів. Але одночасне зменшення ПДП на боці електронного дрейфу В×∇В і зростання електронної густини та електронного циклотронного випромінювання вказують на покращення утримання електронів.В условиях обнаруженного ранее спонтанного изменения режима удержания в торсатроне У-3М с естественным винтовым дивертором показано, что на начальной стадии этого изменения уменьшаются все составляющие плазменного диверторного потока (ПДП) и растёт содержание тепловых (ТИ) и сверхтепловых (СТИ) ионов в основной плазме, свидетельствуя об улучшении их удержания. Начальная стадия завершается возрастанием ПДП на стороне ионного дрейфа В×∇В, уменьшением содержания ТИ и СТИ в основной плазме и повышенным их уходом в ПДП, что говорит об ухудшении удержания ионов. Однако, при этом уменьшается ПДП на стороне электронного дрейфа В×∇В и растут плотность электронов и электронное циклотронное излучение, что указывает на улучшение удержания электронов

Effects of plasma heating on the magnitude and distribution of plasma flows in the helical divertor of the Uragan-3M torsatron

Recently, a strong up-down asymmetry in the poloidal distributions of diverted plasma flows has been observed in the l = 3/m = 9 Uragan-3M torsatron, in many features similar to what have been observed in the l = 2 Heliotron E heliotron/torsatron. With this asymmetry, the predominant outflow of the diverted plasma is directed with the ion toroidal drift. On this basis, the asymmetry can be related to the space non-uniformity of the charged particle loss. In the work reported, the magnitude of divertor flow in U-3M and the vertical asymmetry in its distribution are studied as functions of the heating parameter P/, P being the power absorbed in the plasma, and are juxtaposed with corresponding P-related changes in the density and fast ion content in the plasma. As P/ increases, an increase of fast ion content and of particle loss, on the one hand, and an increase of divertor flow magnitude and of vertical asymmetry of the flow, on the other hand, are observed. A mutual accordance between these processes validates the hypothesis on a dominating role of fast particle loss in formation of vertical asymmetry of divertor flows in helical devices

Adult Type 3 Adenylyl Cyclase–Deficient Mice Are Obese

Background: A recent study of obesity in Swedish men found that polymorphisms in the type 3 adenylyl cyclase (AC3) are associated with obesity, suggesting the interesting possibility that AC3 may play a role in weight control. Therefore, we examined the weight of AC3 mice over an extended period of time. Methodology/Principal Findings: We discovered that AC3 2/2 mice become obese as they age. Adult male AC3 2/2 mice are about 40 % heavier than wild type male mice while female AC3 2/2 are 70 % heavier. The additional weight of AC3 2/2 mice is due to increased fat mass and larger adipocytes. Before the onset of obesity, young AC3 2/2 mice exhibit reduced physical activity, increased food consumption, and leptin insensitivity. Surprisingly, the obesity of AC3 2/2 mice is not due to a loss of AC3 from white adipose and a decrease in lipolysis. Conclusions/Significance: We conclude that mice lacking AC3 exhibit obesity that is apparently caused by low locomotor activity, hyperphagia, and leptin insensitivity. The presence of AC3 in primary cilia of neurons of the hypothalamus suggests that cAMP signals generated by AC3 in the hypothalamus may play a critical role in regulation of body weight