Leveling the field--Ensuring equity through National Health Care Reform

Members of minority groups have higher rates of disease, poorer health, and more limited access to care than their white counterparts. They account for half of the uninsured population and 58% of the low-income uninsured population. Even when they have coverage, minority patients are at risk for receiving lower-quality medical and surgical care than white patients. The factors underlying these inequities are complex and go far beyond the health care system,but any meaningful reform must, at a minimum, confront disparities in care. Health care reform provides a unique opportunity to reversea legacy of inequality in health and health care. This chance should not be squandered

Perfecting Patient Flow: America\u27s Safety Net Hospitals and Emergency Department Crowding

Emergency department crowding and delays have become major issues for America\u27s safety net hospitals and health systems. Many facilities are experiencing increasing wait times, a need to board admitted patients in emergency department (ED) hallways, and rising numbers of hours spent on diversion or bypass. These trends result from increased patient demand at a time when the number of emergency departments has declined and hospital inpatient capacity has lagged. Other factors also may contribute to the crisis. Patients without access to medical specialists may view the ED as the quickest route to specialized services. Overburdened physicians may be more likely to refer patients to an ED for care, especially if they view the ED as a comprehensive diagnostic center. Meanwhile, shortages of nurses and on-call specialists may slow the care of patients once they get to the ED. Given these complex factors, solutions we once thought would relieve ED demand, like expanded primary care capacity, may actually do little to alleviate this crisis. For patients as well as caregivers, these are more than issues of convenience. Many of the patients who, due to their frustration at the long wait, leave a hospital ED without being seen by a physician do indeed need immediate medical care. Overworked health professionals are more prone to error, and a crowded ED is more likely to experience high turnover and vacancy rates. Long delays and overextended staffing are recipes for low quality, medical error, and poor morale. Faced with the unique mandate of the Emergency Medical Treatment and Labor Act of 1986 (EMTALA), as well as with historic missions to care for all, safety net hospitals may be especially strained by these conditions. These hospitals often run large emergency departments with trauma and other specialized services and treat many medically and socially complex patients in an environment of declining or no payment. Yet they are expected to care for all comers, and to do it well while being accountable to the public. The National Association of Public Hospitals and Health Systems (NAPH) commissioned this report, Perfecting Patient Flow: America\u27s Safety Net Hospitals and Emergency Department Crowding, to describe practical approaches to reducing ED crowding as implemented in three member hospitals. Each of these hospitals participated in the year-long Robert Wood Johnson Foundation-funded safety net collaborative, Urgent Matters. These three hospitals, The Regional Medical Center at Memphis, Boston Medical Center, and Grady Health System in Atlanta, were chosen through a highly selective process to participate in the project, which was headquartered at The George Washington University Medical Center School of Public Health and Health Services

On codes with local joint constraints

AbstractWe study the largest number of sequences with the property that any two sequences do not contain specified pairs of patterns. We show that this number increases exponentially with the length of the sequences and that the exponent, or capacity, is the logarithm of the joint spectral radius of an appropriately defined set of matrices. We illustrate a new heuristic for computing the joint spectral radius and use it to compute the capacity for several simple collections. The problem of computing the achievable rate region of a collection of codes is introduced and it is shown that the region may be computed via a similar analysis

Emergency Department Operations in Top-Performing Safety-Net Hospitals

This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that entails: recognition that ED crowding is a hospital-wide issue; leadership provided by the CEO and other senior staff; vigilance in pursuing change, reviewing outcomes, and working to improve; transparency; and a commitment to quality for safety-net populations

Lean Years

Contributors: Kim Deitch, Leslie, John Pound, Mike Royer, Trina, Chris Warner. Barry Siegel and Bruce Simon, editors. Member: United Cartoon Workers of America. The Adler Archive of Underground Comix, Gift of Bill Adler.https://digitalcommons.risd.edu/specialcollections_adlerarchive_undergroundcomix/1085/thumbnail.jp

First-in-man evaluation of 124I-PGN650: A PET tracer for detecting phosphatidylserine as a biomarker of the solid tumor microenvironment

Purpose: PGN650 is a F(ab′) 2 antibody fragment that targets phosphatidylserine (PS), a marker normally absent that becomes exposed on tumor cells and tumor vasculature in response to oxidative stress and increases in response to therapy. PGN650 was labeled with 124 I to create a positron emission tomography (PET) agent as an in vivo biomarker for tumor microenvironment and response to therapy. In this phase 0 study, we evaluated the pharmacokinetics, safety, radiation dosimetry, and tumor targeting of this tracer in a cohort of patients with cancer. Methods: Eleven patients with known solid tumors received approximately 140 MBq (3.8 mCi) 124 I-PGN650 intravenously and underwent positron emission tomography–computed tomography (PET/CT) approximately 1 hour, 3 hours, and either 24 hours or 48 hours later to establish tracer kinetics for the purpose of calculating radiation dosimetry (from integration of the organ time-activity curves and OLINDA/EXM using the adult male and female models). Results: Known tumor foci demonstrated mildly increased uptake, with the highest activity at the latest imaging time. There were no unexpected adverse events. The liver was the organ receiving the highest radiation dose (0.77 mGy/MBq); the effective dose was 0.41 mSv/MBq. Conclusion: Although 124 I-PGN650 is safe for human PET imaging, the tumor targeting with this agent in patients was less than previously observed in animal studies

Turbulent dispersal promotes species coexistence

Several recent advances in coexistence theory emphasize the importance of space and dispersal, but focus on average dispersal rates and require spatial heterogeneity, spatio-temporal variability or dispersal-competition tradeoffs to allow coexistence. We analyse a model with stochastic juvenile dispersal (driven by turbulent flow in the coastal ocean) and show that a low-productivity species can coexist with a high-productivity species by having dispersal patterns sufficiently uncorrelated from those of its competitor, even though, on average, dispersal statistics are identical and subsequent demography and competition is spatially homogeneous. This produces a spatial storage effect, with an ephemeral partitioning of a ‘spatial niche’, and is the first demonstration of a physical mechanism for a pure spatiotemporal environmental response. ‘Turbulent coexistence’ is widely applicable to marine species with pelagic larval dispersal and relatively sessile adult life stages (and perhaps some wind-dispersed species) and complements other spatial and temporal storage effects previously documented for such species

Walking a Tightrope: The State of the Safety Net in Ten U.S. Communities

This report presents the findings from the Urgent Matters safety net assessments and identifies common characteristics, opportunities and challenges for communities that wish to better serve the health care needs of uninsured and underserved individuals. It also illustrates differences across many of the communities, especially in terms of the structure and financing of their safety nets. It is a companion report to the individual safety net assessments and provides an overarching perspective of problems that affect safety nets across the country