Perception of Trust, Virtual Care, and Access Among the Uninsured Population: A Multi-Site Study at Student Run Free Clinics

Introduction/Problem: Since the onset of the COVID-19 pandemic, utilization of virtual visits has significantly increased. Advantages of virtual visits include lower healthcare costs and improved access to healthcare. Although one of the main goals of implementing virtual visits is to increase access to the underserved population, there have been few studies with a focus on the opinions of African Americans or the uninsured. Moreover, distrust in physicians and healthcare, although universal, is more prevalent among the African American and uninsured populations. It is also known that trust leads to better self-reported health outcomes, patient satisfaction, health behaviors, quality of life, and symptom severity. Therefore, identifying ways to increase trust is essential to improving healthcare, especially among the underserved. The aim of our study is to evaluate the knowledge, attitudes, and experiences of the uninsured community living in Detroit regarding virtual care and trust in physicians and the healthcare system. We hypothesize that factors such as virtual care and free clinic use will be correlated with increased trust. Methods/Interventions: This project involves three student-run free clinics located in a large Midwestern metropolitan city. We are conducting a survey-based research study evaluating the knowledge, attitudes, and experiences of uninsured people in Detroit with virtual healthcare services, physician trust, and trust in the overall healthcare system using combined, previously published, survey instruments. The data will be analyzed by a report of the demographics and average responses. Then, using Student’s t-tests and ANOVA via the SPSS platform, the effect of virtual care and free clinic use on trust will be evaluated. Results Data collection is currently in progress. At this point in time, we have a sample size of 32 uninsured participants above the age of 18 years and approximately an 89% response rate. We aim to have over 50 participants by the conference deadline in order to extrapolate more meaningful interpretations from data analysis. Currently, 71.8% of the participants are African American and 75% earn less than $40,000 per year. Our initial findings show that 84.4% of participants have utilized free clinics before, with 96.4% of those reporting an extremely or mostly positive experience. Furthermore, preliminary analysis finds that 90.6% of participants trust their physician’s judgment about their medical care. In regard to telemedicine, 43.8% have previously accessed health care via phone or video chat, although only 23.8% of users report obtaining “better access to healthcare services by use of telemedicine”. Conclusion Further research is necessary to illuminate perceptions of access and trust in free clinics and telehealth services in underserved populations and to determine mechanisms which can be implemented to improve these views

Evolution of the bilayer nu = 1 quantum Hall state under charge imbalance

We use high-mobility bilayer hole systems with negligible tunneling to examine how the bilayer nu = 1 quantum Hall state evolves as charge is transferred from one layer to the other at constant total density. We map bilayer nu = 1 state stability versus imbalance for five total densities spanning the range from strongly interlayer coherent to incoherent. We observe competition between single-layer correlations and interlayer coherence. Most significantly, we find that bilayer systems that are incoherent at balance can develop spontaneous interlayer coherence with imbalance, in agreement with recent theoretical predictions.Comment: 4 pages, 4 figure

Anomalous peak in Antarctic sea-ice area, winter 1998, coincident with ENSO

The results of an updated satellite analysis of hemispheric and regional Antarctic sea-ice cover are presented based on October 1987-September I999 Special Sensor Microwave/Imager (SSM/I) data. These show an ongoing slight but significant hemispheric increase of 3.7(±0.3) in extent and 6.6(±1.5) in area. In the two principal sectors, Weddell Sea ice extent (area) decreased by 3.4(±1.0) (3.9(±4.6)) and Ross Sea ice extent (area) increased by 10.9(±1.0) (18.3(±4.6)). Hemispheric, Ross Sea and Western Pacific Ocean ice peaks in September 1998 were anomalously high, and may have been related to atmospheric and oceanic anomalies in the Pacific Ocean and beyond associated with that year's exceptionally strong ENSO. Preliminary comparison of Antarctic sea-ice-concentration data with European Centre for Medium-Range Weather Forecasts (ECMWF) operational analyses fields suggests that the unusually extensive sea ice in winter 1998 was concomitant with an equatorward shift of the circumpolar westerly surface winds over the southern Pacific Ocean

Anomalous peak in Antarctic sea-ice area, winter 1998, coincident with ENSO

The results of an updated satellite analysis of hemispheric and regional Antarctic sea-ice cover are presented based on October 1987-September I999 Special Sensor Microwave/Imager (SSM/I) data. These show an ongoing slight but significant hemispheric increase of 3.7(±0.3) in extent and 6.6(±1.5) in area. In the two principal sectors, Weddell Sea ice extent (area) decreased by 3.4(±1.0) (3.9(±4.6)) and Ross Sea ice extent (area) increased by 10.9(±1.0) (18.3(±4.6)). Hemispheric, Ross Sea and Western Pacific Ocean ice peaks in September 1998 were anomalously high, and may have been related to atmospheric and oceanic anomalies in the Pacific Ocean and beyond associated with that year's exceptionally strong ENSO. Preliminary comparison of Antarctic sea-ice-concentration data with European Centre for Medium-Range Weather Forecasts (ECMWF) operational analyses fields suggests that the unusually extensive sea ice in winter 1998 was concomitant with an equatorward shift of the circumpolar westerly surface winds over the southern Pacific Ocean

Central Corneal Thickness: A Retrospective Comparison of Handheld Ultrasound Pachymetry and Optical Biometric Analysis Measurements

Purpose To determine if the measure of central cornea thickness among suspected and confirmed glaucomatous patients is significantly influenced by instrument device. Methods We retrospectively examined the charts of all patients having a central corneal thickness (CCT) measured with both ultrasound pachymetry and IOL Master 700 at the Kresge Eye Institute within the past year. Intraocular pressure and demographic data including age and race, were also collected. Significant corneal disease such as Fuchs corneal dystrophy, other corneal dystrophies, corneal transplant, and corneal edema were excluded. Statistical analysis of the paired CCT measurements were performed with a paired t-test and regression analysis. Results The total number of patients having a CCT measured with both ultrasound pachymetry and IOLMaster700 was 59. Mean CCT measured with ultrasound pachymetry was 539.38 ± 49.56 µm (n=118). Mean CCT measured with IOLMaster700 was 536.83 ± 42.52 µm (n=112). The intraparticipant mean of differences between the ultrasound pachymetry and the IOLMaster700 was 3.16 ± 25 µm. Analysis with a paired t-test did not find a significant difference between the two groups (p=0.19). A regression analysis of the paired CCTs yielded an R2 value of 0.74. Conclusion There is no significant difference between CCT measurements taken with handheld ultrasound pachymetry compared to the IOL Master 700. More data is warranted to confirm, but the IOL Master 700 may yield lower variability and a lower mean CCT, possibly due to greater instrument precision and increased likelihood of a central measurement. In practice, the IOL Master 700 may provide a more reliable measure of central cornea thickness when compared with ultrasound pachymetry

Adopt to adapt: Efforts to Keep the RAMPART Trial of Adjuvant Immunotherapy in Renal Cancer on Track in the COVID-19 Era

Introduction: The RAMPART trial is an international, UCL-led, multi-arm multi-stage (MAMS) platform trial investigating the use of immune checkpoint inhibitors after nephrectomy in patients with renal cell carcinoma. It was initiated with a control (active monitoring) and two research arms (durvalumab monotherapy and durvalumab with tremelimumab) and has been open to recruitment since July 2018. Due to the COVID-19 pandemic, recruitment and treatment delivery was suspended for four months in the Spring/Summer of 2020 and accrual has only recovered in 2022. / Methods/Approach: The RAMPART team provided clear communication to sites on how to manage priorities during the temporary suspension and relaunch of the trial. The protocol was amended to ensure the safe treatment of patients and to offer flexibility to conduct consent and certain assessments remotely. Sites were asked to focus on the submission of high priority data to permit continued oversight of patient safety and allow primary outcome data to be collected. Data completeness has been carefully monitored and targeted data chases have been conducted to maximise data integrity. We have explored the extent to which the pandemic will prolong recruitment and follow-up, and the timelines for our primary analyses. To maximise options for patients and to aid accrual, we examined the impact of re-randomisation of control arm patients within the protocol, an approach that has been employed in other trials within the CTU in other disease areas. / Results Structure & Timelines: This section will contain an update on compliance, recruitment, sites open and timelines for analysis. In order to be able to present these adequately and robustly, we will use data up to September 2022. / Potential Relevance & Impact: The pandemic era has been challenging for clinical trials. Adaptations can be made to prioritise patient safety, to allow activity to continue where there is capacity and to ensure trial integrity is maintained

Shape-induced force fields in optical trapping

Advances in optical tweezers, coupled with the proliferation of two-photon polymerization systems, mean that it is now becoming routine to fabricate and trap non-spherical particles. The shaping of both light beams and particles allows fine control over the flow of momentum from the optical to mechanical regimes. However, understanding and predicting the behaviour of such systems is highly complex in comparison with the traditional optically trapped microsphere. In this Article, we present a conceptually new and simple approach based on the nature of the optical force density. We illustrate the method through the design and fabrication of a shaped particle capable of acting as a passive force clamp, and we demonstrate its use as an optically trapped probe for imaging surface topography. Further applications of the design rules highlighted here may lead to new sensors for probing biomolecule mechanics, as well as to the development of optically actuated micromachines

Portfolio Vol. II N 1

Browne, Phil. The Approach to Fraternity Row . Picture. 2. Simmons, Fate. The Sand House . Prose. 3. The College Catbird, Groucho. Ode to my Fellow Students . Poem. 6. Varney, Chester. The Tramp . Prose. 7. Browne, Phil. Shell Shock . Prose. 9. West, Bill C. Mr. Freud... . Poem. 10. West, Bill C. Bacchanal . Poem. 10. De Chavannes, Pierre Puvis de. Summer . Poem. 10. Pierce, Ames. A Student Looks at Europe . Prose. 11. Timrud, David. Though you Knew it Not . Poem. 13. Timrud, David. Le Joi De Vivre . Poem. 13. Timrud, David. The Ghostly Loom . Poem. 13. Dohanos, Stephen. West Quoddy Light, Maine . Picture. 13. Millet, Jean Francois. Peasants Going to Work . Picture. 14. Kent, Rockwell. Maine Coast . Picture. 14. Beier, Dean. Review of New Recordings . Prose. 15. Beier, Dean. Advice on Band Booking . Prose. 15. Millay, Edna St. Vincent. From \u27Conversation at Midnight\u27 . Prose. 16. Black, James. Playing Around . Prose. 17. Saunders, Paul. Review of New Books .Prose. 17. Salietti, Alberto. A country Woman . Picture. 18. Eschman, Barbara. Color Scheme . Poem. 18. Whitehead, Richard. A Tribute . Picture. 19. Beckham, Adela. Gethsemane . Poem. 20. Beckham, Adela. Blues Singer . Poem. 20. Flory, Doris. Revelation . Poem. 20. Flory, Doris. Fervor . Poem. 20. Hanna, Stanley. Men of Fortune . Poem. 20. Sweitzer, Harry J. Denison and Education . Prose. 21. Hopkins, Kate. Twillight . Prose. 23. Hopkins, Kate. Afterward . Prose. 23