Navigating the Health Care Labyrinth: Portraits of the Socioeconomically Disadvantaged

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75$190,000 per year in personal income (Hyden, 2011), a paradigm for potential discrimination is created through heterogeneous customers seeking health care services from a mostly affluent homogeneous workforce. What are the experiences of the underinsured in attempting to obtain routine and emergent medical care in the United States? Based on the identified void in the current body of scholarship that leaves silent the voices of millions of underserved and socioeconomically disadvantaged patients, this dissertation will extend the muted voices and, thus, create a platform to learn through the patients\u27 personal contexts and unique health stories. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

Navigating the Health Care Labyrinth: Portraits of the Socioeconomically Disadvantaged

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75$190,000 per year in personal income (Hyden, 2011), a paradigm for potential discrimination is created through heterogeneous customers seeking health care services from a mostly affluent homogeneous workforce. What are the experiences of the underinsured in attempting to obtain routine and emergent medical care in the United States? Based on the identified void in the current body of scholarship that leaves silent the voices of millions of underserved and socioeconomically disadvantaged patients, this dissertation will extend the muted voices and, thus, create a platform to learn through the patients\u27 personal contexts and unique health stories. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

Determinants of Farm Productivity in Africa: A Synthesis of Four Case Studies

Productivity Analysis, Downloads July 2008 - July 2009: 20,

The Properties of Poor Groups of Galaxies: II. X-ray and Optical Comparisons

We use ROSAT PSPC data to study the X-ray properties of a sample of twelve poor groups that have extensive membership information (Zabludoff and Mulchaey 1997; Paper I). Diffuse X-ray emission is detected in nine of these groups. In all but one of the X-ray detected groups, the X-ray emission is centered on a luminous elliptical galaxy. Fits to the surface brightness profiles of the X-ray emission suggest the presence of two X-ray components in these groups. The first component is centered on the central elliptical galaxy. The location and extent of this component, combined with its X-ray temperature and luminosity, favor an origin in the interstellar medium of the central galaxy. Alternatively, the central component may be the result of a large-scale cooling flow. The second X-ray component is detected out to a radius of at least 100-300 kpc. This component follows the same relationships found among the X-ray temperature, X-ray luminosity and optical velocity dispersion of rich clusters. This result suggests that the X-ray detected groups are low-mass versions of clusters and that the extended gas component can properly be called the intragroup medium, in analogy to the intracluster medium in clusters. We also find a trend for the position angle of the optical light in the central elliptical galaxy to align with the position angle of the large-scale X-ray emission. (Abridged)Comment: 38 pages, AASLaTeX with 16 PS figures. Figure 1a-1l available in gzipped postscript format at ftp://corvus.ociw.edu/pub/mulchae

The Extended Blue Continuum and Line Emission around the Central Radio Galaxy in Abell 2597

We present results from detailed imaging of the centrally dominant radio elliptical galaxy in the cooling flow cluster Abell 2597, using data obtained with the Wide Field and Planetary Camera 2 (WFPC2) on the Hubble Space Telescope (HST). This object is one of the archetypal "blue-lobed" cooling flow radio elliptical galaxies, also displaying a luminous emission-line nebula, a compact radio source, and a significant dust lane and evidence of molecular gas in its center. We show that the radio source is surrounded by a complex network of emission-line filaments, some of which display a close spatial association with the outer boundary of the radio lobes. We present a detailed analysis of the physical properties of ionized and neutral gas associated with the radio lobes, and show that their properties are strongly suggestive of direct interactions between the radio plasma and ambient gas. We resolve the blue continuum emission into a series of knots and clumps, and present evidence that these are most likely due to regions of recent star formation. We investigate several possible triggering mechanisms for the star formation, including direct interactions with the radio source, filaments condensing from the cooling flow, or the result of an interaction with a gas-rich galaxy, which may also have been responsible for fueling the active nucleus. We propose that the properties of the source are plausibly explained in terms of accretion of gas by the cD during an interaction with a gas-rich galaxy, which combined with the fact that this object is located at the center of a dense, high-pressure ICM can account for the high rates of star formation and the strong confinement of the radio source.Comment: Astrophysical Journal, in press, 34 pages, includes 6 PostScript figures. Latex format, uses aaspp4.sty and epsf.sty file

Cold gas in the Intra Cluster Medium: implications for flow dynamics and powering optical nebulae

We show that the mechanical energy injection rate generated as the intra-cluster medium (ICM) flows around cold clouds may be sufficient to power the optical and near infra-red emission of nebulae observed in the central regions of a sample of seven galaxy clusters. The energy injection rate is extremely sensitive to the velocity difference between the ICM and cold clouds, which may help to explain why optical and infra-red luminosity is often larger than expected in systems containing AGNs. We also find that mass recycling is likely to be important for the dynamics of the ICM. This effect will be strongest in the central regions of clusters where there is more than enough cold gas for its evaporation to contribute significantly to the density of the hot phase.Comment: 8 pages, 2 figures, accepted for publication in MNRA

Quality Control Methods for Optimal BCR-ABL1 Clinical Testing in Human Whole Blood Samples

Reliable breakpoint cluster region (BCR)–Abelson (ABL) 1 measurement is essential for optimal management of chronic myelogenous leukemia. There is a need to optimize quality control, sensitivity, and reliability of methods used to measure a major molecular response and/or treatment failure. The effects of room temperature storage time, different primers, and RNA input in the reverse transcription (RT) reaction on BCR-ABL1 and β-glucuronidase (GUSB) cDNA yield were assessed in whole blood samples mixed with K562 cells. BCR-ABL1 was measured relative to GUSB to control for sample loading, and each gene was measured relative to known numbers of respective internal standard molecules to control for variation in quality and quantity of reagents, thermal cycler conditions, and presence of PCR inhibitors. Clinical sample and reference material measurements with this test were concordant with results reported by other laboratories. BCR-ABL1 per 103 GUSB values were significantly reduced (P = 0.004) after 48-hour storage. Gene-specific primers yielded more BCR-ABL1 cDNA than random hexamers at each RNA input. In addition, increasing RNA inhibited the RT reaction with random hexamers but not with gene-specific primers. Consequently, the yield of BCR-ABL1 was higher with gene-specific RT primers at all RNA inputs tested, increasing to as much as 158-fold. We conclude that optimal measurement of BCR-ABL1 per 103 GUSB in whole blood is obtained when gene-specific primers are used in RT and samples are analyzed within 24 hours after blood collection