Quality and Cost of Diabetes Mellitus Care in Community Health Centers in the United States

Objective To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings. Research Design and Methods We used data from the 2005–2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to predict expenditures for CHC users compared to non-users of CHCs, conditional on patients with positive expenditures. Results Results showed that variations of quality between CHC users and non-CHC users were not statistically significant. Patients with diabetes mellitus who used CHCs saved payers and individuals approximately $1,656 in ambulatory care costs compared to non-users of CHCs. Conclusions These findings suggest an opportunity for policymakers to control costs for diabetes mellitus patients without having a negative impact on quality of care

Effects of 30-, 60-, and 90-Day Bed Rest on Postural Control in Men and Women

INTRODUCTION Head-down-tilt bed rest (HDT) has been used as a safe gr ound-based analog to mimic and develop countermeasures for the physiological effects of spaceflight, including decrements in postural stability. The purpose of this investigation was to characterize the effects of 30-, 60-, and 90-day bed rest on postural control in men and women. METHODS Twenty-nine subjects (18M,11F) underwent 13 days of ambula tory acclimatization and were placed in 6? HDT for 30 (n=12), 60 (n=8), or 90 (n=9) days, followed by 14 days of ambulatory recovery. Computerized dynamic posturography (CDP) was used to assess changes in sensory and motor components of postural control, and recovery after HDT. Sensory Organization Tests (SOTs) objectively evaluate one?s ability to effectively use or suppress visual, vestibular, and proprioceptive information for postural control. Stability during the SOTs was assessed using peak-to-peak sway and convergence toward stability limits to derive an equilibrium score. Motor Control Tests (MCTs) evaluate one?s ability to recover from unexpected support surface perturbations, with performance determined by center-of-pressure path length. Whole-body kinematic data were collected to determine body-sway strategy used to maintain stability during each condition. Baselines were determined pre-HDT. Recovery was tracked post-HDT on days 0, 1, 2, and 4. RESULTS Immediately after HDT, subjects showed decreased performance on most SOTs, primarily on sway-referenced support conditions, typically returning to baseline levels within 4 days. MCT performance was not significantly affected. There were no significant gender or duration differences in performance. Kinematic data revealed a tendency to use ankle strategy to maintain an upright stance during most SOT conditions. Interestingly, six subjects (2M,4F) experienced orthostatic intolerance and were unable to complete day 0 testing. CONCLUSION HDT mimics some un loading mechanisms of spaceflight and elicits orthostatic issues present post-spaceflight (contributing to instability); however, it does not sufficiently address the vestibular dysfunction which occurs post-spaceflight

The Power of Community: The Role of Community-Based Organizations in Mitigating COVID-19-Related Impacts on Well-Being Among South Florida's Minoritized Populations

The rapid closure of schools and businesses during the COVID-19 pandemic has had a significant impact in South Florida, highlighting diverse challenges to community well-being. Community-based organizations (CBOs) have served as a source of support for community members, particularly in stressful times. Using a combination of quantitative and qualitative methods, and in collaboration with Breakthrough Miami, a CBO committed to addressing the educational opportunity gap in Miami-Dade County, we conducted a study to assess challenges to the well-being of systematically minoritized families during the heart of the COVID-19 pandemic. The study included longitudinal survey data collected via ecological momentary assessment and in-depth interviews with Breakthrough Miami families to gather richer and nuanced data regarding indicators of well-being and CBO engagement. Quantitative results indicated that as perceived stress increased over time, so too did emotional and informational support. Follow-up qualitative interviews indicated that 100% of families identified Breakthrough Miami as a source of academic support during the pandemic. Additionally, families cited the important role Breakthrough Miami played beyond their standard academic programs and services in coping with the most significant sources of stress reported through the pandemic: meeting basic needs and threats to socioemotional well-being. Implications for CBOs are addressed

The Power of Community: The Role of Community-Based Organizations in Mitigating COVID-19-Related Impacts on Well-Being Among South Florida's Minoritized Populations

The rapid closure of schools and businesses during the COVID-19 pandemic has had a significant impact in South Florida, highlighting diverse challenges to community well-being. Community-based organizations (CBOs) have served as a source of support for community members, particularly in stressful times. Using a combination of quantitative and qualitative methods, and in collaboration with Breakthrough Miami, a CBO committed to addressing the educational opportunity gap in Miami-Dade County, we conducted a study to assess challenges to the well-being of systematically minoritized families during the heart of the COVID-19 pandemic. The study included longitudinal survey data collected via ecological momentary assessment and in-depth interviews with Breakthrough Miami families to gather richer and nuanced data regarding indicators of well-being and CBO engagement. Quantitative results indicated that as perceived stress increased over time, so too did emotional and informational support. Follow-up qualitative interviews indicated that 100% of families identified Breakthrough Miami as a source of academic support during the pandemic. Additionally, families cited the important role Breakthrough Miami played beyond their standard academic programs and services in coping with the most significant sources of stress reported through the pandemic: meeting basic needs and threats to socioemotional well-being. Implications for CBOs are addressed

Primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphomas: reappraisal of a provisional entity in the 2016 WHO classification of cutaneous lymphomas.

Primary cutaneous CD8-positive aggressive epidermotropic T-cell lymphoma is a rare and poorly characterized variant of cutaneous lymphoma still considered a provisional entity in the latest 2016 World Health Organization Classification of Cutaneous lymphomas. We sought to better characterize and provide diagnostic and therapeutic guidance of this rare cutaneous lymphoma. Thirty-four patients with a median age of 77 years (range 19-89 years) presented primarily with extensive annular necrotic plaques or tumor lesions with frequent mucous membrane involvement. The 5-year survival was 32% with a median survival of 12 months. A subset of 17 patients had a prodrome of chronic patches prior to the development of aggressive ulcerative lesions. We identified cases with lack of CD8 or αβ T-cell receptor expression yet with similar clinical and pathological presentation. Allogeneic stem cell transplantation provided partial or complete remissions in 5/6 patients. We recommend the term primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphoma as this more broad designation better describes this clinical-pathologic presentation, which allows the inclusion of cases with CD8 negative and/or αβ/γδ T-cell receptor chain double-positive or double-negative expression. We have identified early skin signs of chronic patch/plaque lesions that are often misdiagnosed as eczema, psoriasis, or mycosis fungoides. Our experience confirms the poor prognosis of this entity and highlights the inefficacy of our standard therapies with the exception of allogeneic stem cell transplantation in selected cases

A person-centered approach to understanding negative reinforcement drinking among first year college students [post-print]

The current study used a person-centered approach (i.e. latent profile analysis) to identify distinct types of college student drinkers based on the predictions of motivational, social learning, and stress and coping theories of maladaptive drinking. A large sample (N = 844; 53% female) of first-year undergraduates from two institutions, public and private, who reported consuming one or more drinks in the last three months completed measures of depressive and anxiety symptoms, positive alcohol-outcome expectancies, negative life events, social support, drinking motives, drinking level and drinking-related problems. Latent profile analysis revealed a small subgroup of individuals (n = 81, 9%) who conformed to the anticipated high-risk profile; specifically, this group demonstrated high levels of negative affect, coping motives, drinks per week, and drinking-related problems. However, additional groups emerged that showed patterns inconsistent with the proposed vulnerability profile (e.g., high negative affect, positive expectancies, and negative life events, but relatively low drinking levels). Findings from our person-centered approach showing the presence of groups both consistent and inconsistent with the predictions of motivational, social learning, and stress and coping theories highlight the need to identify and target certain college students for prevention and intervention of negative affect-related drinking

Metabolic Syndrome Is Associated with Greater Histologic Severity, Higher Carbohydrate, and Lower Fat Diet in Patients with NAFLD

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73077/1/j.1572-0241.2006.00719.x.pd

Multifaceted Role for p53 in Pancreatic Cancer Suppression

The vast majority of human pancreatic ductal adenocarcinomas (PDACs) harbor TP53 mutations, underscoring p53\u27s critical role in PDAC suppression. PDAC can arise when pancreatic acinar cells undergo acinar-to-ductal metaplasia (ADM), giving rise to premalignant pancreatic intraepithelial neoplasias (PanINs), which finally progress to PDAC. The occurrence of TP53 mutations in late-stage PanINs has led to the idea that p53 acts to suppress malignant transformation of PanINs to PDAC. However, the cellular basis for p53 action during PDAC development has not been explored in detail. Here, we leverage a hyperactive p53 variant-p5353,54-which we previously showed is a more robust PDAC suppressor than wild-type p53, to elucidate how p53 acts at the cellular level to dampen PDAC development. Using both inflammation-induced and KRASG12D-driven PDAC models, we find that p5353,54 both limits ADM accumulation and suppresses PanIN cell proliferation and does so more effectively than wild-type p53. Moreover, p5353,54 suppresses KRAS signaling in PanINs and limits effects on the extracellular matrix (ECM) remodeling. While p5353,54 has highlighted these functions, we find that pancreata in wild-type p53 mice similarly show less ADM, as well as reduced PanIN cell proliferation, KRAS signaling, and ECM remodeling relative to Trp53-null mice. We find further that p53 enhances chromatin accessibility at sites controlled by acinar cell identity transcription factors. These findings reveal that p53 acts at multiple stages to suppress PDAC, both by limiting metaplastic transformation of acini and by dampening KRAS signaling in PanINs, thus providing key new understanding of p53 function in PDAC

Observable, low-order dynamical controls on thresholds of the Atlantic meridional overturning circulation

We examine the dynamics of thresholds of the Atlantic Meridional Overturning Circulation (AMOC) in an Atmosphere–Ocean General Circulation Model (AOGCM) and a simple box model. We show that AMOC thresholds in the AOGCM are controlled by low-order dynamics encapsulated in the box model. In both models, AMOC collapse is primarily initiated by the development of a strong salinity advection feedback in the North Atlantic. The box model parameters are potentially observable properties of the unperturbed (present day) ocean state, and when calibrated to a range of AOGCM states predict (within some error bars) the critical rate of fresh water input (Hcrit) needed to turn off the AMOC in the AOGCM. In contrast, the meridional fresh water transport by the MOC (MOV, a widely-used diagnostic of AMOC bi-stability) on its own is a poor predictor of Hcrit. When the AOGCM is run with increased atmospheric carbon dioxide, Hcrit increases. We use the dynamical understanding from the box model to show that this increase is due partly to intensification of the global hydrological cycle and heat penetration into the near-surface ocean, both robust features of climate change projections. However changes in the gyre fresh water transport efficiency (a less robustly modelled process) are also important