Barbara\u27s Fart Creates a Fracas

We read address, swerved, veered car at West Exeter Street; we were at Barbara\u27s fete, as were Vera, Bert, Bart, Dave, Fred, Sara, Steve. Actress Barbara, a faded stage star, fretted re: fat, crafted decreased-stew, beer bread, watercress, grated feta, brew, sweet dessert served were fat-free

Designing Maine's DirigoChoice Benefit Plan

Outlines the evolution and design of the Dirigo Health Reform Act of 2003, which was developed to provide Maine businesses that have 50 or fewer eligible employees and the self-employed with an affordable, high-quality option for health coverage

State Strategies to Improve Quality and Efficiency: Making the Most of Opportunities in National Health Reform

Examines ten states' initiatives to address key components of quality and efficiency improvement, including data collection, aggregation, and standardization; public reporting; payment reform; consumer engagement; and provider engagement

Birthing into death: stories of Jewish pregnancy from the Holocaust

This thesis investigates the stories of Jewish women and men living in Europe during the Holocaust who made decisions related to pregnancy, abortion, birth, and ‘parenting’ in ghettos, concentration camps, and in hiding. By reviewing existing, publicly accessible survivor testimonies, and by interviewing still-living survivors, I analyze the various ways Jewish women and men used available but limited forms of reproductive assistance to preserve their own lives and to secure the safety of their unborn or born children. Jewish women and their doctors or other ad-hoc medical providers weighed the risks of possible illness or diseases resulting from clandestine care against the seemingly greater or graver risk of Nazi exposure. By highlighting stories from Holocaust survivors who speak about experiences receiving or providing reproductive “health care” during the Holocaust, this study emphasizes what survivors say about seeking or providing abortions under conditions they might not have otherwise accepted, pursued, or suggested. Women who became pregnant during the Holocaust embody the unspeakable dilemma of “birthing into death,” as reproduction often meant murder for Jewish mothers. Pregnant Jewish women and their partners, the medical providers who attended to them, and their witnesses during the Holocaust all have unique perspectives on their own in-the-moment responses to pregnancy under extreme conditions. Their testimonies speak to how the decisions they made involved Jewish cultural notions of childrearing in Europe during the time of the Holocaust, and to the complex shaping of traumatic memory

States' Roles in Shaping High Performance Health Systems

Analyzes results from the State Health Policies Aimed at Promoting Excellent Systems survey and a review of current research on efforts to improve state healthcare systems, with a focus on coverage; quality, safety, and value; and infrastructure

State Health Policies Aimed at Promoting Excellent Systems: A Report on States’ Roles in Health Systems Performance

States shape the health system in many ways: as purchasers, regulators, and conveners. Despite these various roles, there is little systematic effort to monitor state choices, learn from the choices states make, and purposefully spread one state’s innovations to other states. Coordination between states and the federal government on approaches to improving the health care system is often lacking, limiting our nation’s ability to address critical problems. In an effort to improve health system performance and increase the spread of innovation, the National Academy for State Health Policy (NASHP), with support from the Commonwealth Fund, prepared this report on a broad array of state health policies and practices. This report describes a tremendous amount of activity at the state level and which has implications for how well the health care system performs

Strengthening Medicaid as a Critical Lever in Building a Culture of Health

Strengthening Medicaid as a Critical Lever in Building a Culture of Health is a nonpartisan study panel report which offers a series of steps that would enable Medicaid to leverage its unique role as an insurer to increase its capacity for addressing the underlying social determinants of health. The study panel was convened to assess the current and possible future role of Medicaid in building a Culture of Health. The panel included state Medicaid program directors, public health and health policy experts, health researchers, medical and health professionals, and health plan representatives.The panel discussed strategies that could increase Medicaid's potential to help move the dial on individual and population health, while improving health care quality and program efficiency. The findings are divided into two categories: those that can be accomplished administratively (without any further legislative action) and those that would require legislative change.The report also recognizes key challenges that Medicaid faces, including the high cost states already bear for insuring vulnerable populations, the chronic insufficiency of funding for social service programs that could partner with Medicaid to foster health, and the complexities of implementing innovative care delivery models, among others.While the current political landscape signals new policy discussions about the future of the program and its funding, the analysis and options included in this report recognize that health care coverage is a critical underpinning for improving health. Whether and how Medicaid might be changed, its role as an insurer is foundational; this report assumes that Medicaid will continue to be central to the health care safety net as an insurer of low-income, vulnerable populations

Gathering Diverse Perspectives to Tackle “Wicked Problems”: Racial/Ethnic Disproportionality in Educational Placement

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a “wicked problem,” for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders’ perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the “wickedness” of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change

Late-onset renal vein thrombosis: A case report and review of the literature

AbstractINTRODUCTIONRenal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment.PRESENTATION OF CASEWe report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst.DISCUSSIONCompression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst.CONCLUSIONEarly detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population

Utilizing Computational Machine Learning Tools to Understand Immunogenic Breadth in the Context of a CD8 T-Cell Mediated HIV Response

Predictive models are becoming more and more commonplace as tools for candidate antigen discovery to meet the challenges of enabling epitope mapping of cohorts with diverse HLA properties. Here we build on the concept of using two key parameters, diversity metric of the HLA profile of individuals within a population and consideration of sequence diversity in the context of an individual's CD8 T-cell immune repertoire to assess the HIV proteome for defined regions of immunogenicity. Using this approach, analysis of HLA adaptation and functional immunogenicity data enabled the identification of regions within the proteome that offer significant conservation, HLA recognition within a population, low prevalence of HLA adaptation and demonstrated immunogenicity. We believe this unique and novel approach to vaccine design as a supplement to vitro functional assays, offers a bespoke pipeline for expedited and rational CD8 T-cell vaccine design for HIV and potentially other pathogens with the potential for both global and local coverage.Fil: McGowan, Ed. Imperial College London; Reino UnidoFil: Rosenthal, Rachel. Francis Crick Institute; Reino UnidoFil: Fiore Gartland, Andrew. Fred Hutchinson Cancer Research Cente; Estados UnidosFil: Macharia, Gladys. Imperial College London; Reino UnidoFil: Balinda, Sheila. Uganda Virus Research Institute; UgandaFil: Kapaata, Anne. Uganda Virus Research Institute; UgandaFil: Umviligihozo, Gisele. Center for Family Health Research; RuandaFil: Muok, Erick. Center for Family Health Research; RuandaFil: Dalel, Jama. Imperial College London; Reino UnidoFil: Streatfield, Claire L.. Imperial College London; Reino UnidoFil: Coutinho, Helen. Imperial College London; Reino UnidoFil: Dilernia, Dario. University of Emory; Estados UnidosFil: Monaco, Daniela C.. University of Emory; Estados UnidosFil: Morrison, David. South Walsham; Reino UnidoFil: Yue, Ling. University of Emory; Estados UnidosFil: Hunter, Eric. University of Emory; Estados UnidosFil: Nielsen, Morten. Technical University of Denmark; Dinamarca. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gilmour, Jill. Imperial College London; Reino UnidoFil: Hare, Jonathan. International Aids Vaccine Initiative; Estados Unido