592 research outputs found
Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences
Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need
Electrically Conductive CNT Composites at Loadings below Theoretical Percolation Values
The article of record as published may be found at https://doi.org/10.3390/nano9040491It is well established that dramatic increases in conductivity occur upon the addition of
conductive filler materials to highly resistive polymeric matrices in experimental settings. However,
the mechanisms responsible for the observed behavior at low filler loadings, below theoretical
percolation limits, of even high aspect ratio fillers such as carbon nanotubes (CNT) are not completely
understood. In this study, conductive composites were fabricated using CNT bundles dispersed
in epoxy resins at diverse loadings, using different dispersion and curing protocols. Based on
electron microscopy observation of the CNTs strands distribution in the polymeric matrices and the
corresponding electrical conductivities of those specimens, we concluded that no single electron
transfer model can accurately explain the conductive behavior for all the loading values. We propose
the existence of two different conductive mechanisms; one that exists close to the percolation limit,
from ‘low loadings’ to higher CNT contents (CNT % wt > 0.1) and a second for ‘extremely low
loadings’, near the percolation threshold (CNT % wt < 0.1). The high conductivity observed for
composites at low CNT loading values can be explained by the existence of a percolative CNT
network that coexists with micron size regions of non-conductive material. In contrast, samples
with extremely low CNT loading values, which present no connectivity or close proximity between
CNT bundles, show an electrical conductivity characterized by a current/voltage dependence. Data
suggests that at these loadings, conduction may occur via a material breakdown mechanism, similar
to dielectric breakdown in a capacitor. The lessons learned from the data gathered in here could
guide future experimental research aimed to control the conductivity of CNT composites
Primary reading exercises for use with the Durrell Analysis of Reading Difficulty
Thesis (Ed.M.)--Boston Universit
A comfort assessment of existing cervical orthoses
Purpose: identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses.
Method: convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0-6) and location.
Results: participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort
score=1.64, SD=1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in
discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age
correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced.
Conclusion: existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses' design the more significant factor. This work
informed the design of a new orthosis and future orthoses developments
Helimeric porphyrinoids: Stereostructure and chiral resolution of meso -tetraarylmorpholinochlorins
The synthesis and chiral resolution of free-base and Ni(II) complexes of a number of derivatives of meso-tetraphenylmorpholinochlorins, with and without direct β-carbon-to-o-phenyl linkages to the flanking phenyl groups, is described. The morpholinochlorins, a class of stable chlorin analogues, were synthesized in two to three steps from meso-tetraphenylporphyrin. The conformations and the relative stereostructures of a variety of free-base and Ni(II) complexes of these morpholinochlorins were elucidated by X-ray diffractometry. Steric and stereoelectronic arguments explain the relative stereoarray of the morpholino-substituents, which differ in the free-base and Ni(II) complexes, and in the monoalkoxy, β-carbon-to-o-phenyl linked morpholinochlorins, and the dialkoxy derivatives. The Ni(II) complexes were all found to be severely ruffled whereas the free-base chromophores are more planar. As a result of the helimeric distortion of their porphyrinoid chromophores, the ruffled macrocycles possess a stable inherent element of chirality. Most significantly, resolution of the racemic mixtures was achieved, both by classical methods via diastereomers and by HPLC on a chiral phase. Full CD spectra were recorded and modeled using quantum-chemical computational methods, permitting, for the first time, an assignment of the absolute configurations of the chromophores. The report expands the range of known pyrrole-modified porphyrins. Beyond this, it introduces large chiral porphyrinoid π-systems that exist in the form of two enantiomeric, stereochemically stable helimers that can be resolved. This forms the basis for possible future applications, for example, in molecular-recognition systems or in materials with chiroptic properties. © 2011 American Chemical Society
UBVRIz Light Curves of 51 Type II Supernovae
We present a compilation of UBV RIz light curves of 51 type II supernovae
discovered during the course of four different surveys during 1986 to 2003: the
Cerro Tololo Supernova Survey, the Calan/Tololo Supernova Program (C&T), the
Supernova Optical and Infrared Survey (SOIRS), and the Carnegie Type II
Supernova Survey (CATS). The photometry is based on template-subtracted images
to eliminate any potential host galaxy light contamination, and calibrated from
foreground stars. This work presents these photometric data, studies the color
evolution using different bands, and explores the relation between the
magnitude at maximum brightness and the brightness decline parameter (s) from
maximum light through the end of the recombination phase. This parameter is
found to be shallower for redder bands and appears to have the best correlation
in the B band. In addition, it also correlates with the plateau duration, being
thus shorter (longer) for larger (smaller) s values.Comment: 110 pages, 9 Figures, 6 Tables, accepted in A
The Eighth Data Release of the Sloan Digital Sky Survey: First Data from SDSS-III
The Sloan Digital Sky Survey (SDSS) started a new phase in August 2008, with
new instrumentation and new surveys focused on Galactic structure and chemical
evolution, measurements of the baryon oscillation feature in the clustering of
galaxies and the quasar Ly alpha forest, and a radial velocity search for
planets around ~8000 stars. This paper describes the first data release of
SDSS-III (and the eighth counting from the beginning of the SDSS). The release
includes five-band imaging of roughly 5200 deg^2 in the Southern Galactic Cap,
bringing the total footprint of the SDSS imaging to 14,555 deg^2, or over a
third of the Celestial Sphere. All the imaging data have been reprocessed with
an improved sky-subtraction algorithm and a final, self-consistent photometric
recalibration and flat-field determination. This release also includes all data
from the second phase of the Sloan Extension for Galactic Understanding and
Evolution (SEGUE-2), consisting of spectroscopy of approximately 118,000 stars
at both high and low Galactic latitudes. All the more than half a million
stellar spectra obtained with the SDSS spectrograph have been reprocessed
through an improved stellar parameters pipeline, which has better determination
of metallicity for high metallicity stars.Comment: Astrophysical Journal Supplements, in press (minor updates from
submitted version
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Biological, clinical and population relevance of 95 loci for blood lipids.
Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary artery disease (CAD) and are targets for therapeutic intervention. We screened the genome for common variants associated with plasma lipids in >100,000 individuals of European ancestry. Here we report 95 significantly associated loci (P < 5 x 10(-8)), with 59 showing genome-wide significant association with lipid traits for the first time. The newly reported associations include single nucleotide polymorphisms (SNPs) near known lipid regulators (for example, CYP7A1, NPC1L1 and SCARB1) as well as in scores of loci not previously implicated in lipoprotein metabolism. The 95 loci contribute not only to normal variation in lipid traits but also to extreme lipid phenotypes and have an impact on lipid traits in three non-European populations (East Asians, South Asians and African Americans). Our results identify several novel loci associated with plasma lipids that are also associated with CAD. Finally, we validated three of the novel genes-GALNT2, PPP1R3B and TTC39B-with experiments in mouse models. Taken together, our findings provide the foundation to develop a broader biological understanding of lipoprotein metabolism and to identify new therapeutic opportunities for the prevention of CAD
Observation of resonances consistent with pentaquark states in decays
Observations of exotic structures in the channel, that we refer to
as pentaquark-charmonium states, in decays are
presented. The data sample corresponds to an integrated luminosity of 3/fb
acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude
analysis is performed on the three-body final-state that reproduces the
two-body mass and angular distributions. To obtain a satisfactory fit of the
structures seen in the mass spectrum, it is necessary to include two
Breit-Wigner amplitudes that each describe a resonant state. The significance
of each of these resonances is more than 9 standard deviations. One has a mass
of MeV and a width of MeV, while the second
is narrower, with a mass of MeV and a width of MeV. The preferred assignments are of opposite parity, with one
state having spin 3/2 and the other 5/2.Comment: 48 pages, 18 figures including the supplementary material, v2 after
referee's comments, now 19 figure
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