How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes.

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent.

Does iodinated contrast medium amplify DNA damage during exposure to radiation.

There is a recognized increased risk of cancer following exposure of humans to ionizing radiation; this is felt to be most likely due to damage to DNA strands during exposure. Damage to DNA strands can be demonstrated microscopically following exposure to X-rays, and new evidence is emerging that this effect may be compounded by administration of iodinated contrast agents.

Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results.

This historical analysis shows that in the years just prior to the Affordable Care Act's expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual provider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status.

Occupant Kinematics in Laboratory Rollover Tests: ATD Response and Biofidelity.

Rollover crashes are a serious public health problem in United States, with one third of traffic fatalities occurring in crashes where rollover occurred. While it has been shown that occupant kinematics affect the injury risk in rollover crashes, no anthropomorphic test device (ATD) has yet demonstrated kinematic biofidelity in rollover crashes. Therefore, the primary goal of this study was to assess the kinematic response biofidelity of six ATDs (Hybrid III, Hybrid III Pedestrian, Hybrid III with Pedestrian Pelvis, WorldSID, Polar II and THOR) by comparing them to post mortem human surrogate (PMHS) kinematic response targets published concurrently; and the secondary goal was to evaluate and compare the kinematic response differences among these ATDs.

Occupant Kinematics in Laboratory Rollover Tests: PMHS Response.

The objective of the current study was to characterize the whole-body kinematic response of restrained PMHS in controlled laboratory rollover tests. A dynamic rollover test system (DRoTS) and a parametric vehicle buck were used to conduct 36 rollover tests on four adult male PMHS with varied test conditions to study occupant kinematics during the rollover event. The DRoTS was used to drop/catch and rotate the test buck, which replicated the occupant compartment of a typical mid-sized SUV, around its center of gravity without roof-to-ground contact.

Blunt impacts to the back: Biomechanical response for model development.

The development of advanced injury prediction models requires biomechanical and injury tolerance information for all regions of the body. While numerous studies have investigated injury mechanics of the thorax under frontal impact, there remains a dearth of information on the injury mechanics of the torso under blunt impact to the back. A series of hub-impact tests were performed to the back surface of the mid-thorax of four mid-size male cadavers.

The role of thymosin-β4 in kidney disease.

Therapies that modulate inflammation and fibrosis have the potential to reduce the morbidity and mortality associated with chronic kidney disease (CKD). A promising avenue may be manipulating thymosin-β4, a naturally occurring peptide, which is the major G-actin sequestering protein in mammalian cells and a regulator of inflammation and fibrosis. Thymosin-β4 is already being tested in clinical trials for heart disease and wound healing.

Thymosin β4: multiple functions in protection, repair and regeneration of the mammalian heart.

Introduction: Despite recent improvements in interventional medicine, cardiovascular disease still represents the major cause of morbidity worldwide, with myocardial infarction being the most common cardiac injury. This has sustained the development of several regenerative strategies based on the use of stem cells and tissue engineering approaches in order to achieve cardiac repair and regeneration by enhancing coronary neovascularization, modulating acute inflammation and supporting myocardial regeneration to provide new functional muscle.

Areas Covered: The actin monomer binding peptide, Thymosin β4 (Tβ4), has recently been described as a powerful regenerative agent with angiogenic, anti-inflammatory and cardioprotective effects on the heart and which specifically acts on its resident cardiac progenitor cells.

Cardiac lymphatics are heterogeneous in origin and respond to injury.

The lymphatic vasculature is a blind-ended network crucial for tissue-fluid homeostasis, immune surveillance and lipid absorption from the gut. Recent evidence has proposed an entirely venous-derived mammalian lymphatic system. By contrast, here we show that cardiac lymphatic vessels in mice have a heterogeneous cellular origin, whereby formation of at least part of the cardiac lymphatic network is independent of sprouting from veins.

Nurse-Enhanced Computerized Cognitive Training Increases Serum Brain-Derived Neurotropic Factor Levels and Improves Working Memory in Heart Failure.

Background: Memory loss is common in heart failure (HF) patients, but few interventions have been tested to treat it. The objective of this study was to evaluate efficacy of a cognitive training intervention, Brain Fitness, to improve memory, serum brain-derived neurotropic factor (BDNF) levels, working memory, processing speed, executive function, instrumental activities of daily living, mobility, depressive symptoms, and health-related quality of life.

Methods And Results: Twenty-seven HF patients were randomly assigned to Brain Fitness and health education active control interventions.

Open aortic arch replacement in high-risk patients: the gold standard.

Objectives: Open total aortic arch replacement (TAR) in high-risk patients is considered by some to be associated with a prohibitively perioperative risk. Recent reports describe hybrid techniques to treat this group. We reviewed our outcomes of open surgery in a 'high-risk' group of patients.

Radioguided occult lesion localisation using iodine-125 seeds ('ROLLIS') for removal of impalpable breast lesions: First Australian experience.

Introduction: Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands.

The solar magnetic activity band interaction and instabilities that shape quasi-periodic variability.

Solar magnetism displays a host of variational timescales of which the enigmatic 11-year sunspot cycle is most prominent. Recent work has demonstrated that the sunspot cycle can be explained in terms of the intra- and extra-hemispheric interaction between the overlapping activity bands of the 22-year magnetic polarity cycle. Those activity bands appear to be driven by the rotation of the Sun's deep interior.

Xylitol-containing products for preventing dental caries in children and adults.

Background: Dental caries is a highly prevalent chronic disease which affects the majority of people. It has been postulated that the consumption of xylitol could help to prevent caries. The evidence on the effects of xylitol products is not clear and therefore it is important to summarise the available evidence to determine its effectiveness and safety.

Cartilage hair hypoplasia: characteristics and orthopaedic manifestations.

Purpose: Cartilage hair hypoplasia (CHH) is a rare metaphyseal chondrodysplasia characterized by short stature and short limbs, found primarily in Amish and Finnish populations. Cartilage hair hypoplasia is caused by mutations in the RMRP gene located on chromosome 9p13.3.

Oxidative calcium release from catechol.

Oxidation of 4-methylcatechol previously exposed to aqueous calcium chloride was shown by ion chromatography to be associated with release of calcium ions. The catechol was oxidised to the corresponding orthoquinone by the use of tyrosinase from Agaricus bisporus. The oxidative release of calcium from the catechol is ascribed to the diminution of the available hydroxyl functions able to act as chelating groups.

Understanding how pre-impact posture can affect injury outcome in side impact sled tests using a new tool for visualization of cadaver kinematics.

The effect of posture and subject-specific factors on injury outcome is an active field of research in injury biomechanics, in particular in automotive safety research where post-mortem human subjects (PMHS) are used as surrogates. Current PMHS tests routinely include acquisition of the subjects׳ geometry and kinematics. However, combining these two datasets to better understand the injury mechanism is still a challenge.

Matrix Rigidity Mediates TGFβ1-Induced Epithelial-Myofibroblast Transition by Controlling Cytoskeletal Organization and MRTF-A Localization.

Myofibroblasts mediate normal wound healing and upon chronic activation can contribute to the development of pathological conditions including organ fibrosis and cancer. Myofibroblasts can develop from epithelial cells through an epithelial-mesenchymal transition (EMT) during which epithelial cells exhibit drastic morphological changes and upregulate cytoskeletal associated proteins that enable exertion of large contractile forces and remodeling of the surrounding microenvironment. Increased matrix rigidity is a hallmark of fibrosis and tumor progression and mechanical tension has been identified as a regulator of EMT; however, the mechanisms governing the mechanical regulation of EMT are not completely understood.

Tissue adhesives for closure of surgical incisions.

Background: Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later.

Interventions for the management of oral ulcers in Behçet's disease.

Background: Behçet's disease is a chronic inflammatory vasculitis that can affect multiple systems. Mucocutaneous involvement is common, as is the involvement of many other systems such as the central nervous system and skin. Behç̧et's disease can cause significant morbidity, such as loss of sight, and can be life threatening.

Child and environmental factors associated with leisure participation in adolescents born extremely preterm.

Background: Developmental impairments persist among adolescents born extremely preterm, and these individuals are at an increased risk for chronic disease later in life. Participating in active and positive leisure activities may act as a buffer against negative outcomes, but involvement in active-physical and skill-based activities is low in youth born preterm.

Aims: To explore the child and environmental determinants of leisure participation among adolescents born extremely preterm.

Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures.

Objectives: Hip fractures account for less than 1% of all pediatric fractures; however, femoral head osteonecrosis (ON) after this injury ranges from 0% to 92%. The aim of this investigation was to add our experience to the literature and identify factors that may increase or decrease the risk of ON in pediatric patients with hip fractures.

Design: Institutional review board-approved retrospective review.

Informing the scale-up of Kenya's nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production.

Background: Given the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya.

Methods: This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data.