Does providing care for uninsured patients decrease emergency room visits and hospitalizations?

Background: Access to primary care could reduce use of more costly health care by uninsured individuals through prevention and early treatment. We analyzed data from a program providing free primary care to test this hypothesis.

Methods: We compared emergency room (ER) visits and hospitalizations among uninsured, low-income adults who received immediate versus delayed access to a program providing free primary care, including labs, X-rays, and specialty consultation.

Defining plasma polymerization: new insight into what we should be measuring.

External parameters (RF power and precursor flow rate) are typically quoted to define plasma polymerization experiments. Utilizing a parallel-plate electrode reactor with variable geometry, it is shown that these parameters cannot be transferred to reactors with different geometries in order to reproduce plasma polymer films using four precursors. Measurements of ion flux and power coupling efficiency confirm that intrinsic plasma properties vary greatly with reactor geometry at constant applied RF power.

Self-assembling influenza nanoparticle vaccines elicit broadly neutralizing H1N1 antibodies.

Influenza viruses pose a significant threat to the public and are a burden on global health systems. Each year, influenza vaccines must be rapidly produced to match circulating viruses, a process constrained by dated technology and vulnerable to unexpected strains emerging from humans and animal reservoirs. Here we use knowledge of protein structure to design self-assembling nanoparticles that elicit broader and more potent immunity than traditional influenza vaccines.

Fracture risk in nursing home residents initiating antipsychotic medications.

Objectives: To determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between users of first- and second-generation antipsychotics, and whether fracture rates differ between users of haloperidol, risperidone, olanzapine, and quetiapine.

Design: Time-to-event analyses were conducted in a retrospective cohort using linked Medicaid; Medicare; Minimum Data Set; and Online Survey, Certification, and Reporting data sets.

Setting: Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.

A confirmed Ehrlichia ewingii infection likely acquired through platelet transfusion.

Ehrlichiosis is a tick-borne disease that ranges in severity from asymptomatic infection to fatal sepsis. Ehrlichiosis acquired from transfusion of blood products has not been documented in the literature to date. A case of Ehrlichia ewingii infection likely transmitted by transfusion of leukoreduced platelets is described, and public health implications are discussed.

Evaluation of a peer-led hypertension intervention for veterans: impact on peer leaders.

Volunteer peer leaders (PLs) benefit from their involvement in health interventions but we know little about how they compare with other non-PL volunteers or with the intervention recipients themselves. We randomized 58 veterans' service organizations' posts (e.g.

On the effect of monomer chemistry on growth mechanisms of nonfouling PEG-like plasma polymers.

It has been shown that both ions and neutral species may contribute to plasma polymer growth. However, the relative contribution from these mechanisms remains unclear. We present data elucidating the importance of considering monomer structure with respect to which the growth mechanism dominates for nonfouling PEG-like plasma polymers.

Immobilization of heparan sulfate on electrospun meshes to support embryonic stem cell culture and differentiation.

As our understanding of what guides the behavior of multi- and pluripotent stem cells deepens, so too does our ability to utilize certain cues to manipulate their behavior and maximize their therapeutic potential. Engineered, biologically functionalized materials have the capacity to influence stem cell behavior through a powerful combination of biological, mechanical, and topographical cues. Here, we present the development of a novel electrospun scaffold, functionalized with glycosaminoglycans (GAGs) ionically immobilized onto the fiber surface.

Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards.

Background: The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on 7 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards.

Structural and genetic basis for development of broadly neutralizing influenza antibodies.

Influenza viruses take a yearly toll on human life despite efforts to contain them with seasonal vaccines. These viruses evade human immunity through the evolution of variants that resist neutralization. The identification of antibodies that recognize invariant structures on the influenza haemagglutinin (HA) protein have invigorated efforts to develop universal influenza vaccines.

Elicitation of broadly neutralizing influenza antibodies in animals with previous influenza exposure.

The immune system responds to influenza infection by producing neutralizing antibodies to the viral surface protein, hemagglutinin (HA), which regularly changes its antigenic structure. Antibodies that target the highly conserved stem region of HA neutralize diverse influenza viruses and can be elicited through vaccination in animals and humans. Efforts to develop universal influenza vaccines have focused on strategies to elicit such antibodies; however, the concern has been raised that previous influenza immunity may abrogate the induction of such broadly protective antibodies.

Pulmonary embolism in patients with CKD and ESRD.

Background And Objectives: CKD and ESRD are growing burdens. It is unclear whether these conditions affect pulmonary embolism (PE) risk, given that they affect both procoagulant and anticoagulant factors. This study examined the frequency and associated outcomes of PE in CKD and ESRD.

Location and organizational features: what type of veteran communities participate in health programs?

Background: Research shows that community-based membership organizations are effective partners in health promotion activities; however, most community organizations do not participate in such partnerships. There is little research regarding the geographical and organizational characteristics associated with participation.

Objective: We examined the factors associated with community-based veterans service organization (VSO) units' decision to participate in a health promotion project.

The development and validation of the hypertension evaluation of lifestyle and management knowledge scale.

Hypertension knowledge is an integral component of the chronic care model. A valid scale to assess hypertension knowledge and self-management skills is needed. The hypertension evaluation of lifestyle and management (HELM) scale was developed as part of a community-based study designed to improve self-management of hypertension.

The relationship between perceived discrimination and coronary artery obstruction.

Background: Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors.

Methods: Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed.

Pulmonary embolism: the weekend effect.

Background: Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism.

A hierarchically ordered porous novel vanado-silicate catalyst for highly efficient oxidation of bulky organic molecules.

A novel hierarchically ordered porous vanado-silicate nanocomposite with interconnecting macroporous windows and meso-microporous walls containing well dispersed vanadyl species has been fabricated and used as a heterogeneous catalyst for the oxidation of a bulky organic molecule, namely cyclooctene.

Veterans service organization engagement in 'POWER,' a peer-led hypertension intervention.

Objectives: The purpose of this study was to determine the influence of program factors on participant engagement in POWER, a peer-led intervention designed to reduce hypertension, increase hypertension knowledge, and improve other relevant health behaviors, such as diet and exercise, among US veterans involved in veterans service organizations throughout Southeastern Wisconsin.

Methods: Two hundred and nineteen hypertensive members from 58 VSOs participated in a year-long peer-led intervention designed to improve hypertension knowledge, disease self-management behaviors, and health outcomes. This study represents a qualitative evaluation of post and participant engagement in this intervention.

Glycosaminoglycan (GAG) binding surfaces for characterizing GAG-protein interactions.

Glycosaminoglycans play an important role in tissue organisation through interactions with a diverse range of proteins, growth factors and other chemokines. In this report, we demonstrate the GAG-binding 'fingerprint' of two important GAG-binding proteins - osteoprotogerin and TIMP-3. The technique uses a straightforward method for attaching GAGs to assay surfaces in a non-covalent manner using plasma polymerization that leaves the adsorbed GAG able to participate in subsequent ligand binding.

The effect of distractors on saccades and adaptation of saccades in strabismus.

This paper reports two experiments to determine the contribution of the suppressing eye to the generation of saccadic eye movements in constant strabismus. Eye movements were recorded using a Skalar infra-red recorder. Experiment 1 tested six participants with constant strabismus, pathological suppression and no clinically demonstrable binocular single vision (BSV).

Engaging community-based veterans' organizations in health promotion programs.

Community organizations, such as churches, clubs, and senior centers, can be important locations for health programs. However, little is known about the organizational factors that influence participation and engagement in health programs. To learn more, we evaluated a community-based program designed to help US military veterans better manage their high blood pressure.

Nationwide trends of severe sepsis in the 21st century (2000-2007).

Background: Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances.

Broadly neutralizing human antibody that recognizes the receptor-binding pocket of influenza virus hemagglutinin.

Seasonal antigenic drift of circulating influenza virus leads to a requirement for frequent changes in vaccine composition, because exposure or vaccination elicits human antibodies with limited cross-neutralization of drifted strains. We describe a human monoclonal antibody, CH65, obtained by isolating rearranged heavy- and light-chain genes from sorted single plasma cells, coming from a subject immunized with the 2007 trivalent influenza vaccine. The crystal structure of a complex of the hemagglutinin (HA) from H1N1 strain A/Solomon Islands/3/2006 with the Fab of CH65 shows that the tip of the CH65 heavy-chain complementarity determining region 3 (CDR3) inserts into the receptor binding pocket on HA1, mimicking in many respects the interaction of the physiological receptor, sialic acid.

Electrodiagnostic consultation and identification of neuromuscular conditions in persons with diabetes.

Introduction: Although the American Association of Neuromuscular and Electrodiagnostic Medicine recommends that electrodiagnostic procedures should be performed by physicians with specialty training, these procedures are increasingly being performed by non-specialists.

Methods: We used a nationally representative sample of Medicare beneficiaries with diabetes who used electrodiagnostic services in 2006 to examine whether specialists and non-specialists were different in the rates of identifying common neuromuscular conditions.

Results: Specialists (neurologists and physiatrists) performed 62% of electrodiagnostic consultations; non-specialist physicians and non-physicians performed 31% and 5%, respectively.