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The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health
The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation's underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations.
In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA's pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk.
HHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.
Journal Article
السلوك المضاد للمجتمع عند الأطفال والمراهقين : تحليل خاص بالنمو ونموذج للتدخل
هذا الكتاب خلاصة دراسات استمرت ثلاثين عاما في مراكز بحوث متخصصة وجامعات كان من أبرزها مركز بحوث أوريجون توصل فيها المؤلفون إلى الأسباب النفسية للسلوك المضاد للمجتمع عند الأطفال والمراهقين والذي قد يتطور إلى العنف وارتكاب النشئ للجرائم وإدمان المخدرات وما قد يصحب هذا من فشل دراسي وشذوذ جنسي وتبدأ هذه الأسباب منذ الطفولة المبكرة وتمتد حتى نهاية المراهقة وبداية مرحلة الرشد.
Book
Genome-Wide Analyses of the NAC Transcription Factor Gene Family in Pepper (Capsicum annuum L.): Chromosome Location, Phylogeny, Structure, Expression Patterns, Cis-Elements in the Promoter, and Interaction Network
The NAM, ATAF1/2, and CUC2 (NAC) transcription factors form a large plant-specific gene family, which is involved in the regulation of tissue development in response to biotic and abiotic stress. To date, there have been no comprehensive studies investigating chromosomal location, gene structure, gene phylogeny, conserved motifs, or gene expression of NAC in pepper (Capsicum annuum L.). The recent release of the complete genome sequence of pepper allowed us to perform a genome-wide investigation of Capsicum annuum L. NAC (CaNAC) proteins. In the present study, a comprehensive analysis of the CaNAC gene family in pepper was performed, and a total of 104 CaNAC genes were identified. Genome mapping analysis revealed that CaNAC genes were enriched on four chromosomes (chromosomes 1, 2, 3, and 6). In addition, phylogenetic analysis of the NAC domains from pepper, potato, Arabidopsis, and rice showed that CaNAC genes could be clustered into three groups (I, II, and III). Group III, which contained 24 CaNAC genes, was exclusive to the Solanaceae plant family. Gene structure and protein motif analyses showed that these genes were relatively conserved within each subgroup. The number of introns in CaNAC genes varied from 0 to 8, with 83 (78.9%) of CaNAC genes containing two or less introns. Promoter analysis confirmed that CaNAC genes are involved in pepper growth, development, and biotic or abiotic stress responses. Further, the expression of 22 selected CaNAC genes in response to seven different biotic and abiotic stresses [salt, heat shock, drought, Phytophthora capsici, abscisic acid, salicylic acid (SA), and methyl jasmonate (MeJA)] was evaluated by quantitative RT-PCR to determine their stress-related expression patterns. Several putative stress-responsive CaNAC genes, including CaNAC72 and CaNAC27, which are orthologs of the known stress-responsive Arabidopsis gene ANAC055 and potato gene StNAC30, respectively, were highly regulated by treatment with different types of stress. Our results also showed that CaNAC36 plays an important role in the interaction network, interacting with 48 genes. Most of these genes are in the mitogen-activated protein kinase (MAPK) family. Taken together, our results provide a platform for further studies to identify the biological functions of CaNAC genes.
Journal Article
Action Comics #1000
\"Action Comics #1 gave birth to America's greatest superhero, Superman. Now celebrate 1,000 issues of Action Comics with this collector's item hardcover, including an all-star lineup of writers and artists such as Brian Michael Bendis, Geoff Johns, Tom King, Brad Meltzer, Scott Snyder, Jim Lee, John Cassaday, Olivier Coipel, and an unpublished story from Marv Wolfman and ... Man of Steel artist Curt Swan, plus more\"-- Provided by publisher.
Book
Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States
Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women's health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings.
Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010-2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women's health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences.
Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women's health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.
Journal Article
Something borrowed
Rachel is a generous and loyal pal to her engaged best friend Darcy. But after celebrating her 30th birthday, perpetual good girl Rachel unexpectedly ends up in the arms of Dex, the guy she's had a crush on since law school, and who happens to be Darcy's fiancé. In the frantic weeks leading up to Darcy's wedding, Rachel finds herself caught between her longtime friendship with Darcy and the prospect of losing the love of her life.
DVD
Influenza in Asthmatics: For Better or for Worse?
Asthma and influenza are two pathologic conditions of the respiratory tract that affect millions worldwide. Influenza virus of the 2009 pandemic was highly transmissible and caused severe respiratory disease in young and middle-aged individuals. Asthma was discovered to be an underlying co-morbidity that led to hospitalizations during this influenza pandemic albeit with less severe outcomes. However, animal studies that investigated the relationship between allergic inflammation and pandemic (p)H1N1 infection, showed that while characteristics of allergic airways disease were exacerbated by this virus, governing immune responses that cause exacerbations may actually protect the host from severe outcomes associated with influenza. To better understand the relationship between asthma and severe influenza during the last pandemic, we conducted a systematic literature review of reports on hospitalized patients with asthma as a co-morbid condition during the pH1N1 season. Herein, we report that numerous other underlying conditions, such as cardiovascular, neurologic, and metabolic diseases may have been underplayed as major drivers of severe influenza during the 2009 pandemic. This review synopses, (1) asthma and influenza independently, (2) epidemiologic data surrounding asthma during the 2009 influenza pandemic, and (3) recent advances in our understanding of allergic host-pathogen interactions in the context of allergic airways disease and influenza in mouse models. Our goal is to showcase possible immunological benefits of allergic airways inflammation as countermeasures for influenza virus infections as a learning tool to discover novel pathways that can enhance our ability to hinder influenza virus replication and host pathology induced thereof.
Journal Article
Batman rebirth deluxe edition
\"The first two volumes of BATMAN as a part of DC Universe Rebirth are collected here in hardcover for the first time ever! The Caped Crusader has never been stopped. Not by the Joker. Not by Two-Face. Not even by the entire Justice League. But now, in the wake of DC UNIVERSE: REBIRTH, Batman must face his most challenging foe ever--a hero who wants to save Gotham...from the Batman! This collection features the first two paperback volumes of the series, combined to make a deluxe edition graphic novel in hardcover for the first time ever.\"-- Provided by publisher.
BOOK
The Alcohol and Epoxy Alcohol of Zingiberene, Produced in Trichomes of Wild Tomato, Are More Repellent to Spider Mites Than Zingiberene
Allelochemicals that are present in trichome secretions of wild tomato species play a major role in mediating interactions with arthropods, often conferring a high level of resistance
antibiosis and antixenosis. Many accessions of the wild tomato relative,
(
), possess high levels of resistance to arthropods. The monocyclic sesquiterpene hydrocarbon, 7-epi-zingiberene, is a major defensive component found in trichome secretions of certain accessions of
. We have used LA2329, an
. accession, as a donor in a breeding program designed to introgress zingiberene into cultivated tomato. However, the composition of trichome secretions in our population of LA2329 is segregating, with some individuals producing mainly 7-epi-zingiberene in their secretions while others producing two additional, unidentified compounds in their trichome secretions. To investigate if these other compounds may also contribute to arthropod resistance, trichome secretions were collected from plants of
LA2329 grown under greenhouse conditions and then major compounds were isolated by silica gel column chromatography and tested for their ability to repel two spotted-spider mite (TSSM),
. Isolation and identification of allelochemicals were aided by use of gas chromatography/mass spectroscopy. The results revealed the presence of three predominate chromatographic peaks: 7-epi-zingiberene, 9-hydroxy zingiberene, and 9-hydroxy,10,11-epoxy-zingiberene. Results of testing isolated compounds for repellency to TSSM using bridge bioassays revealed that the repellent activities of 9-hydroxy zingiberene and 9-hydroxy,10,11-epoxy-zingiberene were each significantly higher than that for 7-epi-zingiberene. These results support the idea that the degree of repellency may differ among plant allelochemicals and also emphasize the potential value of introgressing the presence of 9-hydroxy zingiberene and 9-hydroxy,10,11-epoxy-zingiberene into cultivated tomato to enhance its arthropod resistance.
Journal Article