The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation

Explores how North Dakota has met the healthcare challenges of rural communities with support for primary care and the idea of a medical home, organization of care through coordination and cooperation networks, and the innovative use of technology

Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Oxidative stress in pre-eclampsia; have we been looking in the wrong place?

Pre-eclampsia is a disorder of late pregnancy. It is a major cause of maternal and perinatal morbidity and mortality, accounting for nearly 18% of all maternal deaths worldwide; an estimated 77,000 maternal deaths per year [1]. Poor placentation is considered to be an initial cause of the placental ischemia [2]. Placental ischemia in turn gives rise to oxidative stress in the placenta and leads to shedding of syncytiotrophoblast debris into the maternal circulation provoking a systemic maternal inflammatory response and release of sFLT and sENG causing maternal vascular endothelial dysfunction. The ubiquitous nature of the maternal vascular endothelium accounts for the diverse multi-system nature of pre-eclampsia. Currently there is no treatment for pre-eclampsia except delivery of the placenta and the baby, with the attendant risk of iatrogenic prematurity and significant neonatal morbidity and mortality. As a result, intensive research endeavours have focused on defining the molecular mechanisms of pre-eclampsia and the identification of new pre-symptomatic biomarkers of the condition. This review focuses on the role of elevated oxidative stress in the pathology of pre-eclampsia and potential therapeutic agents targeting oxidative stress that may prevent or ameliorate this disorder

Naturopathic Physician Attitudes and Practices for Vaccination and Primary Care in the State of Vermont

Introduction: Recent increase in measles cases has sparked vaccination controversy. Naturopathic physicians (NDs) have been recognized as primary care providers by VT since 2012. It is not well understood how NDs address vaccination with patients. Our goal was to determine how Vermont NDs address vaccines and preventative care with their patients.https://scholarworks.uvm.edu/comphp_gallery/1234/thumbnail.jp

MyRun: balancing design for reflection, recounting and openness in a museum-based participatory platform

Cultural organisations are increasingly looking towards using digital technologies to supplement, augment and extend visitors' experiences of exhibits and museums. In this paper, we describe the design and evaluation of MyRun, a 'participatory platform' for a museum. Our goal with MyRun was to use experience-centered design principles of reflecting, recounting and openness as a basis for engaging visitors in sharing stories about experiences related to a nationally significant cultural event. We undertook a qualitative evaluation of the system based upon observations of its use, the contributions visitors made to the platform, and interviews with 10 visitors. We discuss how visitors approached MyRun, contributed and browsed stories, and the challenges associated with the expectations visitors and curators placed on cultural exhibits. We close by identifying a series of design opportunities for future participatory platforms in museum settings

How Can Genetic Studies Help Us to Understand Links Between Birth Weight and Type 2 Diabetes?

PURPOSE OF REVIEW: In observational epidemiology, both low and high birth weights are associated with later type 2 diabetes. The mechanisms underlying the associations are poorly understood. We review evidence for the roles of genetic and non-genetic factors linking both sides of the birth weight distribution to risk of type 2 diabetes, focusing on contributions made by the most recent genome-wide association studies (GWAS) of birth weight. RECENT FINDINGS: There are now nine genetic loci robustly implicated in both fetal growth and type 2 diabetes. At many of these, the same alleles are associated both with a higher risk of type 2 diabetes and a lower birth weight. This supports the Fetal Insulin Hypothesis and reflects a general pattern for type 2 diabetes susceptibility alleles: genome-wide, there is an inverse genetic correlation with birth weight, and initial estimates suggest genetic factors explain a large part of the covariance between the two traits. However, the associations at individual loci show heterogeneity; some fetal risk alleles are associated with higher birth weight. For most of these, the association reflects their correlation with the maternal risk allele which raises maternal glucose, thus increasing fetal insulin-mediated growth. SUMMARY: GWAS have improved our understanding of the mechanisms underlying associations between type 2 diabetes and birth weight but questions remain about the relative importance of genetic versus non-genetic factors and of maternal versus fetal genotypes. To answer these questions, future work will require well-powered analyses of parents and offspring

Photometric Redshift Probability Distributions for Galaxies in the SDSS DR8

We present redshift probability distributions for galaxies in the SDSS DR8 imaging data. We used the nearest-neighbor weighting algorithm presented in Lima et al. 2008 and Cunha et al. 2009 to derive the ensemble redshift distribution N(z), and individual redshift probability distributions P(z) for galaxies with r < 21.8. As part of this technique, we calculated weights for a set of training galaxies with known redshifts such that their density distribution in five dimensional color-magnitude space was proportional to that of the photometry-only sample, producing a nearly fair sample in that space. We then estimated the ensemble N(z) of the photometric sample by constructing a weighted histogram of the training set redshifts. We derived P(z) s for individual objects using the same technique, but limiting to training set objects from the local color-magnitude space around each photometric object. Using the P(z) for each galaxy, rather than an ensemble N(z), can reduce the statistical error in measurements that depend on the redshifts of individual galaxies. The spectroscopic training sample is substantially larger than that used for the DR7 release, and the newly added PRIMUS catalog is now the most important training set used in this analysis by a wide margin. We expect the primary source of error in the N(z) reconstruction is sample variance: the training sets are drawn from relatively small volumes of space. Using simulations we estimated the uncertainty in N(z) at a given redshift is 10-15%. The uncertainty on calculations incorporating N(z) or P(z) depends on how they are used; we discuss the case of weak lensing measurements. The P(z) catalog is publicly available from the SDSS website.Comment: 29 pages, 9 figures, single colum