Access to care in the US--Still a formidable challenge 30+ years later

2012 ◽  
Keyword(s):  
Access To Care ◽  
Formidable Challenge ◽  
The Us

Access to radiation oncology centers with brain tumor treatment expertise for patients with resectable brain tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Mehee Choi ◽  
Brian P. Martin ◽  
Lisa Misell ◽  
Joseph M. Zabramski ◽  
David G. Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation

e18509 Background: Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Utilization of brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile, GT Medical Technologies, Tempe, AZ USA) was developed. GammaTile (GT) is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and for newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. Methods: We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant GT. Results: 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥1 in every state, a 4-fold increase over the number of RCs offering SRS. Conclusions: For many patients, substantial travel distances limit their access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.[Table: see text]

scholarly journals Access to Care for Homeless Veterans During Disasters

2018 ◽  
Vol 9 ◽  
pp. 215013271881538
Author(s):  
Alicia R. Gable ◽  
Claudia Der-Martirosian ◽  
Aram Dobalian
Keyword(s):  
Access To Care ◽  
Natural Disaster ◽  
Department Of Veterans Affairs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medicaid Coverage ◽  
Homeless Veterans ◽  
Medical Centers ◽  
Medical Facilities ◽  
The Us

Introduction: Since 1970, natural disasters have led to both temporary and permanent closures of multiple medical centers and outpatient clinics at the US Department of Veterans Affairs (VA) nationwide. Access to care during such events is critical for vulnerable populations, especially homeless veterans. As such, facility closures may disproportionately affect homeless veteran patients who are both more likely to experience adverse effects from disasters and face multiple barriers to care. Methods: A cross-sectional survey was administered to a probability sample of 2000 homeless VA patients living in and receiving VA health care in the Northeast United States. The survey was completed by 383 respondents (20% adjusted response rate). This pilot study examines predictors of difficulty accessing care in the event that the VA facility that homeless VA patients routinely use is forced to close because of a natural disaster. Results: In a multivariate logistic regression, homeless VA patients who had Medicaid were less likely (OR 0.38; 95% CI: 0.18-0.78; P < .01) to report that they would have difficulty obtaining care elsewhere if their normal VA facility was closed in a future natural disaster. Conclusions: Findings suggest that Medicaid coverage has the potential to facilitate access to care for homeless veteran VA patients during disasters. Policy changes that decrease Medicaid coverage could limit access to care for homeless veterans during closures of VA medical facilities.

scholarly journals Low copper-2 intake in Switzerland does not result in lower incidence of Alzheimer’s disease and contradicts the Copper-2 Hypothesis

2020 ◽  
Vol 245 (3) ◽  
pp. 177-179 ◽  
Author(s):  
Marc Solioz
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Drinking Water ◽  
Dietary Supplements ◽  
Tap Water ◽  
Anthropogenic Factors ◽  
Western World ◽  
Formidable Challenge ◽  
Slow Progression ◽  
The Us

In recent years, the “Copper-2 Hypothesis” has been put forth in an attempt to explain the epidemic of Alzheimer’s disease (AD) in the Western world. According to this hypothesis, “free” copper (copper-2) in drinking water, dietary supplements, and meat is the chief cause of the increased incidence of AD in recent decades. In contrast to the US, copper plumbing for drinking water is not used in Switzerland and tap water is very low in copper. Other “risk” factors including dietary supplements and meat consumption are also lower in Switzerland than in the US. Yet, the incidence of AD is closely similar in the two countries. This contradicts the Copper-2 Hypothesis. Impact statement The Western world is faced with an Alzheimer’s epidemic. Identifying the life style and anthropogenic factors involved has become a priority. This is a formidable challenge due to the complexity and the slow progression of the disease. A hypothesis put forth by George Brewer postulates divalent copper (copper-2), chiefly present in drinking water from copper pipes, to be a major risk factor for Alzheimer’s disease. In Switzerland, copper pipes are not used for drinking water, but the frequency of Alzheimer’s disease is similar to that of other Western countries. This contradicts Brewer’s hypothesis and suggests that other factors are responsible for today’s Alzheimer’s epidemic.

Fracked Taxpayers and Communities

2021 ◽  
Author(s):  
Shanti Gamper-Rabindran
Keyword(s):  
Public Health ◽  
United States ◽  
Oil And Gas ◽  
Institutional Support ◽  
Indigenous Communities ◽  
The United States ◽  
Local Communities ◽  
Environmental Costs ◽  
Formidable Challenge ◽  
The Us

The US and Argentinian shale industry enjoyed staunch support from domestic political, financial, and legal institutions, which enabled the industry to expand while externalizing financial, public health, and environmental costs to the general public. The Argentinian government’s decision to finance shale investments and the US and Argentinian governments’ decisions to finance the industry bailout sustained the industry even as its poor financial outlook that predated the COVID-19 crisis became widely acknowledged. State and provincial governments in both the United States and Argentina employed the legal system to prohibit local government and local communities, including Indigenous communities, from restricting shale development and infrastructures in their localities. Politicians’ support for the industry, cloaked as concerns for workers and communities, fortified the industry’s privileges. Reforming the entrenched institutional support for the industry, although a formidable challenge, is necessary for these countries to shift away from oil and gas dependency.

scholarly journals Considerations for Selecting Applicants to Rural Medicine Programs

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
David Bramm
Keyword(s):  
Medical Students ◽  
Medical School ◽  
Access To Care ◽  
Rural Practice ◽  
Rural America ◽  
Rural Medicine ◽  
The Us ◽  
Rural Program ◽  
Selection Of

The selection of medical students destined for rural practice is important in order to help provide access to care for the 20% of the US population who live in rural America.  Knowing which medical school applicants will go into rural practice is an inexact science, although the objective predictive characteristics of future rural doctors are well known and evident in the literature.  The role of rural program directors is to identify which applicants will likely choose a FM residency, done primarily by identifying which rural predictive characteristics the applicants possess. Admissions committee members are not expected to determine the likely practice locations of rural applicants, and need only have the responsibility of determining which applicants should become physicians.

INNV-32. ACCESS TO SPECIALTY RADIATION CARE FOR PATIENTS WITH RESECTABLE BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi112-vi112
Author(s):  
Mehee Choi ◽  
Brian Martin ◽  
Joseph Zabramski ◽  
Lisa Misell ◽  
David Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation ◽  
Limit Access

Abstract INTRODUCTION Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile (GT), GT Medical Technologies, Tempe, AZ) was developed. The device is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. METHODS We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant the device. RESULTS 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived &gt;30-, &gt;60-, &gt;90-, and &gt;120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥ 1 in every state, a 4-fold increase over the number of RCs offering SRS. CONCLUSIONS For many patients, substantial travel distances limit access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.

scholarly journals Implications for informatics given expanding access to care for Veterans and other populations

2015 ◽  
Vol 22 (4) ◽  
pp. 917-920 ◽  
Author(s):  
Brian E Dixon ◽  
David A Haggstrom ◽  
Michael Weiner
Keyword(s):  
Access To Care ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Department Of Veterans Affairs ◽  
Expanded Access ◽  
The Us ◽  
Timely Access ◽  
New Policies ◽  
New Research

Abstract Recent investigations into appointment scheduling within facilities operated by the US Department of Veterans Affairs (VA) illuminate systemic challenges in meeting its goal of providing timely access to care for all Veterans. In the wake of these investigations, new policies have been enacted to expand access to care at VA facilities as well as non-VA facilities if the VA is unable to provide access within a reasonable timeframe or a Veteran lives more than 40 miles from a VA medical facility. These policies are similar to broader health reform efforts that seek to expand access to care for other vulnerable populations. In this perspective, we discuss the informatics implications of expanded access within the VA and its wider applicability across the US health system. Health systems will require robust health information exchange, to maintain coordination while access to care is expanded. Existing informatics research can guide short-term implementation; furthermore, new research is needed to generate evidence about how best to achieve the long-term aim of expanded access to care.

scholarly journals Engineering sub-2 nm ultrasmall high-entropy alloy nanoparticles with extremely superior performance for hydrogen evolution catalysis

2021 ◽  
Author(s):  
Dingguo Xia ◽  
Guang Feng ◽  
Fanghua Ning ◽  
Jin Song ◽  
Huaifang Shang ◽  
...  
Keyword(s):  
Hydrogen Evolution ◽  
Active Sites ◽  
Large Scale ◽  
Catalytic Mechanism ◽  
Theoretical Calculations ◽  
Superior Performance ◽  
High Entropy Alloy ◽  
High Entropy ◽  
Formidable Challenge ◽  
The Us

Abstract The development of intrinsically effective and low-cost catalysts is critical for the large-scale commercial applications of electrocatalytic hydrogen production. Although various electrocatalysts have demonstrated high activities for hydrogen evolution reaction (HER), it remains a formidable challenge to develop an extremely efficient and durable catalyst for practical use, especially in acidic media. Here, we report quinary ultrasmall NiCoFePtRh high-entropy alloy (us-HEA) nanoparticles (NPs) with extremely superior performance for HER. The us-HEA NPs are well dispersed on the carbon supports, with an average diameter of 1.68 nm, which is the smallest size in the reported HEAs. The us-HEA/C achieves an ultrahigh mass activity of 28.3 A mg-1noble metals (much higher than that of other reported advanced catalysts) at -0.05 V (vs the reversible hydrogen electrode, RHE) for HER in 0.5 M H2SO4 solution, which is 40.4 and 74.5 times higher than those of the commercial Pt/C and Rh/C catalysts, respectively. Moreover, the us-HEA/C demonstrates the highest reported turnover frequency of 30.1 s−1 at 50 mV overpotential (41.8 times higher than that of the Pt/C catalyst) and excellent stability with no decay after 10,000 cycles. Both operando X-ray absorption spectroscopy and theoretical calculations reveal the true active sites and a synergistic effect among five elements, which endow us-HEA/C with significantly enhanced HER activity. This work not only provides a general and facile strategy for synthesizing us-HEA NPs, highlights HEAs as sufficiently advanced materials in energy electrocatalysis, but also acts as a guidance for elucidating the actual reaction process and catalytic mechanism of complex multi-element systems.

scholarly journals Are higher unintended pregnancy rates among minorities a result of disparate access to contraception?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Michele Troutman ◽  
Saima Rafique ◽  
Torie Comeaux Plowden
Keyword(s):  
Access To Care ◽  
Unintended Pregnancy ◽  
Women Of Color ◽  
Significant Risk ◽  
Pregnancy Rates ◽  
Unintended Pregnancies ◽  
Global Issue ◽  
The Us ◽  
The Relationship ◽  
Access To Contraception

Abstract Unintended pregnancy is a major global issue. Women who experience an unintended pregnancy have a significant risk of morbidity and mortality. Additionally, these women also experience substantial financial hardships. Many women, particularly women of color, do not have adequate access to reliable and affordable contraception resulting in major health disparities among this group. This review explores the relationship between unintended pregnancy and inadequate access to contraception and is divided into 5 sections: addressing problems associated with unintended pregnancies, unintended pregnancy rate in the US, disparities of unintended pregnancy rates and access to care, addressing potential solutions, and finally conclusions. Keyterms unintended pregnancy, healthcare disparities, contraception, access to care.

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