Diffuse small bowel thickening in aids patient - a case report

Background  

Diarrhea is common in HIV/AIDS patients, caused by both classic enteric pathogens and different opportunistic agents. Infection with these different pathogens may lead to similar radiological findings, thus causing diagnostic confusion.     

Dynamic allocation of same-day requests in multi-physician primary care practices in the presence of prescheduled appointments

Appointments in primary care are of two types: 1) prescheduled appointments, which are booked in advance of a given workday; and 2) same-day appointments, which are booked as calls come during the workday. The challenge for practices is to provide preferred time slots for prescheduled appointments and yet see as many same-day patients as possible during regular work hours. It is also important, to the extent possible, to match same-day patients with their own providers (so as to maximize continuity of care). In this paper, we present a mathematical framework (a stochastic dynamic program) for same-day patient allocation in multi-physician practices in which calls for same-day appointments come in dynamically over a workday. Allocation decisions have to be made in the presence of prescheduled appointments and without complete demand information. The objective is to maximize a weighted measure that includes the number of same-day patients seen during regular work hours as well as the continuity provided to these patients. Our experimental design is motivated by empirical data we collected at a 3-provider family medicine practice in Massachusetts. Our results show that the location of prescheduled appointments – i.e. where in the day these appointments are booked – has a significant impact on the number of same-day patients a practice can see during regular work hours, as well as the continuity the practice is able to provide. We find that a 2-Blocks policy which books prescheduled appointments in two clusters – early morning and early afternoon – works very well. We also provide a simple, easily implementable policy for schedulers to assign incoming same-day requests to appointment slots. Our results show that this policy provides near-optimal same-day assignments in a variety of settings.     

Mapping glutamate in subcortical brain structures using high‐resolution GluCEST MRI

In vivo measurement of glutamate (Glu) in brain subcortex can elucidate the role these structures play in cognition and neuropsychiatric disorders. However, accurate quantification of Glu in subcortical regions is challenging. Recently, a novel MRI method based on the Glu chemical exchange saturation transfer (GluCEST) effect has been developed for detecting brain Glu in millimolar concentrations. Here, we use GluCEST to map Glu distributions in subcortical structures of the human brain (e.g. amygdala, hippocampus). Overall, GluCEST was ~40% higher in gray matter than in white matter. Within the subcortical gray matters, amygdala showed the highest GluCEST contrast. Utilizing MR spectroscopic data, in vivo GluCEST detection sensitivity (~0.8% mM^?1) in subcortical gray matter was evaluated and was consistent with the previously reported values. In general, the GluCEST map approximates the Glu receptor distribution reported in previous positron emission tomography (PET) studies. These findings suggest that high‐resolution GluCEST MRI of subcortical brain structures may prove to be a useful tool in diagnosis of brain disorders or treatment responses. Copyright © 2013 John Wiley & Sons, Ltd.     

Improving Clinical Access and Continuity through Physician Panel Redesign

Background  

Population growth, an aging population and the increasing prevalence of chronic disease are projected to increase demand for primary care services in the United States.     

Hypoglossal Schwannoma of Parapharyngeal Space: An Unusual Case Report

Schwannomas are benign tumor of the schwann cells. These are common in eighth, tenth cranial nerves and parasympathetic chain. Hypoglossal schwannomas are rare. Among the hypoglossal schwannomas the intracranial and dumb-bell shaped schwannomas are frequent but extra cranial hypoglossal schwannomas are rare. We describe a parapharyngeal hypoglossal schwannoma in a 25 years female presenting as slow growing mass in right side of the neck.