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Matthew F. Bouchonville Margaret M. Paul John Billings Jessica B. Kirk Sanjeev Arora 《Current diabetes reports》2016,16(10):96
Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a “telementoring” program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world. 相似文献
33.
Anuj Gupta Veena Puri Rajeshwar Sharma Sanjeev Puri 《Experimental and toxicologic pathology》2012,64(3):225-232
Systemic administration of folic acid (FA) in mice was used for studying the pathogenesis associated with acute renal failure (ARF). However, the mechanism by which FA induces ARF remains poorly understood. The present study therefore, was planned to investigate the effect of folic acid administration on prooxidant state and associated ultrastructural changes in renal tissue. Balb/c male mice of 4–6 weeks old were divided into control and two folic acid treatment groups (Groups A and B). The animals in group A were administered intraperitoneal injection of folic acid (100 mg kg?1 body weight) for a period of 7 consecutive days while the animal in group B were administered a single intraperitoneal dose of folic acid (250 mg kg?1 body weight). The renal tissues were collected and used for the analyses of lipid peroxidative indices and activities of antioxidant enzymes in renal tissues. To corroborate biochemical findings scanning electron microscopy (SEM) in renal tissue was studied. Folic acid treated animals demonstrated marked renal hypertrophy accompanied by severe impairment of renal function. Glutathione levels (GSH) and antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) levels were significantly decreased and LPO levels increased following FA treatment. SEM results further substantiated the observed biochemical changes as evident by severe inflammation in glomeruli, swelling in primary and secondary pedicels, blebbing in villi, and tremendous deprivation of erythrocytes (RBCs) in FA treated kidneys. The present study therefore suggests that acute administration of folic acid leads to the generation of oxidative stress and altered membrane architecture responsible for folic acid induced ARF. 相似文献
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Joel Martin Geiderman Sanjeev Malik James J. McCarthy Andy Jagoda 《The American journal of emergency medicine》2018,36(10):1881-1885
People identified as Very Important Persons (VIPs) often present or are referred to the Emergency Department (ED). Celebrities are a small subset of this group, but many others are included. Triage of these patients, including occasional prioritization, creates practical and ethical challenges. Treatment also provides challenges with the risks of over testing, overtreatment, over consultation, and over or under admission to the hospital. This article presents a practical and ethical framework for addressing the care of VIPs in the ED. 相似文献
36.
Sanjeev R. Chowksey Hiteshwari Baghel Priyank Sharma Brijesh Singh 《The Indian journal of surgery》2014,76(3):247-250
Gallstone disease is common and complications frequently encountered include acute cholecystitis, acute pancreatitis, and cholangitis, but gallbladder perforation (GBP) is rare. A definitive diagnosis is uncommon before surgery and morbidity and mortality associated with this condition are high. Reported incidence ranges between 2 and 10.6 % in patients with acute cholecystitis but is higher in patients managed conservatively. We report here five patients with GBP to show the difficulty in making an early diagnosis. 相似文献
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J. Dinakaran Mohammad Hanief Archana Meena K. S. Rao 《Proceedings of the National Academy of Sciences, India. Section B.》2014,84(3):487-504
According to Kyoto protocol carbon sequestration in terrestrial ecosystem is a low cost option to mitigate the increasing atmospheric CO2 concentrations. It has been understood that the world’s forests and their soils have a high potential to sequester the atmospheric carbon. For the last two decades there has been increasing interest among scientists in terrestrial soil carbon storage processes. This review made an attempt to summarize the major chronological advancement of soil organic carbon (SOC) sequestration research and also to underpin the problems yet to be focused on this research at global level. SOC sequestration research began in the early seventies, where most of the studies were estimating the size/stock of the global SOC. In the early eighties, most of the researchers have started to focus on the factors involved in the storage of organic carbon in different ecosystems. Subsequently, the researchers started to work on different types of SOC pools, their size, turnover and chemical characterization in different types of ecosystems. Recently the researcher’s main focus has been the temperature sensitivity of organic carbon in different types of soil and their mechanism of stabilization. There has been interest among researchers on the contribution of microbial derived (microbial necromass) carbon in recalcitrant pool of SOC and their sequestration process in different types of ecosystems. Arguably, the contribution in SOC sequestration research on the fate of sequestered carbon in different types of soil and their stabilization mechanisms is insufficient. India is the country spread over regions from temperate to dry desert zones with different types of fragile ecosystems and its vulnerable nature to the global climate change. Therefore, the future research must focus on SOC sensitivity to temperature and SOC stabilization mechanisms in different ecosystems for better understanding of the soil carbon cycle. 相似文献
39.
Anand Yuvaraj Anusha Rohit Priyanka Joseph Koshy P. Nagarajan Sanjeev Nair 《Renal failure》2014,36(9):1466-1467
A 68-year-old diabetic chronic kidney disease patient on continuous ambulatory peritoneal dialysis for two years developed Candida haemulonii peritonitis without any predisposing factors. There is no effective treatment for this fungus. A peritoneal biopsy showed morphological changes of acute inflammation and chronicity. 相似文献
40.
Adam Sipe Sebastian R. McWilliams Lauren Saling Constantine Raptis Vincent Mellnick Sanjeev Bhalla 《Emergency radiology》2017,24(1):73-80
Fistulae between the aorta and adjacent structures are a rare, emergent, and potentially life-threatening process. Most commonly, aortic fistulae arise secondarily as a complication of prior aortic surgery with fistulization to adjacent structures. Rarely, a primary fistula may arise from the aorta in the setting of a pre-existing aneurysm or from a mass, inflammation, or infection. Although the incidence of aortic fistulae remains low, the frequency continues to increase as aortic surgical interventions and post-surgical follow-up with imaging become more common. Computed tomography (CT) is the modality of choice in evaluating the patient with suspected aortic fistula because of its accessibility and short scan time. In addition, CT allows for more clear depiction of para-aortic or intra-aortic gas than ultrasound or magnetic resonance (MR). This gas may be the first clue of a fistula. Given the high mortality associated with aortic fistulae, familiarity with the imaging findings of the spectrum of aortic fistulae is essential knowledge in the emergency setting. This review will discuss the imaging appearance of aortic and arterial fistulae to the bronchi, esophagus, gastrointestinal tract, ureters, and veins on CT. 相似文献