Randall University

Medicare Advantage (MA) enrollment increased by 22.2 million beneficiaries (337.0percent) from 2006 through 2022, whereas traditional Medicare enrollment declined by 1.0 million (-2.9percent) over that period. In 2022, adjusted MA penetration was 49.9percent nationally, and 24.0percent of Medicare beneficiaries with Parts A and B lived in a county with adjusted MA penetration equal to or exceeding 60percent.

This research examines the case of a service-learning project embedded within a CBPR-based Native American tribal nation and research university collaboration in the US. Transformative learning (TL) served as the theoretical framework by which we, the multidisciplinary research team, came to appreciate the significance of the tribal nation’s lived history and deep sense of cultural loss, as well as the social impact of the service-learning project. To date, the majority of research on transformative learning has focused on the individual. This research builds on the work of a growing cadre of TL theorists who consider the role of the collective in transformation. This is especially salient for community-focused research efforts that incorporate service-learning. In this case, we treat consciousness raising, observed through documents, direct observation and participant observation, as evidence of collective transformation. 
 
 Results indicate that the service-learning project served as a catalyst for tribal nation higher education students and tribal leaders to collectively engage in critical reflection. In doing so, both groups came to develop new, emergent views of tribal membership. Students, in particular, emerged with transformed world views and deepened cultural connections, while tribal leaders came to appreciate service-learning relative to tribal needs. We thus assert that service-learning can be a culturally appropriate, sustainable educational mechanism that has application across a wide range of Indigenous
 communities, thereby highlighting the instrumentality of this case. 
 
 The research also indicates how higher education institutions and fellow researchers oriented to CBPR may render more successful their future collaboration practices with historically marginalised communities. We advocate that service-learning be directed by the tribal nation or community in question. As such, the community’s lived experience and world view becomes the focal point of the partnership, thereby making it culturally relevant and broadening the views of other stakeholders.

Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease of unknown etiology which causes a worsening ventilation-perfusion mismatch leading to activity-limiting dyspnea and physical inactivity. Recent studies indicate that aerobic exercise training (AET) improves physical function and health-related quality of life in populations with PAH, yet little is known about the mechanisms responsible for adaptations to AET. PURPOSE: To examine changes in peripheral muscle oxygen use after 10 weeks of vigorous AET in a population with PAH. METHODS: Twenty-four women with WHO Group I PAH were randomly assigned to receive either 10 weeks of AET or 10 weeks of education lectures (EDU). The AET consisted of treadmill walking thrice weekly for 30-45 minutes each session, with treadmill speed and inclination continuously adjusted to maintain subjects’ heart rates between 70 and 80% of heart rate reserve. Graded treadmill exercise tests (GXT) were performed on all subjects before and after the 10-week intervention period. Metabolic gases were collected and cardiac output (CO) was measured via impedance electrocardiography. Muscle tissue oxygen use was measured during both GXTs using near-infrared spectroscopy with the optodes placed over the right lateral belly of the gastrocnemius. RESULTS: Eleven women were assigned to the AET group (54±11 yrs, BMI=30±7 kg/m2; mean±SD) and 13 to the EDU group (56±9 yrs, BMI=32±7 kg/m2). The AET group improved GXT duration by 121±75 sec (p=0.001) with no significant change in the EDU group. Significant differences were observed between the groups for amplitude changes during GXT for oxyhemoglobin (O2Hb) (AET: -1.61±2.82 vs. EDU: 1.1±3.41 a.u., p=0.048) and hemoglobin difference (HbDiff) levels (-3.18±4.93 vs. 0.82±4.45 a.u., p=0.048). No significant changes were observed between groups for deoxyhemoglobin, total hemoglobin, or cardiac output. CONCLUSIONS: Ten weeks of AET improved physical performance without improving CO. Improvements in O2Hb suggest more oxygen availability within the muscle, and decreased HbDiff indicates more oxygen reserve was used after AET. These results suggest that peripheral rather than central adaptations may play a larger role in cardiorespiratory fitness improvements observed with AET in patients with PAH. Funding NIH/IRP 1 Z01 CL06006802.

A wide range of toxic chemicals have been found in the umbilical cord blood of newborns, indicating the potential for health risks from chemical exposure that begin in utero. The neonatal intensive care unit (NICU) setting may also have potential chemical exposures that create health risks. Given the extreme vulnerability of this patient population, it is critical to minimize unnecessary hazardous chemicals. Neonatal intensive care unit nurses have an important role to play in making the NICU as safe as possible for their patients and themselves. This article will focus on the human health effects of several chemical exposures commonly found in the NICU for which nurses can help to eliminate or select safer alternatives: (1) diethylhexyl phthalates (a plasticizer commonly found in intravenous tubing/bags and other products); (2) bisphenol A (commonly found in the lining of baby formula cans); (3) personal care products used in the NICU; (4) cleaning, sterilants, and disinfectants; and (5) mercury. A tool for assessing environmental health risks will be presented and associated intervention options including purchasing policies; hospital-wide chemical policies; and development of institutional infrastructures, such as Green Teams, to address NICU and hospital-wide environmental health concerns. Nursing's evolving role in environmental health will be reviewed.

I moved to Washington, DC, at the turn of the millennium. Shortly after September 11th, I found myself with a job to do, an artist in the center of power during times of crisis. I held a desire to engage, not as a passive observer, but with an active role—the artist's role, one who sees, listens, analyzes, translates and illuminates the dangerous mechanisms of the unfolding political situation in America. This resulted in the founding of the US Department of Art & Technology. The following narrative account is a portrait of the artist as mediator “between a strange, hostile world and the human spirit.”

Name: BC Ethnicity: Caucasian Medical Hx: Significant for melanoma in her right arm as well as on the back and on the neck, emphysema, acute bronchitis, and COPD as well as degenerative disc disease. Social Hx: The patient enjoys gardening. She uses Dial soap. Family Hx: Significant for heart disease in her mother, breast cancer in her sister, and lung cancer in her brother. Medications: Xanax, Wellbutrin, Lipitor, Serevent, and Albuterol nebulizer. Allergies: The patient has allergies to Codeine and Darvocet. Chief complaint: This 62-year-old female presented to our clinic bringing to our attention a lesion on her nose and one on her left chest. Physical findings: Physical exam revealed a pleasantly affected female who appeared older than her stated age whose bridge of her nose revealed a flesh-colored, dome-shaped papule approximately 4 mm across. She admitted to a previous cancer surgery of this area but did not know the type of cancer. A brownish-red, variegated verrucous lesion was also noted on the left chest. She had dozens of red scaling and small exophytic red-brown lesions on her arms, legs, neck, and face. Primary assessment/diagnosis:

The role of endomyocardial biopsy (EMB) in the diagnosis and treatment of adult and pediatric cardiovascular disease remains controversial, and the practice varies widely even among cardiovascular centers of excellence. A need for EMB exists because specific myocardial disorders that have unique prognoses and treatment are seldom diagnosed by noninvasive testing.1 Informed clinical decision making that weighs the risks of EMB against the incremental diagnostic, prognostic, and therapeutic value of the procedure is especially challenging for nonspecialists because the relevant published literature is usually cited according to specific cardiac diseases, which are only diagnosed after EMB. To define the current role of EMB in the management of cardiovascular disease, a multidisciplinary group of experts in cardiomyopathies and cardiovascular pathology was convened by the American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC). The present Writing Group was charged with reviewing the published literature on the role of EMB in cardiovascular diseases, summarizing this information, and making useful recommendations for clinical practice with classifications of recommendations and levels of evidence. The Writing Group identified 14 clinical scenarios in which the incremental diagnostic, prognostic, and therapeutic value of EMB could be estimated and compared with the procedural risks. The recommendations contained in the present joint Scientific Statement are derived from a comprehensive review of the published literature on specific cardiomyopathies, arrhythmias, and cardiac tumors and are categorized according to presenting clinical syndrome rather than pathologically confirmed disease. The ultimate intent of this document is to provide an understanding of the range of acceptable approaches for the use of EMB while recognizing that individual patient care decisions depend on factors not well reflected in the published literature, such as local availability of specialized facilities, cardiovascular pathology expertise, and operator experience. The use of EMB …

Background Diminished oxidative metabolic capacity has been proposed as a mechanism for debilitating fatigue in individuals with HIV infection. Recently we reported that this impairment is most pronounced in those taking highly active antiretroviral therapy (HAART) medication. PURPOSE The objective of this study was to examine the role of the pulmonary system in limiting oxidative capacity in asymptomatic HIV positive individuals. METHODS Fifteen subjects with HIV (9 males, 7 females) who were taking HAART (HIVmed+), 15 subjects (9 males, 7 females) with HIV who were naïve to HAART (HIVmed−) and 15 healthy, uninfected, age and gender matched controls participated in the study. All subjects completed a maximum treadmill exercise test using the modified Bruce protocol, during which pulmonary gas exchange and flow rates, and cardiac output, were measured at peak exercise, using noninvasive methods. RESULTS Cardiac output was not significantly different among the groups. Peak VO2 was lowest in HIVmed+ (HIVmed+ 25.9±5.2 ml/kg/min; HIVmed− 28.9±8.8ml/kg/min, Controls 35.5±7.8 ml/kg/min; p > 0.0037), as was peak arteriovenous oxygen difference (HIVmed+ 9.9±1.1%; HIVmed− 11.5±1.8%; Controls 12.8±2.4%; p > 0.0002). Significant differences in respiratory rate (HIVmed+ 45.7±8.4 bpm; HIVmed− 45.3±9.4 bpm; Controls 39.9±7.9 bpm), expired minute ventilation (Ve) (HIVmed+ 80.1±13 l/min; HIVmed− 84.9±21 l/min, Controls 90.7±29 l/min) and Ve to VO2 ratio, (HIVmed+ 41.1±7.1; HIVmed− 41.6±5.3 Controls 35.3±8.9) were not observed. CONCLUSION Oxidative capacity did not appear to be limited by abnormal pulmonary function in either HIVmed+ or in HIVmed−. These findings provide additional support for the hypothesis that, in individuals who have asymptomatic HIV infection, impaired oxidative metabolism is one result of the detrimental effects of HAART medication at the level of the working muscles.

E&P Asset Value and Its Implications on Share Price Gregg A. Jacobson Gregg A. Jacobson Randall & Dewey, Inc. Search for other works by this author on: This Site Google Scholar Paper presented at the SPE Hydrocarbon Economics and Evaluation Symposium, Dallas, Texas, April 2001. Paper Number: SPE-68581-MS https://doi.org/10.2118/68581-MS Published: April 02 2001 Cite View This Citation Add to Citation Manager Share Icon Share Twitter LinkedIn Get Permissions Search Site Citation Jacobson, Gregg A. "E&P Asset Value and Its Implications on Share Price." Paper presented at the SPE Hydrocarbon Economics and Evaluation Symposium, Dallas, Texas, April 2001. doi: https://doi.org/10.2118/68581-MS Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll ProceedingsSociety of Petroleum Engineers (SPE)SPE Hydrocarbon Economics and Evaluation Symposium Search Advanced Search AbstractEvery day E&P companies are confronted with opportunities and decisions, which will impact the value of the assets and enterprise that they manage. As the goal of publicly held companies is to maximize shareholder value, companies tend to respond by attempting to maximize Wall Street's preferred valuation metric of the day. Return on capital employed (ROCE), cash flow per share, reserve replacement and finding and development costs per BOE are used to judge the industry's performance over time; but the most significant determinant of both absolute and relative shareholder returns remains a company's ability to increase the value of its reserve base in an economic fashion. A multi-year study of 45 publicly held independent E&P companies establishes the strong correlation between reserve value and share price performance.IntroductionDiscounted cash flow techniques are well established as the most effective building block in the creation of an accurate and functional valuation.1 The share price an investor is willing to pay generally reflects the present value of the future cash flows from existing operations as well as the prospective value of a firm's ability to create wealth from initiatives not currently implemented. For an E&P company, the timing and nature of future cash flows from existing operations are a direct function of reserve life, reserve quality and development status. Unfortunately, the quantification of reserve value is not direct and not publicly reported in a timely and useful format. With no tangible measure of value, analysts will focus on the known and quantifiable metrics generated from current period reporting such as earnings per share, cash flow per share and return on capital employed.Modern accounting methods capture the scope of value creation only over the course of a full cycle evaluation. Rarely is the impact of value creation for an E&P company reflected in the reported results in the period the value has been created.2For an extraction based industry such as exploration and production, current period results may have no direct relations to the future value of projected production and therefore, have limited utility in either effective valuation or performance measurement. The influence of emphasis on near term reporting results cannot be overstated. How often is it heard that a certain field was divested in order to increase subsequent ROCE or that an acquisition is immediately accretive to cash flow per share? Unfortunately, near term net income, ROCE, cash flow per share and even production volumes can sometimes be maximized while simultaneously destroying long term value. It can be demonstrated that reserve value creation has the most direct and lasting influence on shareholder return significantly more than any other widely accepted performance measure.Evaluation FrameworkForty-five U.S. based E&P companies were evaluated for the four-year period from 1996 to 1999. The companies selected were the largest publicly traded E&P companies at year-end 1996 that were still traded at year-end 1999. Due to the active mergers and acquisition market for E&P companies, some of the larger and well-known entities in 1996 were subsequently bought or merged into the surviving entities. Non-E&P assets had to represent less than 25% of operating cash flow in 1996 for the entity to be considered for this study. As a result, integrated companies or at least companies that were integrated in 1996, have been excluded from the analysis. The valuation approaches discussed in this analysis are applicable to the upstream component of an integrated enterprise, but the correlation to share price and shareholder returns are not as directly influenced by reserve value for an integrated enterprise as for a more "pure" independent E&P. Keywords: premium valuation, implication, cash flow, reserves replacement, valuation, reserve value, capital, evaluation, randall, share price Subjects: Asset and Portfolio Management, Reserves replacement, booking and auditing This content is only available via PDF. 2001. Society of Petroleum Engineers You can access this article if you purchase or spend a download.