Sheehan Medical (United States)

This secondary data analysis aimed to determine the nature of the relationship between obstructive sleep apnea (OSA) risk, biological age acceleration, and nonspecific chronic low back pain (CLBP). In total, 199 adults aged 18-82 years who filled both STOPBANG and pain questionnaires subsetted for secondary analysis. Based on the STOPBANG questionnaire, 104 had a low OSA risk and 95 had an intermediate or high OSA risk. Dunedin Pace of Aging Computed from the Epigenome (DunedinPACE), Horvath's, Hannum's, PhenoAge, and GrimAge clocks were used to determine biological age and pace of biological aging. Individuals with low OSA risk reported increased DunedinPACE compared to those with intermediate/high OSA risk (p < 0.001). There was a significant correlation between the risk for OSA and biological age acceleration measured by PhenoAge as well as pace of biological aging (p < 0.05). Mediation analysis detected indirect effects of OSA risk on chronic pain outcomes through the pace of biological aging. Targeted interventions addressing OSA risk offers a promising therapeutic strategy. This could be particularly valuable for aging populations where both accelerated biological aging and chronic pain conditions are prevalent, offering a more holistic approach to improving nonspecific chronic pain outcomes through quality of sleep and restfulness.

This paper studies emergency financial assistance for people at risk of homelessness using federal tax and census data. We use an established quasi-experimental research design to examine how assistance affects address histories, number of children, and receipt of food benefits (SNAP) in Illinois. We find no evidence that assistance affects moves or children, but we observe a small increase in SNAP uptake among the lowest-income callers. We consider whether prior studies that limit focus to local geography estimate treatment effects with bias; we find that limiting outcomes to Illinois does not noticeably change observed treatment effects.

Families in poverty face numerous barriers to establishing stable economic footing. This paper estimates experimental effects of a holistic, individualized wraparound service intervention for low-income individuals. The intervention includes a detailed assessment, an individualized service plan, intensive case management administered by a two-person team with small caseloads, and strategic financial assistance. The program improved employment and housing outcomes two years postenrollment. Given the customized nature of the services, overall program effects mask heterogeneity. Exploratory analysis suggests that the program helped employ participants who lacked employment but had stable housing and that those without stable housing were helped in securing it. (JEL I32, I38, L31, R23)

Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7percent by 2032 (up from 17.3percent in 2022). National health expenditures are projected to have grown 7.5percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1percent of the population being insured that year. In 2024, Medicaid enrollment is projected to decline significantly as states continue their eligibility redeterminations. Simultaneously, private health insurance enrollment is projected to increase because of the extension of enhanced subsidies for direct-purchase health insurance under the Inflation Reduction Act (IRA) of 2022, as well as a temporary special enrollment period for qualified people losing Medicaid coverage (after eligibility redeterminations). Over the course of 2024-26, the IRA expands Medicare's drug benefit generosity and implements drug price negotiations for beneficiaries; concurrently, the extended enhanced subsidies for direct-purchase health insurance expire in 2026. During 2027-32, personal health care price inflation and growth in the use of health care services and goods contribute to projected health spending that grows at a faster rate than the rest of the economy.

The integration of Information and Communication Technology (ICT) into conventional teaching practices has given rise to the concept of Blended Learning—an educational model that merges in-person classroom instruction with digital learning components. This paper examines the impact of blended learning on both cognitive and affective dimensions of student development by analyzing secondary sources, including scholarly research, institutional reports, and theoretical frameworks. The review indicates that blended learning substantially improves cognitive skills such as critical thinking, comprehension, and knowledge retention. Simultaneously, it nurtures affective qualities like motivation, active participation, and a more positive outlook toward the learning process. Overall, the study affirms that blended learning represents an effective and forward-looking pedagogical strategy suited to the evolving demands of 21st-century education.

The expansion of primary care wound services serves to alleviate secondary and tertiary care utilization. However, patient satisfaction is required to ensure service uptake. In recent years, various community pharmacies in Australia have begun to offer dedicated wound clinics; however, evaluations of patient experiences have yet to be conducted. Thus, the present study seeks to explore: (1) the experiences and satisfaction of patients who have received wound care consultations for their acute wounds in a community pharmacy setting; and (2) how current pharmacy-based wound services can be improved. Semi-structured individual interviews were conducted with patients across five pharmacy-based wound care clinics in Western Australia. Interviews were audio-recorded, transcribed verbatim, and imported into QSR NVivo 12 Plus. Interview transcripts were coded and thematically analyzed using the framework method. Twelve interviews were required to reach data saturation. Five key themes emerged: the accessibility of wound services, the comprehensiveness of wound care services, confidence in wound care consultants, the awareness and promotion of wound services, and the expansion of wound care services. Overall, participants were satisfied with the accessibility and comprehensiveness of pharmacy-based wound service delivery, trusted the health care providers, and wanted the service to be expanded. The reported patient satisfaction, confidence in the health care provider, and desire to expand the service suggests there is potential for the service to grow in Australia. Due to the growing costs of wound care globally, there is scope to further evaluate and expand wound care services in the primary care setting on an international level.

To evaluate the strength of associations between single-task and dual-task gait measures and posterior cingulate gyrus (PCG) neurochemicals in acutely concussed collegiate athletes. Participants were recruited from an NCAA Division 1 University. Nineteen collegiate athletes acutely (<4 days) following sports-related concussion. We acquired magnetic resonance spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed to measure the effect of gait performance, in the single- and dual-task settings, and sex on the 6 neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, postconcussion symptom score, and number of previous concussions. Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, and creatine. Single-task gait speed (P = .0056) and cadence (P = .0065) had significant effects on myo-inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (P = .047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry. These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within 4 days of sports-related concussion.

セルフタンニング化粧料の主成分となるジヒドロキシアセトン（DHA）は非常に反応性が高く，不安定な物質であるために高配合は困難であり，皮膚着色効果は低かった。そのため，今日までに皮膚着色強度を向上するためにセルフタンニング剤を含有する多種多様な化粧組成物が使用されている。中でもDHAと多価アルコールを併用することで皮膚着色強度が増大することがしられている。本研究では少量のDHA配合下で十分な着色効果が発揮される処方開発を目的とし，多価アルコールを含めた水溶性成分を用いて皮膚着色強度の向上を検討した。その中で，ポリエチレングリコール（PEG）骨格を有する成分において，高い着色効果が見られた。マトリクス支援レーザー脱離イオン化質量分析（MALDI-MS）や水素結合測定などからPEG鎖中の酸素がアミノ酸およびDHAと水素結合を介して，メディエーターの役割を果たしていることが示唆された。

Background and Purpose: Given the benign natural history of intracranial low-grade dural arteriovenous fistulas (dAVFs), their routine treatment remains controversial. The aim of this study is to compare the outcomes of low-grade dAVF treatment to conservative management. Methods: We performed a retrospective review of dAVF patients derived from 12 institutions participating in the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). Patients with low-grade (Borden I) dAVFs were included and categorized into treatment and observation cohorts. Primary outcome was defined as modified Rankin Scale (mRS) score at final follow-up. Secondary outcomes were rates of excellent (mRS 0-1) and good (mRS 0-2) functional outcomes, symptomatic improvement, mortality, and obliteration at final follow-up. Results: The treatment and observation cohorts comprised 230 and 112 patients, respectively. At last follow up, no difference in primary or secondary outcomes was observed between the two cohorts, with the exception of obliteration, which was higher in the treatment cohort (79.3% vs. 28.2%, p&lt;0.001; Table 1). The two cohorts were then matched in a 1:1 ratio, resulting in 64 patients in each matched cohort. No difference in primary or secondary outcomes was observed between the matched cohorts, with the exception of obliteration, which was higher in the matched treatment cohort (75.4% vs. 28.6%, p&lt;0.001; Table 2). Subgroup analysis of symptomatic patients demonstrated higher obliteration rate in the treatment cohort, but no difference in primary or other secondary outcomes were found. Conclusions: Low-grade dAVF treatment was not associated with increased functional disability compared to conservative management. Although higher obliteration rates were achieved in the treatment cohort, rates of symptomatic improvement were similar between the two cohorts. This study did not provide evidence to support the routine treatment of low-grade dAVFs.