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For four decades, health centers have provided quality, cost-effective primary healthcare to underserved populations. Using the Uniform Data System, this study analyzes national trends in health center patients, providers, and financial performance for 1998-2004, and state-specific data for 2004. Between 1998 and 2004, health centers served increasing numbers of underserved patients, which included patients who were uninsured or on Medicaid, minorities, and patients at or below poverty level. Even though the number of health center providers and patients increased, patient-to-provider ratios did not change significantly. Medicaid remained the single largest source of health center revenue, accounting for 36.4 percent of total revenue in 2004. Compared with Medicare, private insurance, and self-pay, Medicaid consistently reimbursed health centers at the highest rate per patient. Federal and nonfederal grants to support care for the uninsured as well as enabling services such as transportation, translation, and other support systems is one of many important sources of revenue. Financial challenges for health centers included increasing costs and varied or declining rates of reimbursement for services rendered. However, health centers became more self-sufficient over time, average net revenues increased, and operating margins were predominantly positive. Data on individual states, with different numbers and types of health centers, varied widely in all of these categories. In conclusion, health centers rely on federal and nonfederal grant support in concert with the Medicaid program as major funding sources and continued financial stability will be contingent upon health centers' ability to balance revenues with the cost of managing the vulnerable populations that they serve. [ABSTRACT FROM AUTHOR]

Introduction: A wide range of positive, negative, and cognitive symptoms compose the clinical presentation of schizophrenia. Schizophrenia is a multifactorial disorder in which genetic and environmental risk factors interact for a full emergence of the disorder. Infectious challenges during pregnancy are a well-known environmental risk factor for schizophrenia. Also, genetic variants affecting the function of fractalkine signaling between neurons and microglia were linked to schizophrenia. Translational animal models recapitulating these complex gene-environment associations have a great potential to untangle schizophrenia neurobiology and propose new therapeutic strategies., Methods: Given that genetic variants affecting the function of fractalkine signaling between neurons and microglia were linked to schizophrenia, we compared the outcomes of a well-characterized model of maternal immune activation induced using the viral mimetic polyinosinic:polycytidylic acid (Poly I:C) in wild-type versus fractalkine receptor knockout mice. Possible behavioral and immune alterations were assessed in male and female offspring during adulthood. Considering the role of the hippocampus in schizophrenia, microglial analyses and bulk RNA sequencing were performed within this region to assess the neuroimmune dynamics at play. Males and females were examined separately., Results: Offspring exposed to the dual challenge paradigm exhibited symptoms relevant to schizophrenia and unpredictably to mood disorders. Males displayed social and cognitive deficits related to schizophrenia, while females mainly presented anxiety-like behaviors related to mood disorders. Hippocampal microglia in females exposed to the dual challenge were hypertrophic, indicative of an increased surveillance, whereas those in males showed on the other end of the spectrum blunted morphologies with a reduced phagocytosis. Hippocampal bulk-RNA sequencing further revealed a downregulation in females of genes related to GABAergic transmission, which represents one of the main proposed causes of mood disorders., Conclusions: Building on previous results, we identified in the current study distinctive behavioral phenotypes in female mice exposed to a dual genetic and environmental challenge, thus proposing a new model of neurodevelopmentally-associated mood and affective symptoms. This paves the way to future sex-specific investigations into the susceptibility to developmental challenges using animal models based on genetic and immune vulnerability as presented here., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Long non-coding RNAs (lncRNAs) are increasingly recognized as functional units in cancer and powerful biomarkers; however, most remain uncharacterized. Here, we analyze 5,592 prognostic lncRNAs in 9,446 cancers of 30 types using machine learning. We identify 166 lncRNAs whose expression correlates with survival and improves the accuracy of common clinical variables, molecular features, and cancer subtypes. Prognostic lncRNAs are often characterized by switch-like expression patterns. In low-grade gliomas, HOXA10-AS activation is a robust marker of poor prognosis that complements IDH1/2 mutations, as validated in another retrospective cohort, and correlates with developmental pathways in tumor transcriptomes. Loss- and gain-of-function studies in patient-derived glioma cells, organoids, and xenograft models identify HOXA10-AS as a potent onco-lncRNA that regulates cell proliferation, contact inhibition, invasion, Hippo signaling, and mitotic and neuro-developmental pathways. Our study underscores the pan-cancer potential of the non-coding transcriptome for identifying biomarkers and regulators of cancer progression., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Morbid obesity is a relatively common and vastly increasing condition that can have a profound impact on morbidity and mortality during the administration and maintenance of general and regional anesthesia. Physiological derangements, difficult airway management, and biological augmentation in pharmacokinetics are some of the clinical challenges involved with this particular patient population. This case report discusses the advantages of regional versus general anesthesia in the morbidly obese patient population, in conjunction with an analysis of the various types of spinal anesthetics. This will be followed by a focused discussion related to the management of a morbidly obese patient undergoing a nonelective orthopedic procedure.

Patients with Tourette Syndrome often state that their sensitivity to sensations is equally or more disruptive than are motor tics. However, their sensory sensitivity is not addressed by standard clinical assessments nor is it a focus of research. This lapse likely results from our limited awareness and understanding of the symptom. In this study (1) we defined the patients' experience of sensitivity to external stimuli in detail, and (2) we tested 2 hypotheses regarding its origin. First, we interviewed in depth and administered a lengthy questionnaire to adult Tourette patients (n = 19) and age-matched healthy volunteers (n = 19). Eighty percent of patients described heightened sensitivity to external stimuli, with examples among all 5 sensory modalities. Bothersome stimuli were characterized as faint, repetitive or constant, and nonsalient, whereas intense stimuli were well tolerated. We then determined whether the sensitivity could be the result of an increased ability to detect faint stimuli. After measuring the threshold of detection for olfactory and tactile stimuli among the patients and healthy volunteers, we found no significant differences between them for either sensory modality. These results indicate that patients' perceived sensitivity derives from altered central processing rather than enhanced peripheral detection. Last, we assessed one aspect of processing: the perception of intensity. When subjects rated the intensity of near-threshold tactile and olfactory stimuli, there was a surprising difference: Tourette patients more frequently used the lowest range of the scale than did healthy volunteers. Future research is necessary to define the anatomical and physiological basis of the patients' experience of heightened sensitivity. © 2011 Movement Disorder Society., (Copyright © 2011 Movement Disorder Society.)

Objective: This study evaluated the accuracy of placing right atrial catheters using an electrocardiographic (ECG) technique., Summary Background Data: Placement of right atrial catheters for vascular access is a common operative procedure. Accurate placement is essential for proper function. Previous placement techniques have used fluoroscopy, which is both time consuming and hazardous., Methods: The accuracy of placement of 1236 right atrial catheters using an ECG technique was compared to placement of 586 catheters using fluoroscopy between March 1991 and November 1995. In the ECG technique, the catheter was flushed with sodium bicarbonate. A sterile left-leg ECG lead was attached to the catheter with the other ECG leads applied normally. On advancing the catheter through the superior vena cava, the P-wave amplitude (lead II) increased in negative deflection until greater than the QRS complex. Passing the sinoatrial node, the P-wave developed an initial positive then negative deflection. The catheter was positioned so the P-wave was biphasic, representing a position midway between the sinoatrial and atrioventricular nodes. For the fluoroscopic technique, catheters were positioned under direct observation just within the atrium estimated from cardiac contour. Use of contrast was optional if atrial anatomy was unclear., Results: Postoperative portable chest x-rays showed the ECG method to position the catheter tip within the right atrium just as accurately (average, 1.9 +/- 1.3 cm) as with the use of fluoroscopy (average, 1.1 +/- 1.6 cm). The ECG method eliminated an average of 20 seconds of radiation exposure, an average of 3.0 minutes operating room time (p < 0.04), avoided all risks of contrast dye, and saved $279.10 per case., Conclusions: The ECG method is a satisfactory alternative to that of fluoroscopy for placement of long-term central venous catheters into the right atrium.