University of Saint Mary

About: University of Saint Mary is a education organization based out in Leavenworth, Kansas, United States. It is known for research contribution in the topics: Population & Galaxy. The organization has 2276 authors who have published 2399 publications receiving 58990 citations. The organization is also known as: University of St. Mary & University of St Mary.

Key Neuroanatomical Structures for Post-Stroke Cognitive Impairment

Abstract: The neuroanatomical substrate of vascular cognitive impairment (VCI) has traditionally included the subcortex of the brain, especially sub-frontal white matter circuits, strategic areas of single infarction that may mediate cognitive impairment such as the dominant thalamus or angular gyrus, and the left hemisphere, and bilateral brain infarcts or volume-driven cortical-subcortical infarctions reaching a critical threshold of tissue loss or injury. We provide an update on the neuroanatomical substrates of VCI and emphasize the following structures or areas: (1) new concepts in relation to hippocampal involvement in VCI based on neuropathological and MRI studies of microinfarcts and the role of traditional cardiovascular risk factors in possibly mediating or potentiating cognitive impairment; (2) advances in our understanding of cerebral microbleeds; and (3) an update on white matter hyperintensities and small vessel disease.

On the black hole content and initial mass function of 47 Tuc

Abstract: The globular cluster (GC) 47 Tuc has recently been proposed to host an intermediate-mass black hole (IMBH) or a population of stellar mass black holes (BHs). To shed light on its dark content, we present an application of self-consistent multimass models with a varying mass function and content of stellar remnants, which we fit to various observational constraints. Our best-fitting model successfully matches the observables and correctly predicts the radial distribution of millisecond pulsars and their gravitational accelerations inferred from long-term timing observations. The data favours a population of BHs with a total mass of 430+−386301 M☉, but the most likely model has very few BHs. Since our models do not include a central IMBH and accurately reproduce the observations, we conclude that there is currently no need to invoke the presence of an IMBH in 47 Tuc. The global present-day mass function inferred is significantly depleted in low-mass stars (power-law slope α = −0.52+−001716). Given the orbit and predicted mass-loss history of this massive GC, the dearth of low-mass stars is difficult to explain with a standard initial mass function (IMF) followed by long-term preferential escape of low-mass stars driven by two-body relaxation, and instead suggests that 47 Tuc may have formed with a bottom-light IMF. We discuss alternative evolutionary origins for the flat mass function and ways to reconcile this with the low BH retention fraction. Finally, by capturing the effect of dark remnants, our method offers a new way to probe the IMF in a GC above the current main-sequence turn-off mass, for which we find a slope of −2.49 ± 0.08.

Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users.

Abstract: Introduction: High-need, high-cost patients can over-utilize acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased US healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods: Using a pre/post test design, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. Analysis was conducted between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department visits. Included patients had three or more hospital visits (ED or IP) in the 12 months prior to initiation of a CCM© (n=339). Individualized CCMs© were created and made available in the Electronic Medical Record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost accounting system for 12 months before and after CCMs© implementation. Both descriptive and limited inferential statistics were utilized. Results: ED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), CT mean scans decreased 62% (p<0.001), and OBS/IP LOS mean days decreased 41% (p<0.001). Gross charges decreased 45 % (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001). Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001). Conclusion: Individualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care.

Supplementary growth hormone treatment of women with poor ovarian response to exogenous gonadotrophins: changes in serum and follicular fluid insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3)

Abstract: The effects of supplementary growth hormone (GH) treatment upon insulin-like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3) concentrations in serum and ovarian follicular fluid were investigated in women undergoing buserelin human menopausal gonadotrophin (HMG) ovulation induction for in-vitro fertilization. Women (n = 40), aged 24-39 (mean 35 years), who showed poor ovarian responses to HMG, were recruited and randomly divided into two groups. Each patient received two cycles of ovulation induction, one with GH (12 IU/day x 12 days/HMG/buserelin) and another with placebo/HMG. Serum IGF-1 increased substantially during the GH treatment and remained significantly higher than the control 2 days after the last GH injection. Serum IGFBP-3 fell steadily during the placebo/HMG treatment and to a nadir on the day of oocyte retrieval (P < 0.05 compared to serum before any treatment). In contrast, IGFBP-3 was increased (P < 0.01) during the GH administration and returned to the control level 2 days after GH injection. Serum oestradiol concentrations on the eighth day of HMG and the day of human chorionic gonadotrophin (HCG) were not significantly different between the two groups. Serum IGF-1 was highly correlated with IGFBP-3 before any treatment (r = 0.433, P < 0.001). This correlation disappeared after buserelin, placebo/HMG treatment in the control group, but it was maintained during GH/HMG treatment (r = 0.343, P = 0.04). Follicular fluid concentrations of GH and IGF-1, not IGFBP-3 or oestradiol, were significantly elevated in the GH-treated women.(ABSTRACT TRUNCATED AT 250 WORDS)