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Scholarly Works (20 results)

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Article

The Miami Indians of Indiana: A Persistent People 1654-1994. By Stewart Rafert

Sleeper-Smith, Susan

American Indian Culture and Research Journal , Volume 21, Issue 1 (1997)

Cover page: The Miami Indians of Indiana: A Persistent People 1654-1994. By Stewart Rafert

Creative Commons 'BY-NC' version 4.0 license

Article
Peer Reviewed

A Nude Judith from Padua and the Reception of Donatello's Bronze David

Smith, Susan L.

Comitatus: A Journal of Medieval and Renaissance Studies, Volume 25, Issue 1 (1994)

Cover page: A Nude Judith from Padua and the Reception of Donatello's Bronze David

Article

Half a Million Older Californians Living Alone Unable to Make Ends Meet

Recent Work (2009)

Using the Elder Economic Security Standard™ Index (Elder Index), the authors of this policy brief find that nearly half a million elders (495,000) living alone in California in 2007 could not make ends meet—lacking sufficient income to pay for a minimum level of housing, food, health care, transportation and other basic expenses. The authors find particular cost inequities for elderly renters, for Latinos, women and the very old and find the Federal Poverty Level (FPL) that many programs use as part of eligibility guidelines is inadequate to support the needs of many seniors in California. The Elder Index is an estimation tool based on the actual cost in each county of basic necessities for older adults. This policy brief presents the first data on older Californians using the 2007 Elder Index. The supporting materials web page includes additional detailed county by county information. This analysis in this report was supported by: UCOP-California Program on Access to Care, Los Angeles County Area Agency on Aging, Aging & Independent Services of San Diego and the Insight Center for Community Economic Development.

Cover page: Half a Million Older Californians Living Alone Unable to Make Ends Meet

Article
Peer Reviewed

Older Adults Need Twice the Federal Poverty Level to Make Ends Meet in California

Recent Work (2010)

This policy brief uses 2009 data to calculate the Elder Economic Security Standard™ Index (Elder Index), a measure of the basic cost of living for seniors in all 58 California counties. It shows that both singles and couples age 65 or older who rent need more than twice the amount established by the Federal Poverty Level (FPL) Guideline to meet basic living expenses. The gap is greater for elders who own their home and are paying a mortgage than for renters. The gap between basic expenses and the FPL is smaller for owners without a mortgage, but still exists.

Housing and health care are the primary drivers of the high costs. This policy brief documents that the Elder Index provides a better measure of income adequacy than the Federal Poverty Level guideline (FPL) for older adults because it accounts for those costs at the county level. It also details the growing number of public and nonprofit organizations using the Elder Index for planning and programs that improve the health and income security of California's rapidly aging population.

Article
Peer Reviewed

Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future

UC San Francisco Previously Published Works (2020)

This Perspective presents a case study of multidimensional clinical transformation in an academic general internal medicine practice. In the face of increasing internal and external pressures, health systems and individual medical practices have pursued multiple strategies to improve quality, patient experience, and efficiency, while reducing staff and provider stress and burnout. We describe a Lean-informed approach that emphasizes the importance of organizational alignment in goals, evidence-based problem solving, and leadership behaviors to support a culture of continuous improvement. Our aim in this Perspective is to provide a real-world example of a feasible process for the planning, preparation, and execution of effective transformation, and to present lessons that may be useful to other academic health center practices seeking to develop innovative models to achieve the quadruple aim.

Cover page: Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future

Article
Peer Reviewed

Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery.

UC Irvine Previously Published Works (2016)

Background

Little prospective data exists regarding the procedures constituting female genital plastic/cosmetic surgery (FGPS).

Objectives

To evaluate whether the procedures of labiaplasty and vaginoperineoplasty improve genital self image, and evaluate effects on sexual satisfaction.

Methods

Prospective cohort case-controlled study of 120 subjects evaluated at baseline, 6, 12, and 24 months postoperative, paired with a demographically similar control group. Interventions include labiaplasty, clitoral hood reduction, and/or aesthetic vaginal tightening, defined as perineoplasty + "vaginoplasty" (aka "vaginal rejuvenation."). Outcome measures include body image, genital self-image, sexual satisfaction, and body esteem.

Results

As a group, study patients tested at baseline showing body dissatisfaction, negative genital self-image, and poorer indices of sexual satisfaction. Preoperative body image of study patients were in a range considered to be mild to moderately dysmorphic, but matched controls at one and two years; genital self-image scores at entry were considerably lower than controls, but by 2-year follow-up had surpassed control value at entry. Similarly, sexual satisfaction values, significantly lower at entry, equaled at one, and surpassed control values, at 2 years. Postoperatively, at all points in time, these differences in body image and genital self-image disappeared, and sexual satisfaction markedly improved. Overall body esteem did not differ between study and control groups, with the exception of the genital esteem quotient, which improved after surgery.

Conclusions

Women requesting and completing FGPS, when tested by validated instruments, at entry report sexual dissatisfaction and negative genital self-image. When tested at several points in time after surgery up to two years, these findings were no longer present. When performed by an experienced surgeon, FGPS appears to provide sexual and genital self-image improvement.

Level of evidence

2 Therapeutic.

Cover page: Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery.

Article
Peer Reviewed

Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience

UC San Francisco Previously Published Works (2023)

Introduction: The coronavirus disease 2019 (COVID-19) pandemic made it necessary to practice social distancing and limited in-person encounters in health care. These restrictions created alternative opportunities to enhance patient access to care in the ambulatory setting. We hypothesized that by transforming clinics into centers that prioritize procedures and transitioning ambulatory appointments to telehealth, we could establish a secure, streamlined, and productive method for providing patient care. Methods: Clinic templates were restructured to allow the use of the physical space to perform procedure-based clinics exclusively, while switching to virtual telemedicine for all nonprocedural encounters. Staff members were given specific roles to support one of the patient care modalities for a given day (Procedures vs. Telehealth). Performance and patient satisfaction metrics were collected between two periods of time defined as P1 (February-June 2019) and P2 Post-COVID (February-June 2020) and compared. These served as proxies of periods when the clinic workflow and templates were structured in the traditional versus the emerging way. Statistical analysis was performed using bivariate analyses. Results: The percentage of procedures performed among all in-person visits were higher in P2 compared to P1 (45% vs. 29%, p < 0.001). Although total charges and relative value units were lower in P2, the overall revenue generated was higher compared to P1 ($4,597,846 vs. $4,517,427$, respectively). This increase in revenue was mainly driven by the higher relative income generated by procedures. Patient experience, reflected through patient-reported outcomes, was more favorable in P2 where patients seemed more likely to "Recommend this provider office" (90% vs. 85.7%, p = 0.01), report improved "Access overall" (56% vs. 49%, p = 0.02), and felt they were "Moving through your visit overall" (59% vs. 51%, p = 0.007). Conclusions: Our data suggest that reorganizing urology clinics into a space that is centered around outpatient procedures can represent a model that improves the patient's access to care and clinical experience, while simultaneously improving operational financial strength. This efficient care model could be considered for many practice settings and drive high-value outpatient care.

Cover page: Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience

Article
Peer Reviewed

Decoding the IGF1 signaling gene regulatory network behind alveologenesis from a mouse model of bronchopulmonary dysplasia

UC San Diego Previously Published Works (2022)

Lung development is precisely controlled by underlying gene regulatory networks (GRN). Disruption of genes in the network can interrupt normal development and cause diseases such as bronchopulmonary dysplasia (BPD) - a chronic lung disease in preterm infants with morbid and sometimes lethal consequences characterized by lung immaturity and reduced alveolarization. Here, we generated a transgenic mouse exhibiting a moderate severity BPD phenotype by blocking IGF1 signaling in secondary crest myofibroblasts (SCMF) at the onset of alveologenesis. Using approaches mirroring the construction of the model GRN in sea urchin's development, we constructed the IGF1 signaling network underlying alveologenesis using this mouse model that phenocopies BPD. The constructed GRN, consisting of 43 genes, provides a bird's eye view of how the genes downstream of IGF1 are regulatorily connected. The GRN also reveals a mechanistic interpretation of how the effects of IGF1 signaling are transduced within SCMF from its specification genes to its effector genes and then from SCMF to its neighboring alveolar epithelial cells with WNT5A and FGF10 signaling as the bridge. Consistently, blocking WNT5A signaling in mice phenocopies BPD as inferred by the network. A comparative study on human samples suggests that a GRN of similar components and wiring underlies human BPD. Our network view of alveologenesis is transforming our perspective to understand and treat BPD. This new perspective calls for the construction of the full signaling GRN underlying alveologenesis, upon which targeted therapies for this neonatal chronic lung disease can be viably developed.

Cover page: Decoding the IGF1 signaling gene regulatory network behind alveologenesis from a mouse model of bronchopulmonary dysplasia

Article
Peer Reviewed