Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008-2017.

Objectives. To measure changes in the contraceptive methods used by Title X clients after implementation of Delaware Contraceptive Access Now, a public-private initiative that aims to increase access to contraceptives, particularly long-acting reversible contraceptives (LARCs).Methods. Using administrative data from the 2008-2017 Family Planning Annual Reports and a difference-in-differences design, we compared changes in contraceptive method use among adult female Title X family planning clients in Delaware with changes in a set of comparison states. We considered permanent methods, LARCs, moderately effective methods, less effective methods, and no method use.Results. Results suggest a 3.2-percentage-point increase in LARC use relative to changes in other states (a 40% increase from baseline). We were unable to make definitive conclusions about other contraceptive method types.Conclusions. Delaware Contraceptive Access Now increased LARC use among Title X clients. Our results have implications for states considering comprehensive family planning initiatives.

Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type.

BACKGROUND: Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion. OBJECTIVES: To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. RESEARCH DESIGN: A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states. SUBJECTS: Administrative data from Family Planning Annual Reports that describe Title X clients who sought services. MEASURES: Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15-44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type. RESULTS: We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification. CONCLUSIONS: Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.

The effects of KRAS Mutations on the Prognosis of Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Surgery.

BACKGROUND: Rectal cancers with mutations in the KRAS gene have worse prognoses than wild-type malignancies. Variants at codon 12 of KRAS have particularly detrimental effects on prognosis. We aimed to analyze whether KRAS mutations act as adverse prognostic factors following neoadjuvant concurrent chemoradiotherapy (CRT) and surgery for rectal cancer treatment. METHODS: We analyzed the effects of KRAS mutations on disease-free survival (DFS) and locoregional recurrence-free survival (LRFS) in 125 patients with cT2-4N0-2M0 rectal cancer who underwent surgery following CRT between June 2014 and March 2023 Inje University Busan Paik Hospital. RESULTS: The median follow-up period was 39.7 (range, 7.5-98.2) months. There were 25 patients (20.0%) who harbored KRAS mutations. Among them, 22 patients (17.6%) had codon 12 variants. Overall, 43 patients (34.4%) showed recurrence, of which 10 (8.0%) had locoregional recurrence and 35 (28.0%) had distant metastases (two occurred simultaneously). DFS was significantly reduced in the patients with KRAS mutations (p = 0.005). LRFS was also reduced in patients with KRAS mutations (p = 0.039). DFS and LRFS were also relatively low in the subgroup with KRAS mutations at codon 12 (n = 22) (p = 0.003 and p = 0.017, respectively). However, pathologic complete response rate following CRT was not affected by KRAS mutations (p = 0.197). Overall survival was also not associated with KRAS mutations (p = 0.486). CONCLUSION: KRAS mutation is related to decreased DFS and LRFS, when surgery is performed following neoadjuvant CRT to treat rectal cancer. These effects are particularly pronounced for KRAS mutations at codon 12.

Improvement in the breakdown properties of electrowetting using polyelectrolyte ionic solution.

We report the improvement in the breakdown properties of electrowetting using a mixture of poly(acrylic acid) (PAA) polyelectrolyte and a surfactant (Tween 80, TW80). Onset of breakdown was initially determined via visual observation and further verified by investigating impedance phase shift. Breakdown characteristics of the large-molecule ionic solution were compared with those of conventional electrolytes (Na(2)SO(4)) that produce small molecules. Experiments with various conductivities and hydrophobic coatings on a thin silicon nitride dielectric layer (∼500 Å) showed that the breakdown voltage of the PAA-TW80 system was at least two times higher than that of the Na(2)SO(4)-TW80 system. Our results demonstrate that defects in the dielectric and hydrophobic layers are less vulnerable to larger ionic molecules.

Zeolite-loaded alginate-chitosan hydrogel beads as a topical hemostat.

Hemorrhage is the leading cause of preventable death after a traumatic injury, and the largest contributor to loss of productive years of life. Hemostatic agents accelerate hemostasis and help control hemorrhage by concentrating coagulation factors, acting as procoagulants and/or interacting with erythrocytes and platelets. Hydrogel composites offer a platform for targeting both mechanical and biological hemostatic mechanisms. The goal of this work was to develop hydrogel particles composed of chitosan, alginate, and zeolite, and to assess their potential to promote blood coagulation via multiple mechanisms: erythrocyte adhesion, factor concentration, and the ability to serve as a mechanical barrier to blood loss. Several particle compositions were synthesized and characterized. Hydrogel bead composition was optimized to achieve the highest swelling capacity, greatest erythrocyte adhesion, and minimal in vitro cytotoxicity. These results suggest a polymer hydrogel-aluminosilicate composite material may serve as a platform for an effective hemostatic agent that incorporates multiple mechanisms of action. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1662-1671, 2018.

Acute myocardial infarction following scrub typhus infection.

Up to recently, a few cases of myocarditis in the cardiac manifestations of scrub typhus have been reported. However, acute myocardial infarction (AMI) associated with scrub typhus has not been previously reported. We presented a case of AMI ensued on scrub typhus, which were successfully treated by percutaneous coronary intervention (PCI).

Holographic optical elements recorded in silver halide sensitized gelatin emulsions. Part 2. Reflection holographic optical elements.

Silver halide sensitized gelatin (SHSG) holograms are similar to holograms recorded in dichromated gelatin (DCG), the main recording material for holographic optical elements (HOEs). The drawback of DCG is its low energetic sensitivity and limited spectral response. Silver halide materials can be processed in such away that the final hologram will have properties like a DCG hologram. Recently this technique has become more interesting since the introduction of new ultra-fine-grain silver halide (AgHal) emulsions. In particular, high spatial-frequency fringes associated with HOEs of the reflection type are difficult to construct when SHSG processing methods are employed. Therefore an optimized processing technique for reflection HOEs recorded in the new AgHal materials is introduced. Diffraction efficiencies over 90% can be obtained repeatably for reflection diffraction gratings. Understanding the importance of a selective hardening process has made it possible to obtain results similar to conventional DCG processing. The main advantage of the SHSG process is that high-sensitivity recording can be performed with laser wavelengths anywhere within the visible spectrum. This simplifies the manufacturing of high-quality, large-format HOEs, also including high-quality display holograms of the reflection type in both monochrome and full color.

Holographic diffuser by use of a silver halide sensitized gelatin process.

Diffusers play an important role in liquid crystal display (LCD) application as a beam-shaping device, a brightness homogenizer, a light-Scattering device, and an imaging screen. The transmittance and diffusing angle of the diffusers are the critical aspects for the applications to the LCD. The holographic diffusers by use of various processing methods have been investigated. The diffusing characteristics of different diffusing materials and processing methods have been evaluated and compared. The microstructures of holographic diffuse have been investigated by use of using scanning electron microscopy. The holographic diffusers by use of the silver halide sensitized gelatin (SHSG) method have the structural merits for the improvement of the quality of diffusers. The features of holographic diffuser were exceptional in terms of transmittance and diffusing angle. The replication method by use of the SHSG process can be directly used for the manufacturing of diffusers for the display application.