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Biomedical subjects

J Greene

Publications and source records attributed to J Greene.

At least 55 records · Page 3Linked to original sources
PubMed2000

Homeless and runaway youths' access to health care.

PURPOSE: To describe use of health services and self-reported access to regular and emergency care by homeless adolescents and street youth. METHODS: Interviewer-administered surveys addressed use of health services, availability of sources of care for emergencies, and types of care sources used. An abbreviated version of the questionnaire used for youth in shelters was used for street youth. A nationally representative sample of 640 sheltered youth and a purposive sample of 600 street youth aged 12-21 years were interviewed. All data were collected in 1992. RESULTS: Half of street youth and 36% of sheltered youth did not have a regular source of health care (p < or =.05). One-fourth of street youth and 18% of sheltered youth also reported serious health problems within the past year (p < or =.05). Street youth were more likely than sheltered youth to have used emergency treatment (36% vs. 29%; p < or =.05) and alcohol- or drug-related emergency treatment (25% vs. 13%; p < or =.05). Sheltered youth with a regular source of care were more likely to use nonemergency sites than those without a source of primary care (46% vs. 20%; p < or =.001). Few sheltered or street youth perceived shelter clinics, clinics for runaway youth, or free youth clinics to be available to meet their emergency care needs. CONCLUSIONS: Significant numbers of homeless youth did not have a regular source of health care. Those who had a regular source of care were more likely to have continuity between routine and emergency care. Integration of health services with other agencies serving youth in shelters or on the street may improve access to care for those without a routine source of care and provide better continuity for these high-risk youth.

Adolescent↗
PubMed2000

True fix.

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Humans↗
PubMed2000

A better ending.

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Attitude of Health Personnel↗
PubMed2000

Circle of life.

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Awards and Prizes↗
PubMed2000

The Circle of Life. The AHA recognizes end-of-life programs with awards.

The Circle of Life awards were presented for the first time this year by the American Hospital Association to highlight breakthrough innovations in end-of-life care. The three award winners, profiled here, demonstrate that care, comfort, and compassion must go hand-in-hand in the final stage of life.

American Hospital Association↗
PubMed1999

Modulation of cell firing in the nucleus accumbens.

Pennartz et al. have proposed that functions of the nucleus accumbens (NA) are subserved by the activity of ensembles of neurons rather than by an overall neuronal activation. Indeed, the NA is a site of convergence for a large number of inputs from limbic structures that may modulate the flow of prefrontal cortical information and contribute to defining such ensembles, as exemplified in the ability of hippocampal input to gate cortical throughput in the nucleus accumbens. NA neurons exhibit a bistable membrane potential, characterized by a very negative resting membrane potential (down state), periodically interrupted by plateau depolarizations (up state), during which the cells may fire in response to cortical inputs. A dynamic ensemble can be the result of a distributed set of neurons in their up state, determined by the moment-to-moment changes in the spatial distribution of hippocampal inputs responsible for transitions to the up state. Ensembles may change as an adaptation to the contextual information provided by the hippocampal input. Furthermore, for dynamic ensembles to be functionally relevant, the model calls for near synchronous transitions to the up state in a group of neurons. This can be accomplished by the cell-to-cell transfer of information via gap junctions, a mechanism that can allow for a transfer of slow electrical signals, including "up" events between coupled cells. Furthermore, gap junction permeability is tightly modulated by a number of factors, including levels of dopamine and nitric oxide, and cortical inputs, allowing for fine-tuning of this synchronization of up events. The continuous selection of such dynamic ensembles in the NA may be disputed in schizophrenia, resulting in an inappropriate level of activity of thalamocortical systems.

Afferent Pathways↗
PubMed1999

Brain regions involved in articulation.

BACKGROUND: The left inferior frontal gyrus (Broca's area) is generally believed to be critical for the motor act of speech. A lesion-based analysis has, however, shown that the left anterior insula is necessary for accurate articulation. We used functional imaging in normal people to show the neural systems involved in speech during different speech tasks. METHODS: 12 normal people underwent positron emission tomography with oxygen-15-labelled water as tracer. We measured cerebral activity while participants performed three different tasks: repetition of heard nouns at different rates; listening to single nouns at different rates; and anticipation of listening or repetition. We analysed the data with imaging software. FINDINGS: Repetition of single words did not activate Broca's area but activity in three left-lateralised regions was seen: the anterior insula, a localised region in the lateral premotor cortex, and the posterior pallidum. The left anterior insula and lateral premotor cortex showed a conjunction of activity for hearing and articulation. In addition, articulation modulated the response to hearing words in the left dorsolateral temporal cortex, the physiological expression of the speaker's auditory attention being directed towards the stimuli and not his or her articulated responses. INTERPRETATION: The formulation of an articulatory plan is a function of the left anterior insula and lateral premotor cortex and not of Broca's area. The left basal ganglia seem to be dominant for speech, although the axial muscles involved receive their motor output from both cerebral hemispheres.

Adult↗
PubMed1999

Comprehension of contrastive stress by Broca's aphasics.

Comprehension of stress as a determiner of reference for pronouns was compared in eight patients with Broca's aphasia (BA) and five age-matched control subjects. The subjects were asked to listen to sentences in which the stressed or unstressed condition of the pronoun was a critical criterion for the establishment of reference. For each sentence, subjects were shown three pictures and asked to point to the correct referent of the pronoun. While the controls were nearly perfect in both the stressed and unstressed conditions, BA patients were significantly worse than normals, showing chance performance in both cases. However, a significant disparity was found in the BA patients' selection of the object NP as the referent under stressed and unstressed conditions, indicating that BA subjects are, indeed, sensitive to the stress patterns of pronouns. It was thus hypothesized that the BA patients' chance performance was the result of an inability to implement their knowledge of stress during the processing of sentences involving discourse-related linguistic operations, such as the establishment of pronoun reference (Grodzinsky, Wexler, Chien, Marakovitz, & Solomon, 1993). To test this hypothesis, a second experiment was conducted in which discourse-related operations were eliminated. In this second experiment, comprehension of stress by the same two groups was compared in tasks involving purely morphosyntactic processes. The contrastive stress patterns of otherwise homophonous compound nouns and adjectival phrases (e.g., BLACKboard, black BOARD), rather than those of pronouns, were examined. In this grammatically "simpler" experiment (i.e., without discourse-related operations), BA subjects scored significantly above chance in their comprehension of sentences involving compound nouns; unexpectedly, however, these same subjects did not show significantly above-chance performance in their comprehension of sentences containing adjectival phrases. Nevertheless, the results obtained in these two experiments seem to support the view that aphasic patients may have a lack of processing capacity, resulting in more errors during the processing of discourse-related linguistic constructions.

Aged↗
PubMed1999

The impact of Medicaid managed care on community clinics in Sacramento County, California.

OBJECTIVES: The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. METHODS: Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. RESULTS: There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. CONCLUSIONS: The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics.

Analysis of Variance↗
PubMed1999

From whodunit to what happened.

An amnesty on errors? A few hospitals are declaring one, finding that it actually helps reduce mistakes. "This is a very hard sell," acknowledges one nursing executive. "But once people trusted they wouldn't be disciplined for reporting mistakes, we were able to look at systems and solve problems."

Employee Discipline↗
PubMed1999

Head games. Hiring trends.

The times demand executives who can deal well with doctors and handle the chaos of rapid change. And that's why your next job interview could include a personality test. "I can't supplement efficiencies in those areas with machinery or equipment or even training," says one recruiter. "A hospital can give you all the tools in the world, but the only one that counts is the one between your ears."

Hospital Administrators↗