Patient with a deletion of chromosome 21q and minimal phenotype.
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Child, Preschool↗
Biomedical subjects
Kathleen Reynolds
Publications and source records attributed to Kathleen Reynolds.
Integration of behavioral and physical health care for a medicaid population through a public-public partnership.
This article documents a unique organizational, legal, and financial partnership between a state, a university, a Medicaid managed health care plan, and a county to provide integrated mental health, substance abuse, and primary and specialty health care services to Medicaid, low-income, and indigent consumers in Washtenaw county, Michigan. Major regulatory, financial, and clinical changes were required within and among the various partners in the Washtenaw County Integrated Health Care Project. A new entity--the Washtenaw Community Health Organization--was created to implement the project. By sharing resources as well as financial risks, the state, the county, and the university have been able to provide ongoing integrated care to a vulnerable population of patients. Although resource intensive in conceptualization and implementation, the project can be viewed as a model for other states that face growing needy populations and decreasing Medicaid budgets.
Academic Medical Centers↗
Adult bone marrow stromal stem cells express germline, ectodermal, endodermal, and mesodermal genes prior to neurogenesis.
Bone marrow stromal stem cells (MSCs) normally differentiate into mesenchymal derivatives but recently have also been converted into neurons, classical ectodermal cells. To begin defining underlying mechanisms, we extended our characterization of MSCs and the differentiated neurons. In addition to expected mesodermal mRNAs, populations and clonal lines of MSCs expressed germinal, endodermal, and ectodermal genes. Thus, the MSCs are apparently "multidifferentiated" in addition to being multipotent. Conversely, the differentiating neurons derived from populations and clonal lines of MSCs expressed the specific markers beta-III tubulin, tau, neurofilament-M, TOAD-64, and synaptophysin de novo. The transmitter enzymes tyrosine hydroxylase and choline acetyltransferase were localized to neuronal subpopulations. Our observations suggest that MSCs are already multidifferentiated and that neural differentiation comprises quantitative modulation of gene expression rather than simple on-off switching of neural-specific genes.
Age Factors↗
Barriers to addressing patient sexuality concerns across five areas of specialization.
PURPOSE AND OBJECTIVES: The aim of this study was to examine the barriers to addressing patient sexuality across areas of specialization. DESIGN: A descriptive correlational design was used in this study. SAMPLE AND SETTING: A convenience sample of nurses (N = 302) was recruited from a large Midwestern medical center. METHOD: In this study, a survey using the Sexuality Attitudes and Beliefs Survey and a demographic questionnaire was conducted. FINDINGS: The number one barrier to addressing patient sexuality concerns across all areas of specialization was the nurses' perceptions that patients do not expect nurses to address their sexuality concerns. Other high-ranking barriers included a lack of comfort and confidence in addressing sexuality and failure to make time to discuss patient sexuality concerns. IMPLICATIONS FOR PRACTICE: Educational programs with both general and specific content are needed to help nurses across areas of specialization overcome barriers to addressing patient sexuality concerns. In addition, clinical nurse specialists are challenged to think of ways in which their practice competencies might be used creatively to overcome barriers to addressing patient sexuality concerns and promote the sexual health of individuals and groups. CONCLUSIONS: Further research is needed to determine whether the assumption that patients do not expect nurses to address sexuality concerns matches the reality of patients' expectations.
Adult↗