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Healthcare Access in Medically Underserved Areas During the COVID-19 Era: An International Medical Graduate Perspective From a Rural State
Srikrishna V Malayala et al. Cureus. 2020.
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Background Physician shortage and healthcare access are serious issues in rural states like Kentucky and further worsened during the coronavirus disease 2019 (COVID-19) pandemic. International Medical Graduates (IMGs) serve the underserved communities of Kentucky to fill in the physician gap. However, uncertainties surrounding immigration policies added significant challenges to physicians and the rural communities served by them during the pandemic. Methods A survey was created using the data collection platform "SurveyMonkey" and sent to IMG physicians practicing on a visa to understand their role and their immigration-related challenges. Only the physicians practicing in Kentucky were included in this study. Results It was found that 84% practice in primary care specialties like internal medicine, pediatrics, or family medicine, 92.9% practice in Medically Underserved Areas or Health Professional Shortage Areas, and 71.4% practice in rural settings. Also, 61.5% practice in a "frontline" COVID-19 specialty and 92.3% were involved in direct care of COVID-19 infected or suspected patients. Of the physicians, 88.5% were in an "immigration backlog"; 92.6% of them were the primary visa holders of their families and 88.9% expressed concern that their families face hardship if they have a disability during the pandemic. It was reported by 92.3% of them that visa-related restrictions limited them from providing additional coverage in these places. Conclusions Lack of physician access is a critical issue facing many rural states in America like Kentucky, and IMG physicians play a valuable role in taking care of this underserved population and fighting the COVID-19 pandemic. The challenges surrounding the immigration backlog are contributing to significant hardships and remain a hurdle to expand healthcare access to the rural and medically underserved communities.
Keywords: coronavirus disease (covid-19); covid 19; covid-19 outbreak; epidemiology and public health; imgs; immigration policy; internal medicine in rural areas; physician shortage; public health policy; rural areas.
Copyright © 2020, Malayala et al.
Conflict of interest statement
The authors have declared that no competing interests exist.
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Figure 1. Medically Underserved Areas in the…

Figure 2. Current incidence of COVID-19 cases…
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Balance and limits: modeling graduate medical education reform based on recommendations of the Council on Graduate Medical Education
F Mullan et al. Milbank Q. 1994.
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National commissions, medical philanthropies, scholars, and policy analysts agree that the key to improved health care access and cost containment is a physician workforce built on a generalist foundation. They propose a national system to allocate a specific and limited number of graduate medical education (GME) positions. The Council on Graduate Medical Education recommended that training positions be limited to 110 percent of the graduates of U.S. allopathic and osteopathic medical schools and that the system graduate 50 percent into primary care practice (50/50-110 proposal). The 50/50-110 option would significantly modify GME training: surgical and support specialty positions would be reduced, and increased numbers of medical and pediatric residents would enter general practice. This workforce composition would facilitate provision of universal health care access and help control costs--the basic tenets of reform.
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Randomized Controlled Trial
Pressure RElieving Support SUrfaces: a Randomised Evaluation 2 (PRESSURE 2): study protocol for a randomised controlled trial
Sarah Brown et al. Trials. 2016.
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Background: Pressure ulcers represent a major burden to patients, carers and the healthcare system, affecting approximately 1 in 17 hospital and 1 in 20 community patients. They impact greatly on an individual's functional status and health-related quality of life. The mainstay of pressure ulcer prevention practice is the provision of pressure redistribution support surfaces and patient repositioning. The aim of the PRESSURE 2 study is to compare the two main mattress types utilised within the NHS: high-specification foam and alternating pressure mattresses, in the prevention of pressure ulcers.
Methods/design: PRESSURE 2 is a multicentre, open-label, randomised, double triangular, group sequential, parallel group trial. A maximum of 2954 'high-risk' patients with evidence of acute illness will be randomised on a 1:1 basis to receive either a high-specification foam mattress or alternating-pressure mattress in conjunction with an electric profiling bed frame. The primary objective of the trial is to compare mattresses in terms of the time to developing a new Category 2 or above pressure ulcer by 30 days post end of treatment phase. Secondary endpoints include time to developing new Category 1 and 3 or above pressure ulcers, time to healing of pre-existing Category 2 pressure ulcers, health-related quality of life, cost-effectiveness, incidence of mattress change and safety. Validation objectives are to determine the responsiveness of the Pressure Ulcer Quality of Life-Prevention instrument and the feasibility of having a blinded endpoint assessment using photography. The trial will have a maximum of three planned analyses with unequally spaced reviews at event-driven coherent cut-points. The futility boundaries are constructed as non-binding to allow a decision for stopping early to be overruled by the Data Monitoring and Ethics Committee.
Discussion: The double triangular, group sequential design of the PRESSURE 2 trial will provide an efficient design through the possibility of early stopping for demonstrating either superiority, inferiority of mattresses or futility of the trial. The trial optimises the potential for producing robust clinical evidence on the effectiveness of two commonly used mattresses in clinical practice earlier than in a conventional design.
Trial registration: ISRCTN01151335 . Registered on 14 May 2013. Protocol version: 5.0, dated 25 September 2015 Trial sponsor: Clare Skinner, Faculty Head of Research Support, University of Leeds, Leeds, LS2 9JT; 0113 343 4897; C.E.Skinner@leeds.ac.uk.
Keywords: Alternating pressure mattress; Double triangular group sequential design; Pressure ulcers; Quality of life; Randomised controlled trial; Standard foam mattress.
Figures

Fig. 1
Trial flow diagram

Fig. 2
Schedule of enrolment, interventions, and…

Fig. 3
Double triangular group sequential design
Similar articles
Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT.
Nixon J, et al. Health Technol Assess. 2019. PMID: 31559948 Free PMC article. Clinical Trial.
Pressure relieving support surfaces: a randomised evaluation.
Nixon J, et al. Health Technol Assess. 2006. PMID: 16750060 Clinical Trial.
Pressure RElieving Support SUrfaces: a Randomised Evaluation 2 (PRESSURE 2) photographic validation sub-study: study protocol for a randomised controlled trial.
McGinnis E, et al. Trials. 2017. PMID: 28320482 Free PMC article. Clinical Trial.
Support surfaces for pressure ulcer prevention.
McInnes E, et al. Cochrane Database Syst Rev. 2008. PMID: 18843621 Updated. Review.
Support surfaces for pressure ulcer prevention.
Cullum N, et al. Cochrane Database Syst Rev. 2004. PMID: 15266452 Updated. Review.
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A Comparative Study Between Two Support Surfaces for Pressure Ulcer Prevention and Healing in ICU Patients.
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References
Kaltenthaler E, Withfield MD, Walters SJ, Akehurst RL, Paisley S. UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare? J Wound Care. 2001;10(1):530–5. doi: 10.12968/jowc.2001.10.1.26039. - DOI - PubMed
McGinnis E, Briggs M, Collinson M, Wilson L, Dealey C, Brown J, et al. Pressure ulcer related pain in community populations: a prevalence survey. BMC Nurs. 2014;13:16. doi: 10.1186/1472-6955-13-16. - DOI - PMC - PubMed
Smith IL, Nixon J, Brown S, Wilson L, Coleman S. Pressure ulcer and wounds reporting in NHS hospitals in England part 1: audit of monitoring systems. J Tissue Viability. 2016;25(1):3–15. doi: 10.1016/j.jtv.2015.11.001. - DOI - PubMed
Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57(7):1175–83. doi: 10.1111/j.1532-5415.2009.02307.x. - DOI - PubMed
Gorecki C, Closs SJ, Nixon J, Briggs M. Patient-reported pressure ulcer pain: a mixed-methods systematic review. J Pain Symptom Manag. 2011;42(3):443–59. doi: 10.1016/j.jpainsymman.2010.11.016. - DOI - PubMed
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Publication types
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
MeSH terms
Beds* / economics
Clinical Protocols
Cost-Benefit Analysis
Equipment Design
Hospital Costs
Humans
Photography
Pressure
Pressure Ulcer / economics
Pressure Ulcer / pathology
Pressure Ulcer / physiopathology
Pressure Ulcer / therapy*
Quality of Life
Research Design
State Medicine
Surveys and Questionnaires
Time Factors
Treatment Outcome
United Kingdom
Wound Healing
Associated data
ISRCTN/ISRCTN01151335
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Chemical polarization effects of electromagnetic field radiation from the novel 5G network deployment at ultra high frequency
Ugochukwu O Matthew et al. Health Technol (Berl). 2021.
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The wide-spectrum of non-ionizing, non-visible radiation emitted from the novel 5G network deployment was investigated and found liable to produce effects capable of heating up and altering human body nomenclature. The Ultra-high frequency magnetic fields, induced circulation of currents in the surrounding human body when potentially exposed. The quantum of these electromagnetic charges is influenced by the magnitude of the external magnetic field. The Magnetic fields warming is the major organic consequence of the electromagnetic fields radiofrequency radiation emitted from 5G network installation especially at a very high frequencies. From the current research, the levels of electromagnetic fields to which individuals are naturally unmasked under 4G network and 5G network technology in SCENARIO1, SCENARIO 2 and SCENARIO 3 are very negligible to alter human body dipolar chemistry. On the several findings of the research, deploying 5G network technology under the ultra-high frequency above 20 GHz will produce effect that will heat up the human body tissues due to electromagnetic field inducement since human body is dipolar in nature. The research established that while the current digital society will continue investment into 5G network technology, caution must be applied not to deploy 5G network under ultra-high frequency above 20 GHz due to its adverse health effects.
Keywords: 5G network adverse health effects; Electromagnetic fields; Healthcare; Mobile networking technology; Non-ionizing radiation; Toxic dipolar stimulus combinations; Wireless radiation.
© IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2021.
Conflict of interest statement
Conflict of interestThe authors declare that they have no conflict of interest
Figures

Fig. 1
Spectrum allocation over time

Fig. 2
5G spectrum Distribution across the…

Fig. 3
Spectrum Trade –Off [18]

Fig. 4
5G Network Deployment consideration [2]

Fig. 5
Health hazard of deploying 5G…

Fig. 6
A polarized dielectric material
All figures (10)
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[Protection of the population health from electromagnetic hazards - challenges resulting from the implementation of the 5G network planned in Poland].
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Adverse health effects of 5G mobile networking technology under real-life conditions.
Kostoff RN, et al. Toxicol Lett. 2020. PMID: 31991167
5 G wireless telecommunications expansion: Public health and environmental implications.
Russell CL. Environ Res. 2018. PMID: 29655646
[Conditionings of population exposure to electromagnetic fields associated with the rational use of 5G radiocommunication networks in Poland].
Bieńkowski P, et al. Med Pr. 2020. PMID: 31793558 Review. Polish.
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References
Ungureanu O. Flexible and Programmable Evolved Packet Core: A New SDN-based Model. 2014.
Parvez I, Rahmati A, Guvenc I, Sarwat AI, Dai H. A survey on low latency towards 5G: RAN, core network and caching solutions. IEEE Communications Surveys & Tutorials. 2018;20(4):3098–3130. doi: 10.1109/COMST.2018.2841349. - DOI
Kostoff RN, Heroux P, Aschner M, Tsatsakis A. Adverse health effects of 5G mobile networking technology under real-life conditions. Toxicol Lett. 2020;323:35–40. doi: 10.1016/j.toxlet.2020.01.020. - DOI - PubMed
Mavrogiorgou A, Kiourtis A, Touloupou M, Kapassa E, Kyriazis D, Themistocleous M. The road to the future of healthcare: Transmitting interoperable healthcare data through a 5G based communication platform. Paper presented at the European, Mediterranean, and Middle Eastern Conference on Information Systems. 2018.
Pramanik, P. K. D., Pal, S., & Mukhopadhyay, M. (2019). Healthcare big data: A comprehensive overview Intelligent Systems for Healthcare Management and Delivery (pp. 72–100): IGI Global.
Show all 38 references
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SEED servers: high-performance access to the SEED genomes, annotations, and metabolic models
Ramy K Aziz et al. PLoS One. 2012.
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The remarkable advance in sequencing technology and the rising interest in medical and environmental microbiology, biotechnology, and synthetic biology resulted in a deluge of published microbial genomes. Yet, genome annotation, comparison, and modeling remain a major bottleneck to the translation of sequence information into biological knowledge, hence computational analysis tools are continuously being developed for rapid genome annotation and interpretation. Among the earliest, most comprehensive resources for prokaryotic genome analysis, the SEED project, initiated in 2003 as an integration of genomic data and analysis tools, now contains >5,000 complete genomes, a constantly updated set of curated annotations embodied in a large and growing collection of encoded subsystems, a derived set of protein families, and hundreds of genome-scale metabolic models. Until recently, however, maintaining current copies of the SEED code and data at remote locations has been a pressing issue. To allow high-performance remote access to the SEED database, we developed the SEED Servers (http://www.theseed.org/servers): four network-based servers intended to expose the data in the underlying relational database, support basic annotation services, offer programmatic access to the capabilities of the RAST annotation server, and provide access to a growing collection of metabolic models that support flux balance analysis. The SEED servers offer open access to regularly updated data, the ability to annotate prokaryotic genomes, the ability to create metabolic reconstructions and detailed models of metabolism, and access to hundreds of existing metabolic models. This work offers and supports a framework upon which other groups can build independent research efforts. Large integrations of genomic data represent one of the major intellectual resources driving research in biology, and programmatic access to the SEED data will provide significant utility to a broad collection of potential users.
Conflict of interest statement
Competing Interests: RKA is a volunteer member of the editorial board of PLOS ONE, and as such had no access to the peer review or acceptance process for this manuscript. Other than that, the authors have declared that no competing interests exist. The submitted manuscript has been created in part by UChicago Argonne, LLC, Operator of Argonne National Laboratory ("Argonne"). Argonne, a U.S. Department of Energy Office of Science laboratory, is operated under Contract No. DE-AC02-06CH11357 and Award DE-SC0004921. The U.S. Government retains for itself, and others acting on its behalf, a paid-up nonexclusive, irrevocable worldwide license in said article to reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
Figures

Figure 1. Architecture of the SEED servers.

Figure 2. Entities and relationships in the…

Figure 3. Processing ids_to_sequences.
(a) The ids_to_sequences…
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Seaver SM, et al. Proc Natl Acad Sci U S A. 2014. PMID: 24927599 Free PMC article.
MicroScope-an integrated resource for community expertise of gene functions and comparative analysis of microbial genomic and metabolic data.
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An Experimental Approach to Genome Annotation: This report is based on a colloquium sponsored by the American Academy of Microbiology held July 19-20, 2004, in Washington, DC.
[No authors listed] American Society for Microbiology. 2004. PMID: 33001599 Free Books & Documents. Review.
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[No authors listed] American Society for Microbiology. 2002. PMID: 33119230 Free Books & Documents. Review.
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Overbeek R (2000) Genomics: what is realistically achievable? Genome Biol 1: COMMENT2002. - PMC - PubMed
Ahmed N (2009) A flood of microbial genomes-do we need more? PLoS ONE 4: e5831. - PMC - PubMed
Pagani I, Liolios K, Jansson J, Chen IM, Smirnova T, et al. (2012) The Genomes OnLine Database (GOLD) v.4: status of genomic and metagenomic projects and their associated metadata. Nucleic Acids Res 40: D571–579. - PMC - PubMed
Barrett T, Clark K, Gevorgyan R, Gorelenkov V, Gribov E, et al. (2012) BioProject and BioSample databases at NCBI: facilitating capture and organization of metadata. Nucleic Acids Res 40: D57–63. - PMC - PubMed
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Publication types
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
MeSH terms
Computational Biology / methods*
Databases, Factual / statistics & numerical data*
Escherichia coli / genetics
Escherichia coli / metabolism
Genomics / methods
Genomics / statistics & numerical data
Information Storage and Retrieval / methods*
Internet
Metabolomics / methods
Metabolomics / statistics & numerical data
Molecular Sequence Annotation / methods
Molecular Sequence Annotation / statistics & numerical data
Reproducibility of Results
Software*
Related information
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