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Abstract. .Background Uninsured Patients With Diabetes

ABSTRACT Background: Uninsured patients with diabetes are at increased risk for poor outcomes and often have limited access to health and prescription services necessary to manage diabetes. The Cooper Rowan Clinic is a medical student-run, attending-supervised free clinic that offers primary care to the uninsured individuals in the Camden New Jersey area. Student-run clinics are emerging safety-net practices for the uninsured; but despite the growing number of clinics that currently operate across the United States little data exist on the quality of care being delivered at these sites. Purpose: To evaluate the effectiveness of health care provided for uninsured diabetic patients at the Cooper Rowan Clinic Methods: Quantitative analysis†¦show more content†¦Although the ACA drastically expanded coverage it failed to provide adequate health insurance for millions including millions of undocumented immigrants who reside in the US; forcing these individuals to seek alternative treatment options. Student Run Free Clinics (SRFC) serve as a viable healthcare option for many of those seeking primary care when they otherwise wouldn’t be eligible for healthcare coverage. A reasonable assumption could be that otherwise medically underserved patients would gain clinical benefits from receiving care at SRFCs, few published reports support this notion. Although some studies have demonstrated that SRFCs can meet national care guidelines for chronic medical illnesses, surprisingly few have assessed longitudinal improvement in clinical outcomes. The goal of this study is to add to the existing literature surrounding SRFCs by investigating diabetes outcomes. The Cooper Rowan Clinic (CRC) is a SRFC that aims to serve the city’s underserved population and reduce healthcare disparities in Camden, NJ. Since 2012 the clinic has been providing access to quality care for uninsured, underinsured, and undocumented patients over the age of 14. Medical students from Cooper Medical School of Rowan University and pharmacy students from University of the Sciences in Philadelphia work together in teams to provide care to patients at the CRC, under close supervision of at least one licensed faculty physician andShow MoreRelatedState Health Policy Analysis8008 Words   |  33 PagesState Health Policy Analysis William Bythwood MHA620 Health Policy Analyses Professor Saran Tucker March 7, 2011 State Health Policy Analysis Abstract: The rises of health cost have put strains on State, Federal and employers budgets and have severely hurt US families’ income in recent years. 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The Secret of Ella and Micha Chapter 10 Free Essays

string(29) " her shirt to pull her down\." Ella I can remember the first time I wanted to kiss Micha as clearly as the day I found my mother dead. Both times were equally as terrifying, but in two different ways. Micha and I had been sitting on the hood of his car at our secret spot tucked away in the trees, staring out at the lake. We will write a custom essay sample on The Secret of Ella and Micha Chapter 10 or any similar topic only for you Order Now It was harder than hell to get back to the spot, but the view and serenity made it worth it. It had been quiet between the two of us for a while, which was normal except for the jealousy stirring inside me over Micha’s latest hook up, Cassandra. I’d never felt this way before and it puzzled me. It wasn’t like the girl was anything special to Micha, but he’d told Ethan that she had the potential to be girlfriend material and it was bugging me. Micha’s arms were tucked under his head and his eyes were shut as the sunlight beamed down on him. His shirt had ridden up and I could see his tattoo peeking out. As I stared at it the urge to run my fingers along it drove me crazy. â€Å"I don’t like Cassandra,† I abruptly sputtered out, sitting up quickly. Micha’s eyebrows knitted as his eyes gradually opened against the sunlight. â€Å"Huh?† â€Å"That Cassandra girl you were talking about the other day,† I said, staring out at the water rippling in the gentle breeze. â€Å"I don’t think you should date her.† He rose up on his elbows. â€Å"Because you don’t like her?† â€Å"No†¦Ã¢â‚¬  I tucked strands of my auburn hair out of my eyes. â€Å"I just don’t want you to date her.† The wind filled the silence. Micha sat up and wrapped an arm around my shoulder. â€Å"Okay, I won’t,† he said as if it was as simple as breathing. I pressed back a smile, not fully understanding why the hell I was so happy. Micha lay back down and drew me with him. I rested my head on his chest and listened to his heart beating, steady as a rock, unlike mine which was dancing inside my chest. The longer I stayed in his arms, the more content I became. I felt safe, like nothing could hurt me, but I was in complete denial that I was starting to fall in love with my best friend. *** It’s been a week since the car racing incident and I’ve been hiding out in my bedroom living on mac n’ cheese and Diet Dr. Pepper. Dean still hasn’t headed home, but Lila did the morning after the race. She wanted to stay, but I didn’t want her to and I think her dad wasn’t too keen on the idea either. It’s been kind of lonely, though. I still haven’t listened to Micha’s voicemail, and the constant flashing on the screen torments me. I decide to take a break from the house today and do something I’ve been meaning to do for a while. I want to sketch my mother’s grave because I won’t always be close enough to visit it. It’s been bothering me the entire eight months that I’ve been gone. I feel guilty because it was me who put her there and then I just left her. I collect my sketch book and pencils from the drawer of my night stand, slip on my shoes and sunglasses, and head out the front door where I’m less likely to run into Micha. It’s a warm day and the blue sky glitters with sunshine. I walk up the sidewalk toward Cherry Hill and decide to make a last minute stop at Grady’s. I knock on the trailer door and Amy, the nurse, answers it wearing blue scrubs. â€Å"Oh, hi Ella, I don’t think Grady’s up for any visitors today, sweetie.† â€Å"But he told me to stop by,† I say stupidly. â€Å"I know it’s a little later than I told him and I’m sorry.† â€Å"He’s not mad at you, Ella,† she says kindly. â€Å"I’ve just got him hooked up on oxygen and he’s got a cough.† I shield my eyes from the sun and stare up at her. â€Å"Is he okay?† She sighs, leaning against the doorframe. â€Å"He’s just having a rough day today, but try back in a few days, okay hun.† I nod and back down the steps as she shuts the door. I stare helplessly at the back window which leads to Grady’s room. He’s sick and there’s nothing I can do. I have no control over this. Micha was right. I can’t control everything. As horrid images of my mom’s death flash through my mind, I run into the field and throw up. *** The town’s cemetery is located up on Cherry Hill, which on foot is quite a hike, but I enjoy the break from the reality of life. There is no one up there – there hardly ever is. I push through the gate and situate by a tree right in front of my mom’s headstone. It’s a small cemetery bordered by trees and the grass is covered with dry leaves. As I sketch the lines of the fence and the vines that coil it, I angle downward and draw the curve of her tombstone. I become lost in the movements, adding wings to the side of it, because she was always so fascinated with flying. A few weeks before her death, my mother begged me to go on a walk with her. I gave in even though I had plans that day. It was sunny and the air smelled like cut grass. It felt like nothing could go wrong. She wanted to go to the bridge so we walked all the way across town to the lake. When we arrived there, she climbed on the railing and spread her hands out to balance as her long auburn hair flapped in the wind. â€Å"Mom, what are you doing?† I said, reaching for the back of her shirt to pull her down. You read "The Secret of Ella and Micha Chapter 10" in category "Essay examples" She sidestepped down the railing out of my reach and stared at the water below. â€Å"Ella May, I think I can fly.† â€Å"Mom, stop it and get down,† I said, not taking her very seriously at first. But when she turned her head and looked at me, I could see in her eyes that she wasn’t joking. She really believed she could fly. I tried to stay as composed as possible. â€Å"Mom, please get down. You’re scaring me.† She shook her head and her legs wobbled a little. â€Å"It’s okay honey. I’ll be fine. I can feel it in my body that I can fly.† I took a cautious step toward her and my foot bumped the curb of the bridge. The cement rubbed my toe raw and I could feel blood oozing out, but I didn’t look down at it. I was too afraid to take my eyes off her. â€Å"Mom, you can’t fly. People can’t fly.† â€Å"Then maybe I’m a bird,† she said seriously. â€Å"Maybe I have wings and feathers and they can carry me away and I can become one with the wind.† â€Å"You’re not a bird!† I shouted and reached for her again, but she hopped onto one of the beams and laughed like it was a game. I tugged my fingers through my hair and steadied onto the railing. It was a far fall, one that would crush our bodies on impact, even in the water. I braced my hands on the beams above my head. â€Å"Mom, if you love me at all, you’ll get down.† She shook her head. â€Å"No, I’m going to fly today.† A truck rolled up and stopped on the middle of the bridge as I edged toward her. Ethan jumped out and didn’t so much as flinch at the scenario. â€Å"Hey, Mrs. Daniels. How’s it going?† I gaped at him and hissed, â€Å"What are you doing?† He ignored me. â€Å"You know it’s not really safe out there.† My mom angled her head to the side. â€Å"I think I’ll be okay. My wings will carry me away.† I was mortified, but Ethan didn’t miss a beat. He rested his arms on the railing. â€Å"As much as that could be true, what if it’s not? Then what? I mean is it really worth the risk?† I glanced back at my mom and she looked like she was weighing the options. She stared at the dark water below her feet and then at the bright sky above her head. â€Å"Maybe I should think about it for a little bit.† Ethan nodded. â€Å"I think that’s probably a good idea.† She made a path across the beam and planted her feet on the railing. Ethan helped her down and we got her into the backseat of his truck. She fell asleep within minutes and I slumped my head back against the chair. â€Å"How did you do that?† I asked quietly. â€Å"One of my friends was tripping out of their mind one night and I had to talk him out of jumping off the roof,† he explained. â€Å"It was all about making her realize that there was more than one scenario.† I nodded and we stayed quiet for the rest of the drive to my house. Ethan never brought it up to me, nor did he treat me differently and I was grateful for it. After a doctor’s visit, it was determined that my mother had started to suffer from ‘Delusions of Grandeur,’ which happens sometimes in bipolar patients. I finally pull away from the drawing when it’s nearly dark. I gather my sketchpad and pencils and head down the hill. In front of the arch iron entryway is Micha, sitting on the hood of his mom’s car, wearing jeans, and a black and red plaid shirt. His head is tipped down and wisps of his blonde hair cover his forehead as he messes around with his phone. I stop a little ways off from him. â€Å"What are you doing here?† His eyes lift from his phone. â€Å"I’m waiting for you.† â€Å"How did you know I was here?† â€Å"I saw you leave with your sketchpad and head this way, so I came up to check on you.† I take a tentative step forward. â€Å"How long have you been sitting here?† He slides off the hood and puts his phone away. â€Å"For a while, but I didn’t want to disturb you. You looked too peaceful.† I press my lips together and stare at him, craving to sketch him like I used to. He would sit on my bed and it was like he owned my hand. â€Å"Look, about the other night, I think – â€Å" He strides across the grass toward me, moving so impulsively that there’s no time to react as his finger covers my lips. â€Å"Just let it be for a while, okay?† Uncertain of his exact meaning, I nod anyway. He lets his finger fall from my lips, trailing a line down my chest, finally pulling away at the bottom of my stomach. â€Å"You want a ride home?† His voice comes out ragged. I glance at the grey sky and the birds flying across it. â€Å"That would be nice. Thank you.† Micha She’s preoccupied during the drive and so am I. I was so pissed off about my father that I got into the car about to do something reckless, however, then I saw Ella wandering down the street, and I followed her. The way she walked was very entertaining, her auburn hair blowing in the wind, and the way she swayed her ass in the short denim shorts she was wearing. It calmed me down watching her sit up on the hill and draw, but I can’t stop thinking about the phone conversation. â€Å"We should go somewhere,† I announce when we drive onto the main road. Ella jolts in her seat and turns away from the window. â€Å"I should probably go home.† â€Å"Come on.† I pout, hoping it’ll win her over. â€Å"Just come with me somewhere and we can relax.† She’s tempted. â€Å"Where exactly?† I turn the volume of the stereo down and let my arm rest on the top of the steering wheel. â€Å"To our spot by the lake.† â€Å"But it takes forever to get there.† Her eyes rise to the dark sky. â€Å"And it’s getting late.† â€Å"Since when have you been afraid of the dark?† â€Å"It’s not the dark I’m afraid of.† I sigh and downshift. â€Å"Come on, just you and me. We don’t even have to talk. We can just sit in silence.† â€Å"Fine,† she surrenders, tossing her sketchpad into the backseat. â€Å"Just as long as you don’t ask me questions.† I hold up my hand innocently. â€Å"Scouts honor. I’ll keep my questions to myself.† Her eyes narrow. â€Å"I know you’ve never been in the scouts before.† I laugh, feeling the pressure lift from my chest. â€Å"It doesn’t matter. I’ll keep my questions to myself, but with everything else, all bets are off.† She pretends to have an itch on her nose, but really it’s to obscure her smile and it makes me smile myself. *** Its pitch black by the time we reach our spot on the shore that’s secluded by tall trees. The moon reflects against the water and the night air is a little chilly. I get my jacket out of the trunk and offer it to Ella, knowing she’s cold because of the goosebumps on her arms and the way her nipples are poking through her shirt. She slips the jacket on and zips it up, covering up her perky nipples. I sigh, hop onto the hood, and open my arms for her to join me. Hesitantly, she climbs onto the hood, but stays at the front, with her feet propped up on the bumper, gazing out at the water. I scoot down by her and keep my knees up, resting my elbows on them. â€Å"What are you thinking about?† Her eyes are huge in the moonlight. â€Å"Death.† â€Å"What about death?† I wonder if we’re finally going to go back to that night. â€Å"That Grady’s going to die,† she whispers softly. â€Å"And there’s nothing I can do about it.† I brush her hair back from her forehead. â€Å"You need to stop worrying about everything that can’t be controlled.† She sighs and leans away from my hand. â€Å"That’s just it, though. It’s all I can think about anymore. It’s like this fixation I have no control over which makes no sense because I’m fixated on controlling the uncontrollable.† She’s breathing wildly. Shit. I need to calm her down. â€Å"Hey, come here.† I loop my arms around her waist and lie her down on the windshield with me. She rests her head on my chest and I play with her hair, breathing in her vanilla scent. â€Å"Do you remember when you decided that it would be a good idea if you climbed up the scaffolding in the gym?† â€Å"I wanted to prove to Gary Bennitt that I was as tough as the boys.† She buries her face into my shirt, ashamed. â€Å"Why do you remember everything?† â€Å"How could I forget that? You scared the hell out of me when you fell. Yet, somehow you managed to land on the board just below it.† â€Å"I thought I was going to die,† she murmurs. â€Å"I was so stupid.† â€Å"You weren’t stupid, you just saw life at a different angle,† I say. â€Å"I’ve always envied you for it. Like when you used to dance in a room where no one was dancing or how you stuck up for people. But there was always that wall you put up. You would never let anyone completely through.† She’s soundless for a while and I expect for her to push me away. But she sits up and hovers over me, her hair veiling our faces. Her breath is ragged, like she’s terrified out of her mind. â€Å"I opened up to you once,† she whispers. â€Å"When we were here in this spot doing this same thing.† I can’t take my eyes off her lips. â€Å"I’m not sure what you’re talking about.† She licks her lips. â€Å"I told you I didn’t want you dating Cassandra.† â€Å"Cassandra†¦ Oh, was that what that was about?† I start to laugh. â€Å"What’s so funny?† she asks, but I can’t stop laughing. She pinches my nipple and I jerk upward, smacking my forehead against hers. â€Å"Ow.† She blinks, rubbing her forehead and a laugh escapes her lips. â€Å"Tell me what’s so funny.† She looks beautiful, trying to be pissed, when deep down she’s relishing the moment. I’m enjoying myself, which I didn’t envisage tonight, but if anyone can cheer me up, it’s her. Like when my dad left and she caught me in the garage, clutching onto his tool box crying like a baby. She gave me her Popsicle and then just sat there with me until I ran out of tears. I eye her over and she fusses with her hair self-consciously. With one quick movement, I flip us over so my body is covering hers. â€Å"When I told Ethan about that day when you told me not to see Cassandra, he told me you had a thing for me. He’s usually not right about those things.† â€Å"I didn’t have a thing for you,† she argues. â€Å"I just didn’t want anyone else to have a thing for you.† â€Å"You’re adorable when you deny the truth. You always have been.† â€Å"Micha, I used to have studs on every item of clothing I owned and enough black eyeliner to make an entire sketch. That’s not adorable.† â€Å"It is on you.† I wink at her. She shakes her head and pokes a finger at my chest. â€Å"Don’t try and use your player moves on me.† We remain silent, frozen in the moment, until I finally speak again. â€Å"I have an idea.† Curiosity slowly takes over her face as I shift over her body. My arms are at the side of her head, barely holding my weight up. My face hovers above hers, our lips only an inch apart, and she lies perfectly still. â€Å"I want to kiss you.† She shakes her head promptly. â€Å"I don’t think that’s a good idea.† I trace one of my fingers over her lips. I’ve been going about this all wrong. I can’t force myself on her. I have to move slow and think of her as a skittish cat that needs to be approached cautiously. â€Å"Just kiss. I swear to God that’s all we’ll do.† I move my finger away from her lips. â€Å"And kissing’s not that scary, right?† â€Å"With you it is,† she says truthfully. â€Å"If you want me not to, just say it.† Taking my time, I leisurely lower my lips toward hers. She stays stationary, her big green eyes targeted on my mouth. Slowly, so she has time to let her thoughts slow down, I caress my lips across hers. A small gasp flees from her lips and I slip my tongue into her mouth. Her hands glide up my back and into my hair. My body conforms to hers as I explore her mouth with my tongue. She bites down on my bottom lip, sucking my lip ring into her mouth before releasing it. Fuck. She’s making this hard. I intensify the kiss as my body becomes more impatient, but I keep my promise and only kiss her, even when she fastens her legs around my waist and rubs up against me. Ella He said just kiss and it seemed okay, but now my body has developed a mind of its own. I’m writhing my hips against him enjoying the pleasure erupting inside me. He’s hard between my legs as he kisses me so fiercely that my lips are swollen. His fingers tangle in my hair and his tongue plunges deeper and deeper into my mouth the more I rock against him. My head falls back and my eyes open to the stars shining in the sky. It feels like I’m falling or flying†¦ I’m not sure, but whatever it is I can’t seem to control it. For a second, I want to capture the moment, put it in a jar, and always have it with me, but panic seizes my mind and I jerk away from his lips. His eyes snap open and his pupils are vast. â€Å"What’s wrong?† â€Å"Nothing†¦ It’s just†¦ I have to calm down.† I take a deep breath, my skin still tingling in the spots his hands touched. Micha nods, breathless. Carefully, he moves off of me and leans back against the window, securing his hand around mine. We don’t speak as we stare up at the sky. He traces his finger along the folds between my fingers and my eyelids drift shut. I feel a wall crumble, leaving behind dust, debris, and pieces that desperately need to be put back together. *** â€Å"Are you okay?† I ask Micha when we pull into my driveway. He’s been quiet the whole drive home and I can tell something’s bothering him. â€Å"Yeah, I’m fine,† he says with a shrug and then his gaze darts to the back window as headlights shine up behind us. â€Å"Although, you might not be.† My eyebrows furrow. â€Å"Why? What’s wrong?† He points a finger at a car parking at the curb in front of my house; a shiny black Mercedes with a familiar blonde-haired driver sitting in it. â€Å"Oh my God, is that Lila’s car?† I ask. â€Å"I’m guessing yes, since I doubt anyone around here owns a Mercedes.† Lila climbs out of the car and it’s clear that she’s been crying. Her eyes are swollen and her cheeks are red. She has her pajama bottoms on and a hoodie pulled over her head. The last time she walked around in an outfit like that she’d just broken up with her boyfriend. â€Å"I think she might have some issues at home,† I tell him, grabbing the door handle. â€Å"She acted like she didn’t want to go home.† â€Å"But you didn’t ask her about it?† he questions with an arch of his eyebrow. I bite my lip guiltily. â€Å"I wasn’t sure I wanted to know the answer.† God, I’m a terrible friend. Lila heads up the driveway and we get out to meet her around the back. Before I can say anything, she hugs me and starts to sob. I tense, not used to being hugged, except by Micha. â€Å"I didn’t want to go back there,† she cries. â€Å"I knew this was going to happen.† I look over Lila’s head at Micha for help. â€Å"It’ll be okay.† He gives me a sympathetic look and mouths, take her inside. I nod and he waves at me, getting back into his car. I guide Lila into the house holding her weight up for her like she’s ill. When I get her into my room, she curls up on my bed and hugs a pillow. I wait a minute before I speak. â€Å"Do you want to talk about it?† She shakes her head. â€Å"I just want to go to sleep.† â€Å"Alright.† I turn off the light and collapse onto the trundle. I need to get into my pajamas, but it’s been an exhausting day. â€Å"My dad hates me,† Lila whispers through sobs. I freeze and then sit up, squinting at her through the dark. â€Å"I’m sure he doesn’t hate you.† â€Å"Yes, he does,† she says. â€Å"He always says so – that he wished he had sons instead of daughters because they’re easier to deal with.† â€Å"Are you going to be okay?† I ask, unsure what else to say. â€Å"I will be. It’ll just take some time.† Was that the magical cure? Time. I flop back down and fall asleep to the murmur of her sobs. How to cite The Secret of Ella and Micha Chapter 10, Essay examples

Can You Recover Memories of Childhood Abuse Essay Example For Students

Can You Recover Memories of Childhood Abuse Essay The idea of whether a memory can be forgotten and then remembered, and the thought of suggesting a memory and then have it remembered are at the heart of the childhood abuse issue. Most clinical psychologists believe recovered memory is rare, although laboratory studies have shown that the memory is usually not accurate and can be influenced by outside factors. This issue has not been directly studied since researchers have not subjected people to traumatic events to test their memory of them. Therefore, it has not been determined if a traumatic event is encoded and stored differently in memory compared to a non-traumatic event. (American Psychological Association, 1995). Traumas affect the short and long term memory of children differently from adults. Some believe childhood trauma may lead to problems in memory storage and retrieval. Severe forms of child sexual abuse are conducive to disturbances of memory such as disassociation or delayed memory. Researchers have argued that there is no support that disassociation shelters people from the pain of memory. There is a consensus among researchers and clinicians that most people that were sexually abused as children remember most of the encounter. (American Psychological Association, 1995). The issue that relates to Recovered memory versus a pseudomemory continues to have conflicting views. Most leaders agree that it is a rare occurrence that early childhood abuse that has been forgotten can be remembered later. The leaders also agree that it is possible to construct psuedomemories for events that never happened. A growing body of research evidence suggests that psuedomemories of child abuse even though it never happened are both persistent and convincing. (Brainerd Reyna, 1998). The issues that relate to the validity of memories of childhood abuse has raised many critical issues for the psychological community. Several issues have not been solved which points to the ideas that many areas of research must still be pursued. Some of them are as follows: †¢ Need a better understanding of how we store recollections of events in memory both accurate and inaccurate. (American Psychological Association, 1995). †¢ Determine which clinical techniques are more likely to lead to the creation of false memories versus those that create conditions where actual events of childhood abuse can be remembered accurately.