bluuebunny/crossref_metadata_2025 huggingface dataset:
Subnational Income, Growth, and the COVID-19 Pandemic
Authors: Choudhary M Ali , Dal Barco Ilaria , Haqqani Ijlal A , Lenzi Federico , Limodio Nicola
Published: June 2024

Using real-time data and machine-learning methods, we produce monthly aggregates on gross national income (GNI) for 147 Pakistani districts between 2012 and 2021. We use them to understand whether and how the COVID-19 pandemic affected the growth and subnational distribution of income in Pakistan. Three findings emerge from our analysis. First, districts experienced a sizable decline in income during the pandemic, as their monthly growth rate dropped on average by 0.133 percentage points. Second, a larger income drop took place in districts with a higher COVID-19 incidence, which correspond to urban areas characterized by a higher population density. Third, COVID-19 caused a decline in income inequality across districts, with richer districts experiencing more negative income growth during the pandemic.
Primary Cutaneous Peripheral T-Cell Lymphoma NOS: Diagnostic Criteria and Challenges
Authors: Robson Alistair , Bakr Farrah , Cabeçadas Jose
Published: June 2024

Primary cutaneous peripheral T-cell lymphoma not otherwise specified (PTCL NOS) denotes lymphomas that do not conform to a recognized entity. Within this category, 3 specific lymphoproliferative diseases had been granted provisional status pending further confirmation of their validity as distinct entities; acral CD8+ lymphoma—recently accepted as acral CD8+ lymphoproliferative disorder—aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma, and CD4+ small-medium T-cell lymphoproliferative disorder. The adoption of stringent diagnostic criteria, which include clinical, morphological, and immunohistochemical data, and some inherent variations of these within individual cases, raises problems as to the boundaries between these tumors and a diagnosis of PTCL NOS. This review discusses the evolution of our knowledge of these tumors and their diagnostic criteria with respect to the wider PTCL NOS category.
Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes
Authors: Rydberg Mattias , Perez Raquel , Merlo Juan , Dahlin Lars B.
Published: June 2024

Background:

Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF. CTS and TF could be early signs of preclinical T2D, and early detection of T2D is crucial to prevent complications and morbidity. Therefore, we investigate the association between CTS/TF and T2D in an adult population without previous T2D using big data registers in Sweden.

Methods:

Data were collected by crosslinking five nationwide Swedish registers. Individuals aged 40–85 years on December 31, 2010, without prior overt diabetes, were included (n = 3,948,517) and followed up from baseline (ie, a diagnosis of CTS or TF) or January 1, 2011, for controls, until a diagnosis of T2D, prescription of oral antidiabetics or insulin, or end of follow-up four years after baseline. Multivariate Cox regression models were created to calculate hazard ratios for T2D.

Results:

In total, 37,346 (0.95%) patients were diagnosed with CTS, whereof 1329 (3.46%) developed T2D. There were 17,432 (0.44%) patients who developed TF, whereof 639 (3.67%) developed T2D. Among the controls, 2.73% developed T2D. Compared with controls, there was an increased risk of developing T2D after being diagnosed with either CTS (HR 1.35; 95% confidence interval 1.28–1.43) or TF (HR 1.21; 95% confidence interval 1.12–1.31).

Conclusion:

Compared with controls, a diagnosis of CTS or TF was associated with 35% and 21% higher risk for later T2D, respectively, which might indicate the existence of undetected T2D in this population.
Evaluation of Empirical Antibiotic Therapy in Women With Acute Cystitis Visiting Outpatient Clinic in South Korea
Authors: Jeon Song Hyeon , Kim Taeyeon , Jeon Nam Kyung
Published: June 2024

Background

The overuse and misuse of antibiotics are a major public health concern, contributing to the rise of antibiotic-resistant bacteria. This study aimed to determine the prevalence of inappropriate antibiotic prescription for acute uncomplicated cystitis (AUC) in primary care clinics in Korea and identify contributing factors.

Methods

Data from 20- to 64-year-old female AUC patients in the Health Insurance Review and Assessment Service–National Patient Sample were analyzed. Four categories of inappropriate antibiotic use were evaluated: inappropriate selection, duration, use of parenteral antibiotics, and multiple oral antibiotics. Multiple logistic regression was used to determine the impact of factors on inappropriate prescriptions.

Results

Of the 3125 patients, 2285 (73.1%) received inappropriate antibiotics. The most common categories were the use of parenteral antibiotics. Health care facility–dependent factors were the primary contributors to inappropriate prescription. Urology-specialized clinics had more than double the rate of inappropriate prescription compared with other clinics.

Conclusion

More than 70% of AUC patients received inappropriate antibiotics in Korean outpatient clinics. The data highlight the urgent need for antimicrobial stewardship in the outpatient setting, with AUC as a “high-priority condition.”
A randomized, placebo-controlled trial of long-acting dexamethasone viscous gel delivered by transforaminal injection for lumbosacral radicular pain
Authors: Miller Alan , Candido Kenneth D. , Knezevic Nebojsa Nick , Rivera José , Lunseth Paul , Levinson Dennis J. , Formoso Ferdinand , Solanki Daneshvari , Tavel Edward , Krull Angela , Radnovich Richard , Burkhead Daniel , Souza Dmitri , Helm Standiford , Katz Nathaniel , Dworkin Robert H. , Cohen Steven P. , Rathmell James P. , Buvanendran Asokumar , Levin Joshua , Stannard Elizabeth , Ambrose Chris , Jaros Mark , Vought Kip , Lissin Dmitri
Published: June 2024

Epidural steroid injections are used to treat lumbosacral radicular pain. However, there are no Food and Drug Administration–approved corticosteroids for lumbosacral radicular pain and all currently available injectable corticosteroids carry safety warnings about their use in epidural steroid injection procedures. SP-102 (dexamethasone injectable viscous gel) was developed to provide a safer option with extended local effect. In a randomized, double-blind, placebo-controlled, multicenter trial, 401 patients with moderate-to-severe leg pain from unilateral intervertebral lumbar disc herniation were randomized (1:1) to receive transforaminal SP-102 or sham intramuscular (IM) placebo injection and followed for 24 weeks. If clinically warranted, a repeat open-label SP-102 injection was allowed between 4 and 20 weeks for both groups. Primary and key secondary end points were change in average daily pain on the Numeric Pain Rating Scale in the affected leg and disability measured by Oswestry Disability Index over 4 weeks. Other secondary end points included time to repeat injection, pain, and quality of life assessments. Over 4 weeks, SP-102 demonstrated statistically significant pain relief compared with placebo (least-squares mean group difference −0.52 [SE 0.163] [P = 0.002]) in the intent-to-treat population. Oswestry Disability Index mean improvement was −3.38 (1.388) (least-squares mean group difference [SE]) for SP-102 vs placebo (P = 0.015). Median time to repeat injection was 84 days for SP-102 vs 58 days for placebo (P = 0.001). Most other secondary end points were statistically significant for SP-102 compared with placebo. There were no serious adverse events related to study medication or procedure, no adverse events leading to death, and no AEs of special interest (paraplegia, hematoma, or infection).

Trial Registration

ClinicalTrials.gov Identifier: NCT03372161.
Prediction of the response to repetitive transcranial magnetic stimulation of the motor cortex in peripheral neuropathic pain and validation of a new algorithm
Authors: Attal Nadine , Branders Samuel , Pereira Alvaro , Bouhassira Didier
Published: June 2024

Motor cortex repetitive transcranial magnetic stimulation (M1-rTMS) induces analgesic effects in neuropathic pain, but not all patients are good responders, and no clinical predictors of the response have been identified. The present study aimed to develop and validate a simple and easy-to-use predictive algorithm for the individual response to M1-rTMS in peripheral neuropathic pain that may be potentially applicable to any chronic pain condition. This was based on a secondary analysis from a recent double-blind, placebo-controlled trial demonstrating the efficacy of high-frequency M1-rTMS against placebo-rTMS and rTMS of the dorsolateral prefrontal cortex in 149 patients with peripheral neuropathic pain. Baseline variables were entered in the model without preconception, and categorized into sociodemographic, pain, and psychological variables. Good responders to rTMS were defined based on 50% pain relief on average pain intensity (rated on a 0-10 numerical rating scale) at 25 weeks. Ridge regression, feature selection, and Monte Carlo cross-validation were used to build and validate a predictive model specific for the response to M1-rTMS at 25 weeks. The algorithm included 3 variables: 2 were psychological variables (depressive symptoms, magnification dimension of the Pain Catastrophizing Scale) and 1 was related to pain distribution (distal lower extremity pain). It demonstrated 85% sensitivity (P = 0.005) and 84% specificity (P < 0.0001) to predict a good response to M1-rTMS at 25 weeks. It was not predictive of the response to placebo or dorsolateral prefrontal cortex-rTMS. This simple and user-friendly algorithm may contribute to individualize treatment with M1-rTMS in patients with peripheral neuropathic pain in routine and in further clinical trials.

Clinical trial registration:

NCT02010281.
The microbial composition of pancreatic ductal adenocarcinoma: a systematic review of 16S rRNA gene sequencing
Authors: Merali Nabeel , Chouari Tarak , Sweeney Casie , Halle-Smith James , Jessel Maria-Danae , Wang Bing , O’ Brien James , Suyama Satoshi , Jiménez José I. , Roberts Keith J. , Velliou Eirini , Sivakumar Shivan , Rockall Timothy A. , Demirkan Ayse , Pedicord Virginia , Deng Dongmei , Giovannetti Elisa , Annels Nicola E. , Frampton Adam E.
Published: June 2024

Background:

Pancreatic cancer, specifically pancreatic ductal adenocarcinoma (PDAC), continues to pose a significant clinical and scientific challenge. The most significant finding of recent years is that PDAC tumours harbour their specific microbiome, which differs amongst tumour entities and is distinct from healthy tissue. This review aims to evaluate and summarise all PDAC studies that have used the next-generation technique, 16S rRNA gene amplicon sequencing within each bodily compartment. As well as establishing a causal relationship between PDAC and the microbiome.

Materials and methods:

This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive search strategy was designed, and 1727 studies were analysed.

Results:

In total, 38 studies were selected for qualitative analysis and summarised significant PDAC bacterial signatures. Despite the growing amount of data provided, we are not able to state a universal 16S rRNA gene microbial signature that can be used for PDAC screening. This is most certainly due to the heterogeneity of the presentation of results, lack of available datasets, and the intrinsic selection bias between studies.

Conclusion:

Several key studies have begun to shed light on causality and the influence the microbiome constituents and their produced metabolites could play in tumorigenesis and influencing outcomes. The challenge in this field is to shape the available microbial data into targetable signatures. Making sequenced data readily available is critical, coupled with the coordinated standardisation of data and the need for consensus guidelines in studies investigating the microbiome in PDAC.
Gender disparities in high-quality dermatology research over the past 15 years
Authors: Zlakishvili Barak , Horev Amir
Published: June 2024

Background:

In the last 15 years, an increase in U.S. female dermatologists from 41 to 52.2% and a surge in female authorship (FAP) have been noted. Authorship is a pivotal objective measurement of academic productivity and, contribution as first or senior author, plays a major role in the promotion process of active physicians and faculty members.

Objective:

To validate, analyze, and clarify trends in FAP in high-quality dermatology research in the last 15 years.

Methods:

The Thomson Reuters Web of Science Journal Citation Reports 2021 was used to retrieve the 100 most-cited original articles from the top 5 dermatology journals (determined by 2021 impact factors) in 5 consecutive 3-year intervals between 2009 and 2023. Gender application programming interface, a gender algorithm, was used to identify FAP according to country of origin and first name. Monotonic trend test significance level was set at 5%.

Results:

In total, 14,187 articles were retrieved and subdivided into the 100 most-cited in 3-year intervals. A total of 418 first and 447 senior authors' gender were identified. FAP was found in 43%, 31%, and 37% of the first, last, and total authors. Trend analysis revealed a decrease in the last 15 years (S = −4610, P = .068) in senior FAP. Similarly, the trend persists in the United States (S = −1606, P = .052).

Limitations:

Due to the usage of a binary gender identification algorithm, Nonbinary gender could not be identified in this analysis.

Conclusion:

The last 15 years show an inverse relationship, with an increase in female dermatologists and a decrease in senior FAP in high-quality journals in the general dermatology community.
Outcomes After Heartmate 3 Left Ventricular Assist Device Implantation Using a 10 mm Outflow Graft
Authors: Worku Berhane , Vinogradsky Alice , Ibrahim Aminat , Rossi Camilla Sofia , Mack Charles , Gambardella Ivancarmine , Srivastava Ankur , Takeda Koji , Naka Yoshifumi
Published: June 2024

The presence of adhesions and patent bypass grafts may create challenges for standard 14 mm outflow graft placement during left ventricular assist device implantation. We retrospectively describe our experience using a 10 mm Bioline Fusion graft (Getinge, Goteborg, Sweden) as the outflow graft in patients undergoing primary Heartmate 3 (Abbott, Abbott Park, IL) implantation. One hundred one patients underwent Heartmate 3 left ventricular assist device implantation, 80% via a thoracotomy approach, with the standard 14 mm outflow graft (78) or a 10 mm Bioline Fusion outflow graft (23). Initial postoperative rotor speed-to-flow ratio (the revolutions per minutes (RPMs) required to achieve a given flow) was significantly higher in 10 mm graft patients (1,472 vs. 1,283 RPM/L/min; p = 0.03), suggesting elevated resistance in the smaller graft. Furthermore, the initial postoperative vasoactive-inotrope score was higher in the 10 mm graft patients (24.1 vs. 17.6; p = 0.022). Postoperative outcomes were similar between groups. In conclusion, the use of a 10 mm graft was associated with higher RPMs needed to generate a given flow and a higher vasoactive-inotrope score, but these differences were not associated with increased right ventricular failure or mortality.
Meta-analysis of combined azithromycin and inhaled budesonide treatment for Chinese pediatric patients with mycoplasma pneumonia
Authors: Zhao Jing , Pan Xiaojing , Shao Peng
Published: June 2024

Background:

Budesonide, capable of reducing vascular permeability, suppressing mucus secretion, and alleviating edema and spasms, is widely used in China for combined infectious disease treatment. This study assesses budesonide’s efficacy and safety as an adjunct to azithromycin in pediatric Mycoplasma pneumonia management in China, aiming to establish a strong theoretical foundation for its clinical application.

Methods:

We conducted a comprehensive search for qualifying studies across 5 English databases and 4 Chinese databases, covering publications until October 31, 2023. Endpoint analyses were performed using standard software (Stata Corporation, College Station, TX). This study was conducted in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results:

A total of 24 randomized controlled trials were involved in the current study, including 2034 patients. Our findings indicate that the combination of budesonide with azithromycin for the treatment of pediatric Mycoplasma pneumonia delivers superior therapeutic efficacy (Intravenous: odds ratio [OR], 0.156, P < .001; Sequential: OR, 0.163, P = .001; Oral: OR, 0.139, P < .001), improved pulmonary function (Forced expiratory volume in 1 second: weighted mean differences [WMD], −0.28, P = .001; Peak expiratory flow: WMD, −0.554, P = .002; Forced vital capacity: WMD, −0.321, P < .001), diminished lung inflammation (IL-6: WMD, 4.760, P = .002; c-reactive protein: WMD, 5.520, P < .001; TNF-α: WMD, 9.124, P < .001), reduced duration of fever, faster resolution of cough and rales, all without increasing the occurrence of adverse events.

Conclusion:

The combination of budesonide and azithromycin demonstrates enhanced therapeutic effectiveness, promotes improved pulmonary function, shortens the duration of symptoms, and effectively mitigates the overexpression of inflammatory factors like c-reactive protein, TNF-α, and IL-6, all without an associated increase in adverse reactions in pediatric mycoplasma pneumonia.
Progress and research trends in neurogenic bladder after spinal cord injury bibliometric analysis based on web of science database: An observational study
Authors: Bing Jingyu , You Haihua , Dai Yaowen , Ding Yunxia
Published: June 2024

Neurogenic bladder (NB) is a significant complication that often occurs after spinal cord injury. It results from urinary dysfunction caused by the injury, disrupting the normal neural control of the bladder and urethra. Symptoms of NB can include urinary frequency, urgency, incontinence, and retention, all of which can greatly impact the quality of life of affected individuals. While there are articles and reviews on NB, fewer specifically address NB following spinal cord injury. This study examined 1095 publications from January 1, 2000, to March 27, 2024, in the Web of Science core database using bibliometric software like VOSviewer, CiteSpace, and Bibliometrics. The analysis revealed an increasing trend in the number of publications, with the United States and China leading in research output. Professor Jeremy B. Myers from the University of Utah had the highest number of publications, while the University of Michigan and the University of Pittsburgh were the institutions with the most publications. The journal Neurourology and Urodynamics had the highest number of articles, and common keywords included management, quality of life, and dysfunction, highlighting key areas of focus for scholars.
Centering marginalized voices in advocacy for equitable policy change in kidney disease
Authors: Rizzolo Katherine , Rockey Nathan , Cervantes Lilia
Published: June 2024

Purpose of review

Inequities in kidney disease are a result of differences in healthcare access and inequitable structural policies that lead to downstream social challenges. An individual with kidney disease sits at the intersection of a variety of governmental and institutional policies that directly affect their access to kidney healthcare and different care delivery models. However, their voice in policy change is often neglected by stakeholders with more structural power. Marginalized individuals with kidney disease are disproportionately affected by kidney disease and inequitable policies can further these health disparities. The review aims to describe how marginalized individuals can be centered in research and lead in advocacy efforts to promote equitable policy change.

Recent findings

The marginalized patient voice is critical in advocacy to promote equitable policy change. We discuss examples illustrating research and advocacy methods which center and partner with marginalized communities to catalyze effective policy interventions.

Centralizing the patient voice when engaging in advocacy can identify and contextualize the effects of inequitable public policy and improve advocacy efforts.
Safety, Feasibility, and Advantages of Oral Microbiota Transplantation: The First Clinical Case
Authors: Goloshchapov Oleg V. , Chukhlovin Alexey B. , Bug Dmitrii S. , Polev Dmitriy E. , Kosarev Oleg V. , Klementeva Ruslana V. , Izmailova Ekaterina A. , Kazantsev Ilya V. , Khalipskaia Margarita S. , Goloshchapova Мaria О. , Yudintseva Olesya S. , Barkhatov Ildar M. , Petukhova Natalia V. , Zubarovskaya Ludmila S. , Kulagin Alexander D. , Moiseev Ivan S.
Published: June 2024

The pilot clinical study presented demonstrates the possibility, safety, and effectiveness of oral microbiota transplantation from a healthy donor to a patient with neuroblastoma to prevent chemotherapy-induced oral mucositis. A 6-month-old patient with a diagnosis of retroperitoneal neuroblastoma was treated according to the NB 2004 protocol. Due to the development of severe oral mucositis, it was decided to perform oral microbiota transplantation. During the next 3 chemotherapy cycles and conditioning regimen before autologous hematopoietic cell transplantation (auto-HCT), the patient was repeatedly injected per os with donor saliva from her healthy mother. Oral microbiota transplantation was shown to effectively prevent the development of oral mucositis after chemotherapy, and only grade 1 oral mucositis developed after auto-HCT. In all loci of the oral cavity, there was a decreased abundance of bacteria from the Staphylococcaceae, Micrococcaceae, and Xanthomonadaceae families. Conversely, there was an increase in the relative abundance of Streptococcaceae and certain other bacterial taxa. In conclusion, the transplantation of maternal saliva in this patient prevented severe mucositis and was accompanied by a compositional change of the patient’s oral microbiota. No adverse events due to the transplantation of maternal saliva were noted.
Optimizing Quality Improvement Methods in Practice
Authors: Reynolds Staci S. , Waldrop Julee B.
Published: June 2024

Background:

Quality improvement (QI) initiatives help ensure patients are receiving high-quality care. Iterative Plan-Do-Study-Act (PDSA) cycles are used to test change. Data are evaluated over time, and tests of change can be modified or discarded as needed.

Problem:

Health care QI teams lack the flexibility to conduct PDSA cycles, often conducting pre/post quasi-experimental research studies instead.

Approach:

This article reviews a case study of a “personal improvement” initiative as an example of QI methods and data evaluation for an individual trying to lose weight. The purpose of this article is to provide guidance on best practices for conducting QI initiatives; common pitfalls that clinicians may face when leading their own QI initiatives are identified and recommendations to overcome these challenges are discussed.

Conclusions:

Concepts from this case study, along with supplemental resources provided, can help clinicians optimize QI methodologies in the health care setting.
Evaluation of a Cardiovascular Disease/Diabetes Mellitus Expansion Program for Community Health Workers Employed by Rhode Island Community Health Teams
Authors: McAtee Cali M. , Baker Justan T. , DeWolf Breanne M. , Sheridan Megan N. , George Elise M. , Sutton Nancy A.
Published: June 2024

Context:

The integration of certified community health workers (CCHWs) with specialty chronic disease training into clinical care teams has demonstrated improvements in chronic disease quality of care, management, and outcomes.

Program:

Rhode Island Department of Health’s Diabetes, Heart Disease, and Stroke Program expanded the roles of CCHWs employed by Community Health Teams for chronic disease with a focus on cardiovascular disease (CVD) and diabetes mellitus (DM) from 2020 to 2023. Rhode Island Department of Health’s Diabetes, Heart Disease, and Stroke Program sought to determine whether patient health behaviors and clinical outcomes improved with specialty trained CCHW support.

Implementation:

Community Health Teams identified high-risk or rising-risk patients with hypertension, high cholesterol, and/or diabetes. During an infrastructure phase, patients were assigned a CCHW who had not received CVD/DM specialty training. During a performance phase, a separate cohort of patients was assigned a CVD/DM specialty-trained CCHW. In each phase, patients were seen by the CCHWs at least twice and completed baseline and follow-up health assessments. The trained CCHWs utilized the baseline assessment to offer health coaching specific to the patient’s chronic disease–related needs.

Evaluation:

Improvements in blood pressure readings and cholesterol were observed at an individual level for CVD patients. However, a significant difference was not observed for hypertension or high cholesterol when comparing phases. Individual-level results indicated improved HbA1c values for DM patients; however, the differences in clinical values were not significant. Although there were no significant differences for clinical values between the phases, the proportion of patients who reported confidence in managing their condition(s) increased from baseline to follow-up for both phases.

Discussion:

It cannot be concluded that specialty-trained CCHWs have significant impact on patient behaviors and clinical outcomes. However, overall CCHW intervention did result in improved self-efficacy in patients to manage their chronic conditions. Further evaluation is needed to understand what factors led to improved patient confidence levels.
Virtual Expansion of the YMCA's Blood Pressure Self-Monitoring (BPSM) Program: Using Telehealth to Adapt an Evidence-Based Program to Reach Rural Communities in South Carolina
Authors: Grant Brittney , Myers Kristian , Patterson Halie , Suthar Ishan , Garst Kaylin , James Michele , Tucker Chet
Published: June 2024

Context:

Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large.

Program:

The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions.

Implementation:

The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program.

Evaluation:

A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure.

Discussion:

Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.
Strengthening Linkages Between Health Care and Public Health: A Novel Framework for Public Health Action in Health Care Settings to Improve Cardiovascular Disease Risk
Authors: Fryda Candice , Gebhart-Morgan Liz , Anderson-Knott Mindy , Roseberry Nicole , Hahn Jamie , Niemeier Kelli , Rutt Jennifer , Miller Debra
Published: June 2024

The Chronic Disease Prevention and Control Program (CDPCP) at the Nebraska Department of Health and Human Services developed a novel public health framework and tools to translate public health knowledge, grant work, and terminology to a health care audience in order to inform clinical practice changes in the management of hyperlipidemia and hypertension. The CDPCP piloted the tools with 2 accountable care organizations that included 19 clinics and then funded 9 independent clinics. The project sought to empower clinics to design and implement interventions for reducing high blood pressure and high blood cholesterol focused on populations disproportionately at risk for those conditions utilizing electronic health records. A team comprising the CDPCP and evaluation specialists created a framework called CAAPIE (Capture, Assess, Action Plan, Implement, Evaluate) to provide a clinic-friendly approach to the public health–focused work. For the capture phase, baseline data were collected from clinics. To guide the assess, action plan, and evaluate phases, the team created a Scan & Plan Tool for clinics to assess practices and policies and then use results to develop an action plan. The assessment was repeated upon completion of the project to evaluate change. Interviews were conducted to assess the utility of these tools and capture information related to the implementation of the project. Clinicians reported the framework and tools provided a useful approach, aiding clinics in understanding public health terminology and intended outcomes of the project. Work resulted in the creation of new or enhanced clinical policies and procedures that led to modest improvements in the management of high blood pressure and high cholesterol. The CAAPIE framework is a novel approach for state health departments to utilize in translating public health grant work to health care professionals, promoting a working relationship between the spheres to achieve positive impacts on individual and population-based health care.
Preparing to Address Social Determinants of Health (SDOH): Approaches to Clinic Transformation
Authors: Liu Xinran , Boak Brandi , Eggleston Molly , Rodi Andrea , Biscardi Ashley , Elias Thistle
Published: June 2024

Context:

Pennsylvanians' health is influenced by numerous social determinants of health (SDOH). Integrating SDOH data into electronic health records (EHRs) is critical to identifying health disparities, informing public health policies, and devising interventions. Nevertheless, challenges remain in its implementation within clinical settings. In 2018, the Pennsylvania Department of Health (PADOH) received the Centers for Disease Control and Prevention's DP18-1815 “Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke” grant to strengthen SDOH data integration in Pennsylvania practices.

Implementation:

Quality Insights was contracted by PADOH to provide training tailored to each practice's readiness, an International Classification of Diseases, Tenth Revision (ICD-10) guide for SDOH, Continuing Medical Education on SDOH topics, and introduced the PRAPARE toolkit to streamline SDOH data integration and address disparities. Dissemination efforts included a podcast highlighting success stories and lessons learned from practices. From 2019 to 2022, Quality Insights and the University of Pittsburgh Evaluation Institute for Public Health (Pitt evaluation team) executed a mixed-methods evaluation.

Findings:

During 2019-2022, Quality Insights supported 100 Pennsylvania practices in integrating SDOH data into EHR systems. Before COVID-19, 82.8% actively collected SDOH data, predominantly using PRAPARE tool (62.7%) and SDOH ICD-10 codes (80.4%). Amidst COVID-19, these statistics shifted to 65.1%, 45.2%, and 42.7%, respectively. Notably, the pandemic highlighted the importance of SDOH assessment and catalyzed some practices' utilization of SDOH data. Progress was evident among practices, with additional contribution to other DP18-1815 objectives. The main challenge was the variable understanding, utilization, and capability of handling SDOH data across practices. Effective strategies involved adaptable EHR systems, persistent efforts by Quality Insights, and the presence of change champions within practices.

Discussion:

The COVID-19 pandemic strained staffing in many practices, impeding SDOH data integration into EHRs. Addressing the diverse understanding and use of SDOH data requires standardized training and procedures. Customized support and sustained engagement by facilitating organizations are paramount in ensuring practices' efficient SDOH data collection and integration.
Testing an Innovative Approach to Improve Hypertension Management at a Federally Qualified Health Center
Authors: Barragan Noel C. , Wu Cecilia , Ly Ana , Oh Sang-Mi , Kuo Tony
Published: June 2024

Despite the availability of effective treatments, hypertension control rates remain inadequate in the United States and locally in Los Angeles County. To address this health condition, QueensCare Health Centers developed and launched a team-based hypertension management program that was led by clinical pharmacists and designed to mitigate treatment barriers encountered at the system, provider, and patient levels. System- and provider-focused strategies included incorporating self-monitored blood pressure values into the electronic health record and retraining clinicians to regularly review these values; adding a community health worker to the disease management team; and utilizing clinical pharmacists to assess and titrate medications. Patient-focused strategies included tailoring education materials to reduce literacy and linguistic barriers; providing tailored one-on-one education and support; and providing blood pressure cuffs and pedometers. This multilevel intervention serves as a practical example of how team-based care can be optimized at a Federally Qualified Health Center.
Outcome Evaluation of a Public Health Intervention on Cardiovascular Disease (CVD) Prevention Among Women Aged 40-64 with Low Incomes in Nebraska
Authors: Daniels Jianping , Leypoldt Melissa , Dillon Cathy , Sweazy Aaron , Crane Jill
Published: June 2024

Objectives:

To evaluate the effectiveness of the program interventions on cardiovascular disease in Nebraska women who are low income and have no health insurance.

Design:

This evaluation used pre- and post-comparison approach. Paired t test and McNemar’s test were used to examine the changes after the program interventions.

Participants:

Nebraska women aged 40 to 64 years, without health insurance, and with household incomes up to 225% Federal Poverty Level.

Setting and Intervention:

A network of community–clinical linkages in which medical providers provided preventive screening services and risk reduction counseling in clinical settings and community health workers provided lifestyle interventions in community settings either over the phone or in person.

Main Outcome Measure:

The data included weight, blood pressure measures, self-blood pressure monitoring and management, total cholesterol, fasting glucose or A1C, smoking status, nutrition, and physical activities.

Results:

Among 2649 participants, 82.2% were overweight, 50.3% had hypertension, 52.7% had high cholesterol, 20.7% had diabetes, 22.5% were current smokers, and 56.4% had more than 1 risk factor. A total of 1312 participants (57.3%) participated in at least 1 lifestyle intervention session, and among them, 65.8% completed at least 3 sessions. Paired t test and McNemar’s test indicated significant improvement in hypertension control and self-management; a significant amount of weight loss with 24.1% losing at least 5 pounds; and an increase in healthy eating and physical activity.

Conclusions:

These participants benefited from the Nebraska program. Utilizing a statewide clinical network and participating in lifestyle interventions through local health departments, participants improved some chronic health conditions and decreased their risks of developing cardiovascular diseases.
Outcomes of Fully Robotic Recipient Living Donor Liver Transplant in Relation to the Open Approach
Authors: Broering Dieter C. , Elsheikh Yasser , Malago Massimo , Alnemary Yasir , Alabbad Saleh , Boehnert Markus U. , Raptis Dimitri A.
Published: June 2024

Background.

Over the past 20 y, robotic surgery has entered nearly all surgical disciplines, aiming to improve patient outcomes. Liver transplantation has evolved with these advancements, and fully robotic liver transplants represent the latest innovation in this field. This study reports on the world’s first series of fully robotic recipient liver transplants from robotic living donors, comparing them with matched cases from the standard open transplant approach.

Methods.

A case-control study was conducted at our center from August to December 2023. Patient selection criteria for robotic recipient liver transplantation included a Model for End-stage Liver Disease score of ≤25, specific anatomical characteristics, and logistics. A propensity score analysis with a 1:4 matching ratio was used.

Results.

The study analyzed 10 fully robotic living donor and robotic recipient liver transplant pairs with a median donor age of 29 y and a recipient age of 61 y. The main indication for transplantation was nonalcoholic steatohepatitis (6/10). There was 1 robotic to open conversion, and the median operation time was 10 h, with a median hospital stay of 13 d, shorter than the 18 d in the open group. Three recipients experienced a complication, and there was no mortality.

Conclusions.

The first-ever series of fully robotic living donor recipient liver transplants showed encouraging initial results with a markedly reduced hospital stay. The ultimate goal is to refine the technique to offer robotic liver transplants to the majority of recipients, overcoming the current selection criteria. Further research and a planned randomized controlled trial will aim to confirm these results.
Renalase inhibition regulates β cell metabolism to defend against acute and chronic stress
Authors: MacDonald Tara , Ryback Birgitta , da Silva Pereira Jessica Aparecida , Wei Siying , Mendez Bryhan , Cai Erica , Ishikawa Yuki , Weir Gordon , Bonner-Weir Susan , Kissler Stephan , Yi Peng
Published: June 2024

Renalase (Rnls), annotated as an oxidase enzyme, is a GWAS gene associated with Type 1 Diabetes (T1D) risk. We previously discovered that Rnls inhibition delays diabetes onset in mouse models of T1Din vivo, and protects pancreatic β cells against autoimmune killing, ER and oxidative stressin vitro. The molecular biochemistry and functions of Rnls are entirely uncharted. Here we find that Rnls inhibition defends against loss of β cell mass and islet dysfunction in chronically stressed Akita micein vivo. We used RNA sequencing, untargeted and targeted metabolomics and metabolic function experiments in mouse and human β cells and discovered a robust and conserved metabolic shift towards glycolysis, amino acid abundance and GSH synthesis to counter protein misfolding stress,in vitro. Our work illustrates a function for Rnls in mammalian cells, and suggests an axis by which manipulating intrinsic properties of β cells can rewire metabolism to protect against diabetogenic stress.
Biomolecular Condensates Can Enhance Homotypic RNA Clustering
Authors: Mahendran Tharun Selvam , Wadsworth Gable M , Singh Anurag , Gupta Ritika , Banerjee Priya R
Published: June 2024

Intracellular aggregation of repeat expanded RNA has been implicated in many neurological disorders. Here, we study the role of biomolecular condensates on irreversible RNA clustering. We find that physiologically relevant, and disease-associated repeat RNAs spontaneously undergo an age-dependent percolation transition inside multi-component protein-nucleic acid condensates to form nanoscale clusters. Homotypic RNA clusters drive the emergence of multiphasic condensate structures, with an RNA-rich solid core surrounded by an RNA-depleted fluid shell. The timescale of the RNA clustering, which accompanies a liquid-to-solid transition of biomolecular condensates, is determined by the sequence features, stability of RNA secondary structure, and repeat length. Importantly, G3BP1, the core scaffold of stress granules, introduces heterotypic buffering to homotypic RNA-RNA interactions and impedes intra-condensate RNA clustering in an ATP-independent manner. Our work suggests that biomolecular condensates can act as sites for RNA aggregation. It also highlights the functional role of RNA-binding proteins in suppressing aberrant RNA phase transitions.
Genomic and morphological characterization ofTrichuris incognita, a Human-InfectingTrichurisspecies
Authors: Bär Max A. , Kouamé Nadège A. , Touré Sadikou , Coulibaly Jean T. , Schneeberger Pierre H. H. , Keiser Jennifer
Published: June 2024

Trichuriasis is a neglected tropical disease that affects as many as 500 million individuals and can cause significant morbidity. For decades, it was thought to be caused by one species of whipworm,Trichuris trichiura. Significant differences in response rates to the best available anthelmintic treatment — a combination of albendazole and ivermectin — for trichuriasis exist across clinical trial reports yet the underlying reasons are unclear. Here, we present and characterize a human-infectingTrichurisspecies that we namedTrichuris incognita. Combining long- and short-read sequencing approaches, we assembled a high-quality reference genome ofT. incognitato construct the species tree of theTrichurisgenus using 12434 orthologous groups. We sequenced a total of 747 individual worms which were used to confirm the phylogenetic placement. Comparative genomic analysis of genes implied in the resistance of either albendazole or ivermectin in helminths revealed a high copy number of the beta-tubulin (TUBB) gene, present in the whole population ofT. incognita, compared to the canonicalT. trichiuraspecies. We conducted a genome wide association study (GWAS) comparing 160 albendazole-ivermectin sensitive to 492 drug non-sensitive worms, which did not point towards an adaptation to drug pressure within the same species. Our results demonstrate that trichuriasis can be caused by multiple species of whipworm. This discovery, coupled with high tolerability ofT. incognitato albendazole-ivermectin marks a significant shift in how we understand and approach whipworm infections.
Comparison of sequence- and structure-based antibody clustering approaches on simulated repertoire sequencing data
Authors: Waury Katharina , Lelieveld Stefan H. , Abeln Sanne , van den Ham Henk-Jan
Published: June 2024

Repertoire sequencing allows us to investigate the antibody-mediated immune response. The clustering of sequences is a crucial step in the data analysis pipeline, aiding in the identification of functionally related antibodies. The conventional clustering approach of clonotyping relies on sequence information, particularly CDRH3 sequence identity and V/J gene usage, to group sequences into clonotypes. It has been suggested that the limitations of sequence-based approaches to identify sequence-dissimilar but functionally converged antibodies can be overcome by using structure information to group antibodies. Recent advances have made structure-based methods feasible on a repertoire level. However, so far, their performance has only been evaluated on single-antigen sets of antibodies. A comprehensive comparison of the benefits and limitations of structure-based tools on realistic and diverse repertoire data is missing. Here, we aim to explore the promise of structure-based clustering algorithms to replace or augment the standard sequence-based approach, specifically by identifying low-sequence identity groups. Two methods, SAAB+ and SPACE2, are evaluated against clonotyping. We curated a dataset of well-annotated pairs of antibodies that show high overlap in epitope residues and thus bind the same region within their respective antigen. This set of antibodies was introduced into a simulated repertoire to compare the performance of clustering approaches on a diverse antibody set. Our analysis reveals that structure-based methods do produce more multiple-occupancy clusters compared to clonotyping. However, it also highlights the limitations associated with the need for same-length CDR regions by SPACE2. This work thoroughly compares the utility of different clustering methods and provides insights into what further steps are required to effectively use antibody structural information to group immune repertoire data.
Virtual Colon: Spatiotemporal modelling of metabolic interactions in a computational colonic environment
Authors: Marinos Georgios , Zimmermann Johannes , Taubenheim Jan , Kaleta Christoph
Published: June 2024

Host-microbial metabolic interactions have been recognised as an essential factor in host health and disease. Genome-scale metabolic modelling approaches have made important contributions to our understanding of the interactions in such communities. One particular such modelling approach is BacArena in which metabolic models grow, reproduce, and interact as independent agents in a spatiotemporal metabolic environment. Here, we present a modelling application of BacArena, a virtual colonic environment, which reveals spatiotemporal metabolic interactions in a computational colonic environment. This environment resembles the crypt space together with the mucus layers, the lumen and fluid dynamics. Our proof-of-principle experiments include mono-colonisation simulations of context-specific colonic cells and simulations of context-specific colonic cells with the SIHUMIx minimal model microbiome. Our simulations propose host-microbial and microbial-microbial interactions that can be verified based on the literature. Most importantly, the Virtual Colon offers visualisation of interactions through time and space, adding another dimension to the genome-scale metabolic modelling approaches. Lastly, like BacArena, it is freely available and can be easily adapted to model other spatially structured environments (http://www.github.com/maringos/VirtualColon).