bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ambassador Project: Evaluating a Five-Year Nationwide Leadership Program to Bridge the gap Between Policy and District Nursing Practice
Authors: Wolbers I. , Lalleman P.C.B. , Schoonhoven L. , Bleijenberg N.
Published: October 2021

District nurses have a crucial position in healthcare provision and are expected to use leadership practices to ensure optimal quality patient care. To better equip them, a leadership program named the ambassador project was developed to support the development of a liaison role between policy and district nursing practice. This research aims to evaluate from different perspectives the impact of this nationwide, five-year leadership program for district nurses at the organizational, regional, and societal levels. A mixed-methods study was conducted using two focus groups based on peer-to-peer shadowing (n = 14), semistructured interviews (n = 13), and an online questionnaire (n = 45). The analysis shows that the impact of a nationwide leadership program for district nurses was perceived as predominantly positive, and nurses experienced an increase in courage, assertiveness, professional pride, and leadership skills. They obtained confidence in representing the group of district nurses at the organizational, regional, and societal levels when speaking with various key stakeholders from the healthcare system. They were able to bridge the gaps among daily practice, policymaking, and politics by using translations and shaping actions and information into terms suiting the needs of those involved.
Who Tells Your Story? A Card-Sort Activity for Eliciting Authentic Narratives
Authors: Brent Rebecca , Orr Marisa , Brawner Catherine E. , Mobley Catherine
Published: October 2021

Card sorting has been used in qualitative studies in various fields to better understand how individuals organize information and make choices based on it. As part of a mixed-methods study of why Black engineering students initially chose their major and why they subsequently decided to persist in or switch out of it, we developed a card-sort activity and used it in 79 semi-structured student interviews. Besides generating data relevant to the mission of our study, the activity shifted the students' focus to their own experiences and away from the interviewers, who were not matched with them on race or age and with whom there was a power differential (interviewers with doctorates talking with undergraduates). The article contains a brief overview of the broader study, a description of steps taken to promote authentic storytelling by the interviewees, an outline of the development and application of the card-sort activity, representative findings, and recommendations for other researchers contemplating using a similar technique. We believe our experience in using the card-sort technique and our subsequent mixed-method analysis of the resulting data will benefit qualitative researchers seeking authentic stories.
The bioinformatics analysis of quercetin in octagonal lotus for the screening of breast cancer MYC, CXCL10, CXCL11, and E2F1
Authors: Ma Yuexing , Peng Zirong , Pan Rongbin , Zhu Zhixin , Meng Xiaoqi , Hu Huiming , Qiao Xin , Huang Xuening , Hou Mengyu
Published: October 2021

Background

Comprehensive bioinformatics analysis of the effective molecular screening of Podophyllum octagonal in breast cancer treatment by using network pharmacology.

Methods

We collected the active ingredients and target genes of Chinese medicine octagonal lotus through the Traditional Chinese Medicine System Pharmacology Analysis Platform (TCMSP); downloaded human protein annotation information on the protein database Uniport; and collected data from five databases: GeneCards, OMIM, PharmGkb, TDD, and DrugBank. Construct the practical ingredient-target gene data intersection to obtain the target gene-disease gene and draw the Venn diagram. We use Cytoscape 3.8.0 software to construct the effective component-target gene-disease gene network. The STRING database protein interaction (PPI) networks were erected, and we used Cytoscape 3.8.0 software to screen out its core sub-networks and hub gene networks. Through survival analysis, core genes and hub genes were screened to identify several key genes. We performed key target gene ontology (GO) analysis and gene interaction (KEGG) analysis, which were followed by molecular docking of the key active ingredients in the star anise corresponding to several key genes.

Results

19 active ingredients, 444 drug targets, and 10,941 disease-related genes were obtained. The key active ingredient was quercetin. GO analysis revealed 2471 affected biological processes, and 167 pathways were obtained in KEGG enrichment analysis.

Conclusion

This study initially screened the key active ingredients of star aniseed lotus and analyzed key genes and several essential pathways. Traditional Chinese medicine is expected to provide new evidence and research ideas to prevent and treat breast cancer.
Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model
Authors: Jones Carolyn , Duea Stephanie , Griggs Kellie , Johnstone William , Kinsey Debbie
Published: October 2021

Context:

Increasing rates of Opioid Use Disorder among pregnant women are a significant public health issue. Care for these women is fragmented, and multiple barriers to care have been identified. Program: The Tides, Inc. is attempting to address these needs by providing comprehensive, coordinated care, beginning in pregnancy and extending beyond the birth of their infant.

Implementation:

Using a collaborative model, care is coordinated between multiple existing agencies in an effort to reduce barriers and improve access to care. Funding for these services is provided through county funding and existing payor sources (eg, insurance, Medicaid).

Evaluation:

Participant and program outcomes were evaluated at the end of each year of the program. In addition, participants who had completed the program at the end of year 1 were asked to complete a survey providing qualitative information about their experience in the program. Of these participants, 73% reported no opiate use and 100% had full custody of their infants.

Discussion:

The Tides, Inc. program utilizes existing resources to provide coordinated and comprehensive care for pregnant women with Opioid Use Disorder. In addition to improving outcomes for women and their infants, this program can reduce cost and burden on community entities such as the justice system and foster care networks. This program can serve as a model for other communities to coordinate care for women and their infants.
Work-Life Balance and Gender Differences: A Study of College and University Teachers From Karnataka
Authors: Mayya Shreemathi S. , Martis Maxie , Ashok Lena , Monteiro Ashma Dorothy , Mayya Sureshramana
Published: October 2021

Teaching responsibilities in today’s higher education sector are increasingly demanding. Apart from the focus on the quality of teaching-learning activities, teachers of today are evaluated for their active involvement in professional and societal growth. Women in academia shoulder equal responsibilities as of men, but in India, women play multiple roles in the non-work setting unlike men. The primary objective of this cross-sectional study was to find out the gender difference in Work-Life Balance (WLB) among teachers of higher education. Institutional Ethical Committee’s approval was obtained. Data was collected using the WLB questionnaire, from 127 male and 136 female faculties employed on a tenure basis in the Public Universities in Karnataka. The multiple regression analysis indicated an association of better WLB with the upper age group, male gender, and faculties of science discipline. Strategies at the organizational level and initiatives at the personal level are essential to address the issues of WLB.
Does Money Matter for Electability? Lesson Learned From the 2014 Legislative Election in Indonesia
Authors: Virananda I Gede Sthitaprajna , Dartanto Teguh , Wijaya Bintang Dara
Published: October 2021

Reform toward open-list elections in Indonesia has transformed the nature of campaigning to become more personalized. This has raised questions regarding the role of money in elections and calls for stricter campaign finance regulation. However, the merits of limits on campaign finance depend on whether and how campaign finance affects incumbents and challengers differently. Literature on this issue has produced ambiguous results, with only few studies conducted in a developing country democracy. This study estimates the effect of campaign money, along with other factors including list position and incumbency status, on the probability of a candidate being elected in the 2014 legislative election in Indonesia. Our econometric estimations confirm that campaign money effectively raises the probability of candidates being elected. The probability of getting elected will increase up to approximately 5 percentage points for each additional IDR 100 million of campaign money. Campaign money is positive and significant for both incumbents and challengers, with the magnitude being bigger for incumbents. However, the effect of diminishing returns of campaign money is slightly stronger for incumbents. Since raising additional campaign funding benefits incumbents more than it does for challengers, this study suggests the enforcement of campaign spending limits to create a more level playing field in Indonesia’s legislative elections.
Vitamins are Indeed Vital Amines: A Discussion of 3 Deficiencies With Neurologic Manifestations
Authors: Tarhan Bedirhan , Rahman Sydur , Joseph Nancy , Hyder Douglas , Zingariello Carla , Borum Peggy R. , Sladky John , Winesett Steven Parrish
Published: October 2021

Optimal functioning of the human nervous system depends on a constant supply of nutrients, vitamins, and minerals. In the developed world, nutritional deficiencies are relatively rare and infrequently present with neurologic manifestations. These neurologic disorders can be mistaken for inflammatory and/or autoimmune phenomena. This manuscript describes 2 pediatric cases with neurologic signs/symptoms arising from vitamin deficiencies—(1) optic neuropathy and (2) Wernicke encephalopathy associated with a Guillain-Barre-like pattern of weakness. The 2 cases and the subsequent discussion of vitamin A, B1, and B12 deficiencies underscore the value of taking a thorough dietary history and emphasize risk factors for these 3 nutritional deficiencies.
Association Between Physical Function and Neighborhood Environment in Healthy, Older Adults: An Exploratory Study Using Regression Tree Analysis
Authors: Ando Masataka , Kamide Naoto , Shiba Yoshitaka , Sakamoto Miki , Sato Haruhiko , Murakami Takeshi , Watanabe Shuichiro
Published: October 2021

The aim of this study was to perform an exploratory investigation of the individual characteristics of older adults that affect the relationships between physical function and neighborhood environment. A total of 624 community-dwelling older adults living independently, aged ≥65 years, participated in this cross-sectional study. Physical function was assessed by muscle strength (grip strength and knee extension strength) and physical performance (5-m walking time and Timed Up and Go Test). The neighborhood environment was assessed using the International Physical Activity Questionnaire Environmental Module. The individual characteristics that affect the association between both were analyzed using multiple regression analysis and Classification and Regression tree (CaRT) analysis. In both older men and women, multiple regression analysis showed that neighborhood environment was significantly associated with physical function. On the other hand, on CaRT analyses, older men ≤80 years of age without low back pain and depressive symptoms and perceived good access to recreational facilities had the shortest 5-m walking time. However, CaRT analyses found no relationship between physical function and neighborhood environment in older women. The relationships between physical function and neighborhood environment may be altered by sex, age, and physical and mental health conditions.
Removable Denture Wearing as a Risk Predictor for Pneumonia Incidence and Time to Event in Older Adults
Authors: Alzamil H. , Wu T.T. , van Wijngaarden E. , Mendoza M. , Malmstrom H. , Fiscella K. , Kopycka-Kedzierawski D.T. , Billings R.J. , Xiao J.
Published: October 2021

Introduction:

Older adults are more susceptible to a common respiratory infection: pneumonia. Nearly 1 million older adults per year are hospitalized for community-acquired pneumonia in the United States.

Objective:

To examine whether wearing removable dentures are associated with an increased risk of pneumonia incidence in a geriatric population.

Methods:

We conducted a retrospective cohort study among patients >65 y of age within a large academic health system (University of Rochester Medical Center). The medical and dental electronic records from 2010 to 2018 were reviewed and used for data collection. The exposure was removable denture wearing. The main outcome variables were the incidence of pneumonia and time to event of pneumonia. A Cox proportional hazards regression was used to examine the association between pneumonia onset and wearing removable dentures, adjusting for demographics, socioeconomic status, and medical and dental conditions.

Results:

A total of 2,364 patients were included, with 1,189 (50.29%) in the denture-wearing group and 1,175 (49.70%) in the non–denture wearing group. The annual pneumonia incidence rate per 100,000 persons was 1,191 in the denture-wearing group and 128 per 100,000 persons in the non–denture wearing group, with a crude incidence rate ratio of 9.33 (95% CI, 5.41 to 18.81; P < 0.0001). The mean ± SD age of the pneumonia onset was 78.0 ± 10.0 and 78.6 ± 9.0 y among denture-wearing and nonwearing groups (P = 0.84). The time to event of pneumonia was associated with removable denture wearing (yes/no; hazard ratio, 7.68 [95% CI, 3.91 to 15.08]; P < 0.001) after adjusting for covariates.

Conclusions:

Wearing removable dentures was found to be a risk predictor for pneumonia incidence among the geriatric population even after accounting for other risk factors.

Knowledge Transfer Statement:

Wearing removable dentures was found to be a risk predictor of pneumonia incidence among older adults. Although the current study does not imply a causal relationship between denture wearing and pneumonia, clinicians and older patients could reference the study results when choosing dental prostheses to restore missing teeth.
TAGOPSIN: collating taxa-specific gene and protein functional and structural information
Authors: Bundhoo Eshan , Ghoorah Anisah W. , Jaufeerally-Fakim Yasmina
Published: October 2021

Background

The wealth of biological information available nowadays in public databases has triggered an unprecedented rise in multi-database search and data retrieval for obtaining detailed information about key functional and structural entities. This concerns investigations ranging from gene or genome analysis to protein structural analysis. However, the retrieval of interconnected data from a number of different databases is very often done repeatedly in an unsystematic way.

Results

Here, we present TAxonomy, Gene, Ontology, Protein, Structure INtegrated (TAGOPSIN), a command line program written in Java for rapid and systematic retrieval of select data from seven of the most popular public biological databases relevant to comparative genomics and protein structure studies. The program allows a user to retrieve organism-centred data and assemble them in a single data warehouse which constitutes a useful resource for several biological applications. TAGOPSIN was tested with a number of organisms encompassing eukaryotes, prokaryotes and viruses. For example, it successfully integrated data for about 17,000 UniProt entries of Homo sapiens and 21 UniProt entries of human coronavirus.

Conclusion

TAGOPSIN demonstrates efficient data integration whereby manipulation of interconnected data is more convenient than doing multi-database queries. The program facilitates for instance interspecific comparative analyses of protein-coding genes in a molecular evolutionary study, or identification of taxa-specific protein domains and three-dimensional structures. TAGOPSIN is available as a JAR file at https://github.com/ebundhoo/TAGOPSIN and is released under the GNU General Public License.
Using multi-layer perceptron to identify origins of replication in eukaryotes via informative features
Authors: Fan Yongxian , Wang Wanru
Published: October 2021

Background

The origin is the starting site of DNA replication, an extremely vital part of the informational inheritance between parents and children. More importantly, accurately identifying the origin of replication has great application value in the diagnosis and treatment of diseases related to genetic information errors, while the traditional biological experimental methods are time-consuming and laborious.

Results

We carried out research on the origin of replication in a variety of eukaryotes and proposed a unique prediction method for each species. Throughout the experiment, we collected data from 7 species, including Homo sapiens, Mus musculus, Drosophila melanogaster, Arabidopsis thaliana, Kluyveromyces lactis, Pichia pastoris and Schizosaccharomyces pombe. In addition to the commonly used sequence feature extraction methods PseKNC-II and Base-content, we designed a feature extraction method based on TF-IDF. Then the two-step method was utilized for feature selection. After comparing a variety of traditional machine learning classification models, the multi-layer perceptron was employed as the classification algorithm. Ultimately, the data and codes involved in the experiment are available at https://github.com/Sarahyouzi/EukOriginPredict.

Conclusions

The prediction accuracy of the training set of the above-mentioned seven species after 100 times fivefold cross validation reach 92.60%, 90.80%, 91.22%, 96.15%, 96.72%, 99.86%, 96.72%, respectively. It denotes that compared with other methods, the methods we designed could accomplish superior performance. In addition, our experiments reveals that the models of multiple species could predict each other with high accuracy, and the results of STREME shows that they have a certain common motif.
Genome-wide association analyses of carcass traits using copy number variants and raw intensity values of single nucleotide polymorphisms in cattle
Authors: Rafter Pierce , Gormley Isobel Claire , Purfield Deirdre , Parnell Andrew C. , Naderi Saeid , Berry Donagh P.
Published: October 2021

Background

The carcass value of cattle is a function of carcass weight and quality. Given the economic importance of carcass merit to producers, it is routinely included in beef breeding objectives. A detailed understanding of the genetic variants that contribute to carcass merit is useful to maximize the efficiency of breeding for improved carcass merit. The objectives of the present study were two-fold: firstly, to perform genome-wide association analyses of carcass weight, carcass conformation, and carcass fat using copy number variant (CNV) data in a population of 923 Holstein-Friesian, 945 Charolais, and 974 Limousin bulls; and secondly to perform separate association analyses of carcass traits on the same population of cattle using the Log R ratio (LRR) values of 712,555 single nucleotide polymorphisms (SNPs). The LRR value of a SNP is a measure of the signal intensity of the SNP generated during the genotyping process.

Results

A total of 13,969, 3,954, and 2,805 detected CNVs were tested for association with the three carcass traits for the Holstein-Friesian, Charolais, and Limousin, respectively. The copy number of 16 CNVs and the LRR of 34 SNPs were associated with at least one of the three carcass traits in at least one of the three cattle breeds. With the exception of three SNPs, none of the quantitative trait loci detected in the CNV association analyses or the SNP LRR association analyses were also detected using traditional association analyses based on SNP allele counts. Many of the CNVs and SNPs associated with the carcass traits were located near genes related to the structure and function of the spliceosome and the ribosome; in particular, U6 which encodes a spliceosomal subunit and 5S rRNA which encodes a ribosomal subunit.

Conclusions

The present study demonstrates that CNV data and SNP LRR data can be used to detect genomic regions associated with carcass traits in cattle providing information on quantitative trait loci over and above those detected using just SNP allele counts, as is the approach typically employed in genome-wide association analyses.
Long-term survival of a patient with microsatellite-stable refractory colorectal cancer with regorafenib and PD-1 inhibitor sintilimab: a case report and review of literature
Authors: Zhang Yong , Zhang Fang , Zhao Lingdi , Fu Xiaomin , Shang Yiman , Gao Quanli
Published: October 2021

Background

Colorectal cancer (CRC) is the third most prevalent cancer worldwide and poses a serious challenge for clinicians. Previous studies have shown promising results in patients with Microsatellite Stable microsatellite-stable CRC refractory to chemotherapy upon treating with (Programmed Cell Death Protein 1) PD-1 inhibitor combined with regorafenib. Herein, we report a unique case of a patient for whom the conventional chemotherapy and radiotherapy were ineffective, but showed a prolonged stable disease with third-line treatment with regorafenib and PD-1 inhibitor, sintilimab.

Case presentation

A 64-year-old East Asian female patient was admitted to a regional cancer hospital presenting with abdominal unease due to increased stool frequency and bloody stool. Digital anal examination revealed adenocarcinoma, while genetic profiling of the tumor resections detected wild-type KRAS mutations in codon 12 and 13. Microsatellite instability (MSI) analysis for detecting germline mutations of (Mismatch-repair) MMR genes showed stable phenotype. In December 2016, Miles’ resection for intestinal adhesion release and iliac vessel exploration in the rectum was performed (Tumor, Node, Metastasis [TNM]: T3N0M0; stage IIA). The adjuvant chemotherapeutic regimen consisted of a combination of capecitabine at 1.5 g (twice daily) and oxaliplatin therapy at 200 mg for three cycles from February 2016; followed by administering capecitabine tablets orally (1.5 g bid) for five cycles as post-operative palliative care. The patient tested positive for hepatic C virus, which was managed by oral antiviral agents. Following recurrence of rectal adenocarcinoma after 4 years and disease progression with a previous chemotherapeutic regimen, regorafenib was administered at 120 mg once daily combined with sintilimab 200 mg, and the patient's progress was monitored. A follow-up computerized tomography imaging in March 2020 showed disease progression, additionally presented nodule formation (TNM: T3NxM1b; stage IVB). According to Response Evaluation Criteria in Solid Tumors criteria (RECIST), the patient showed a complete response (CR) after treatment with regorafenib and sintilimab immunotherapy.

Conclusion

Data from this clinical case report support future exploration of combination treatment of the oral multi-kinase inhibitor regorafenib with PD-1 targeted monoclonal antibodies in patients with metastatic microsatellite-stable CRC.
Implementing supportive exercise interventions in the colorectal cancer care pathway: a process evaluation of the PREPARE-ABC randomised controlled trial
Authors: Murdoch Jamie , Varley Anna , McCulloch Jane , Jones Megan , Thomas Laura B. , Clark Allan , Stirling Susan , Turner David , Swart Ann Marie , Dresser Kerry , Howard Gregory , Saxton John , Hernon James
Published: October 2021

Background

A colorectal resection is standard treatment for patients with colorectal cancer (CRC). However, the procedure results in significant post-operative mortality and reduced quality of life. Maximising pre-operative cardiopulmonary fitness could improve post-surgical outcomes. PREPARE-ABC is a multi-centre, three-armed, randomised controlled trial investigating the effects of exercise interventions, with motivational support on short and longer-term recovery outcomes in CRC patients undergoing major lower-gastrointestinal surgery. The trial included an internal pilot phase with parallel process evaluation. The aim of the process evaluation was to optimise intervention implementation for the main trial.

Methods

Mixed methods process evaluation conducted in 14 UK hospitals between November 2016 and March 2018. Data included a site profile questionnaire and telephone scoping interview with hospital staff, 34 qualitative observations of standard care and 14 observations of intervention delivery, 13 semi-structured interviews with healthcare professionals (HCPs) and 28 semi-structured interviews with patients. Data analysis focused on describing intervention delivery within each arm, assessing fidelity, acceptability and how variation in delivery was linked to contextual characteristics.

Results

Standard care exercise advice was typically limited to maintaining current activity levels, and with lead-in time to surgery affecting whether any exercise advice was provided. Variation in HCP capacity affected the ability of colorectal units to deploy staff to deliver the intervention. Patients’ exercise history and motivation prior to surgery influenced HCP perceptions and delivery of the motivational components. Observations indicated a high level of fidelity to delivery of the exercise interventions. All but one of the 28 interviewed patients reported increasing exercise levels as a result of receiving the intervention, with most finding them motivational and greatly valuing the enhanced level of social support (versus standard care) provided by staff.

Conclusion

Hospital-supervised and home-based exercise interventions were highly acceptable for most patients undergoing surgery for CRC. Delivery of pre- and post-operative exercise within the CRC care pathway is feasible but systematic planning of capacity and resources is required to optimise implementation.
Thelazia callipaeda infection during phacoemulsification cataract surgery: a case report
Authors: Li Yang , Liu Jie , Tian Qingmei , Guo Dadong , Liu Dongmei , Ma Xianzhen , Bi Hongsheng
Published: October 2021

Background

In August 2020, we found one case of thelazia callipaeda infection during phacoemulsification cataract surgery. This maybe the first report for thelazia callipaeda discovered during phacoemulsification cataract surgery in China.

Case presentation

An 85 years old farmer was found thelazia callipaeda infection during phacoemulsification cataract surgery. The patient admitted whose foreign body sensation was often found in the right eye in recent 2 months. The worm was then taken out with ophthalmic forceps and put into sterile normal saline. The worm was sent to the Eye Institute of Shandong University of Traditional Chinese Medicine for identification. After identification, the worm was regarded as the male thelazia callipaeda. The head is blunt and round, the tail end curls to the abdomen, and the long copulation spines protrudes from the cloaca. The conjunctival sac was washed carefully with a large amount of Sodium Lactate Ringer ‘s Solution. After operation, antibiotics, pranoprofen eye drops, and tobramycin dexamethasone eye drops were further applied. After continuous examination of conjunctival sac for 2 weeks, the patient’s visual acuity maintained 20/20, confirming that there was no residual thelazia.

Conclusions

This report highlights the physician should ask the patient’s history carefully before operation and it is necessary to strengthen health publicity and education, maintaining clean environment and keeping personal eye hygiene.
Mapping geographic clusters of new HIV diagnoses to inform granular-level interventions for HIV epidemic control in western Kenya
Authors: Muttai Hellen , Guyah Bernard , Achia Thomas , Musingila Paul , Nakhumwa Jesse , Oyoo Rose , Olweny Wilfrida , Odeny Redempter , Ohaga Spala , Agot Kawango , Oruenjo Kennedy , Awino Bob , Joseph Rachael H. , Miruka Fredrick , Zielinski-Gutierrez Emily
Published: October 2021

Background

As countries make progress towards HIV epidemic control, there is increasing need to identify finer geographic areas to target HIV interventions. We mapped geographic clusters of new HIV diagnoses, and described factors associated with HIV-positive diagnosis, in order to inform targeting of HIV interventions to finer geographic areas and sub-populations.

Methods

We analyzed data for clients aged> 15 years who received home-based HIV testing as part of a routine public health program between May 2016 and July 2017 in Siaya County, western Kenya. Geospatial analysis using Kulldorff’s spatial scan statistic was used to detect geographic clusters (radius < 5 kilometers) of new HIV diagnoses. Factors associated with new HIV diagnosis were assessed in a spatially-integrated Bayesian hierarchical model.

Results

Of 268,153 clients with HIV test results, 2906 (1.1%) were diagnosed HIV-positive. We found spatial variation in the distribution of new HIV diagnoses, and identified nine clusters in which the number of new HIV diagnoses was significantly (1.56 to 2.64 times) higher than expected. Sub-populations with significantly higher HIV-positive yield identified in the multivariable spatially-integrated Bayesian model included: clients aged 20–24 years [adjusted relative risk (aRR) 3.45, 95% Bayesian Credible Intervals (CI) 2.85–4.20], 25–35 years (aRR 4.76, 95% CI 3.92–5.81) and > 35 years (aRR 2.44, 95% CI 1.99–3.00); those in polygamous marriage (aRR 1.84, 95% CI 1.55–2.16), or separated/divorced (aRR 3.36, 95% CI 2.72–4.08); and clients who reported having never been tested for HIV (aRR 2.35, 95% CI 2.02–2.72), or having been tested > 12 months ago (aRR 1.53, 95% CI 1.41–1.66).

Conclusion

Our study used routine public health program data to identify granular geographic clusters of higher new HIV diagnoses, and sub-populations with higher HIV-positive yield in the setting of a generalized HIV epidemic. In order to target HIV testing and prevention interventions to finer granular geographic areas for maximal epidemiologic impact, integrating geospatial analysis into routine public health programs can be useful.
A historical overview of legislated alcohol policy in the Northern Territory of Australia: 1979–2021
Authors: Clifford Sarah , Smith James A. , Livingston Michael , Wright Cassandra J. C. , Griffiths Kalinda E. , Miller Peter G.
Published: October 2021

Background

The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021.

Methods

Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention.

Results

Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2–3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment.

Discussion

The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people’s consumption.
Socio-demographic and -economic factors associated with 30-day readmission for conditions targeted by the hospital readmissions reduction program: a population-based study
Authors: Murray Frances , Allen Meghan , Clark Collin M. , Daly Christopher J. , Jacobs David M.
Published: October 2021

Background

Early hospital readmissions remain common in patients with conditions targeted by the CMS Hospital Readmission Reduction Program (HRRP). There is still no consensus on whether readmission measures should be adjusted based on social factors, and there are few population studies within the U.S. examining how social characteristics influence readmissions for HRRP-targeted conditions. The objective of this study was to determine if specific socio-demographic and -economic factors are associated with 30-day readmissions in HRRP-targeted conditions: acute exacerbation of chronic obstructive pulmonary disease, pneumonia, acute myocardial infarction, and heart failure.

Methods

The Nationwide Readmissions Database was used to identify patients admitted with HRRP-targeted conditions between January 1, 2010 and September 30, 2015. Stroke was included as a control condition because it is not included in the HRRP. Multivariate models were used to assess the relationship between three social and economic characteristics (gender, urban/rural hospital designation, and estimated median household income within the patient’s zip code) and 30-day readmission rates using a hierarchical two-level logistic model. Age-adjusted models were used to assess relationship differences between Medicare vs. non-Medicare populations.

Results

There were 19,253,997 weighted index hospital admissions for all diagnoses and 3,613,488 30-day readmissions between 2010 and 2015. Patients in the lowest income quartile (≤$37,999) had an increased odds of 30-day readmission across all conditions (P < 0.0001). Female gender and rural hospital designation were associated with a decreased odds of 30-day readmission for most targeted conditions (P < 0.05). Similar findings were also seen in patients ≥65 years old.

Conclusions

Socio-demographic and -economic factors are associated with 30-day readmission rates and should be incorporated into tools or interventions to improve discharge planning and mitigate against readmission.
High-cost high-need patients in Medicaid: segmenting the population eligible for a national complex case management program
Authors: Quinton Jacob K. , Duru O. Kenrik , Jackson Nicholas , Vasilyev Arseniy , Ross-Degnan Dennis , O’Shea Donna L. , Mangione Carol M.
Published: October 2021

Background

High-cost high-need patients are typically defined by risk or cost thresholds which aggregate clinically diverse subgroups into a single ‘high-need high-cost’ designation. Programs have had limited success in reducing utilization or improving quality of care for high-cost high-need Medicaid patients, which may be due to the underlying clinical heterogeneity of patients meeting high-cost high-need designations.

Methods

Our objective was to segment a population of high-cost high-need Medicaid patients (N = 676,161) eligible for a national complex case management program between January 2012 and May 2015 to disaggregate clinically diverse subgroups. Patients were eligible if they were in the top 5 % of annual spending among UnitedHealthcare Medicaid beneficiaries. We usedk-means cluster analysis, identified clusters using an information-theoretic approach, and named clusters using the patients’ pattern of acute and chronic conditions. We assessed one-year overall and preventable hospitalizations, overall and preventable emergency department (ED) visits, and cluster stability.

Results

Six clusters were identified which varied by utilization and stability. The characteristic condition patterns were: 1) pregnancy complications, 2) behavioral health, 3) relatively few conditions, 4) cardio-metabolic disease, and complex illness with relatively 5) low or 6) high resource use. The patients varied by cluster by average ED visits (2.3–11.3), hospitalizations (0.3–2.0), and cluster stability (32–91%).

Conclusions

We concluded that disaggregating subgroups of high-cost high-need patients in a large multi-state Medicaid sample identified clinically distinct clusters of patients who may have unique clinical needs. Segmenting previously identified high-cost high-need populations thus may be a necessary strategy to improve the effectiveness of complex case management programs in Medicaid.
Confronting complexity and supporting transformation through health systems mapping: a case study
Authors: Hussey Anna J. , Sibbald Shannon L. , Ferrone Madonna , Hergott Alyson , McKelvie Robert , Faulds Cathy , Roberts Zofe , Scarffe Andrew D. , Meyer Matthew J. , Vollbrecht Susan , Licskai Christopher
Published: October 2021

Introduction

Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat.

Study description

This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map.

Results

The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care.

Conclusion

The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.
Differences in outcomes of hospitalizations for heart failure after SGLT2 inhibitor treatment: effect modification by atherosclerotic cardiovascular disease
Authors: Shao Shih-Chieh , Chang Kai-Cheng , Lin Swu-Jane , Chang Shang-Hung , Hung Ming-Jui , Chan Yuk-Ying , Lai Edward Chia-Cheng
Published: October 2021

Background

The treatment effects on hospitalization for heart failure (hHF) from sodium-glucose cotransporter 2 (SGLT2) inhibitors may vary among type 2 diabetes (T2D) patients depending on whether or not they have established atherosclerotic cardiovascular diseases (ASCVD). We aimed to examine differences in hHF outcomes after dapagliflozin or empagliflozin use between T2D patients with and without a history of established ASCVD.

Methods

We conducted a retrospective multi-institutional cohort study in Taiwan. We included T2D patients newly receiving dapagliflozin or empagliflozin during 2016–2019, and followed them up until December 31, 2020. We implemented 1:1 propensity score matching to create homogenous groups for comparisons. We generated Cox proportional hazard models to compare the risk of hHF between dapagliflozin and empagliflozin (reference group). We included interaction terms of SGLT2 inhibitor and ASCVD history in the regression models to examine effect modification by ASCVD.

Results

We included a total cohort of 9,586 dapagliflozin new users and 9,586 matched empagliflozin new users. The overall hHF risks were similar for dapagliflozin and empagliflozin (HR: 0.90, 95% CI 0.74–1.09). However, differential hHF risks between dapagliflozin and empagliflozin were observed only in the subgroup without ASCVD (HR: 0.67, 95% CI 0.49–0.90), while not in the subgroup with ASCVD (HR: 1.12, 95% 0.87–1.45), and the p-value for examining interaction was 0.0097.

Conclusion

In this study, history of established ASCVD was associated with different hHF risks among SGLT2 inhibitors. For T2D patients without ASCVD, dapagliflozin may offer a more favorable hHF reduction effect, compared to empagliflozin, in clinical practice. Future prospective studies should be conducted to validate our findings.
Sequential drug delivery by injectable macroporous hydrogels for combined photodynamic-chemotherapy
Authors: Zhong Yuanyuan , Zhang Li , Sun Shian , Zhou Zhenghao , Ma Yunsu , Hong Hao , Yang Dongzhi
Published: October 2021

With hollow mesoporous silica (hMSN) and injectable macroporous hydrogel (Gel) used as the internal and external drug-loading material respectively, a sequential drug delivery system DOX-CA4P@Gel was constructed, in which combretastatin A4 phosphate (CA4P) and doxorubicin (DOX) were both loaded. The anti-angiogenic drug, CA4P was initially released due to the degradation of Gel, followed by the anti-cell proliferative drug, DOX, released from hMSN in tumor microenvironment. Results showed that CA4P was mainly released at the early stage. At 48 h, CA4P release reached 71.08%, while DOX was only 24.39%. At 144 h, CA4P was 78.20%, while DOX release significantly increased to 61.60%, showing an obvious sequential release behavior. Photodynamic properties of porphyrin endow hydrogel (ϕΔ(Gel) = 0.91) with enhanced tumor therapy effect. In vitro and in vivo experiments showed that dual drugs treated groups have better tumor inhibition than solo drug under near infrared laser irradiation, indicating the effectivity of combined photodynamic-chemotherapy.
Decreased exosome-delivered miR-486-5p is responsible for the peritoneal metastasis of gastric cancer cells by promoting EMT progress
Authors: Lin Xian-Ming , Wang Zhi-Jiang , Lin Yu-Xiao , Chen Hao
Published: October 2021

Background

The present study aims to investigate the preliminary mechanism underlying the peritoneal metastasis of gastric cancer cells.

Methods

Exosomes from GC9811 cells (Con-Exo) and from GC9811-P cells (PM-Exo) were extracted by ultracentrifugation, which were identified with transmission electron microscopy (TEM) and nanoparticle trafficking analysis, as well as the expression of CD9, CD63, and CD81 detected by Western blot assay. α-SMA expression was determined by immunofluorescence assay and Western blot assay. The levels of Snail1, E-cadherin, and Actin-related protein 3 (ACTR3) were evaluated by Western blot assay. MiRNA array was performed on exosomes to screen the differentially expressed miRNAs. The expressions of miRNAs, SMAD2, CDK4, and ACTR3 were determined by QRT-PCR. The delivery of miR-486-5p was confirmed by laser confocal detection.

Results

Firstly, TEM, nanoparticle trafficking analysis, and Western blot assays were used to confirm the successful extraction of Con-Exo and PM-Exo. The incubation of Con-Exo and PM-Exo could decrease E-cadherin expression and increase of α-SMA respectively in HMrSV5 cells, with the increased proportion of fusiform cells. More significant changes were observed in PM-Exo-treated HMrSV5 cells. Secondary, compared to Con-Exo, miR-486-5p and miR-132-3p were found downregulated, and miR-132-5p was found upregulated in PM-Exo. The transfection of miR-486-5p and miR-132-3p was observed to suppress EMT, and the transfection of miR-132-3p was observed to induce EMT. Laser confocal detection confirmed the delivery of miR-486-5p from gastric cancer cells to HMrSV5 cells through exosomes. Lastly, the expression of Mothers against decapentaplegic homolog 2 (SMAD2), cyclin-dependent kinase 4 (CDK4), and ACTR3 was found to be downregulated via miR-486-5p.

Conclusion

Decreased delivery of miR-486-5p via exosomes might be responsible for the peritoneal metastasis of gastric cancer cells by promoting epithelial-mesenchymal transition progress.
Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial
Authors: Sutherland Rachel , Campbell Elizabeth , McLaughlin Matthew , Nathan Nicole , Wolfenden Luke , Lubans David R. , Morgan Philip J. , Gillham Karen , Oldmeadow Chris , Searles Andrew , Reeves Penny , Williams Mandy , Evans Nicole , Bailey Andrew , Boyer James , Lecathelinais Christophe , Davies Lynda , McKenzie Tom , Robertson Katie , Wiggers John
Published: October 2021

Background

Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention.

Methods

A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects.

Results

At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student).

Conclusions

The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017.