bluuebunny/crossref_metadata_2025 huggingface dataset:
Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania
Authors: Manzi Fatuma , Marchant Tanya , Hanson Claudia , Schellenberg Joanna , Mkumbo Elibariki , Mlaguzi Mwanaidi , Tancred Tara
Published: September 2020

Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.
Brain ventricular enlargement in human and murine acute intermittent porphyria
Authors: Jericó Daniel , Luis Elkin O , Cussó Lorena , Fernández-Seara María A , Morales Xabier , Córdoba Karol M , Benito Marina , Sampedro Ana , Larriva María , Ramírez María J , de Salamanca Rafael Enríquez , Ortiz-de-Solorzano Carlos , Alegre Manuel , Prieto Jesús , Lanciego José Luis , D’Avola Delia , Gonzalez-Aseguinolaza Gloria , Pastor María A , Desco Manuel , Fontanellas Antonio
Published: September 2020

The morphological changes that occur in the central nervous system of patients with severe acute intermittent porphyria (AIP) have not yet been clearly established. The aim of this work was to analyse brain involvement in patients with severe AIP without epileptic seizures or clinical posterior reversible encephalopathy syndrome, as well as in a mouse model receiving or not liver-directed gene therapy aimed at correcting the metabolic disorder. We conducted neuroradiologic studies in 8 severely affected patients (6 women) and 16 gender- and age-matched controls. Seven patients showed significant enlargement of the cerebral ventricles and decreased brain perfusion was observed during the acute attack in two patients in whom perfusion imaging data were acquired. AIP mice exhibited reduced cerebral blood flow and developed chronic dilatation of the cerebral ventricles even in the presence of slightly increased porphyrin precursors. While repeated phenobarbital-induced attacks exacerbated ventricular dilation in AIP mice, correction of the metabolic defect using liver-directed gene therapy restored brain perfusion and afforded protection against ventricular enlargement. Histological studies revealed no signs of neuronal loss but a denser neurofilament pattern in the periventricular areas, suggesting compression probably caused by imbalance in cerebrospinal fluid dynamics. In conclusion, severely affected AIP patients exhibit cerebral ventricular enlargement. Liver-directed gene therapy protected against the morphological consequences of the disease seen in the brain of AIP mice.

The observational study was registered at Clinicaltrial.gov as NCT02076763.
An unfitted hybrid high-order method for the Stokes interface problem
Authors: Burman Erik , Delay Guillaume , Ern Alexandre
Published: September 2020

We design and analyze a hybrid high-order method on unfitted meshes to approximate the Stokes interface problem. The interface can cut through the mesh cells in a very general fashion. A cell-agglomeration procedure prevents the appearance of small cut cells. Our main results are inf-sup stability and a priori error estimates with optimal convergence rates in the energy norm. Numerical simulations corroborate these results.
The global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli in the community
Authors: Bezabih Yihienew M , Sabiiti Wilber , Alamneh Endalkachew , Bezabih Alamneh , Peterson Gregory M , Bezabhe Woldesellassie M , Roujeinikova Anna
Published: September 2020

Objectives

Intestinal colonization by ESBL Escherichia coli and its association with community-acquired MDR infections is of great concern. This review determined the worldwide prevalence of human faecal ESBL E. coli carriage and its trend in the community over the past two decades.

Methods

A systematic literature search was conducted using PubMed, EMBASE and Google Scholar to retrieve articles published between 1 January 2000 and 13 February 2020 that contained data on the prevalence of faecal carriage of ESBL E. coli among healthy individuals. A cumulative (for the whole period) meta-analysis was used to estimate the global and regional pooled prevalence rates. Articles were grouped into study periods of 3 years, and subgroup meta-analyses were undertaken to examine the global pooled prevalence over time.

Results

Sixty-two articles covering 29 872 healthy persons were included in this meta-analysis. The cumulative (2003–18) global pooled prevalence of ESBL E. coli intestinal carriage in the community was 16.5% (95% CI 14.3%–18.7%; P  <  0.001). The pooled prevalence showed an upward trend, increasing from 2.6% (95% CI 1.6%–4.0%) in 2003–05 to 21.1% (95% CI 15.8%–27.0%) in 2015–18. Over the whole period, the highest carriage rate was observed in South-East Asia (27%; 95% CI 2.9%–51.3%), while the lowest occurred in Europe (6.0%; 95% CI 4.6%–7.5%).

Conclusions

Globally, an 8-fold increase in the intestinal carriage rate of ESBL E. coli in the community has occurred over the past two decades. Prevention of its spread may require new therapeutic and public health strategies.
Online Social Regulation: When Everyday Diplomatic Skills for Harmonious Disagreement Break Down
Authors: Roos Carla A , Koudenburg Namkje , Postmes Tom
Published: September 2020

In group discussions, people rely on everyday diplomatic skills to socially regulate the interaction, maintain harmony, and avoid escalation. This article compares social regulation in online and face-to-face (FtF) groups. It studies the micro-dynamics of online social interactions in response to disagreements. Thirty-two triads discussed, in a repeated measures design, controversial topics via text-based online chat and FtF. The fourth group member was a confederate who voiced a deviant (right-wing) opinion. Results show that online interactions were less responsive and less ambiguous compared with FtF discussions. This affected participants’ social attributions: they felt their interaction partners ignored them and displayed disinhibited behavior. This also had relational consequences: participants experienced polarization and less solidarity. These results offer a new perspective on the process of online polarization: this might not be due to changes in individual psychology (e.g., disinhibition), but to misattributions of online behavior.
Microbial Control of the Emerald Ash Borer (Coleoptera: Buprestidae) Using Beauveria bassiana (Hypocreales: Cordycipitaceae) by the Means of an Autodissemination Device
Authors: Srei Narin , Guertin Claude , Lavallée Robert , Lajoie Marie-Ève , Brousseau Christian , Bergevin Réjean , Miller Fredric , McMillin Kendra , Trudel Richard
Published: September 2020

The FraxiProtec, an autodissemination device loaded with the fungus Beauveria bassiana isolate CFL-A, was tested in the field to evaluate its potential to infect emerald ash borer adults and reduce their populations. During the 2-yr experimental period, the dispersion of B. bassiana-infected adults was also documented to assess the dissemination capacity of the biocontrol agent beyond the treated areas. The mean percentage of infected emerald ash borer in 2017 and 2018 in 15 treated sites was 43.3 ± 2.9% and 39.7 ± 3.9%, respectively, and no significant variation was observed over the tested years. Furthermore, a 40% significant reduction of the mean emerald ash borer population growth per tree in treated sites was recorded when compared to the control sites. Emerald ash borer infected with B. bassiana isolate CFL-A were collected from baited sticky traps in the sentinel stations in the area surrounding the FraxiProtec-treated sites. Even at a distance of 125 m, an average of 9.4 ± 2.6% infected emerald ash borer were collected. Finally, exploratory analyzes were carried out on parameters such as the area to be treated, ash tree density, and FraxiProtec density to document potential relationships, which could be used in the determination of a prescription.
Distributional Preferences in Larger Groups: Keeping up with the Joneses and Keeping Track of the Tails
Authors: Fisman Raymond , Kuziemko Ilyana , Vannutelli Silvia
Published: September 2020

We study distributional preferences in larger “societies”. We conduct experiments via Mechanical Turk, in which subjects choose between two income distributions, each with seven (or more) individuals, with hypothetical incomes that aim to approximate the actual distribution of income in the United States. In contrast to prior work, our design allows us to flexibly capture the particular distributional concerns of subjects. Consistent with standard maximin (Rawlsian) preferences, subjects select distributions in which the bottom individual’s income is higher (but show little regard for lower incomes above the bottom ranking). In contrast to standard models, however, we find that subjects select distributions that lower the top individual’s income, but not other high incomes. Finally, we provide evidence of “locally competitive” preferences—in most experimental sessions, subjects select distributions that lower the income of the individual directly above them, whereas the income of the individual two positions above has little effect on subjects’ decisions. Our findings suggest that theories of inequality aversion should be adapted to account for individuals’ aversion to “topmost” and “local” disadvantageous inequality.
Comparing Selected Life-History Traits of Black Soldier Fly (Diptera: Stratiomyidae) Larvae Produced in Industrial and Bench-Top-Sized Containers
Authors: Yang Fangchun , Tomberlin Jeffery K
Published: September 2020

As global food demand is increasing along with human population growth, there is a greater need for alternative protein sources. Insect protein, especially the larvae of the black soldier fly, Hermetia illucens (L.) (Diptera: Stratiomyidae), has become a key approach for solving this issue in part due to its ability to convert organic waste into insect biomass with minimal resource (e.g., land, water) requirements. However, most information utilized to develop industrial production of this species is reliant on data generated from laboratory-scaled studies. Unfortunately, scaling these data to an industrial level potentially is not linear resulting in over, or under, estimating production. In this study, we compared selected life-history traits of larval black soldier fly produced at benchtop (e.g., 1 liter container with 614 larvae) and industrial scales (e.g., 29.5 liter container inoculated with 10,000 larvae). Larvae were provided a single feeding (2 g/larva) in each treatment. Significant differences in the mean larval weight (24.7%), survivorship (−28.2%), and biomass conversion (−2.7%) were determined between benchtop and industrial treatments. These results indicate larval number and the associated container size are important factors to consider when designing a black soldier fly factory. Furthermore, caution should be taken when applying data from laboratory studies to industrial scale production systems as the values potentially are not linear.
COVID-19: responsibility and accountability in a world of rationing
Authors: Jerry Robert H
Published: September 2020

The COVID-19 pandemic is the first modern public health crisis with the potential to overwhelm the public healthcare system. When rationing of services, drugs, and equipment must occur, healthcare providers have a responsibility to make rationing decisions fairly, both procedurally and substantively. In addition, healthcare providers, like all professionals, are accountable for their decisions. The legal standard of care requires providers to exercise the skill and knowledge normally possessed by providers in good standing in the same field or class of practice acting in the same or similar circumstances. But making rationing decisions in crisis conditions, like those created by COVID-19, is not the same as or similar to decision making in non-crisis conditions. Thus, the standard of care, properly applied, expects less of providers practicing under the stress of COVID-19’s triage conditions. Because many healthcare providers do not perceive this is true, and for pragmatic and normative reasons, policymakers should articulate rules limiting providers’ liability for rationing decisions—as well as other acts and omissions—occurring in and attendant to crisis conditions. These rules should not, however, create absolute immunities. As the COVID-19 pandemic unfolds, more states are embracing this approach.
Establishment of the Invasive Aedes aegypti (Diptera: Culicidae) in the West Valley Area of San Bernardino County, CA
Authors: Mullens Patrick , Su Tianyun , Vong Quan , Thieme Jennifer , Brown Michelle Q
Published: September 2020

The yellow fever mosquito, Aedes aegypti (Linnaeus, 1762), is the most aggressive invasive mosquito species with worldwide distribution. In addition to being a notorious nuisance species, it can pose significant public health concern because of its ability to transmit various viral pathogens. The first adult capture in the West Valley area of San Bernardino County, CA, occurred in September 2015 in Montclair. A strategic surveillance plan was implemented accordingly by the West Valley Mosquito and Vector Control District to document the infestation. The Biogent Sentinel (BG-2) trap augmented with BG-Lure and carbon dioxide (CO2) was deployed as a routine surveillance tool during 2017–2019. Extensive trapping revealed an expanding infestation, when positive trap nights (TN) increased from 14.2% in 2017 to 23.9% in 2018 and 55.6% in 2019. The average counts/TN increased from 0.65 in 2017 and 0.90 in 2018 to 3.83 in 2019. The cities of Montclair, Chino, and Ontario had much higher infestation than other cities in the district with the highest positive TN of 46.0% in Montclair, and highest average trap count of 3.23/TN in Chino. It was interesting to note that males coincided with females with more profound trend during warmer months of July to October when ratios of males ranged 28.4–35.0%. The BG-2 trap significantly outperformed the CO2 trap and gravid trap. The establishment of this invasive species in semiarid inland Southern California was further confirmed by concurrent larval collections.
First Record of Carios kelleyi (Acari: Ixodida: Argasidae) in New Jersey, United States and Implications for Public Health
Authors: Occi James L , Hall MacKenzie , Egizi Andrea M , Robbins Richard G , Fonseca Dina M
Published: September 2020

The soft tick Carios kelleyi (Cooley and Kohls), a parasite of bats known to occur in at least 29 of the 48 conterminous U.S. states, is here reported from New Jersey for the first time, based on larvae collected from big brown bats, Eptesicus fuscus. Although thought to be widespread in North America, the ecology of C. kelleyi is not well understood, despite reports of this species feeding on humans and its consequent potential as a disease vector. The association of C. kelleyi with bat species that regularly roost in human-made structures, such as attics and barns, and recent isolations from this tick of pathogens capable of infecting humans, companion animals, and livestock underscore the need for further studies of these bat ectoparasites.
The Ban of Off-Net/On-Net Price Discrimination in Chile†
Authors: Agostini Claudio A , Willington Manuel , Saavedra Eduardo
Published: September 2020

Chilean antitrust authorities banned termination-based price discrimination in mobile calls in 2012. This paper discusses the antitrust process that led to this prohibition and analyzes its merits. We characterize the discriminatory plans that the largest mobile company in Chile—Movistar—offered in 2010, when the legal dispute began, calibrate a competition model for the Chilean market—both for pre- and post-paid customers—and compare the observed price differentials with those which are justifiable on competitive grounds. The main result is that in most plans, efficiency and strategic reasons could explain the observed differential only for large call externality parameter values. We also discuss Competition Court rulings in the context of several other changes that affected the mobile telephony market in Chile and report the evolution of several key market indicators after the ban was introduced.
The Manager Caregiver
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Parnell Terri Ann
Published: September 2020

As the Manager emerges from a communication climate of HIGH/WARM conformity (strong pull to share in similar values, attitudes, beliefs, and familial role expectations) and HIGH/COLD conversation (frequent and restricted communication contacts within the family system), the priority and commitment to family is prioritized. This priority can subvert the needs of this caregiver, and the Manager can find themselves protecting the care recipient and, at times, other family members from the challenges associated with understanding a diagnosis and its treatment. The Manager is drawn to professional help and support as well as health information, but this does not mean the Manager is sure about either—and they are strongly reliant on opinions of providers and professionals in their midst. The Manager employs similar approaches to all manner of pain (physical, emotional, social, psychological, spiritual) and because of the vigilance of the Manager, serving as the expert on the patient is a key-defining trait that is communicated via interactions with providers, family, patient, and other players. This trait positions the Manager to plan and activate care and advance the dynamics of the family system in which they live.
The Carrier Caregiver
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Parnell Terri Ann
Published: September 2020

For the Carrier caregiver, caregiving is an opportunity to fulfill family duty and demonstrate family commitment through sacrifice and hard work. A HIGH and COLD conformity pattern reveals an obligation to care for other family members, an implicit understanding that illness requires immediate family mobilization, and a belief that gatekeeping is necessary to sustain and preserve family functioning. The LOW and WARM conversation pattern exposes unclear rules for talking about illness. There is inconsistency in topics discussed, ideas are disjointed, and specific circumstances when talk about illness is considered permissible. Self-restraint among family members inhibits open sharing, and nondisclosure is considered honoring family. As protector of the care recipient, the Carrier caregiver is task-driven and focuses on keeping the illness a private family experience.
Introduction
Authors: Rastegar Darius A. , Fingerhood Michael I.
Published: September 2020

The use of a variety of psychoactive substances is common, and substance use disorders are responsible for a tremendous amount of preventable morbidity and mortality. Addiction is increasingly understood as a chronic disorder that involves a complex interplay of genetics, physiology, environment, and behavior. A range of terms and definitions are used when describing these disorders. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders provides criteria for “substance use disorders.” The other major source of terminology and diagnostic criteria is the World Health Organization’s International Classification of Diseases, 10th revision, which divides this into “harmful use” and “dependence syndrome.”
Sedatives
Authors: Fingerhood Michael I.
Published: September 2020

Sedatives are used therapeutically for treatment of anxiety and insomnia; they are also used illicitly for these effects, as well as their sedating effects. An estimated 1.8 million Americans are current nonmedical users of sedatives. Many sedatives act on the gamma-aminobutyric acid receptor, producing depressed cortical function and disinhibition. Toxicity is characterized by slurred speech, impaired judgment, and unsteady gait; overdose results in stupor, coma, respiratory depression, vasomotor collapse, and even death. Withdrawal symptoms include agitation, restlessness, insomnia, anxiety, and seizures. Sedative use should be suspected in individuals with clinical signs of toxicity. Benzodiazepines and barbiturates can be detected in standard urine drug tests. Cognitive impairment and increased risk of accidental injury and falls are the most serious medical complications. Patients can be withdrawn with a taper of a long-acting benzodiazepine or phenobarbital; inpatient treatment may be required for severe use disorder or withdrawal. There are few data on the long-term treatment of sedative use disorders.
Opioids
Authors: Rastegar Darius A.
Published: September 2020

Opioids are a class of drugs that include heroin and prescription pain relievers that produce analgesia and euphoria. More than 2 million Americans have an opioid use disorder. Acute effects include analgesia, respiratory depression, miosis, and euphoria. Overdose is a serious complication of opioid use, characterized by depressed level of consciousness and respiratory depression. It can be treated with naloxone. Withdrawal symptoms include dysphoria, yawning, tearing, diarrhea, cramps, nausea, and piloerection. Buprenorphine, methadone, clonidine, and lofexidine can be used to ameliorate the symptoms of withdrawal. However, supervised withdrawal alone rarely leads to long-term abstinence. There are a number of psychosocial treatments, including self-help groups, outpatient therapy, and residential treatment; the data on their effectiveness are limited. Pharmacotherapy with an opioid agonist (methadone or buprenorphine) is the most effective treatment. Long-acting injectable naltrexone, an opioid antagonist, is also effective, but it is more difficult to initiate.
Stimulants
Authors: Graddy Ryan , Rastegar Darius A.
Published: September 2020

Stimulants are sympathomimetic substances that include cocaine, amphetamines, and cathinones. Approximately 1% of Americans have used illicit stimulants in the past month, and nearly 25,000 deaths were attributed to stimulant overdose in 2017. Acute effects include tachycardia, elevated blood pressure, and euphoria. High doses of stimulants may lead to cardiac arrhythmias, severe hypertension, agitation, myocardial infarction, aortic dissection, stroke, hyperthermia, or rhabdomyolysis. Abstinence after regular use of stimulants may lead to dysphoria, fatigue, insomnia, and agitation. People who use stimulants may present with acute effects or medical complications. Cocaine metabolites and amphetamines can be detected in urine for a few days after use. The most serious complications of acute use are cardiovascular (especially myocardial infarction and stroke) and psychiatric (agitation and delirium); the risk of hyperthermia is also increased. A number of psychosocial modalities appear to reduce stimulant use among selected individuals, including individual and group counseling, cognitive–behavioral therapy, contingency management, and community reinforcement. No medication has been consistently shown to reduce complications and use of stimulants, although prescription stimulants and topiramate show some promise for treating cocaine use disorder. Syringe exchange programs and safe consumption sites are associated with decreased stimulant use-related complications. Caffeine has mild stimulant effects and may lead to a mild dependence syndrome.
Anti-Anxiety Medicines and Hypnotics
Authors: Ansari Arash , Osser David N.
Published: September 2020

The chapter on anti-anxiety medicines and hypnotics discusses and reviews the use of benzodiazepines and barbiturates, medicines without abuse potential used for the treatments of anxiety (such as buspirone, propranolol, clonidine, prazosin, hydroxyzine, pregabalin, gabapentin, and quetiapine), as well as newer hypnotics including “z-drugs” considered for insomnia and sleep. It reviews their mechanisms of action, clinical characteristics, potential medication interactions, adverse effects, as well as their risks of dependence and misuse. It also briefly discusses complementary and alternative pharmacotherapies such as melatonin and cannabidiol. The chapter includes an in-depth discussion of the clinical use of these medications for anxiety and insomnia. It also discusses the use of anxiolytics in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of commonly used anti-anxiety medicines and hypnotics that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.
Delirium
Authors: Meagher David , Daly Cara , Adamis Dimitrios
Published: September 2020

Delirium is a common, complex neuropsychiatric syndrome that occurs in approximately one in five hospitalized patients. It is associated with a range of adverse healthcare outcomes that are independently predicted by the severity and duration of delirium. Typically 50% or more of cases of delirium are missed, misdiagnosed, or diagnosed late in everyday practice. However, routine systematic cognitive testing aligned to formal screening for delirium in high-risk cases can improve detection in everyday practice. The relationship between delirium and dementia is complex; dementia is a potent risk factor for delirium and 50% of delirium occurs in the context of a pre-existing dementia, but evidence also indicates that the occurrence of delirium can accelerate the course of dementia and that many cases of delirium are followed by long-term cognitive impairment. Delirium is highly preventable, with a third of cases avoidable by addressing a variety of patient, illness, and treatment factors. Treatment of incident delirium requires careful consideration of underlying causes, aggravating environmental factors, and prudent use of pharmacological strategies, with antipsychotic agents the preferred pharmacological intervention. Careful attention to post-delirium care can minimize functional loss, address any psychological sequelae, and reduce the risk of further episodes.
Neuropsychiatry in the civil courts
Authors: Bird Jonathan , Rix Keith
Published: September 2020

Neuropsychiatrists play an important role in the administration of justice in a variety of courts and tribunals. This chapter concerns neuropsychiatry, as it pertains to tort law specifically. The necessary considerations taken regarding the validity of an expert witness is explored, such as the expert’s credibility or the relevance of the evidence they provide, with relevance referring in this case to its probative or disprobative qualities. Practicalities are then discussed, from the structure of the neuropsychiatrist’s report to the key issues likely to arise in court, for instance whether the claimant is receiving sufficient care or the possibility they are malingering. Several law reports are cited as further evidence.
Scoping public health problems
Authors: Bammer Gabriele
Published: September 2020

This chapter aims to help you figure out what you can most effectively do, within the constraints of the resources you have, to address the public health problem you are concerned with.
Statistical understanding
Authors: Kumaran Kalyanaraman , Lang Iain
Published: September 2020

In public health practice, you are likely to use statistics for two purposes as follows: To summarize information about populations (descriptive statistics); To make inferences from data derived from research or other analysis (inferential statistics). The objective of this chapter is to help you (a) understand when statistical analysis would be useful, and (b) interpret correctly the statistics you encounter. It also contains an outline of how to use standardization to compare two populations.
Assessing longer-term health trends: disease registers
Authors: Brock Rachael , Stevens Sarah , Rashbass Jem
Published: September 2020

The objectives of this chapter are to: describe different types of disease register; explain the principles and requirements of disease registration; explore two examples of disease registration: cancer registration, and the English National Congenital Anomaly and Rare Disease Registration Service (NCARDRS); enable you to use disease registers effectively, with an awareness of their strengths and limitations.
Translating policy into indicators and targets
Authors: Battersby John
Published: September 2020

An understanding of what indicators are and how indicators and targets are constructed is essential for public health practitioners. You will be called on to interpret indicators, the performance of your department or team may be monitored using indicators, and you will be expected to meet targets. You may also have to construct indicators and set targets for others. Reading this chapter should improve your understanding of: what targets and indicators are; what they can be used for; how to go about constructing a good indicator; how to go about setting a target; when to avoid using indicators and targets. The focus of this chapter is on constructing indicators and setting targets.
Improving quality
Authors: Steel Nick , Ford John , Lang Iain , Khoshaba Bernadette
Published: September 2020

This chapter will help you understand the common approaches taken to improving quality and the competencies required of organisations, teams, and individuals to improve the quality of healthcare delivered.
Evaluating healthcare systems
Authors: McKee Martin , Karanikolos Marina , Nolte Ellen
Published: September 2020

Understand the importance of defining the boundaries of a health system in a given country; Be able to explain the functions of a health system and how these relate to one another; Be able to describe the goals of a health system and how to evaluate progress towards them; Be aware of the major contemporary initiatives to assess health system performance internationally; Recognize the limitations, including the scope for abuse, of health system comparisons.
Value-based healthcare
Authors: Gray Muir J.A. , Ricciardi Walter
Published: September 2020

The term ‘value’ has a different meaning in the singular and plural. Values, in the plural, may be regarded as a synonym for principles as in the statement that ‘this hospital’s values are compassion combined with excellence’. In the singular, the term has more of an economic meaning with four aspects.
Communicating risk
Authors: Ford John , Steel Nick , Guest Charles
Published: September 2020

By reading this chapter, you will be able to use an understanding of risk perception to communicate about risk more effectively. The health of the public is at risk from a wide range of factors, including harmful food or medicines, poorly controlled infectious diseases, pollutants or natural environmental hazards, and poor diet. Public health practitioners are often involved in minimizing the harm from these risks, and this requires communicating directly to the public or influencing stakeholders.
Partnerships
Authors: Elston Julian
Published: September 2020

This chapter should help you understand: what is meant by partnership; how national and local contexts influence partnership; what processes and interactions are key to partnership success; how to develop partnership and achieve collaboration; key elements of success and the signs of a faltering partnership.
Educational intervention
Authors: Iliou Marie Christine , Cupples Margaret E.
Published: September 2020

The impact of a cardiac disease diagnosis on patients is multidimensional. Educational interventions are at the core of the delivery of effective therapy and require multidisciplinary teamwork to identify specific impacts on individuals and coordinate activities to support changes in lifestyle behaviour. Motivational interviewing and negotiation, based on a comprehensive assessment of patients’ circumstances, should identify the support they require to engage in preventive programmes. Interventions to help patients to apply new knowledge to their everyday lives should be underpinned by the use of recognized educational principles to optimize their adoption of new behaviours. Meaningful communication between professionals and patients must be timely and ongoing, to allow appropriate feedback on progress and revision of forward plans for optimal cardiac rehabilitation (CR) and secondary prevention. The quality of programmes delivered should be evaluated regularly using specified criteria.
Management of non-conventional risk factors
Authors: Pedretti Roberto
Published: September 2020

Evidence supports the association of some non-conventional or yet to be established risk factors (RFs), such as serum uric acid (UA) or high-sensitivity C-reactive protein (hs-CRP), with the risk of arterial hypertension (HTN), metabolic syndrome, and chronic kidney disease and a worse prognosis in patients with known coronary vascular disease (CVD). However, there is no evidence from randomized controlled trials to support their use in guiding therapy. In the secondary prevention setting, detection of peripheral vascular damage and kidney dysfunction may provide significant additional prognostic implications.
G107.0+9.0: a new large optically bright, radio, and X-Ray faint galactic supernova remnant in Cepheus
Authors: Fesen Robert A , Weil Kathryn E , Raymond John C , Huet Laurent , Rusterholz Martin , di Cicco Dennis , Mittelman David , Walker Sean , Drechsler Marcel , Faworski Sheldon
Published: September 2020

Wide-field H α images of the Galactic plane have revealed a new supernova remnant (SNR) nearly 3 deg in diameter centred at l = 107.0, b = +9.0. Deep and higher resolution H α and [O iii] 5007 Å images show dozens of H α filaments along the remnant’s northern, western, and southwestern limbs, but few [O iii] bright filaments. The nebula is well detected in the H α Virginia Tech Spectral-Line Survey images, with many of its brighter filaments even visible on Digital Sky Survey images. Low-dispersion spectra of several filaments show either Balmer dominated, non-radiative filaments, or the more common SNR radiative filaments with [S II]/H α ratios above 0.5, consistent with shock-heated line emission. Emission line ratios suggest shock velocities ranging from ≤70 km s−1 along its western limb to ≃ 100 km s−1 along its northwestern boundary. While no associated X-ray emission is seen in ROSAT images, faint 1420 MHz radio emission appears coincident with its western and northern limbs. Based on an analysis of the remnant’s spatially resolved H α and [O iii] emissions, we estimate the remnant’s distance at ∼1.5−2.0 kpc implying a physically large (dia. = 75−100 pc) and old (90−110 × 103 yr) SNR in its post-Sedov radiative phase of evolution expanding into a low-density interstellar medium (n0 = 0.05−0.2 cm−3) and lying some 250−300 pc above the Galactic plane.
Environmental correlates of distribution across spatial scales in the intertidal gastropods Littoraria and Echinolittorina of the Indian coastline
Authors: Bharti D K , Shanker Kartik
Published: September 2020

Marine habitats are a mosaic of environmental conditions, which can limit species distributions despite the high dispersal potential offered by ocean currents. Periwinkle snails from the genera Littoraria and Echinolittorina disperse using planktotrophic larvae and have wide ranges in the Indo-Pacific, but patchy local distributions along the Indian coastline. To understand the environmental drivers of distribution in these intertidal snails, we used species distribution models executed in Maxent at both coastline and ocean basin scales. We obtained location information from primary and secondary sources, and used environmental predictors related to species survival, growth and reproduction spanning terrestrial and marine realms. Explanatory environmental variables broadly corresponded between scales, with maximum sea surface salinity and tidal range being common factors across species differing in their dispersal potential and habitat specificity. The Indian coastline exhibits a steep salinity and tidal range gradient, which may influence adult or larval survival through desiccation stress. In contrast to global-scale studies, temperature and productivity rarely emerged as important at the Indian coastline scale, indicating that variation along other environmental axes can drive distribution patterns at smaller spatial scales and within tropical coastlines. The results from our study provide specific hypotheses related to species-environment relationships that can be tested using field experiments to understand the drivers of species range along the Indian coastline.
Enhancing site-specific DNA integration by a Cas9 nuclease fused with a DNA donor-binding domain
Authors: Ma Shufeng , Wang Xinlong , Hu Yongfei , Lv Jie , Liu Chengfang , Liao Kaitong , Guo Xiaohua , Wang Dong , Lin Ying , Rong Zhili
Published: September 2020

The CRISPR/Cas system is widely used for genome editing. However, robust and targeted insertion of a DNA segment remains a challenge. Here, we present a fusion nuclease (Cas9-N57) to enhance site-specific DNA integration via a fused DNA binding domain of Sleeping Beauty transposase to tether the DNA segment to the Cas9/sgRNA complex. The insertion was unidirectional and specific, and DNA fragments up to 12 kb in length were successfully integrated. As a test of the system, Cas9-N57 mediated the insertion of a CD19-specific chimeric antigen receptor (CD19-CAR) cassette into the AAVS1 locus in human T cells, and induced intrahepatic cholangiocarcinoma in mice by simultaneously mediating the insertion of oncogenic KrasG12D into the Rosa26 locus and disrupting Trp53 and Pten. Moreover, the nuclease-N57 fusion proteins based on AsCpf1 (AsCas12a) and CjCas9 exhibited similar activity. These findings demonstrate that CRISPR-associated nuclease-N57 protein fusion is a powerful tool for targeted DNA insertion and holds great potential for gene therapy applications.
A high-throughput alpha particle irradiation system for monitoring DNA damage repair, genome instability and screening in human cell and yeast model systems
Authors: Stanley Fintan K T , Berger N Daniel , Pearson Dustin D , Danforth John M , Morrison Hali , Johnston James E , Warnock Tyler S , Brenner Darren R , Chan Jennifer A , Pierce Greg , Cobb Jennifer A , Ploquin Nicolas P , Goodarzi Aaron A
Published: September 2020

Ionizing radiation (IR) is environmentally prevalent and, depending on dose and linear energy transfer (LET), can elicit serious health effects by damaging DNA. Relative to low LET photon radiation (X-rays, gamma rays), higher LET particle radiation produces more disease causing, complex DNA damage that is substantially more challenging to resolve quickly or accurately. Despite the majority of human lifetime IR exposure involving long-term, repetitive, low doses of high LET alpha particles (e.g. radon gas inhalation), technological limitations to deliver alpha particles in the laboratory conveniently, repeatedly, over a prolonged period, in low doses and in an affordable, high-throughput manner have constrained DNA damage and repair research on this topic. To resolve this, we developed an inexpensive, high capacity, 96-well plate-compatible alpha particle irradiator capable of delivering adjustable, low mGy/s particle radiation doses in multiple model systems and on the benchtop of a standard laboratory. The system enables monitoring alpha particle effects on DNA damage repair and signalling, genome stability pathways, oxidative stress, cell cycle phase distribution, cell viability and clonogenic survival using numerous microscopy-based and physical techniques. Most importantly, this method is foundational for high-throughput genetic screening and small molecule testing in mammalian and yeast cells.
Programmable cross-ribosome-binding sites to fine-tune the dynamic range of transcription factor-based biosensor
Authors: Ding Nana , Yuan Zhenqi , Zhang Xiaojuan , Chen Jing , Zhou Shenghu , Deng Yu
Published: September 2020

Currently, predictive translation tuning of regulatory elements to the desired output of transcription factor (TF)-based biosensors remains a challenge. The gene expression of a biosensor system must exhibit appropriate translation intensity, which is controlled by the ribosome-binding site (RBS), to achieve fine-tuning of its dynamic range (i.e. fold change in gene expression between the presence and absence of inducer) by adjusting the translation level of the TF and reporter. However, existing TF-based biosensors generally suffer from unpredictable dynamic range. Here, we elucidated the connections and partial mechanisms between RBS, translation level, protein folding and dynamic range, and presented a design platform that predictably tuned the dynamic range of biosensors based on deep learning of large datasets cross-RBSs (cRBSs). In doing so, a library containing 7053 designed cRBSs was divided into five sub-libraries through fluorescence-activated cell sorting to establish a classification model based on convolutional neural network in deep learning. Finally, the present work exhibited a powerful platform to enable predictable translation tuning of RBS to the dynamic range of biosensors.
Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials
Authors: Hujoel Philippe P , Kato Tomotaka , Hujoel Isabel A , Hujoel Margaux L A
Published: September 2020

Context

The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility.

Objectives

(1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility.

Data sources

Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging.

Results

In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 μmol/L (standardized mean difference [SMD], −0.83; 95%CI, −1.16 to −0.49; P < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48  μmol/L or unknown (respective standardized mean differences: −0.23, 95%CI, −0.45 to −0.01, P < 0.05; and −0.56; 95%CI: −1.19 to 0.06, P < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11–28 μmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22–1.77; and 1.64; 95%CI: 1.32–2.03; P < 0.001 for both).

Conclusion

Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.
Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder
Authors: Marks Laura R , Nolan Nathanial S , Jiang Linda , Muthulingam Dharushana , Liang Stephen Y , Durkin Michael J
Published: September 2020

Background

No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated.

Methods

We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research.

Results

ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007).

Conclusions

Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.
A Cys2/His2 Zinc Finger Protein Acts as a Repressor of the Green Revolution GeneSD1/OsGA20ox2in Rice (Oryza sativaL.)
Authors: Duan Min , Ke Xiao-Juan , Lan Hong-Xia , Yuan Xi , Huang Peng , Xu En-Shun , Gao Xiu-Ying , Wang Ru-Qin , Tang Hai-Juan , Zhang Hong-Sheng , Huang Ji
Published: September 2020

Gibberellins (GAs) play important roles in the regulation of plant growth and development. The green revolution gene SD1 encoding gibberellin 20-oxidase 2 (GA20ox2) has been widely used in modern rice breeding. However, the molecular mechanism of how SD1/OsGA20ox2 expression is regulated remains unclear. Here, we report a Cys2/His2 zinc finger protein ZFP207 acting as a transcriptional repressor of OsGA20ox2. ZFP207 was mainly accumulated in young tissues and more specifically in culm nodes. ZFP207-overexpression (ZFP207OE) plants displayed semidwarfism phenotype and small grains by modulating cell length. RNA interference of ZFP207 caused increased plant height and grain length. The application of exogenous GA3 could rescue the semidwarf phenotype of ZFP207OE rice seedlings. Moreover, ZFP207 repressed the expression of OsGA20ox2 via binding to its promoter region. Taken together, ZFP207 acts as a transcriptional repressor of SD1/OsGA20ox2 and it may play a critical role in plant growth and development in rice through the fine-tuning of GA biosynthesis .