Implementing State Health Reform: Lessons for Policymakers

Drawing on five states' experiences, discusses questions and considerations, including the need to coordinate state agencies' work and share data, simplify eligibility and enrollment procedures, and involve community groups and businesses in outreach

Machine vs. Human: Exploring Syntax and Lexicon in German Translations, with a Spotlight on Anglicisms

Machine Translation (MT) has become an integral part of daily life for millions of people, with its output being so fluent that users often cannot distinguish it from human translation. However, these fluid texts often harbor algorithmic traces, from limited lexical choices to societal misrepresentations. This raises concerns about the possible effects of MT on natural language and human communication and calls for regular evaluations of machine-generated translations for different languages. Our paper explores the output of three widely used engines (Google, DeepL, Microsoft Azure) and one smaller commercial system. We translate the English and French source texts of seven diverse parallel corpora into German and compare MT-produced texts to human references in terms of lexical, syntactic, and morphological features. Additionally, we investigate how MT leverages lexical borrowings and analyse the distribution of anglicisms across the German translations

Using the soil and water assessment tool to simulate the pesticide dynamics in the data scarce Guayas River Basin, Ecuador

Agricultural intensification has stimulated the economy in the Guayas River basin in Ecuador, but also affected several ecosystems. The increased use of pesticides poses a serious threat to the freshwater ecosystem, which urgently calls for an improved knowledge about the impact of pesticide practices in this study area. Several studies have shown that models can be appropriate tools to simulate pesticide dynamics in order to obtain this knowledge. This study tested the suitability of the Soil and Water Assessment Tool (SWAT) to simulate the dynamics of two different pesticides in the data scarce Guayas River basin. First, we set up, calibrated and validated the model using the streamflow data. Subsequently, we set up the model for the simulation of the selected pesticides (i.e., pendimethalin and fenpropimorph). While the hydrology was represented soundly by the model considering the data scare conditions, the simulation of the pesticides should be taken with care due to uncertainties behind essential drivers, e.g., application rates. Among the insights obtained from the pesticide simulations are the identification of critical zones for prioritisation, the dominant areas of pesticide sources and the impact of the different land uses. SWAT has been evaluated to be a suitable tool to investigate the impact of pesticide use under data scarcity in the Guayas River basin. The strengths of SWAT are its semi-distributed structure, availability of extensive online documentation, internal pesticide databases and user support while the limitations are high data requirements, time-intensive model development and challenging streamflow calibration. The results can also be helpful to design future water quality monitoring strategies. However, for future studies, we highly recommend extended monitoring of pesticide concentrations and sediment loads. Moreover, to substantially improve the model performance, the availability of better input data is needed such as higher resolution soil maps, more accurate pesticide application rate and actual land management programs. Provided that key suggestions for further improvement are considered, the model is valuable for applications in river ecosystem management of the Guayas River basin

Zwischen Wertschätzung und Überlastung: Wie Schweizerinnen und Schweizer die Fülle von Informationen und Angeboten erleben

Wie erleben Schweizerinnen und Schweizer die Fülle von Informationen und Angeboten in der heutigen digitalen Medienumgebung? Eine Studie der Universität Zürich hat sich dieser Frage gewidmet und das Erleben der Informations- und Angebotsmenge in den Bereichen der Nachrichten, Unterhaltung und der digitalen persönlichen Kommunikation miteinander verglichen. Die Befunde basieren auf Fokusgruppen-Interviews und einer Online-Befragung in der Deutschschweiz

Modelling tools to analyze and assess the ecological impact of hydropower dams

We critically analyzed a set of ecological models that are used to assess the impact of hydropower dams on water quality and habitat suitability for biological communities. After a literature search, we developed an integrated conceptual model that illustrates the linkages between the main input variables, model approaches, the output variables and biotic-abiotic interactions in the ecosystems related to hydropower dams. We found that variations in water flow and water depth coupled with increased nutrient availability are major variables that contribute to structural and functional ecosystem changes. We also found that ecological models are an important tool to assess the impact of hydropower dams. For instance, model simulation of different scenarios (e.g., with and without the dam, different operation methods) can analyze and predict the related ecosystem shifts. However, one of the remaining shortcomings of these models is the limited capacity to separate dam-related impacts from other anthropogenic influences (e.g., agriculture, urbanization). Moreover, collecting sufficient high-quality data to increase the statistical power remains a challenge. The severely altered conditions (e.g., generation of very deep lakes) also lead to difficulties for standardized data collection. We see future opportunities in the integration of models to improve the understanding of the different processes affected by hydropower dam development and operation, as well as the use of remote sensing methods for data collection

Urinary neurotransmitter analysis and canine behavior assessment

Behavioral problems are highly prevalent in domestic dogs, negatively affecting the quality of life of dogs and their owners. In humans and dogs, neuropsychological or neurobehavioral disorders can be associated with deviations in various neurotransmitter systems. Previous evidence has revealed correlations between urinary neurotransmitters and various behavioral disorders; however, a causal relationship has not yet been conclusively demonstrated. Non-invasive urinary neurotransmitter analysis may identify specific biomarkers, which enable a more differentiated assessment of canine behavioral disorders in the future and contribute to more effective neuromodulatory treatment decisions and monitoring. This approach could offer new insights into underlying pathomechanisms of canine neurobehavioral disorders. This study assessed urinary neurotransmitter levels and the descriptive behavior profile of 100 dogs using established rating scales (Canine Behavioral Assessment and Research Questionnaire, Attention Deficit Hyperactivity Disorder Rating Scale, Dog Personality Questionnaire, Canine Cognitive Dysfunction Rating Scale), and explored relationships between these variables. No correlation was found between urinary neurotransmitters and the assessed behavior profiles; however, age-, sex- and neuter-related influences were identified. The lack of correlation could be explained by the many confounding factors influencing both behavior and urinary neurotransmitter excretion, including age, sex and neuter status effects, and methodological issues e.g., low discriminatory power between anxiety and aggression in the descriptive behavior evaluation. Urinary neurotransmitter testing could not be validated as a tool for canine behavior evaluation in this study. However, reliable assessment methods with low susceptibility to human biases could be valuable in the future to support behavioral-phenotype diagnoses

Polymorphism in COMT is associated with IgG 3 subclass level and susceptibility to infection in patients with chronic fatigue syndrome

Background Chronic fatigue syndrome (CFS) is considered as a neuroimmunological disease but the etiology and pathophysiology is poorly understood. Patients suffer from sustained exhaustion, cognitive impairment and an increased sensitivity to pain and sensory stimuli. A subset of patients has frequent respiratory tract infections (RRTI). Dysregulation of the sympathetic nervous system and an association with genetic variations in the catechol-O-methyltransferase (COMT) and glucocorticoid receptor genes influencing sympathetic and glucocorticoid metabolism were reported in CFS. Here, we analyzed the prevalence of SNPs of COMT and glucocorticoid receptor- associated genes in CFS patients and correlated them to immunoglobulin levels and susceptibility to RRTI. Methods We analyzed blood cells of 74 CFS patients and 76 healthy controls for polymorphisms in COMT, FKBP5 and CRHR1 by allelic discrimination PCR. Serum immunoglobulins were determined by immunoturbidimetric technique, cortisol levels by ECLIA. Results Contrary to previous reports, we found no difference between CFS patients and healthy controls in the prevalence of SNPs for COMT, FKBP5 and CRHR1. In patients with the Met/Met variant of COMT rs4680 we observed enhanced cortisol levels providing evidence for its functional relevance. Both enhanced IgE and diminished IgG 3 levels and an increased susceptibility to RRTI were observed in CFS patients with the Met/Met variant. Such an association was not observed in 68 non-CFS patients with RRTI. Conclusion Our results indicate a relationship of COMT polymorphism rs4680 with immune dysregulation in CFS providing a potential link for the association between stress and infection susceptibility in CFS

Evaluation of Antimicrobial Usage in Dogs and Cats at a Veterinary Teaching Hospital in Germany in 2017 and 2018

In contrast to food-producing animals, where the documentation of the usage of antimicrobials is regulated by law, antimicrobial usage (AMU) in dogs and cats is only sparsely monitored. We collected data generated by an electronic practice management software (EPMS) between January 1, 2017 and December 31, 2018 to investigate AMU. All information was obtained from clinical routine data from the Department of Small Animal Medicine and Surgery (DSAM), University of Veterinary Medicine Hannover (TiHo). In 2017, 78,076 drug administrations were documented for 5,471 dogs and cats, of which 14,020 (17.96%) were antimicrobial drugs (AMs) specifically documented in 2,910 (51.31%) dogs and cats. In 2018, 104,481 drug administrations were documented for 5,939 dogs and cats. Of these drug administrations, 18,170 (17.39%) AM administrations were documented for 3,176 (53.48%) dogs and cats. Despite the increasing documentation of AM administrations, differences between 2017 and 2018 were not statistically significant [odds ratio (OR), 1.01; 95% confidence interval (CI), 0.98–1.03]. Prescription diversity (PD) in 2017 for dogs was 0.92 and for cats 0.89. In 2018, PD for dogs was 0.93 and for cats 0.88. As well as the documented number of AM administrations, the documented amount of active ingredients administered in 2018 (total: 17.06 kg; dogs: 16.11 kg, cats: 0.96 kg) increased compared with 2017 (total: 15.60 kg; dogs: 14.80 kg, cats: 0.80 kg). In 2017 and 2018, the most commonly administered antimicrobial groups were penicillins, nitroimidazoles, and quinolones for dogs and cats, respectively. While the in-house point-of-care administration accounts for the largest share of the documented amount of AMs administered, the highest number of documented AM administrations was assigned to inpatient care in 2017 and 2018, respectively. However, AM administration in outpatient care remained the lowest in both years. Since no statistically significant difference in AM administrations was observed between 2017 and 2018 and the most commonly used AMs at the DSAM were ranked, data can be used as a baseline to evaluate how changes in in-house guidelines and future legal requirements affect the prescribing culture. Data generated within the DSAM should be evaluated annually

Gender Disparities in Alcohol Use Disorder Treatment Among Privately Insured Patients with Alcohol‐Associated Cirrhosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147837/1/acer13944_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147837/2/acer13944.pd

Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients

Background Patient demand for email contact with physician practices is high. If physicians met this demand, improvements in communication, quality of care and patient satisfaction could result. However, physicians have typically been hesitant to communicate electronically with patients, largely due to concerns relating to workload, security and lack of compensation. Goal To assess physician attitudes towards electronic communication with patients six months after the implementation of an application called Patient Gateway. Patient Gateway allows patients to access an extract of their medical record and facilitates online communication with medical practices. Methods A paper-based survey was administered to the 43 primary care physicians in one integrated delivery system, with a 56% (24/43) response rate. Results Overall, physicians felt that Patient Gateway’s impact on their practices was positive, especially in the areas of refill and referral request management and appointment scheduling. However, physicians are still hesitant to increase general electronic communication with patients; none opted to use Patient Gateway’s general messaging function with patients, and those who had previously used outside systems to exchange emails with some patients continued to communicate with only a small proportion of their patient panel in this way. However, 38% of physicians already communicate with their own physicians via email, and another 19% would like to do so. Conclusions Physicians’ fears about being overwhelmed with messages were not realised. While physicians were generally enthusiastic about the application, none used it directly to communicate with patients. Over three-quarters of respondents indicated that they would be more enthusiastic about electronic communication with patients if this time were compensated