Unemployment Insurance Application and Receipt: Findings on Demographic Disparities and Suggestions for Change

In this brief, we highlight research published in the October 2012 issue of Monthly Labor Review by Alix Gould-Werth and H. Luke Shaefer of the University of Michigan that examines the extent to which the likelihood of applying for, and of receiving unemployment insurance conditional on application, varies by education level and by racial and ethnic background. Second, we highlight findings showing how perceptions of ineligibility among those who fail to apply may vary by these demographic categories. This research demonstrates that low-educated and racial minority unemployed workers -- those who may need financial support most during periods without work -- are doubly disadvantaged in accessing unemployment insurance: not only do they report lower application rates, but the unemployed who do apply also report lower rates of receipt. Even though the authors' findings leave unanswered questions about the eligibility of non-applicants and the reasons applicants fail to access UI, their evidence suggests that increasing rates of application among disadvantaged populations would narrow the gap in benefit receipt. Thus, after summarizing the relevant findings, we offer recommendations for increasing application rates

Using Mucocartilage in the Embryonic Lamprey to Elucidate the Roles of Genes Implicated in Vertebrate Cartilage Evolution and Development

The evolution and development of the vertebrate jaw provides insights into what the early vertebrate ancestral skeleton looked like. An important part of that evolution was cartilage, whose gene expression and regulatory network has been examined in gnathostomes (jawed vertebrates). The potential role of mucocartilage, a tissue unique to lamprey, in the origin of the jaw is less well understood. In the present study, genes implicated in the gnathostome cartilage gene regulatory network, including Ticho-rhino-phalangeal syndrome A(TRPSA), Growth Differentiation Factor 5 (GDF5), Transforming Growth Factor Beta Receptor 2(TGFBR2), and Transforming Growth Factor Beta Receptor 3(TGFBR3) were analyzed in the embryonic lamprey through&nbsp;in situ&nbsp;hybridizations, sectioning, staining, and preliminary CRISPR-Cas9 mediated mutagenesis to understand their roles in mucocartilage, in order to see if those genes were expressed similarly to that in gnathostomes. It was hypothesized that mucocartilage and joint tissue are homologous tissue types, and that the conserved gene regulatory network seen in gnathostomes would be observed in lamprey. All chosen genes were expressed in mucocartilage in some capacity, but the expression was not ubiquitous, nor was it confined to just mucocartilage. The upper lip, lower lip, and velum were mucocartilage areas with the most repeated cartilage and joint-associated gene expression and may be candidates for joint tissue homology. The exploratory results of the CRISPR-Cas9 mediated mutagenesis showed no functional effect, but genotyping the mutants and performing more CRISPR-Cas9 mediated mutagenesis on other genes associated with the cartilage core gene regulatory network would help elucidate the function and conservation of the chosen genes. </div

Development and characterisation of in vitro models for use in bovine tuberculosis research

Bovine tuberculosis is a pressing agricultural issue that is currently poorly understood and under-researched. The need for further studies on host-pathogen interactions between cattle and its etiological agent Mycobacterium bovis is necessary to improve agricultural economic health and animal welfare. This project first investigates the co-culture epithelial and endothelial cell bovine lung organoid model created by Diane Lee and Mark Chambers and focuses on adapting the model to examine solely the epithelial layer. The model is currently unsuccessful, and a different bovine lung model is explored to examine the response of the alveolar epithelium to M. bovis. This model involves the A549 cell line cultured at air-liquid interface, which allows the apical side of the cells to be exposed to air while being supplied with media from the basolateral side. This model will serve as a surrogate model for bovine alveolar type II (ATII) cells in the alveolar epithelium. While the relationship between M. bovis and alveolar macrophages has been studied extensively, much remains unknown about the relationship between M. bovis and ATII cells. The aim of this project is to explore how the bacterium crosses the alveolar barrier and how it affects tight junctions, mucin production, and cellular viability in the model. Proving a functional model of the response of the alveolar epithelium to M. bovis without the need for animal tissue will present an inexpensive, ethical option for alveolar epithelial host-pathogen studies of an under-researched pathogen. This study draws primarily from the works of Lee and Chambers as well as Wu et al. to create a model of the alveolar epithelium by culturing the popular ATII model cell line A549 at air-liquid interface as well as at a monolayer. Characterisation of the cells cultured as ALI shows tight junction and mucin production, as well as the presence of ATII marker Cytokeratin 18. M. bovis Bacille Calmette-Guerin infection of both the three-dimensional model and the monolayer shows that the three-dimensional model displays higher bacterial uptake than the monolayer. The study also shows that BCG does not cause significant cell death in A549 cells within the first 48 hours of infection

The speaking vocabulary of kindergarten, grade I, grade II, and grade III

Thesis (Ed.M.)--Boston Universit

Qualitative interview study exploring frontline managers’ contributions to hand hygiene standards and audit: local knowledge can inform practice

Background: Frontline managers promote hand hygiene standards and adherence to hand hygiene protocols. Little is known about this aspect of their role. Methods: Qualitative interview study with frontline managers on two acute admission wards in a large National Health Service Trust in the United Kingdom. Results: Managers reported that hand hygiene standards and audit were modelled on World Health Organization guidelines. Hand hygiene outside the immediate patient zone was not documented but managers could identify when additional indications for hand hygiene presented. They considered that audit was worthwhile to remind staff that hand hygiene is important but did not regard audit findings as a valid indicator of practice. Managers identified differences in the working patterns of nurses and doctors that affect the number and types of hand hygiene opportunities and barriers to hand hygiene. Ward managers were accepted as the custodians of hand hygiene standards. Conclusions: Frontline managers identified many of the issues currently emerging as important in contemporary infection prevention practice and research and could apply them locally. Their views should be represented when hand hygiene guidelines are reviewed and updated

Interaction between a MAPT variant causing frontotemporal dementia and mutant APP affects axonal transport.

In Alzheimer's disease, many indicators point to a central role for poor axonal transport, but the potential for stimulating axonal transport to alleviate the disease remains largely untested. Previously, we reported enhanced anterograde axonal transport of mitochondria in 8- to 11-month-old MAPTP301L knockin mice, a genetic model of frontotemporal dementia with parkinsonism-17T. In this study, we further characterized the axonal transport of mitochondria in younger MAPTP301L mice crossed with the familial Alzheimer's disease model, TgCRND8, aiming to test whether boosting axonal transport in young TgCRND8 mice can alleviate axonal swelling. We successfully replicated the enhancement of anterograde axonal transport in young MAPTP301L/P301L knockin animals. Surprisingly, we found that in the presence of the amyloid precursor protein mutations, MAPTP301L/P3101L impaired anterograde axonal transport. The numbers of plaque-associated axonal swellings or amyloid plaques in TgCRND8 brains were unaltered. These findings suggest that amyloid-β promotes an action of mutant tau that impairs axonal transport. As amyloid-β levels increase with age even without amyloid precursor protein mutation, we suggest that this rise could contribute to age-related decline in frontotemporal dementia.This work was supported by Alzheimer’s Research UK (ART/PG2009/2 to R.A.), MRC project grant (MR/L003813/1 to R.A., S.G.), Medical Research Council studentship (S.M.), Alzheimer’s Research UK studentship (ARUKPhD2013-13 to C.D.), Biotechnology and Biological Sciences Research Council Institute Strategic Programme Grant (M.P.C.), the Foundation for Alzheimer Research (FRA/SAO) (JPB) and the Belgian F.N.R.S. (K.A and JPB)

Interventions to improve antibiotic prescribing practices for hospital inpatients

Background Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. Objectives To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. Selection criteria We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and no intervention. Data collection and analysis Two review authors extracted data and assessed study risk of bias. We performed meta-analysis and meta-regression of RCTs and meta-regression of ITS studies. We classified behaviour change functions for all interventions in the review, including those studies in the previously published versions. We analysed dichotomous data with a risk difference (RD). We assessed certainty of evidence with GRADE criteria. Main results This review includes 221 studies (58 RCTs, and 163 NRS). Most studies were from North America (96) or Europe (87). The remaining studies were from Asia (19), South America (8), Australia (8), and the East Asia (3). Although 62% of RCTs were at a high risk of bias, the results for the main review outcomes were similar when we restricted the analysis to studies at low risk of bias. More hospital inpatients were treated according to antibiotic prescribing policy with the intervention compared with no intervention based on 29 RCTs of predominantly enablement interventions (RD 15%, 95% confidence interval (CI) 14% to 16%; 23,394 participants; high-certainty evidence). This represents an increase from 43% to 58% .There were high levels of heterogeneity of effect size but the direction consistently favoured intervention. The duration of antibiotic treatment decreased by 1.95 days (95% CI 2.22 to 1.67; 14 RCTs; 3318 participants; high-certainty evidence) from 11.0 days. Information from non-randomised studies showed interventions to be associated with improvement in prescribing according to antibiotic policy in routine clinical practice, with 70% of interventions being hospital-wide compared with 31% for RCTs. The risk of death was similar between intervention and control groups (11% in both arms), indicating that antibiotic use can likely be reduced without adversely affecting mortality (RD 0%, 95% CI -1% to 0%; 28 RCTs; 15,827 participants; moderate-certainty evidence). Antibiotic stewardship interventions probably reduce length of stay by 1.12 days (95% CI 0.7 to 1.54 days; 15 RCTs; 3834 participants; moderate-certainty evidence). One RCT and six NRS raised concerns that restrictive interventions may lead to delay in treatment and negative professional culture because of breakdown in communication and trust between infection specialists and clinical teams (low-certainty evidence). Both enablement and restriction were independently associated with increased compliance with antibiotic policies, and enablement enhanced the effect of restrictive interventions (high-certainty evidence). Enabling interventions that included feedback were probably more effective than those that did not (moderate-certainty evidence). There was very low-certainty evidence about the effect of the interventions on reducing Clostridium difficile infections (median -48.6%, interquartile range -80.7% to -19.2%; 7 studies). This was also the case for resistant gram-negative bacteria (median -12.9%, interquartile range -35.3% to 25.2%; 11 studies) and resistant gram-positive bacteria (median -19.3%, interquartile range -50.1% to +23.1%; 9 studies). There was too much variance in microbial outcomes to reliably assess the effect of change in antibiotic use. Heterogeneity of intervention effect on prescribing outcomes We analysed effect modifiers in 29 RCTs and 91 ITS studies. Enablement and restriction were independently associated with a larger effect size (high-certainty evidence). Feedback was included in 4 (17%) of 23 RCTs and 20 (47%) of 43 ITS studies of enabling interventions and was associated with greater intervention effect. Enablement was included in 13 (45%) of 29 ITS studies with restrictive interventions and enhanced intervention effect. Authors' conclusions We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions

The Impact of Homogeneous Versus Heterogeneous Emphysema on Dynamic Hyperinflation in Patients With Severe COPD Assessed for Lung Volume Reduction

Dynamic hyperinflation (DH) is a pathophysiologic hallmark of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to investigate the impact of emphysema distribution on DH during a maximal cardiopulmonary exercise test (CPET) in patients with severe COPD. This was a retrospective analysis of prospectively collected data among severe COPD patients who underwent thoracic high-resolution computed tomography, full lung function measurements and maximal CPET with inspiratory manouvers as assessment for a lung volume reduction procedure. ΔIC was calculated by subtracting the end-exercise inspiratory capacity (eIC) from resting IC (rIC) and expressed as a percentage of rIC (ΔIC %). Emphysema quantification was conducted at 3 predefined levels using the syngo PULMO-CT (Siemens AG); a difference >25% between best and worse slice was defined as heterogeneous emphysema. Fifty patients with heterogeneous (62.7% male; 60.9 ± 7.5 years old; FEV(1)% = 32.4 ± 11.4) and 14 with homogeneous emphysema (61.5% male; 62.5 ± 5.9 years old; FEV(1)% = 28.1 ± 10.3) fulfilled the enrolment criteria. The groups were matched for all baseline variables. ΔIC% was significantly higher in homogeneous emphysema (39.8% ± 9.8% vs.31.2% ± 13%, p = 0.031), while no other CPET parameter differed between the groups. Upper lobe predominance of emphysema correlated positively with peak oxygen pulse, peak oxygen uptake and peak respiratory rate, and negatively with ΔIC%. Homogeneous emphysema is associated with more DH during maximum exercise in COPD patients