BUILDING AND SUSTAINING VIRTUAL PATIENT MEDICAL HOMES DURING THE COVID-19 PANDEMIC

The purpose of this study was to evaluate the [redacted] Primary Care Network’s ([redacted] PCN) ability to support 61 primary care practices in building and sustaining virtual Patient Medical Homes (PMHs) during the COVID-19 pandemic. A mixed methods evaluation determined that the [redacted] PCN achieved this mandate. The organization provided physician members with access to allied health care team members using virtual platforms. Care coordinators continued to optimize the use of Electronic Medical Records (EMRs) from their home offices. Patient care remained of high quality, revealed through the analysis of patient experience data collected both before and during the pandemic. Despite a new requirement to work remotely, healthcare teams remained collaborative. The number of clinics that the PCN supported in improvement work remained steady as the pandemic progressed in March and thereafter.http://deepblue.lib.umich.edu/bitstream/2027.42/166317/1/AFM-90-21_PP.pdfDescription of AFM-90-21_PP.pdf : Main ArticleSEL

Agricultural climate change mitigation : Carbon calculators as a guide for decision making

This is an Accepted Manuscript of an article published by Taylor & Francis Group in International Journal of Agricultural Sustainability on 9 November 2017, available online: https://doi.org/10.1080/14735903.2017.1398628. Under embargo. Embargo end date: 9 November 2018.The dairy industry is receiving considerable attention in relation to both its significant greenhouse gas (GHG) emissions, and it’s potential for reducing those emissions, contributing towards meeting national targets and driving the industry towards sustainable intensification. However, the extent to which improvements can be made is dependent on the decision making processes of individual producers, so there has been a proliferation of carbon accounting tools seeking to influence those processes. This paper evaluates the suitability of such tools for driving environmental change by influencing on-farm management decisions. Seven tools suitable for the European dairy industry were identified, their characteristics evaluated, and used to process data relating to six scenario farms, emulating process undertaken in real farm management situations. As a result of the range of approaches taken by the tools, there was limited agreement between them as to GHG emissions magnitude, and no consistent pattern as to which tools resulted in the highest/lowest results. Despite this it is argued, that as there was agreement as to the farm activities responsible for the greatest emissions, the more complex tools were still capable of performing a ‘decision support’ role, and guiding management decisions, whilst others could merely focus attention on key issues.Peer reviewe

Problems of Benchmarking Greenhouse Gas Emissions in Dairy Agriculture

This document is the Accepted Manuscript version. The final, published version is available online at https://doi.org/10.1108/BIJ-10-2015-0101.Purpose – To examine the suitability of free carbon calculators aimed at the agricultural industry, for use in greenhouse gas emission benchmarking, using the European dairy industry as an example. Design/methodology/approach – Carbon calculators which were claimed to be applicable to European dairy farms were identified and tested using six production scenarios based on data from real European farms supplemented using published literature. The resulting greenhouse gas emission estimates, together with estimates apportioned using three functional units, were then compared to determine the robustness of the benchmarking results. Findings – It was found that although there was a degree of agreement between the seven identified carbon calculators in terms of benchmarking total farm emissions, once a suitable functional unit was applied little agreement remained. Tools often ranked farms in different orders, thereby calling into question the robustness of benchmarking in the studied sector. Research limitations – The scenario based approach taken has identified issues liable to result in a lack of benchmarking robustness within this sector; however, there remains considerable scope to evaluate these findings in the field, both within this sector and others in the agricultural industry. Practical implications – The results suggest that there are significant hurdles to overcome if GHG emission benchmarking is to aid in driving forward the environmental performance of the dairy industry. In addition, eco-labelling foods based on GHG benchmarking may be of questionable value. Originality/value – At a time when environmental benchmarking is of increasing importance, this paper seeks to evaluate its applicability to sectors in which there is considerable scope for variation in the results obtained.Peer reviewe

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Children with Chronic Hepatitis B in the United States and Canada

ObjectivesTo test the hypothesis that children with chronic hepatitis B living in the US and Canada would have international origins and characteristic hepatitis B virus (HBV) genotypes and laboratory profiles.Study designClinical characteristics of children enrolled in the Hepatitis B Research Network were collected from 7 US and Canadian centers.ResultsChildren (n = 343) with an age range of 1.0-17.8 years were enrolled; 78% of the children were Asian, 55% were adopted, and 97% had international origins with either the child or a parent born in 1 of 31 countries. The majority had HBV genotype B (43%) or C (32%), and the remainder had genotype A (5%), D (16%), E (4%), or multiple (<1%). Children with genotype B or C were more likely to be Asian (98% and 96%), more consistently hepatitis B envelope antigen positive (95% and 82%), had higher median HBV DNA levels (8.2 and 8.3 log10 IU/mL), and less frequently had elevated alanine aminotransferase values (43% and 57%) compared with children with other genotypes. The percentage of hepatitis B envelope antigen positivity and of those with HBV DNA ≥6 log₁₀ IU/mL declined with age.ConclusionsThe majority of children in the Hepatitis B Research Network have HBV genotypes that reflect their international origins. Clinical and laboratory data differ substantially by patient age and HBV genotype. Use of these data can help drive the development of optimal strategies to manage and treat children with chronic hepatitis B