Leveraging University-Community Partnerships in Rural Georgia: A Community Health Needs Assessment Template for Hospitals

Background: Under the Affordable Care Act, nonprofit hospitals are required to conduct a Community Health Needs Assessment (CHNA) every three years. Using recommendations proposed by Georgia Watch, students and faculty members from the University of Georgia (UGA) conducted a CHNA for a hospital in a rural county in Georgia. The purpose of the CHNA was to identify community health problems and needs, as well as community assets and resources. The aim of this report is to describe the process for conducting the CHNA, the findings, and the lessons learned. Methods: The CHNA team consisted of students and faculty members from UGA’s College of Public Health and a Public Service and Outreach professional who worked in the community. In completing the CHNA, the team used the following fivestep process: define community, collect secondary data on community health, gather community input and collect primary data, prioritize community health needs, and implement strategies to address community health needs. Primary and secondary data were collected. Results: By triangulating findings across data sources, the CHNA team created a community health profile for the service area of the hospital. Based on these findings, the community identified four main areas for improvement, prioritized these health issues, and developed an implementation strategy for the hospital and community. Conclusions: The process used to conduct this CHNA can serve as a model for other rural communities undergoing similar assessments. Lessons learned from completing this CHNA can be applied to future CHNA efforts

Rural Community Health Needs Assessment Findings: Access to Care and Mental Health

This article highlights the qualitative results from focus groups conducted as part of a Community Health Needs Assessments in two rural Georgia communities. Four 1-hr focus groups were facilitated with 32 community stakeholders. Sessions were audio recorded and transcribed verbatim. Thematic analysis identified two primary themes: mental health and barriers to accessing health care. Focus group participants discussed mental health challenges as they related to substance abuse and suicide. Participants acknowledged barriers to access, including no health insurance, cost, eligibility gaps for government-sponsored programs, the low availability of specialty care, and poverty. Addressing mental health and access to care in rural communities may require alternative, tailored programs

Identification of antiviral roles for the exon-junction complex and nonsense-mediated decay in flaviviral infection.

West Nile virus (WNV) is an emerging mosquito-borne flavivirus, related to dengue virus and Zika virus. To gain insight into host pathways involved in WNV infection, we performed a systematic affinity-tag purification mass spectrometry (APMS) study to identify 259 WNV-interacting human proteins. RNA interference screening revealed 26 genes that both interact with WNV proteins and influence WNV infection. We found that WNV, dengue and Zika virus capsids interact with a conserved subset of proteins that impact infection. These include the exon-junction complex (EJC) recycling factor PYM1, which is antiviral against all three viruses. The EJC has roles in nonsense-mediated decay (NMD), and we found that both the EJC and NMD are antiviral and the EJC protein RBM8A directly binds WNV RNA. To counteract this, flavivirus infection inhibits NMD and the capsid-PYM1 interaction interferes with EJC protein function and localization. Depletion of PYM1 attenuates RBM8A binding to viral RNA, suggesting that WNV sequesters PYM1 to protect viral RNA from decay. Together, these data suggest a complex interplay between the virus and host in regulating NMD and the EJC

Interventions to improve or maintain lower-limb function among ambulatory adolescents with cerebral palsy: a cross-sectional survey of current practice in the UK.

2 Objectives: To describe physiotherapy management to improve or maintain lower-limb 1 function among adolescents with cerebral palsy, classified in Gross Motor Function 2 Classification System levels I-III, in the United Kingdom. 3 Methods: A list of interventions was identified using a nominal group technique and 4 developed into a survey, which was distributed to approximately 2,100 paediatric 5 physiotherapists in the UK through the Association of Paediatric Chartered Physiotherapists 6 and a private physiotherapy clinic in London between April and June 2015. One-hundred and 7 thirty-five physiotherapists completed the survey. Survey respondents indicated how 8 frequently they used each intervention (i.e. “frequently”, “sometimes”, “rarely”, “never”) in 9 the past year. 10 Results: Provision of explanations to the child, liaison with families, liaison with health 11 professionals, provision of advice to schools, and stretching were the most frequently used 12 interventions with 90%, 90%, 86%, 79%, and 76% of respondents, respectively, reporting 13 that they frequently used each. The interventions most commonly reported as “never” used 14 were conductive education (88%), MOVE programme (85%), functional electrical 15 stimulation (82%), body-weight supported treadmill training (80%), and rebound therapy 16 (71%). 17 Conclusions: This study suggests that a large number of interventions are used by 18 physiotherapists in the UK to improve or maintain lower-limb function among adolescents 19 with CP, not all of which are evidence-based

Injectable, Reversibly Thermoresponsive Captopril-Laden Hydrogel for the Local Treatment of Sensory Loss in Diabetic Neuropathy

A major and irreversible complication of diabetes is diabetic peripheral neuropathy (DPN), which can lead to significant disability and decreased quality of life. Prior work demonstrates the peptide hormone Angiotensin II (Ang II) is released locally in neuropathy and drives inflammation and impaired endoneurial blood flow. Therefore, we proposed that by utilizing a local thermoresponsive hydrogel injection, we could deliver inhibitors of angiotensin-converting enzyme (ACE) to suppress Ang II production and reduce nerve dysfunction in DPN through local drug release. The ACE inhibitor captopril was encapsulated into a micelle, which was then embedded into a reversibly thermoresponsive pluronics-based hydrogel matrix. Drug-free and captopril-loaded hydrogels demonstrated excellent product stability and sterility. Rheology testing confirmed sol properties with low viscosity at ambient temperature and increased viscosity and gelation at 37 °C. Captopril-loaded hydrogels significantly inhibited Ang II production in comparison to drug-free hydrogels. DPN mice treated with captopril-loaded hydrogels displayed normalized mechanical sensitivity and reduced inflammation, without side-effects associated with systemic exposure. Our data demonstrate the feasibility of repurposing ACE inhibitors as locally delivered anti-inflammatories for the treatment of sensory deficits in DPN. To the best of our knowledge, this is the first example of a locally delivered ACE inhibitor for the treatment of DPN

Can Community Structure Track Sea-Level Rise? Stress and Competitive Controls in Tidal Wetlands

Climate change impacts, such as accelerated sea-level rise, will affect stress gradients, yet impacts on competition/stress tolerance trade-offs and shifts in distributions are unclear. Ecosystems with strong stress gradients, such as estuaries, allow for space-for-time substitutions of stress factors and can give insight into future climate-related shifts in both resource and nonresource stresses. We tested the stress gradient hypothesis and examined the effect of increased inundation stress and biotic interactions on growth and survival of two congeneric wetland sedges, Schoenoplectus acutus and Schoenoplectus americanus. We simulated sea-level rise across existing marsh elevations and those not currently found to reflect potential future sea-level rise conditions in two tidal wetlands differing in salinity. Plants were grown individually and together at five tidal elevations, the lowest simulating an 80-cm increase in sea level, and harvested to assess differences in biomass after one growing season. Inundation time, salinity, sulfides, and redox potential were measured concurrently. As predicted, increasing inundation reduced biomass of the species commonly found at higher marsh elevations, with little effect on the species found along channel margins. The presence of neighbors reduced total biomass of both species, particularly at the highest elevation; facilitation did not occur at any elevation. Contrary to predictions, we documented the competitive superiority of the stress tolerator under increased inundation, which was not predicted by the stress gradient hypothesis. Multifactor manipulation experiments addressing plant response to accelerated climate change are integral to creating a more realistic, valuable, and needed assessment of potential ecosystem response. Our results point to the important and unpredicted synergies between physical stressors, which are predicted to increase in intensity with climate change, and competitive forces on biomass as stresses increase

Tier 1 University Transportation Center Match Funds for the Strategic Implications of Changing Public Transportation Travel Trends

69A3552047141Even before the onset of the COVID-19 pandemic, public transit ridership was declining in many metropolitan areas in the United States. To regain riders, transit agencies and their partners must make decisions about which strategies and policies to pursue within the constraints of their operating environments. To help address this, the Transit-Serving Communities Optimally, Responsively, and Efficiently (T-SCORE) Tier 1 University Transportation Center was set up as a research consortium from 2020 to 2023 led by Georgia Tech with research partners at the University of Kentucky, Brigham Young University and University of Tennessee, Knoxville (UTK). The T-SCORE Center had two primary research tracks: (1) Community Analysis (led by the University of Tennessee; included in this report) and (2) Multi-Modal Optimization and Simulation (led by the University of Kentucky; not included). The Community Analysis research track employed a combination of quantitative and qualitative research methods to assess three main drivers of change that have affected transit ridership: price and socioeconomic factors, the competitive landscape, and system disruptions, including COVID-19. The research approach for the Community Analysis track was divided into separate projects, and the UTK team led three projects that aimed to: (1) quantify the impact of different factors affecting transit ridership - including the COVID-19 pandemic - at a nationwide scale; (2) assess the impacts of shared micromobility, particularly electric scooters, on transit ridership; and (3) evaluate new fare payment technologies and emerging pricing strategies, with the vision of taking a step toward Mobility-as-a-Service (MaaS). The findings of these three Community Analysis projects can help inform transit agencies and city officials making decisions about how to increase transit ridership and plan for a sustainable future

Acute kidney injury in patients treated with immune checkpoint inhibitors

Background: Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. Methods: We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. Results: ICPi-AKI occurred at a median of 16 weeks (IQR 8-32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3-10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. Conclusions: Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery

Mutations Associated with Acquired Resistance to PD-1 Blockade in Melanoma

BACKGROUND: Approximately 75% of objective responses to anti–programmed death 1 (PD-1) therapy in patients with melanoma are durable, lasting for years, but delayed relapses have been noted long after initial objective tumor regression despite continuous therapy. Mechanisms of immune escape in this context are unknown. METHODS: We analyzed biopsy samples from paired baseline and relapsing lesions in four patients with metastatic melanoma who had had an initial objective tumor regression in response to anti–PD-1 therapy (pembrolizumab) followed by disease progression months to years later. RESULTS: Whole-exome sequencing detected clonal selection and outgrowth of the acquired resistant tumors and, in two of the four patients, revealed resistance-associated loss-of-function mutations in the genes encoding interferon-receptor–associated Janus kinase 1 (JAK1) or Janus kinase 2 (JAK2), concurrent with deletion of the wild-type allele. A truncating mutation in the gene encoding the antigen-presenting protein beta-2-microglobulin (B2M) was identified in a third patient. JAK1 and JAK2 truncating mutations resulted in a lack of response to interferon gamma, including insensitivity to its antiproliferative effects on cancer cells. The B2M truncating mutation led to loss of surface expression of major histocompatibility complex class I. CONCLUSIONS: In this study, acquired resistance to PD-1 blockade immunotherapy in patients with melanoma was associated with defects in the pathways involved in interferon-receptor signaling and in antigen presentation. (Funded by the National Institutes of Health and others.