Quality Improvement Intervention to Improve HPV Immunization Rates in Rural Primary Care Settings: Policy Recommendations from Post Intervention Survey

It is estimated that 8 billion dollars annually fund the prevention and treatment of Human Papillomavirus (HPV) associated cancers in the U.S. The HPV vaccine is the most effective way in preventing associated cancers when administered on-time, during adolescence. With HPV vaccination rates remaining low across the country, organizations have been researching effective interventions to improve uptake of the vaccine. In this paper we conducted a descriptive analysis of a survey completed by clinicians upon completion of an eighteen-month quality improvement (QI) intervention to increase HPV vaccination rates in rural primary care settings. New research indicates that differences in HPV vaccination rates may be related to clinic characteristics such as provider type, number of adolescent patients, staff confidence in vaccine recommendation and prioritization of quality improvement activities instead of patient differences (Hatch et al., 2022). Our evaluation explored differences among primary care specialty (family medicine and pediatric) as it relates to the likeliness of using QI processes in the future and the helpfulness of study materials and tools. We also explored differences in survey responses based on clinic ownership. We used standard survey analysis (reliability, frequency, mean and standard deviation) in SPSS to analyze the data. Reliability (Cronbach Alpha) of the survey was strong (0.89) and results suggest minor differences between primary care specialties as well as differences in clinic ownership type. This analysis provides context from the clinic’s perspective on the impact of implementing quality improvement interventions in rural primary care settings. Implications to practice and policy will be discussed as a means to support rural primary care clinics in HPV QI activities leading to improved HPV vaccination rates

Gloxinia—an open-source sensing platform to monitor the dynamic responses of plants

The study of the dynamic responses of plants to short-term environmental changes is becoming increasingly important in basic plant science, phenotyping, breeding, crop management, and modelling. These short-term variations are crucial in plant adaptation to new environments and, consequently, in plant fitness and productivity. Scalable, versatile, accurate, and low-cost data-logging solutions are necessary to advance these fields and complement existing sensing platforms such as high-throughput phenotyping. However, current data logging and sensing platforms do not meet the requirements to monitor these responses. Therefore, a new modular data logging platform was designed, named Gloxinia. Different sensor boards are interconnected depending upon the needs, with the potential to scale to hundreds of sensors in a distributed sensor system. To demonstrate the architecture, two sensor boards were designed—one for single-ended measurements and one for lock-in amplifier based measurements, named Sylvatica and Planalta, respectively. To evaluate the performance of the system in small setups, a small-scale trial was conducted in a growth chamber. Expected plant dynamics were successfully captured, indicating proper operation of the system. Though a large scale trial was not performed, we expect the system to scale very well to larger setups. Additionally, the platform is open-source, enabling other users to easily build upon our work and perform application-specific optimisations

Limitations of snapshot hyperspectral cameras to monitor plant response dynamics in stress-free conditions

Plants' dynamic eco-physiological responses are vital to their productivity in continuously fluctuating conditions, such as those in agricultural fields. However, it is currently still very difficult to capture these responses at the field scale for phenotyping purposes. Advanced hyperspectral imaging tools are increasingly used in phenotyping, and have been applied to detect changes in plants in response to a specific treatment, phenological state or monitor its growth and development. Phenotyping has to evolve towards capturing dynamic behaviour under more subtle fluctuations in environmental conditions, without the presence of clear treatments or stresses. Therefore, we investigated the potential of hyperspectral imaging to capture dynamic behaviour of plants in stress-free conditions at a temporal resolution of seconds. Two growth chamber experiments were set up, in which strawberry plants and four different background materials, serving as controls, were monitored by a snapshot hyperspectral camera in variable conditions of light, temperature and relative humidity. The sampling period was set to three seconds, triggering image acquisition and gas exchange measurements. Different background materials were used to assess the influence of the environment and the camera in both experiments. To separate the plant and background data, static masks were determined. Two datasets were created, which encompass both experiments. One dataset was constructed after averaging over the entire mask to acquire one value per spectral band. These values were then used to calculate a set of vegetation indices. The other dataset used spatial subsampling to retain spatial information. From both datasets, linear models were constructed using ridge regression, which estimated the measured eco-physiological and environmental data. Leaf temperature and vapour pressure deficit based on leaf temperature are the two main eco-physiological characteristics that could be predicted successfully. Stomatal conductance, photosynthesis and transpiration rate show less promising results. We suspect that limited variation, and low spectral resolution and range are the main causes of the inability of the models to extract meaningful predictions. Furthermore, the models that were only trained on background data also showed good predictive performance. This is probably because the main drivers for good performing eco-physiological variables are temperature and incident light intensity. Environmental characteristics that have good performance are photosynthetically active radiation and air temperature. Current hyperspectral sensing technologies are not yet able to uncover most plant dynamic eco-physiological responses when plants are cultivated in stress-free conditions

Diabetes mellitus and hypercortisolism in a cat

A fourteen-year-old Persian cat was referred because of poorly controlled diabetes mellitus despite insulin and dietary treatment. Clinical signs were severe polydipsia/polyuria (pupd), poor hair coat quality, stomatitis and hind limb weakness. At the time of initial presentation, he was treated with glargine insulin (0,75 IU/kg BID). A low dose dexamethasone suppression test (LDDST) revealed hypercortisolism (HC). The cat was additionally treated with trilostane, and remission of diabetes mellitus was obtained one year later. This case illustrates the importance of diagnosing an underlying cause of poorly controlled diabetes mellitus. Although hypercortisolism is rare in cats, it is important to consider the disease in these cases. The hypercortisolism in this cat was efficiently managed with trilostane, resulting in a good quality of life

A geophysical study of Mesquite Valley: Nevada-California border

This paper reports the results of a geophysical investigation of a sedimentary basin, Mesquite Valley, and its surrounding area in the Basin and Range province of the western United States. Mesquite Valley is located about 40 km south-southwest of Las Vegas, Nevada, and straddles the border between Nevada and California (Figure 1). It is surrounded on three sides by mountains in which Paleozoic sedimentary rocks and Precambrian granites and gneisses crop out (Figure 1) [Burchfiel et al., 1974; Durchfiel and Davis, 1971; Hewett, 1956]. Unlike most basins in the Basin and Range province, however, there are no clearly active, range-bounding normal faults, and, in general, the surrounding topography is more subdued than in the regions farther west or north

High-resolution net and gross biological production during a Celtic Sea spring bloom

Shelf seas represent only 10% of the ocean area, but support up to 30% of all oceanic primary production. There are few measurements of shelf-sea biological production at high spatial and temporal resolution in such heterogeneous and physically dynamic systems. Here, we use dissolved oxygen-to-argon (O2/Ar) ratios and oxygen triple isotopes (16O, 17O, 18O) to estimate net and gross biological production in the Celtic Sea during spring 2015. O2/Ar ratios were measured continuously using a shipboard membrane inlet mass spectrometer (MIMS). Additional discrete water samples from CTD hydrocasts were used to measure O2/Ar depth profiles and the δ(17O) and δ(18O) values of dissolved O2. These high-resolution data were combined with wind-speed based gas exchange parameterisations to calculate biologically driven air-sea oxygen fluxes. After correction for disequilibrium terms and diapycnal diffusion, these fluxes yielded estimates of net community (N(O2/Ar)) and gross O2 production (G(17O)). N(O2/Ar) was spatially heterogeneous and showed predominantly autotrophic conditions, with an average of (33±41) mmol m-2 d-1. G(17O) showed high variability between 0 and 424 mmol m-2 d-1. The ratio of N(O2/Ar) to G(17O), ƒ(O2), was (0.18±0.03) corresponding to 0.34±0.06 in carbon equivalents. We also observed rapid temporal changes in N(O2/Ar), e.g. an increase of 80 mmol m-2 d-1 in less than 6 hours during the spring bloom, highlighting the importance of high-resolution biological production measurements. Such measurements will help reconcile the differences between satellite and in situ productivity observations, and improve our understanding of the biological carbon pump

Long-term biochemical results after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy for high risk prostate cancer

Abstract Background Biochemical control from series in which radical prostatectomy is performed for patients with unfavorable prostate cancer and/or low dose external beam radiation therapy are given remains suboptimal. The treatment regimen of HDR brachytherapy and external beam radiotherapy is a safe and very effective treatment for patients with high risk localized prostate cancer with excellent biochemical control and low toxicity.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Interleukin-10 enhances the intestinal epithelial barrier in the presence of corticosteroids through p38 MAPK activity in Caco-2 monolayers : a possible mechanism for steroid responsiveness in ulcerative colitis

Altres ajuts: 2012 Spanish Gastroenterological Association i CIBER G0034Glucocorticosteroids are the first line therapy for moderate-severe flare-ups of ulcerative colitis. Despite that, up to 60% of patients do not respond adequately to steroid treatment. Previously, we reported that low IL-10 mRNA levels in intestine are associated with a poor response to glucocorticoids in active Crohn's disease. Here, we test whether IL-10 can favour the response to glucocorticoids by improving the TNFα-induced intestinal barrier damage (assessed by transepithelial electrical resistance) in Caco-2 monolayers, and their possible implications on glucocorticoid responsiveness in active ulcerative colitis. We show that the association of IL-10 and glucocorticoids improves the integrity of TNFα-treated Caco-2 cells and that p38 MAPK plays a key role. In vitro, IL-10 facilitates the nuclear translocation of p38 MAPK-phosphorylated thereby modulating glucocorticoids-receptor-α, IL-10-receptor-α and desmoglein-2 expression. In glucocorticoids-refractory patients, p38 MAPK phosphorylation and membrane desmoglein-2 expression are reduced in colonic epithelial cells. These results suggest that p38 MAPK-mediated synergism between IL-10 and glucocorticoids improves desmosome straightness contributing to the recovery of intestinal epithelium and reducing luminal antigens contact with lamina propria in ulcerative colitis. This study highlights the link between the intestinal epithelium in glucocorticoids-response in ulcerative colitis