Using Practice Facilitation to Increase Rates of Colorectal Cancer Screening in Community Health Centers, North Carolina, 2012–2013: Feasibility, Facilitators, and Barriers

INTRODUCTION: Practice facilitation involves trained individuals working with practice staff to conduct quality improvement activities and support delivery of evidence-based clinical services. We examined the feasibility of using practice facilitation to assist federally qualified health centers (FQHCs) to increase colorectal cancer screening rates in North Carolina. METHODS: The intervention consisted of 12 months of facilitation in 3 FQHCs. We conducted chart audits to obtain data on changes in documented recommendation for colorectal cancer screening and completed screening. Key informant interviews provided qualitative data on barriers to and facilitators of implementing office systems. RESULTS: Overall, the percentage of eligible patients with a documented colorectal cancer screening recommendation increased from 15% to 29% (P < .001). The percentage of patients up to date with colorectal cancer screening rose from 23% to 34% (P = .03). Key informants in all 3 clinics said the implementation support from the practice facilitator was critical for initiating or improving office systems and that modifying the electronic medical record was the biggest challenge and most time-consuming aspect of implementing office systems changes. Other barriers were staff turnover and reluctance on the part of local gastroenterology practices to perform free or low-cost diagnostic colonoscopies for uninsured or underinsured patients. CONCLUSION: Practice facilitation is a feasible, acceptable, and promising approach for supporting universal colorectal cancer screening in FQHCs. A larger-scale study is warranted

Palynological study of carbonated mounds during the holocene along the atlantic and mediterranean moroccan margins

A palynological study of carbonate mounds of Atlantic and Mediterranean Moroccan margins was conducted on sediment boxcores MD13-3441, MD13-3456, MD13-3461, MD13-3465, MD13-3468 collected during the oceanographic cruise MD 194/Eurofleet - GATEWAY, which took place on June 2013.The organic remaining revealed a dominance of dinoflagellate cysts over the continental fraction, which showed very low rates. The use of pollen data, despite their low representativity, is proving to be a valuable tool for the paleoclimate interpretation.The palynological quantitative and qualitative analysis revealed the evolution of the paleoenvironment and climate change of the carbonate mounds during this study interval. The terminal Pleistocene– basal Holocene passage highlighted by the dominance of cold taxa of dinoflagellate cysts. The presence and dominance of tree and shrub pollen coupled by the presence of altitudinal conifers confirmed a cold climate in both continental and marine environments.During the lower-middle Holocene, the variations in the relative frequencies of dinoflagellate cyst associations reflect the evolution of the paleoenvironment from inner neritic to oceanic.The recorded microflora shows a cyclicity during the lower Holocene from arid to semi-arid between 10.07 and 9.85 ka (the abundance of herbaceous and steppe), to become arid again around (9.69 ka) by the consistently high rate of herbaceous and steppe.In contrast, the paleoclimate recorded during the Middle Holocene is semi-humid to 6.29 ka (high rate of trees and shrubs) and evolves to a warm dry climate at 5.9–5.14 ka, reflected by the abundance of herbaceous and steppe

Probing predilection to Crohn's disease and Crohn's disease flares: A crowd-sourced bioinformatics approach

Background: Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal tract that affects millions of patients. While great strides have been made in treatment, namely in biologic therapy such as anti-TNF drugs, CD remains a significant health burden. Method: We conducted two meta-analyses using our STARGEO platform to tag samples from Gene Expression Omnibus. One analysis compares inactive colonic biopsies from CD patients to colonic biopsies from healthy patients as a control and the other compares colonic biopsies from active CD lesions to inactive lesions. Separate tags were created to tag colonic samples from inflamed biopsies (total of 65 samples) and quiescent tissue in CD patients (total of 39 samples), and healthy tissue from non-CD patients (total of 30 samples). Results from the two meta-analyses were analyzed using Ingenuity Pathway Analysis. Results: For the inactive CD vs healthy tissue analysis, we noted FXR/RXR and LXR/RXR activation, superpathway of citrulline metabolism, and atherosclerosis signaling as top canonical pathways. The top upstream regulators include genes implicated in innate immunity, such as TLR3 and HNRNPA2B1, and sterol regulation through SREBF2. In addition, the sterol regulator SREBF2, lipid metabolism was the top disease network identified in IPA (Fig. 1). Top upregulated genes hold implications in innate immunity (DUOX2, REG1A/1B/3A) and cellular transport and absorption (ABCG5, NPC1L1, FOLH1, and SLC6A14). Top downregulated genes largely held roles in cell adhesion and integrity, including claudin 8, PAQR5, and PRKACB.For the active vs inactive CD analysis, we found immune cell adhesion and diapedesis, hepatic fibrosis/hepatic stellate cell activation, LPS/IL-1 inhibition of RXR function, and atherosclerosis as top canonical pathways. Top upstream regulators included inflammatory mediators LPS, TNF, IL1B, and TGFB1. Top upregulated genes function in the immune response such as IL6, CXCL1, CXCR2, MMP1/7/12, and PTGS2. Downregulated genes dealt with cellular metabolism and transport such as CPO, RBP2, G6PC, PCK1, GSTA1, and MEP1B. Conclusion: Our results build off established and recently described research in the field of CD. We demonstrate the use of our user-friendly platform, STARGEO, in investigating disease and finding therapeutic avenues