Integration of Tobacco Treatment Services into Cancer Care at Stanford.

As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated "opt-out" referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

CITATION: Langlois, E. V., et al. 2016. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Research Policy and Systems, 14:20, doi:10.1186/s12961-016-0089-0.The original publication is available at http://health-policy-systems.biomedcentral.comENGLISH SUMMARY : Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals’ abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a ‘buddying’ process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. Conclusions: The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0089-0Publisher's versio

Understanding the Structure of High Density Lipoprotein

The high-density lipoprotein (HDL), the carrier of ‘good cholesterol’, transports cholesterol from periphery cells to liver for catabolism, a process termed reverse cholesterol transport. In this project we focused on obtaining and characterizing HDL particles.https://engagedscholarship.csuohio.edu/u_poster_2012/1029/thumbnail.jp

Rapid Recovery From Bell\u27s Palsy Using Transcranial Magnetic Stimulation of the Facial Nerve: A Case Report

Transcranial magnetic stimulation (TMS), a non-invasive tool that uses magnetic fields to stimulate specific regions within the brain, has emerged as a versatile treatment modality in both research and clinical settings. While its utilization in psychiatry for treatment-resistant depression is well established, TMS is increasingly gaining traction for its use in diverse neurological conditions, including idiopathic facial nerve palsy, post-stroke rehabilitation, autism spectrum disorder, and hereditary ataxia. Through its ability to trigger neuronal plasticity and potentiate synaptic transmission, it is able to provide significant therapeutic potential. This paper seeks to explore and add to the rising research in treating idiopathic facial nerve palsy with the use of peripheral TMS. A 26-year-old woman with no prior history of facial palsy or related conditions presented with acute-onset left-sided facial paralysis upon awakening, following a strenuous hiking trip the previous day. Based on the modified House-Brackmann scale, she was determined to have grade V facial paralysis (severe facial weakness with barely perceptible motion). After 10 treatments over the course of two weeks, the patient\u27s facial paralysis improved to grade III (obvious, moderate facial weakness, complete eye closure with maximal effort, and good forehead movement). At one-week post-TMS treatment, the patient reported full recovery to all facial expressions and no adverse effects were noted. This case report aims to show the effectiveness of utilizing TMS as a treatment option for idiopathic facial nerve palsy

THE EFFECT OF ACTIGRAPHY MEASURED PHYSICAL ACTIVITY ON EXECUTIVE FUNCTION IN OLDER ADULTS

Executive function (i.e., decision making, self-control, planning) is important for facilitating independent living in older adults. Physical activity may preserve executive function, but previous research has demonstrated sex differences in both physical activity and executive function among older adults. Few studies have investigated sex differences in the association between the two. We examined associations between objectively measured physical activity and executive function with attention to sex differences. We recruited N = 204 participants (Mage =71, SD=6.36; 57% women) with (n=47) and without (n=157) Alzheimer’s disease from the University of Kansas Alzheimer’s Disease Research Center. We used wrist-worn accelerometers (Actigraph GT9X) to measure physical activity 24 hours a day for 7 days in a free-living environment. We categorized physical activity as moderate to vigorous (MVPA) based on the Montoye (2020) Adult Vector Magnitude cut-points. We evaluated sex differences in the association between executive function and MVPA using multiple regression with an interaction term, adjusting for age, education, and dementia status. We used a composite score to combine tests of executive function (Digit Symbol Substitution, Stroop Interference, Trail making Part B, and Verbal Fluency). Results indicated, older age and lower education were associated with lower executive function scores (β=-2.12, p < 0.001; B=2.13, p < .05). In contrast to previous research, we did not find evidence for sex differences in the MVPA, executive function, nor the association between the two in our sample. Future research should investigate whether individualized exercise-based interventions and treatment between men and women may differentially benefit cognitive function

Absence of microglia promotes diverse pathologies and early lethality in Alzheimer’s disease mice

Microglia are strongly implicated in the development and progression of Alzheimer's disease (AD), yet their impact on pathology and lifespan remains unclear. Here we utilize a CSF1R hypomorphic mouse to generate a model of AD that genetically lacks microglia. The resulting microglial-deficient mice exhibit a profound shift from parenchymal amyloid plaques to cerebral amyloid angiopathy (CAA), which is accompanied by numerous transcriptional changes, greatly increased brain calcification and hemorrhages, and premature lethality. Remarkably, a single injection of wild-type microglia into adult mice repopulates the microglial niche and prevents each of these pathological changes. Taken together, these results indicate the protective functions of microglia in reducing CAA, blood-brain barrier dysfunction, and brain calcification. To further understand the clinical implications of these findings, human AD tissue and iPSC-microglia were examined, providing evidence that microglia phagocytose calcium crystals, and this process is impaired by loss of the AD risk gene, TREM2

Sheridan School of Architectural Technology Volume 2 [S2017]

Welcome to Sheridan’s School of Architectural Technician/Technology printed portfolio volume 2. A combination of student work as well as faculty research has once again been been amalgamated into a print and digital portfolio showing the academic excellence of our program. Student work in the book is largely from the course CADD 39788 Architectural Computer Visualisation with a few projects from other courses making guest appearances. Our faculty research section near the back of the book offers insights into the professional interests and engagements of Sheridan professors.https://source.sheridancollege.ca/fast_books/1002/thumbnail.jp

Real-World Applications of Imipenem-Cilastatin-Relebactam: Insights From a Multicenter Observational Cohort Study

Background: Multidrug-resistant (MDR) gram-negative infections are a substantial threat to patients and public health. Imipenem-cilastatin-relebactam (IMI/REL) is a β-lactam/β-lactamase inhibitor with expanded activity against MDR Pseudomonas aeruginosa and carbapenem-resistant Enterobacterales. This study aims to describe the patient characteristics, prescribing patterns, and clinical outcomes associated with IMI/REL. Methods: This was a retrospective, multicenter, observational study of patients ≥18 years old who received IMI/REL for ≥48 hours for a suspected or confirmed gram-negative infection. The primary outcome was clinical success, defined as improvement or resolution of infection-related signs or symptoms while receiving IMI/REL and the absence of 30-day microbiologic failure. Multivariable logistic regression analysis was performed to identify independent predictors of clinical success. Results: The study included 151 patients from 24 US medical centers. IMI/REL was predominantly prescribed for lower respiratory tract infections, accounting for 52.3% of cases. Most patients were infected with a carbapenem-nonsusceptible pathogen (85.4%); P aeruginosa was frequently targeted (72.2%). Clinical success was achieved in 70.2% of patients. Heart failure, receipt of antibiotics within the past 90 days, intensive care unit admission at time of index culture collection, and isolation of difficult-to-treat resistant P aeruginosa were independently associated with a reduced odds of clinical success. Adverse events were reported in 6.0% of patients, leading to discontinuation of IMI/REL in 3 instances. Conclusions: This study provides a comprehensive analysis of the real-world effectiveness and safety of IMI/REL. Comparative studies and investigations of specific subgroups will further enhance our understanding of IMI/REL in treating MDR infections

The Lantern, 2013-2014

• Strikes • Pietro di Venezia • To the Lover of Small Things • Jim\u27s Big Day • Akademiks • Redamancy • A Love Poem for Arctia Caja • Mother River • The Lyrics to Your Song • Nerves • Gemini Season • White Interface • The Last Time I Played with Dolls • The Mechanic • My Goldfish • Put Down Your Hammer • Strip • Hollywood • Identity • The Grey Zone • Sophia • When I Became a Poet • Unbroken • The Veteran Aeronaut • I Have Running Water but They had the Stars • Not A Nigga • Mother, Adam, Eve • From Fragile Seeds: A Palindrome • Conspiring, The Spires • Finally Working Out What Goes Where (God, For Example, is in His Kingdom) • Identity Crisis • Affection • Patience • An Enchanting Lost Cause • False Starts • Soggy Rice, Lukewarm Water • The Glow • Heat • 9-14 • Filigree • Diane Arbus • Touched • Dying Alive • Just Another Drunkard on the Train • Dinner • The French Legionnaire • Conspiracy and Theory • 1249am • Colored Pencils • Sea Glass • Roundtrip • The Muse Heard Music • Lacrimosa • The Allegory of the Maze • The Stars on Stuart Road • To Isabella • For Want of a Potato Chip • Termite Nests • Saving a Rose • Today and Yesterday • A Foggy New York • Cat; Wurtzburg • Embrace • Faces • Geisha • Pacis Leo • Patterns • Te-Whanganui-a-Tara (The Dock)https://digitalcommons.ursinus.edu/lantern/1180/thumbnail.jp

Hepatitis C Virus Induces the Cannabinoid Receptor 1

BACKGROUND: Activation of hepatic CB(1) receptors (CB(1)) is associated with steatosis and fibrosis in experimental forms of liver disease. However, CB(1) expression has not been assessed in patients with chronic hepatitis C (CHC), a disease associated with insulin resistance, steatosis and metabolic disturbance. We aimed to determine the importance and explore the associations of CB(1) expression in CHC. METHODS: CB(1) receptor mRNA was measured by real time quantitative PCR on extracted liver tissue from 88 patients with CHC (genotypes 1 and 3), 12 controls and 10 patients with chronic hepatitis B (CHB). The Huh7/JFH1 Hepatitis C virus (HCV) cell culture model was used to validate results. PRINCIPAL FINDINGS: CB(1) was expressed in all patients with CHC and levels were 6-fold higher than in controls (P<0.001). CB(1) expression increased with fibrosis stage, with cirrhotics having up to a 2 fold up-regulation compared to those with low fibrosis stage (p<0.05). Even in mild CHC with no steatosis (F0-1), CB(1) levels remained substantially greater than in controls (p<0.001) and in those with mild CHB (F0-1; p<0.001). Huh7 cells infected with JFH-1 HCV showed an 8-fold upregulation of CB(1), and CB(1) expression directly correlated with the percentage of cells infected over time, suggesting that CB(1) is an HCV inducible gene. While HCV structural proteins appear essential for CB(1) induction, there was no core genotype specific difference in CB(1) expression. CB(1) significantly increased with steatosis grade, primarily driven by patients with genotype 3 CHC. In genotype 3 patients, CB(1) correlated with SREBP-1c and its downstream target FASN (SREBP-1c; R=0.37, FASN; R=0.39, p<0.05 for both). CONCLUSIONS/SIGNIFICANCE: CB(1) is up-regulated in CHC and is associated with increased steatosis in genotype 3. It is induced by the hepatitis C virus