The misuse of convenient care and importance of establishing a primary care provider

Over the last decade, there has been substantial increase in the use of urgent care (UC) and convenient care (CC) clinics nationwide. While these clinics are valued and serve a purpose in our communities, more patients are utilizing their services exclusively in place of primary care (PC), resulting in millions of Americans not receiving essential preventative care and chronic disease management. An extensive literature review evaluated current and effective interventions used to decrease inappropriate use of CC clinics, while simultaneously exploring strategies in increasing patient compliance with routine comprehensive health management. Based on literature review findings, an education-based project was implemented at a rural CC clinic that serves a large volume of patients without a primary care provider (PCP). Over an eight-week implementation phase, an educational template was electronically incorporated into patient discharge instructions and reviewed verbally by the convenient care provider (CCP). The template explained current definition and scope of practice of emergency departments, UC, CC, and PC clinics. Additionally, the template outlined which respective establishment to visit for numerous common ailments and important health care needs. A total of forty-six patients were identified without a PCP. The patients were counseled and given the printed education. Through initial interview, thirty percent of these patients were found to misunderstand the purpose of the CC clinic. Following counsel and education delivery, forty-eight percent of patients without a PCP reported new motivation to establish care with one. The CCP, who dually served as project stakeholder, reported positive feedback regarding the educational tool and found it valuable, despite COVID-19 barriers and limitations. The CCP continues to use the tool in daily practice and has shared it amongst fellow providers for use. It is recommended that our exploration into the misuse of this CC clinic be furthered with future project implementations that may focus on the role of the current patient advocate coordinator

Older Adult Preferences of Mobile Application Functionality Supporting Medication Self-Management

Health systems and insurers alike are increasingly interested in leveraging mHealth (mobile health) tools to support patient health-related behaviors including medication adherence. However, these tools are not widely used by older patients. This study explores patient preferences for functionality in a smartphone application (app) that supports medication self-management among older adults with multiple chronic conditions. We conducted six discussion groups in Chicago, Miami, and Denver (N = 46). English-speaking older adults (55 and older) who owned smartphones and took five or more prescription medicines were invited to participate. Discussions covered familiarity with and use of current apps and challenges with taking multidrug regimens. Participants reviewed a range of possible mobile app functions and were asked to give feedback regarding the acceptability and desirability of each to support medication management. Very few participants (n = 3) reported current use of a mobile app for medication support, although all were receptive. Challenges to medication use were forgetfulness, fear of adverse events, and managing medication information from multiple sources. Desired features included (1) a list and consolidated schedule of medications, (2) identification and warning of unsafemedication interactions, (3) reminder alerts to take medicine, and (4) the ability record when medications were taken. Features relating to refill ordering, pharmacy information, and comparing costs for medication were not considered to be as important for an app

A comprehensive probabilistic analysis of SIR-type epidemiological models based on full randomized Discrete-Time Markov Chain formulation with applications

[EN] This paper provides a comprehensive probabilistic analysis of a full randomization of approximate SIR-type epidemiological models based on discrete-time Markov chain formulation. The randomization is performed by assuming that all input data (initial conditions, the contagion, and recovering rates involved in the transition matrix) are random variables instead of deterministic constants. In the first part of the paper, we determine explicit expressions for the so called first probability density function of each subpopulation identified as the corresponding states of the Markov chain (susceptible, infected, and recovered) in terms of the probability density function of each input random variable. Afterwards, we obtain the probability density functions of the times until a given proportion of the population remains susceptible, infected, and recovered, respectively. The theoretical analysis is completed by computing explicit expressions of important randomized epidemiological quantities, namely, the basic reproduction number, the effective reproduction number, and the herd immunity threshold. The study is conducted under very general assumptions and taking extensive advantage of the random variable transformation technique. The second part of the paper is devoted to apply our theoretical findings to describe the dynamics of the pandemic influenza in Egypt using simulated data excerpted from the literature. The simulations are complemented with valuable information, which is seldom displayed in epidemiological models. In spite of the nonlinear mathematical nature of SIR epidemiological model, our results show a strong agreement with the approximation via an appropriate randomized Markov chain. A justification in this regard is discussed.Spanish Ministerio de Economia y Competitividad, Grant/Award Number: MTM2017-89664-P; Generalitat Valenciana, Grant/Award Number: APOSTD/2019/128; Ministerio de Economia y Competitividad, Grant/Award Number: MTM2017-89664-PCortés, J.; El-Labany, S.; Navarro-Quiles, A.; Selim, MM.; Slama, H. (2020). A comprehensive probabilistic analysis of SIR-type epidemiological models based on full randomized Discrete-Time Markov Chain formulation with applications. Mathematical Methods in the Applied Sciences. 43(14):8204-8222. https://doi.org/10.1002/mma.6482S820482224314Hamra, G., MacLehose, R., & Richardson, D. (2013). Markov Chain Monte Carlo: an introduction for epidemiologists. International Journal of Epidemiology, 42(2), 627-634. doi:10.1093/ije/dyt043Becker, N. (1981). A General Chain Binomial Model for Infectious Diseases. Biometrics, 37(2), 251. doi:10.2307/2530415Allen, L. J. S. (2010). An Introduction to Stochastic Processes with Applications to Biology. doi:10.1201/b12537Hethcote, H. W. (2000). The Mathematics of Infectious Diseases. SIAM Review, 42(4), 599-653. doi:10.1137/s0036144500371907Brauer, F., & Castillo-Chávez, C. (2001). Mathematical Models in Population Biology and Epidemiology. Texts in Applied Mathematics. doi:10.1007/978-1-4757-3516-1Cortés, J.-C., Navarro-Quiles, A., Romero, J.-V., & Roselló, M.-D. (2018). Some results about randomized binary Markov chains: theory, computing and applications. International Journal of Computer Mathematics, 97(1-2), 141-156. doi:10.1080/00207160.2018.1440290Cortés, J.-C., Navarro-Quiles, A., Romero, J.-V., & Roselló, M.-D. (2017). Randomizing the parameters of a Markov chain to model the stroke disease: A technical generalization of established computational methodologies towards improving real applications. Journal of Computational and Applied Mathematics, 324, 225-240. doi:10.1016/j.cam.2017.04.040Casabán, M.-C., Cortés, J.-C., Romero, J.-V., & Roselló, M.-D. (2015). Probabilistic solution of random SI-type epidemiological models using the Random Variable Transformation technique. Communications in Nonlinear Science and Numerical Simulation, 24(1-3), 86-97. doi:10.1016/j.cnsns.2014.12.016Casabán, M.-C., Cortés, J.-C., Navarro-Quiles, A., Romero, J.-V., Roselló, M.-D., & Villanueva, R.-J. (2016). A comprehensive probabilistic solution of random SIS-type epidemiological models using the random variable transformation technique. Communications in Nonlinear Science and Numerical Simulation, 32, 199-210. doi:10.1016/j.cnsns.2015.08.009Slama, H., Hussein, A., El-Bedwhey, N. A., & Selim, M. M. (2019). An approximate probabilistic solution of a random SIR-type epidemiological model using RVT technique. Applied Mathematics and Computation, 361, 144-156. doi:10.1016/j.amc.2019.05.019Slama, H., El-Bedwhey, N. A., El-Depsy, A., & Selim, M. M. (2017). Solution of the finite Milne problem in stochastic media with RVT Technique. The European Physical Journal Plus, 132(12). doi:10.1140/epjp/i2017-11763-6Kegan, B., & West, R. W. (2005). Modeling the simple epidemic with deterministic differential equations and random initial conditions. Mathematical Biosciences, 195(2), 179-193. doi:10.1016/j.mbs.2005.02.004Dorini, F. A., Cecconello, M. S., & Dorini, L. B. (2016). On the logistic equation subject to uncertainties in the environmental carrying capacity and initial population density. Communications in Nonlinear Science and Numerical Simulation, 33, 160-173. doi:10.1016/j.cnsns.2015.09.009Van den Driessche, P. (2017). Reproduction numbers of infectious disease models. Infectious Disease Modelling, 2(3), 288-303. doi:10.1016/j.idm.2017.06.002Heffernan, J. ., Smith, R. ., & Wahl, L. . (2005). Perspectives on the basic reproductive ratio. Journal of The Royal Society Interface, 2(4), 281-293. doi:10.1098/rsif.2005.0042Khalil, K. M., Abdel-Aziz, M., Nazmy, T. T., & Salem, A.-B. M. (2012). An Agent-Based Modeling for Pandemic Influenza in Egypt. Intelligent Systems Reference Library, 205-218. doi:10.1007/978-3-642-25755-1_1

Population-based analysis of ocular Chlamydia trachomatis in trachoma-endemic West African communities identifies genomic markers of disease severity.

BACKGROUND: Chlamydia trachomatis (Ct) is the most common infectious cause of blindness and bacterial sexually transmitted infection worldwide. Ct strain-specific differences in clinical trachoma suggest that genetic polymorphisms in Ct may contribute to the observed variability in severity of clinical disease. METHODS: Using Ct whole genome sequences obtained directly from conjunctival swabs, we studied Ct genomic diversity and associations between Ct genetic polymorphisms with ocular localization and disease severity in a treatment-naïve trachoma-endemic population in Guinea-Bissau, West Africa. RESULTS: All Ct sequences fall within the T2 ocular clade phylogenetically. This is consistent with the presence of the characteristic deletion in trpA resulting in a truncated non-functional protein and the ocular tyrosine repeat regions present in tarP associated with ocular tissue localization. We have identified 21 Ct non-synonymous single nucleotide polymorphisms (SNPs) associated with ocular localization, including SNPs within pmpD (odds ratio, OR = 4.07, p* = 0.001) and tarP (OR = 0.34, p* = 0.009). Eight synonymous SNPs associated with disease severity were found in yjfH (rlmB) (OR = 0.13, p* = 0.037), CTA0273 (OR = 0.12, p* = 0.027), trmD (OR = 0.12, p* = 0.032), CTA0744 (OR = 0.12, p* = 0.041), glgA (OR = 0.10, p* = 0.026), alaS (OR = 0.10, p* = 0.032), pmpE (OR = 0.08, p* = 0.001) and the intergenic region CTA0744-CTA0745 (OR = 0.13, p* = 0.043). CONCLUSIONS: This study demonstrates the extent of genomic diversity within a naturally circulating population of ocular Ct and is the first to describe novel genomic associations with disease severity. These findings direct investigation of host-pathogen interactions that may be important in ocular Ct pathogenesis and disease transmission

The effectiveness of Chance UK's mentoring programme in improving behavioural and emotional outcomes in primary school children with behavioural difficulties: study protocol for a randomised controlled trial

BACKGROUND: There is a need to build the evidence base of early interventions to promote children's health and development in the UK. Chance UK is a voluntary sector organisation based in London that delivers a 12-month mentoring programme for primary school children identified by teachers and parents as having behavioural and emotional difficulties. The aim of the study is to determine the effectiveness of the programme in terms of children's behaviour and emotional well-being; this is the primary outcome of the trial. METHODS/DESIGN: A randomised controlled trial will be conducted in which participants are randomly allocated on a dynamic basis to one of two possible arms: the intervention arm (n = 123) will be offered the mentoring programme, and the control arm (n = 123) will be offered services as usual. Outcome data will be collected at three points: pre-intervention (baseline), mid-way through the mentoring year (c.9 months after randomisation) and post- mentoring programme (c.16 months after randomisation). DISCUSSION: This study will further enhance the evidence for early intervention mentoring programmes for child behaviour and emotional well-being in the UK. TRIAL REGISTRATION: Current Controlled Trials ISRCTN47154925 . Retrospectively registered 9 September 2014

Kidney Pathology Precedes and Predicts the Pathological Cascade of Cerebrovascular Lesions in Stroke Prone Rats

INTRODUCTION: Human cerebral small vessel disease (CSVD) has been hypothesized to be an age-dependent disease accompanied by similar vascular changes in other organs. SHRSP feature numerous vascular risk factors and may be a valid model of some aspects of human CSVD. Here we compare renal histopathological changes with the brain pathology of spontaneously hypertensive stroke-prone rats (SHRSP). MATERIAL AND METHODS: We histologically investigated the brains and kidneys of 61 SHRSP at different stages of age (12 to 44 weeks). The brain pathology (aggregated erythrocytes in capillaries and arterioles, microbleeds, microthromboses) and the kidney pathology (aggregated erythrocytes within peritubular capillaries, tubular protein cylinders, glomerulosclerosis) were quantified separately. The prediction of the brain pathology by the kidney pathology was assessed by creating ROC-curves integrating the degree of kidney pathology and age of SHRSP. RESULTS: Both, brain and kidney pathology, show an age-dependency and proceed in definite stages whereas an aggregation of erythrocytes in capillaries and arterioles, we parsimoniously interpreted as stases, represent the initial finding in both organs. Thus, early renal tubulointerstitial damage characterized by rather few intravasal erythrocyte aggregations and tubular protein cylinders predicts the initial step of SHRSPs' cerebral vascular pathology marked by accumulated erythrocytes. The combined increase of intravasal erythrocyte aggregations and protein cylinders accompanied by glomerulosclerosis and thrombotic renal microangiopathy in kidneys of older SHRSP predicts the final stages of SHRSPs' cerebrovascular lesions marked by microbleeds and thrombotic infarcts. CONCLUSION: Our results illustrate a close association between structural brain and kidney pathology and support the concept of small vessel disease to be an age-dependent systemic pathology. Further, an improved joined nephrologic and neurologic diagnostic may help to identify patients with CSVD at an early stage

A search for the decay modes B+/- to h+/- tau l

We present a search for the lepton flavor violating decay modes B+/- to h+/- tau l (h= K,pi; l= e,mu) using the BaBar data sample, which corresponds to 472 million BBbar pairs. The search uses events where one B meson is fully reconstructed in one of several hadronic final states. Using the momenta of the reconstructed B, h, and l candidates, we are able to fully determine the tau four-momentum. The resulting tau candidate mass is our main discriminant against combinatorial background. We see no evidence for B+/- to h+/- tau l decays and set a 90% confidence level upper limit on each branching fraction at the level of a few times 10^-5.Comment: 15 pages, 7 figures, submitted to Phys. Rev.

An Objective Scatter Index Based on Double-Pass Retinal Images of a Point Source to Classify Cataracts

PURPOSE: To propose a new objective scatter index (OSI) based in the analysis of double-pass images of a point source to rank and classify cataract patients. This classification scheme is compared with a current subjective system. METHODS: We selected a population including a group of normal young eyes as control and patients diagnosed with cataract (grades NO2, NO3 and NO4) according to the Lens Opacities Classification System (LOCS III). For each eye, we recorded double-pass retinal images of a point source. In each patient, we determined an objective scatter index (OSI) as the ratio of the intensity at an eccentric location in the image and the central part. This index provides information on the relevant forward scatter affecting vision. Since the double-pass retinal images are affected by both ocular aberrations and intraocular scattering, an analysis was performed to show the ranges of contributions of aberrations to the OSI. RESULTS: We used the OSI values to classify each eye according to the degree of scatter. The young normal eyes of the control group had OSI values below 1, while the OSI for subjects in LOCS grade II were around 1 to 2. The use of the objective index showed some of the weakness of subjective classification schemes. In particular, several subjects initially classified independently as grade NO2 or NO3 had similar OSI values, and in some cases even higher than subjects classified as grade NO4. A new classification scheme based in OSI is proposed. CONCLUSIONS: We introduced an objective index based in the analysis of double-pass retinal images to classify cataract patients. The method is robust and fully based in objective measurements; i.e., not depending on subjective decisions. This procedure could be used in combination with standard current methods to improve cataract patient surgery scheduling

Observation and study of baryonic B decays: B -> D(*) p pbar, D(*) p pbar pi, and D(*) p pbar pi pi

We present a study of ten B-meson decays to a D(*), a proton-antiproton pair, and a system of up to two pions using BaBar's data set of 455x10^6 BBbar pairs. Four of the modes (B0bar -> D0 p anti-p, B0bar -> D*0 p anti-p, B0bar -> D+ p anti-p pi-, B0bar -> D*+ p anti-p pi-) are studied with improved statistics compared to previous measurements; six of the modes (B- -> D0 p anti-p pi-, B- -> D*0 p anti-p pi-, B0bar -> D0 p anti-p pi- pi+, B0bar -> D*0 p anti-p pi- pi+, B- -> D+ p anti-p pi- pi-, B- -> D*+ p anti-p pi- pi-) are first observations. The branching fractions for 3- and 5-body decays are suppressed compared to 4-body decays. Kinematic distributions for 3-body decays show non-overlapping threshold enhancements in m(p anti-p) and m(D(*)0 p) in the Dalitz plots. For 4-body decays, m(p pi-) mass projections show a narrow peak with mass and full width of (1497.4 +- 3.0 +- 0.9) MeV/c2, and (47 +- 12 +- 4) MeV/c2, respectively, where the first (second) errors are statistical (systematic). For 5-body decays, mass projections are similar to phase space expectations. All results are preliminary.Comment: 28 pages, 90 postscript figures, submitted to LP0