Urban Communities, Clinics & Committees - A Model for Addressing Health Disparities and Building Clinician Community Engagement

Our Ohio State's Care Point East (CPE) clinic and Near East Health Advisory Committee (NEHAC) is a partnership that actively demonstrates how the principles of community engagement are used to collaboratively address major health disparities. The Near East Community of Columbus is an underserved community with many health disparities. Monthly meetings allow community leaders and physician trainees to learn firsthand about both historic and novel challenges and bring fresh perspective as to why they are important and how they can be addressed. An active consortium allows for shared knowledge of the many resources available for patients as well as community leaders. Young physicians can impact the community in which they practice, all while obtaining a unique experience of community engagement and building leadership skills. Tim Anderson, co-chair of NEHAC, published author and founder of the In My Backyard nonprofit, has focused much of his time on the importance of addressing health disparities and educating physicians who serve inner city communities on why and just how they can be a part of the solution. He has developed the DRIVE Engagement for clinicians. The components are: develop community health leaders; reaffirm patient trust through community involvement; identify patient barriers; identify community resources; improve patient compliance; value community health assets; and enhance community health wellness initiatives through active participation and promotion. Through emphasis on these principles, clinicians can have a basis for the importance of community engagement. In addition, we will discuss common barriers to community engagement and strategies to build physician capacity, especially for young clinicians and via the NEHAC meetings. The Ohio State University Wexner Medical Center, Internal Medicine Residency's primary care track, and now categorical track, offer young physicians the opportunity to train as clinicians in an inner-city clinic of Care Point East, located in the Near East Community. Our partnership with the NEHAC offers a unique training opportunity outside of the clinic, to grow in the DRIVE principles as well as the principles of awareness, integration, stewardship and advocacy.AUTHOR AFFILIATION: Jannel Lee-Allen, Clinical Instructor Housestaff, Internal Medicine, [email protected] (Corresponding Author); Tim Anderson, Co-Chair, NEHAC.Near East Community of Columbus is an under-served, urban community of more than 20,000 residents with many nonprofit, governmental and university partners. It has, like many inner-city communities, suffered from a history of disparities, especially health disparities. Learn about these disparities and how an active model of community consortium are addressing these disparities, while simultaneously garnering physician trainee community engagement and leadership

Benefits of a Multi-institutional, Hybrid Approach to Teaching Course Design for Graduate Students, Postdoctoral Scholars, and Leaders

In this study, graduate students and postdoctoral scholars participated in a hybrid, multi-institutional workshop series about course design. Trainees developed college courses based on their research expertise, posting works-in-progress to a shared, online drive for peer review and collaboration. Learners also met weekly with local facilitators at their institution. The program led to similar learning outcomes as when the program was previously run in a face-to-face only format at one institution. However, the multi-institutional design led to additional benefits, especially for leaders at each institution, who described a rich learning community in their collaborative work

Carbonyl Reduction by YmfI Completes the Modification of EF-P in \u3cem\u3eBacillus subtilis\u3c/em\u3e to Prevent Accumulation of an Inhibitory Modification State

Translation elongation factor P (EF‐P) in Bacillus subtilis is required for a form of surface migration called swarming motility. Furthermore, B. subtilis EF‐P is post‐translationally modified with a 5‐aminopentanol group but the pathway necessary for the synthesis and ligation of the modification is unknown. Here we determine that the protein YmfI catalyzes the reduction of EF‐P‐5 aminopentanone to EF‐P‐5 aminopentanol. In the absence of YmfI, accumulation of 5‐aminopentanonated EF‐P is inhibitory to swarming motility. Suppressor mutations that enhanced swarming in the absence of YmfI were found at two positions on EF‐P, including one that changed the conserved modification site (Lys 32) and abolished post‐translational modification. Thus, while modification of EF‐P is thought to be essential for EF‐P activity, here we show that in some cases it can be dispensable. YmfI is the first protein identified in the pathway leading to EF‐P modification in B. subtilis, and B. subtilis encodes the first EF‐P ortholog that retains function in the absence of modification

Compound heterozygote myocilin mutations in a pedigree with high prevalence of primary open-angle glaucoma

This article is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 3.0, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.Purpose: To describe the phenotype of ocular hypertension and primary open-angle glaucoma in a family with individuals compound heterozygote for Gln368STOP and Thr377Met myocilin (MYOC) mutations. Methods: Family members of the proband underwent comprehensive ocular clinical examination and DNA sequencing for MYOC mutations. Results: A 34-year-old woman with marked ocular hypertension was found to carry Gln368STOP and Thr377Met MYOC mutations. Three other siblings carried both mutations, while one carried Gln368STOP alone. Three of five siblings had received treatment for ocular hypertension or early glaucoma, with the average age of diagnosis 28 years; one required trabeculectomy at age 27. The mother of the proband was found to be a carrier for Gln368STOP alone, which indicates that her offspring with both Gln368STOP and Thr377Met carry variants on opposing alleles. Conclusions: This pedigree is the first report with individuals compound heterozygote for the two most common glaucoma-causing MYOC variants. The combination of mutations manifests a more severe phenotype than either alone. Identification of gene changes associated with glaucoma within the family has enabled unaffected members to stratify their risk of future disease and institute closer monitoring and early treatment.CERA receives Operational Infrastructure Support from the Victorian Government. The Australian and New Zealand Registry of Advanced Glaucoma is funded by the RANZCO Eye Foundation. KPB and JEC are funded by a Career Development Award and Practitioner Fellowship from the National Health and Medical Research Council of Australia, respectively

EF-P Post-Translational Modification Has Variable Impact on Polyproline Translation in \u3cem\u3eBacillus subtilis\u3c/em\u3e

Elongation factor P (EF-P) is a ubiquitous translation factor that facilitates translation of polyproline motifs. In order to perform this function, EF-P generally requires posttranslational modification (PTM) on a conserved residue. Although the position of the modification is highly conserved, the structure can vary widely between organisms. In Bacillus subtilis, EF-P is modified at Lys32 with a 5-aminopentanol moiety. Here, we use a forward genetic screen to identify genes involved in 5-aminopentanolylation. Tandem mass spectrometry analysis of the PTM mutant strains indicated that ynbB, gsaB, and ymfI are required for modification and that yaaO, yfkA, and ywlG influence the level of modification. Structural analyses also showed that EF-P can retain unique intermediate modifications, suggesting that 5-aminopentanol is likely directly assembled on EF-P through a novel modification pathway. Phenotypic characterization of these PTM mutants showed that each mutant does not strictly phenocopy the efp mutant, as has previously been observed in other organisms. Rather, each mutant displays phenotypic characteristics consistent with those of either the efp mutant or wild-type B. subtilis depending on the growth condition. In vivo polyproline reporter data indicate that the observed phenotypic differences result from variation in both the severity of polyproline translation defects and altered EF-P context dependence in each mutant. Together, these findings establish a new EF-P PTM pathway and also highlight a unique relationship between EF-P modification and polyproline context dependence

Children's Transport Built Environments: A Mixed Methods Study of Associations between Perceived and Objective Measures and Relationships with Parent Licence for Independent Mobility in Auckland, New Zealand.

Children's independent mobility is declining internationally. Parents are the gatekeepers of children's independent mobility. This mixed methods study investigates whether parent perceptions of the neighbourhood environment align with objective measures of the neighbourhood built environment, and how perceived and objective measures relate to parental licence for children's independent mobility. Parents participating in the Neighbourhood for Active Kids study (n = 940) answered an open-ended question about what would make their neighbourhoods better for their child's independent mobility, and reported household and child demographics. Objective measures of the neighbourhood built environment were generated using geographic information systems. Content analysis was used to classify and group parent-reported changes required to improve their neigbourhood. Parent-reported needs were then compared with objective neighbourhood built environment measures. Linear mixed modelling examined associations between parental licence for independent mobility and (1) parent neighbourhood perceptions; and (2) objectively assessed neighbourhood built environment features. Parents identified the need for safer traffic environments. No significant differences in parent reported needs were found by objectively assessed characteristics. Differences in odds of reporting needs were observed for a range of socio-demographic characteristics. Parental licence for independent mobility was only associated with a need for safer places to cycle (positive) and objectively assessed cycling infrastructure (negative) in adjusted models. Overall, the study findings indicate the importance of safer traffic environments for children's independent mobility

Children Are Not Just Small Adults: The Urgent Need for High-Quality Trial Evidence in Children

Terry Klassen and colleagues discuss a new study examining whether children and adults with drug-resistant partial epilepsy respond differently to antiepileptic drugs

CYP1B1 copy number variation is not a major contributor to primary congenital glaucoma

This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives License 3.0, or CC BY-NC-ND 3.0 (see http://creativecommons.org/licenses/by-nc-nd/3.0/ for license terms). The authors retain copyright and grant Molecular Vision an irrevocable, royalty-free, perpetual license to publish and distribute the article, in all formats now known or later developed, and to identify Molecular Vision as the original publisher.Purpose: To evaluate the prevalence and the diagnostic utility of testing for CYP1B1 copy number variation (CNV) in primary congenital glaucoma (PCG) cases unexplained by CYP1B1 point mutations in The Australian and New Zealand Registry of Advanced Glaucoma. Methods: In total, 50 PCG cases either heterozygous for disease-causing variants or with no CYP1B1 sequence variants were included in the study. CYP1B1 CNV was analyzed by Multiplex Ligation-dependent Probe Amplification (MLPA). Results: No deletions or duplications were found in any of the cases. Conclusion: This is the first study to report on CYP1B1 CNV in PCG cases. Our findings show that this mechanism is not a major contributor to the phenotype and is of limited diagnostic utility

Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.publishedVersio

A Scoping Review of the Evidence on Health Promotion Interventions for Reducing Waterpipe Smoking: Implications for Practice

Background: Waterpipe tobacco smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region (EMR), but its prevalence is growing worldwide, especially among young people. Although often perceived as less harmful than other methods of tobacco use because the smoke passes through water, accumulating evidence shows harmful effects and that some smokers become addicted. Interventions that deglamourise and denormalise use have been recommended but little is known about the range and impact of different health prevention and promotion interventions.Methods: A scoping review of literature was undertaken to explore the breadth of literature and assess the range and impact of community based health promotion interventions for waterpipe smoking. Searches were conducted in Medline, Embase, CINAHL, Psychinfo, and the Cochrane database of systematic reviews. Interventions were classified using a health promotion framework and data extracted on the aspects of prevention/promotion addressed; key strategies employed, evidence of effectiveness or impact on behavior change as well as barriers to implementation and perceived success factors.Results: Ten studies were included in the review. They include brief interventions to increase quit rates; community campaigns to raise awareness and increase knowledge; web based health education and skill development to increase perceived risks and intention to quit; as well as studies that evaluated product labeling and opportunities for policy interventions to create healthy environments.Conclusions: The evidence base is small but growing. Brief interventions for waterpipe users, community campaigns, and web based tailored information can modify perceptions of addiction and increase intentions to quit. Product labeling may be an effective policy tool to curb waterpipe smoking. A range of policy interventions have been identified but not evaluated