The Effect of Patient Activation on Transition Clinic Adherence

Heart failure (HF) affects more than 5 million Americans and is one of the most commonly occurring reasons for admission to the hospital among adults aged 65 and over. Evidence is growing that the higher amount of patient engagement or activation, the better the health and cost outcomes. The purpose of this study was to determine if there was a relationship between a higher patient activation score, as determined by the PAM-10, and completion in the heart failure transition clinic. The design for this study was a quantitative descriptive study. The patients were given the questionnaire prior to discharge from the hospital and based on the recommendations associated with the PAM-10 tool, the level of activation can help the staff in the transition clinic to tailor specific interventions at the transition clinic. The population for this study was patients who were admitted into the hospital with a primary diagnosis of heart failure. The convenience sample consisted of patients who the inpatient navigator visited in the hospital and who agreed to participate in the study. Those in skilled nursing facilities, cognitively impaired individuals, or non-English speaking patients were excluded. There were 36 participants, half of which scored a level 3 on the PAM-10, and the completion rate of those who were a level 3 was 76%. It was determined that the higher level of activation, the more likely that the participant was to complete the transition program

Leader Distance of Extension Specialists as Experienced During the Beef Cattle Short Course

This study sought to explore the concept of leader distance related to extension specialists as experienced at the 2013 Texas A&M AgriLife Beef Cattle Short Course. Participants’ perception of distance between themselves and extension specialists could affect their satisfaction with the instructors and the program overall. The perception of distance between participants and specialists was explored through evaluation of the Beef Cattle Short Course via quantitative survey data and qualitative interview data. Evaluations for the Beef Cattle Short Course included two measures of perceived distance. Participants perceive low levels of distance between themselves and specialists. The measure of distance relating to the availability of the specialists was not significantly correlated to the customer satisfaction rating of the instructors and of the Beef Cattle Short Course overall. The measure of distance relating to the approachability of the specialists was significantly correlated (p < .01) to the customer satisfaction rating of the instructors and to overall customer satisfaction with the Beef Cattle Short Course. Qualitative interviews with six of the beef cattle extension specialists who present at the Beef Cattle Short Course revealed a low level of distance between themselves and participants. Specialists intentionally create low levels of distance by being physically available and relating to participants with shared experience and shared language

Infection with a Virulent Strain of Wolbachia Disrupts Genome Wide-Patterns of Cytosine Methylation in the Mosquito Aedes aegypti

BACKGROUND Cytosine methylation is one of several reversible epigenetic modifications of DNA that allow a greater flexibility in the relationship between genotype and phenotype. Methylation in the simplest models dampens gene expression by modifying regions of DNA critical for transcription factor binding. The capacity to methylate DNA is variable in the insects due to diverse histories of gene loss and duplication of DNA methylases. Mosquitoes like Drosophila melanogaster possess only a single methylase, DNMT2. DESCRIPTION Here we characterise the methylome of the mosquito Aedes aegypti and examine its relationship to transcription and test the effects of infection with a virulent strain of the endosymbiont Wolbachia on the stability of methylation patterns. CONCLUSION We see that methylation in the A. aegypti genome is associated with reduced transcription and is most common in the promoters of genes relating to regulation of transcription and metabolism. Similar gene classes are also methylated in aphids and honeybees, suggesting either conservation or convergence of methylation patterns. In addition to this evidence of evolutionary stability, we also show that infection with the virulent wMelPop Wolbachia strain induces additional methylation and demethylation events in the genome. While most of these changes seem random with respect to gene function and have no detected effect on transcription, there does appear to be enrichment of genes associated with membrane function. Given that Wolbachia lives within a membrane-bound vacuole of host origin and retains a large number of genes for transporting host amino acids, inorganic ions and ATP despite a severely reduced genome, these changes might represent an evolved strategy for manipulating the host environments for its own gain. Testing for a direct link between these methylation changes and expression, however, will require study across a broader range of developmental stages and tissues with methods that detect splice variants.This research was supported by The National Health and Medical Research Council of Australia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The Relative Importance of Innate Immune Priming in Wolbachia-Mediated Dengue Interference

The non-virulent Wolbachia strain wMel and the life-shortening strain wMelPop-CLA, both originally from Drosophila melanogaster, have been stably introduced into the mosquito vector of dengue fever, Aedes aegypti. Each of these Wolbachia strains interferes with viral pathogenicity and/or dissemination in both their natural Drosophila host and in their new mosquito host, and it has been suggested that this virus interference may be due to host immune priming by Wolbachia. In order to identify aspects of the mosquito immune response that might underpin virus interference, we used whole-genome microarrays to analyse the transcriptional response of A. aegypti to the wMel and wMelPop-CLA Wolbachia strains. While wMel affected the transcription of far fewer host genes than wMelPop-CLA, both strains activated the expression of some immune genes including anti-microbial peptides, Toll pathway genes and genes involved in melanization. Because the induction of these immune genes might be associated with the very recent introduction of Wolbachia into the mosquito, we also examined the same Wolbachia strains in their original host D. melanogaster. First we demonstrated that when dengue viruses were injected into D. melanogaster, virus accumulation was significantly reduced in the presence of Wolbachia, just as in A. aegypti. Second, when we carried out transcriptional analyses of the same immune genes up-regulated in the new heterologous mosquito host in response to Wolbachia we found no over-expression of these genes in D. melanogaster, infected with either wMel or wMelPop. These results reinforce the idea that the fundamental mechanism involved in viral interference in Drosophila and Aedes is not dependent on the up-regulation of the immune effectors examined, although it cannot be excluded that immune priming in the heterologous mosquito host might enhance the virus interference trait

Surviving the Journey Home: Social Support and Student Sojourner

A small, southeastern Christian university has two independent programs for students studying abroad or serving as missionaries for an academic year. This study examines the correlation between perceived support students felt from their university and their academic success in their first returning semester. Because of the differences in these programs our research sought to examine student perceived support before, during and after their year abroad with GPA before and after their experience. No correlation was found between perceived support and academic success, but findings showed that neither group of student sojourners felt significantly supported during the year abroad. Study abroad students’ GPA drop significantly in their first return semester while student missionaries’ GPA dropped only marginally. Further research should identify effective means to increase perceived support of students while abroad and to determine if learning shock may explain the significant drop in study abroad student GPAs

Choroidalyzer: An open-source, end-to-end pipeline for choroidal analysis in optical coherence tomography

Purpose: To develop Choroidalyzer, an open-source, end-to-end pipeline for segmenting the choroid region, vessels, and fovea, and deriving choroidal thickness, area, and vascular index. Methods: We used 5,600 OCT B-scans (233 subjects, 6 systemic disease cohorts, 3 device types, 2 manufacturers). To generate region and vessel ground-truths, we used state-of-the-art automatic methods following manual correction of inaccurate segmentations, with foveal positions manually annotated. We trained a U-Net deep-learning model to detect the region, vessels, and fovea to calculate choroid thickness, area, and vascular index in a fovea-centred region of interest. We analysed segmentation agreement (AUC, Dice) and choroid metrics agreement (Pearson, Spearman, mean absolute error (MAE)) in internal and external test sets. We compared Choroidalyzer to two manual graders on a small subset of external test images and examined cases of high error. Results: Choroidalyzer took 0.299 seconds per image on a standard laptop and achieved excellent region (Dice: internal 0.9789, external 0.9749), very good vessel segmentation performance (Dice: internal 0.8817, external 0.8703) and excellent fovea location prediction (MAE: internal 3.9 pixels, external 3.4 pixels). For thickness, area, and vascular index, Pearson correlations were 0.9754, 0.9815, and 0.8285 (internal) / 0.9831, 0.9779, 0.7948 (external), respectively (all p<0.0001). Choroidalyzer's agreement with graders was comparable to the inter-grader agreement across all metrics. Conclusions: Choroidalyzer is an open-source, end-to-end pipeline that accurately segments the choroid and reliably extracts thickness, area, and vascular index. Especially choroidal vessel segmentation is a difficult and subjective task, and fully-automatic methods like Choroidalyzer could provide objectivity and standardisation

Chronic disease patients’ experience with telehealth interventions and self-care strategies during the first wave of the COVID-19 pandemic

Purpose. During COVID-19 pandemic, Québec (Canada) Public Health Agency asked Family Medicine Group (FMG) to change their practice such as recommending the use of telehealth interventions. However, it is unknown if telehealth meets patients' needs in terms of self-care, especially those suffered from physical and mental chronic condition (PCDs). This study aimed to explore, from a PCD's perspective, the response of FMG about their self-care needs during COVID-19 pandemic. Methods. We conducted an exploratory qualitative descriptive study using semi-structured interviews to reach 40 PCDs from three regions of Québec. We explored FMGs' responses, PCDs needs, coping strategies regarding the COVID-19 and the changes in primary care services. We used the transactional theory of stress and coping to inform the data collection and analysis and the COREQ appraisal grid to report this study. Results. PCDs appreciated telehealth and perceived that the accessibility was increased. Moreover, family physicians from FMG conducted the majority of the follow-ups although interdisciplinary teams were available. The coping strategies raised by the PCDs were primarily aimed at maintaining their health status, while some of them aimed to reduce stress levels. Conclusions. PCDs seem to appreciate telehealth but believe it requires improvements, and it is not adequate for all types of follow-ups. PCDs adopt coping strategies to face the pandemic that were not always optimal for their health. We call for a better understanding of PCDs' needs in times of a pandemic in order to offer them the appropriate services an interdisciplinary team can provide.http://deepblue.lib.umich.edu/bitstream/2027.42/167663/1/Article patients-covid copingVF_PP.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167663/3/Article patients-covid coping VF_V2.pdfDescription of Article patients-covid copingVF_PP.pdf : Main ArticleSEL

Draft genome sequence of the male-killing Wolbachia strain wBol1 reveals recent horizontal gene transfers from diverse sources.

Background The endosymbiont Wolbachia pipientis causes diverse and sometimes dramatic phenotypes in its invertebrate hosts. Four Wolbachia strains sequenced to date indicate that the constitution of the genome is dynamic, but these strains are quite divergent and do not allow resolution of genome diversification over shorter time periods. We have sequenced the genome of the strain wBol1-b, found in the butterfly Hypolimnas bolina, which kills the male offspring of infected hosts during embyronic development and is closely related to the non-male-killing strain wPip from Culex pipiens. Results The genomes of wBol1-b and wPip are similar in genomic organisation, sequence and gene content, but show substantial differences at some rapidly evolving regions of the genome, primarily associated with prophage and repetitive elements. We identified 44 genes in wBol1-b that do not have homologs in any previously sequenced strains, indicating that Wolbachia's non-core genome diversifies rapidly. These wBol1-b specific genes include a number that have been recently horizontally transferred from phylogenetically distant bacterial taxa. We further report a second possible case of horizontal gene transfer from a eukaryote into Wolbachia. Conclusions Our analyses support the developing view that many endosymbiotic genomes are highly dynamic, and are exposed and receptive to exogenous genetic material from a wide range of sources. These data also suggest either that this bacterial species is particularly permissive for eukaryote-to-prokaryote gene transfers, or that these transfers may be more common than previously believed. The wBol1-b-specific genes we have identified provide candidates for further investigations of the genomic bases of phenotypic differences between closely-related Wolbachia strains.Peer reviewe