Improving the Quality and Delivery of Substance Use Disorder Resource List

Introduction The state of New Mexico has numerous organizations that help individuals with substance use disorders (SUDs). University of New Mexico Hospital (UNMH) social workers had previously started a list of these resources; however, it was neither updated nor used often. We aim to improve the quality, awareness, and delivery of this list on UNMH internal medicine (IM) inpatient units. Methods To improve the quality of the list we developed a concise SUD resource document using the pre-existing list as a template. We modified the list after feedback from patients, providers and literacy specialists. The final list was organized alphabetically and categorized according to the services offered, with brief descriptions about each facility added. For baseline data on awareness of the list, we administered surveys to available inpatient IM providers. 31st increase the awareness of the list, we educated IM residents on clinical inpatient services at UNMH biweekly about its purpose and availability. We administered surveys before each education session for two months. To improve the accessibility of the list, we regularly supplied each resident workroom with the resource list. After receiving hospital approval, we uploaded the list onto the UNMH electronic medical record system. Results At baseline, we surveyed 37 IM providers. 89% viewed the delivery of resources to patients with SUD as important. Of this group, 55% were aware that the list was available to give patients and only 20% of them knew how to access it. After two months of education, 100% of surveyed providers viewed the delivery of resources to patients with SUD as important. We increased the awareness and knowledge of its accessibility by 18% and 60%, respectively, from baseline. Conclusion Our quality improvement project increased awareness and ease of access of the SUD resource list. These successes demonstrate that a simple delivery method for resource lists can be implemented in a short time. Our next steps include spreading awareness of how to access the list electronically through biweekly education sessions and ongoing surveying, as well as educating other hospital departments. We are currently assessing whether retrospective chart reviews may help determine the frequency of its use

Archäologische Forschungen in Peru und Honduras im Jahr 2013

Im Arbeitsbereich der Autoren fanden im Jahr 2013 archäologische Forschungsprojekte in Peru und in Honduras statt. Das Projekt „Zentrum und Peripherie: der Siedlungsraum der Paracaskultur (800–200 v. Chr.) im Süden Perus“ wurde im zweiten Jahr mit Förderung der Deutschen Forschungsgemeinschaft (DFG) und in Kooperation mit Partnern von der Ecole des Hautes Etudes en Sciences Sociales (EHESS) durchgeführt. Ziel der Forschungen ist es, durch siedlungsarchäologische Untersuchungen sowohl im Tal von Ica, an der Südküste Perus, als auch in den Hochlandregionen der etwas weiter südlich liegenden Täler von Palpa, den Siedlungs- und Wirtschaftsraum der Paracaskultur, einer der wichtigsten formativzeitlichen Kulturen des zentralen Andenraumes, neu zu definieren. Der Arbeitsschwerpunkt lag in diesem Jahr auf der 3D-Vermessung und Ausgrabung des Fundortes Collanco sowie der geophysikalischen Prospektion des Fundortes Huayuncalla. Im Kleinfundelabor wurde die paracaszeitliche Keramik der beiden genannten Fundorte sowie diejenige von früheren Ausgrabungen an dem Küstenfundort Jauranga analysiert. Das Verbundprojekt „MayaArch3D: Ein webbasiertes 3D-GIS zur Analyse der Archäologie von Copan, Honduras“ wurde ebenfalls im zweiten Jahr mit Förderung des Bundesministeriums für Bildung und Forschung (BMBF) und in Kooperation mit dem Institut für Geoinformatik und dem Interdisziplinären Zentrum für Wissenschaftliches Rechnen (IWR) der Universität Heidelberg, sowie mit der Bruno Kessler Foundation (FBK) in Trento und der ETH Zürich durchgeführt. Die Arbeiten galten der Systematisierung und Strukturierung vorhandener Daten zu dem Maya-Fundort Copan in Honduras, sowie der Aufnahme neuer Daten in Archiven und in Copan selbst. Bei den Feldarbeiten wurden Gebäude, Skulpturen und Friese mit Laserscannern und Digitalkameras aufgenommen, um virtuelle 3D-Modelle für das Dokumentationssystem anzufertigen

Archäologische Forschungen in Peru und Honduras

Im Arbeitsgebiet der Verfasser ist im Berichtszeitraum das interdisziplinäre, vom Bundesministerium für Bildung und Forschung finanzierte Projekt Anden-Transekt ausgelaufen. Im Anschluss daran wurden mehrere, durch Drittmittel finanzierte Forschungsvorhaben initiiert, die in den nächsten Jahren fortgesetzt werden. Die Förderung des interdisziplinären Verbundprojektes Anden-Transekt ging im April 2011 zu Ende. Aus den Forschungsergebnissen ergaben sich zahlreiche neue Fragestellungen für die Archäologie. Eine dieser Fragen, nämlich diejenige nach dem Siedlungsraum der Paracas-Kultur (800–200 v. Chr.), einer der wichtigsten formativzeitlichen Kulturen im Andenraum, wird in einem von der DFG finanzierten archäologischen Forschungsvorhaben weiterverfolgt und vertieft werden. Ein weiteres neues Projekt an der Südküste Perus beinhaltet die Restaurierung und touristische Erschließung einer bereits in früheren Grabungskampagnen freigelegten Grabanlage der Nasca-Kultur (200 v. Chr. – 600 n. Chr.). Mit einem dritten Projekt, MayaArch3D, wird das Engagement des DAI bei der Erforschung vorspanischer Kulturen in Mesoamerika durch die Erforschung einer der wichtigsten Ruinenstätte der Maya-Kultur in Honduras fortgesetzt. Dieses Projekt ist gleichzeitig ein Beitrag zu dem Bestreben des DAI, den Einsatz neuer Technologien und Medien in der Archäologie, insbesondere der Erzeugung, Analyse und langfristigen Speicherung digitaler Daten weiterzuentwickeln

Determining who responds better to a computer vs. human-delivered physical activity intervention: Results from the community health advice by telephone (CHAT) trial

Background Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. Methods Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. Results Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p \u3c 0.01) and private self-consciousness (i.e., tendency to attune to one’s own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p \u3c 0.05) but a variety of other factors (e.g., demographics) did not (p \u3e 0.12). Conclusions Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion

Patient-reported outcome measures in dermatology: a systematic review

By relying on data from existing patient-reported outcome measures of quality of life, the true impact of skin conditions on patients’ lives may be underestimated. This study systematically reviewed all dermatology-specific (used across skin conditions) patient-reported outcome measures and makes evidence-based recommendations for their use. The study protocol is registered on PROSPERO (CRD42018108829). PubMed, PsycInfo and CINAHL were searched from inception to 25 June 2018. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria were used to assess the measurement properties and methodological quality of studies. A total of 12,925 abstracts were identified. Zero patient-reported outcome measures were assigned to category A (ready for use without further validation), 31 to category B (recommended for use, but only with further validation) and 5 to category C (not recommended for use). There is no gold-standard dermatology-specific patient-reported outcome measure that can be recommended or used without caution. A new measure that can comprehensively capture the impact of dermatological conditions on the patient’s life is needed

De novo variants in ATXN7L3 lead to developmental delay, hypotonia and distinctive facial features

Deubiquitination is critical for the proper functioning of numerous biological pathways such as DNA repair, cell cycle progression, transcription, signal transduction, and autophagy. Accordingly, pathogenic variants in deubiquitinating enzymes (DUBs) have been implicated in neurodevelopmental disorders (ND) and congenital abnormalities. ATXN7L3 is a component of the DUB module of the SAGA complex, and two other related DUB modules, and serves as an obligate adaptor protein of 3 ubiquitin-specific proteases (USP22, USP27X or USP51). Through exome sequencing and GeneMatching, we identified nine individuals with heterozygous variants in ATXN7L3. The core phenotype included global motor and language developmental delay, hypotonia, and distinctive facial characteristics including hypertelorism, epicanthal folds, blepharoptosis, a small nose and mouth, and low-set posteriorly rotated ears. In order to assess pathogenicity, we investigated the effects of a recurrent nonsense variant [c.340C>T; p.(Arg114Ter)] in fibroblasts of an affected individual. ATXN7L3 protein levels were reduced, and deubiquitylation was impaired, as indicated by an increase in histone H2Bub1 levels. This is consistent with the previous observation of increased H2Bub1 levels in Atxn7l3-null mouse embryos, which have developmental delay and embryonic lethality. In conclusion, we present clinical information and biochemical characterization supporting ATXN7L3 variants in the pathogenesis of a rare syndromic ND

Neocortical Connectivity during Episodic Memory Formation

During the formation of new episodic memories, a rich array of perceptual information is bound together for long-term storage. However, the brain mechanisms by which sensory representations (such as colors, objects, or individuals) are selected for episodic encoding are currently unknown. We describe a functional magnetic resonance imaging experiment in which participants encoded the association between two classes of visual stimuli that elicit selective responses in the extrastriate visual cortex (faces and houses). Using connectivity analyses, we show that correlation in the hemodynamic signal between face- and place-sensitive voxels and the left dorsolateral prefrontal cortex is a reliable predictor of successful face–house binding. These data support the view that during episodic encoding, “top-down” control signals originating in the prefrontal cortex help determine which perceptual information is fated to be bound into the new episodic memory trace

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Food Insecurity Prevalence Across Diverse Sites During COVID-19: A Year of Comprehensive Data

Key Findings NFACT includes 18 study sites in 15 states as well as a national poll, collectively representing a sample size of more than 26,000 people. Some sites have implemented multiple survey rounds, here we report results from 22 separate surveys conducted during the year since the COVID-19 pandemic began in March 2020. 18 out of 19 surveys in 14 sites with data for before and since the pandemic began found an increase in food insecurity since the start of the COVID-19 pandemic as compared to before the pandemic. In nearly all surveys (18/19) that measured food insecurity both before and during the pandemic, more Black, Indigenous, and People of Color (BIPOC) were classified as food insecure during the pandemic as compared to before it began. Prevalence of food insecurity for BIPOC respondents was higher than the overall population in the majority of surveys (19/20) sampling a general population. In almost all surveys (21/22), the prevalence of food insecurity for households with children was higher than the overall prevalence of food insecurity. Food insecurity prevalence was higher for households experiencing a negative job impact during the pandemic (i.e. job loss, furlough, reduction in hours) in nearly all surveys and study sites (21/22). Food insecurity prevalence in most sites was significantly higher before COVID-19 than estimates from that time period. Reporting a percent change between pre and during COVID-19 prevalence may provide additional information about the rate of change in food insecurity since the start of the pandemic, which absolute prevalence of food insecurity may not capture. Results highlight consistent trends in food insecurity outcomes since the start of the COVID-19 pandemic, across diverse study sites, methodological approaches, and time