Prevention for a Healthier California: Investments in Disease Prevention Yield Significant Savings, Stronger Communities

Estimates how much the state and the nation could save in healthcare costs by investing in disease prevention through community programs that increase physical activity, improve nutrition, and reduce tobacco use. Provides examples of prevention efforts

Molybdenum carbide catalysts for water–gas shift

Molybdenum carbide (Mo 2 C) was demonstrated to be highly active for the water–gas shift of a synthetic steam reformer exhaust stream. This catalyst was more active than a commercial Cu–Zn–Al shift catalyst under the conditions employed (220–295°C and atmospheric pressure). In addition, Mo 2 C did not catalyze the methanation reaction. There was no apparent deactivation or modification of the structure during 48 h on‐stream. The results suggest that high surface area carbides are promising candidates for development as commercial water–gas shift catalysts.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44257/1/10562_2004_Article_327161.pd

Constructing a gene expression atlas of Chia (Salvia hispanica)

• Salvia hispanica, also known as Chia, is an annual plant of the mint family, Lamiaceae. Chia is a vascular plant with perennating buds initially formed at or within the soil surface. Chia grows to roughly one meter tall at maturity, with leaves growing in opposite arrangement, small purple flowers, and black, grey, or white oval shaped seeds between 1 and 2mm lengthwise. • More known for its ornamental use in the terra cotta pot “Chia-pet”, Chia has been a staple in human diets since pre-Columbian times. Currently Chia is popularly used for its health properties. Chia’s high concentrations of Omega-3 fatty acids offer health benefits in childhood development as well as in lowering risks of cardiovascular disease and diabetes in adults. Chia seeds consist of between 25 and 40 percent oil, of which 80% are essential omega oils. Chia is promising as a diversified field crop in its ability to grow well in arid environments. • Our research is focused on achieving broad understanding of the transcriptomic profile of chia, based on selected tissues at various stages of development, in order to provide knowledge and understanding of its Omega oils and broader potential as a human food source. The chia subspecies, Salba, was used for this study

Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study

Background The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. Methods Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. Results Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. Conclusions Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.The T3 Trial was funded by a NHMRC Project Grant 1024812 (2012–2017). The following authors received research fellowship funding from the NHMRC: Dominique Cadilhac (co-funded with Heart Foundation: 1063761 and 1154273) and Chris Levi (Practitioner: 1043913). Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Non-material support provided by the trial sponsor, Australian Catholic University, to house members of the trial team including authors SM, SD, EM, RP, OF, VS and LC

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): A qualitative study

Background: The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90- day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. Methods: Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. Results: Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. Conclusions: Despite initial high ‘buy-in’ from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12614000939695)

Kohti kulttuuripolkua Tuusulan kunnassa – kulttuuripolun mahdollisuudet menetelmänä lastenkulttuuripalvelujen kohdentamisessa

Opinnäytetyön tavoitteena oli ryhtyä suunnittelemaan Tuusulan kuntaan kulttuuripolkumallia ja tutkia kulttuuripolkua palvelujen kohdentamisen välineenä. Kulttuuripolku ja kulttuuriopetussuunnitelma ovat koulujen ja kulttuurilaitosten sekä koulujen ja kunnallisten kulttuuritoimien välistä yhteistyötä ohjaavia suunnitelmallisesti luokka-asteelta toiselle eteneviä malleja. Työn tilaaja oli Tuusulan kunnan kulttuuripalvelut, jossa kirjoittaja on työskennellyt lastenkulttuurista vastaavana tuottajana vuodesta 2006 lähtien. Yhteistyökumppanina sekä kulttuuripolkujen asiantuntijana kehittämistyössä toimi valtakunnallinen lastenkulttuurikeskusten verkosto Taikalamppu. Työssä kartoitettiin Suomessa jo olemassa olevia kulttuuripolkuja ja kulttuuriopetussuunnitelmia. Menetelminä kartoituksessa käytettiin benchmarkkausta (vertaisarviointi) ja dokumenttianalyysiä. Tietoa kerättiin lisäksi kyselyllä. Näin kerättyä tutkimustietoa käytettiin kehittämisen välineenä Tuusulan kulttuuripalvelujen lastenkulttuuritiimin työpajoissa. Työpajojen, kartoituksen ja kyselyn pohjalta hahmoteltiin askeleet kunnalliselle kulttuuritoimelle kohti kulttuuripolkua. Kartoituksesta ilmeni, että kulttuuripolkujen ja kulttuuriopetussuunnitelmien laatimisessa on kaksi pääsuuntausta. Kyselyssä selvisi, että olennaista kulttuuripolkutyössä on moniammatillinen, kulttuuritoimen ja opetustoimen hallinnonrajat ylittävä yhteistyö. Kyselyssä selvisi myös, että kulttuuripolkutoiminta on useassa kunnassa sidoksissa Taikalamppuresursseihin. Sekä kyselyssä että työpajoissa päädyttiin samaan lopputulokseen: kulttuuripolku menetelmänä palvelujen tuotannossa helpottaa aika- ja raharesurssien ennakointia. Työpajoissa selvisi, että Tuusulan kulttuuripalvelujen eri yksiköissä (kulttuuri, museo ja kirjasto) on jo olemassa useita ”kulttuuripolku-elementtejä” ja lastenkulttuuritiimi on tarpeellinen tiedonkulun reitti Tuusulan lastenkulttuuripalveluiden kehittämisessä. Taikalamppu-verkoston haasteena on saada toimintamallit leviämään myös verkoston ulkopuolisiin kuntiin ja mallintaa kulttuuripolkutoimintaa uudessa hankkeessa, johon tämä tutkimus tuotti pohjatietoa. Sovellusarvo tästä opinnäytetyöstä muille kunnallisille kulttuuritoimille on laaja kartoitus olemassa olevista kulttuuripoluista sekä hahmotelma askeleiksi, kuinka käynnistää kulttuuripolkutyö omassa kunnassa.The aim of the thesis was start to plan the Culture Path program to municipality of Tuusula and to study the method Culture Path as a tool to direct the cultural services equally. Culture path and Cultural Curriculum are models to guide systematically the cooperation between schools and cultural institutions from 1st grade to 9th grade throughout the Finnish comprehensive school. The subscriber of this thesis was the cultural services unit of the municipality of Tuusula, where the Author of this thesis has been working since 2006 as a cultural manager in charge of the children´s culture. The co-operation partner and specialist in the subject was Taikalamppu - Aladdin´s Lamp network. It´s a Finnish network of regional Art Centers for Children and young people. The principal methods used in this thesis were benchmarking, document analysis, survey and workshops. The information found by benchmarking and survey was used in the workshops for the children´s culture team of cultural services unit of Tuusula. The team includes members from the art museum, library and cultural management unit. The results from the workshops, benchmarking and survey helped to describe the steps how to build up the Culture Path in municipal cultural services. The benchmarking showed that there are two main trends to make the Culture Path or cultural curriculum. The survey expressed that it´s essential to make good co-operation between municipal educational administration and municipal cultural administration when designing and implementing the Path. The survey showed also that the Culture Path work in many cities and municipalities is dependent on the Taikalamppu network´s resources. Both the workshops and the survey showed that the Culture Path method helps to foreshadow the needed resources in advance. The workshops showed that there are already many Culture Path elements in museum´s, library´s and cultural management unit´s services in Tuusula and the children´s culture team is necessary. It would be possible to plan a Culture Path with existing budget by targeting the services differently. The general result for the Taikalamppu network was the challenge to spread the good practices to those municipalities which are not part of the network