Self-Management and Health Care Use in an Adolescent and Young Adult Medicaid Population With Differing Chronic Illnesses

IntroductionFew studies of adults question the validity of the claim that self-management reduces the use of health care services and, as a result, health care costs. The aim of our study was to determine the relationship between self-management and health care use in a population of adolescent and young adult recipients of North Carolina Medicaid with chronic health conditions, who received care in either the pediatric or adult clinic. Our secondary objective was to characterize the patterns of health care use among this same population.MethodsOne hundred and fifty adolescents or young adults aged 14 to 29 were recruited for this study. Participants completed a demographics questionnaire and the self-management subdomain of the University of North Carolina TRxANSITION Scale. Information on each participant’s emergency department and inpatient use was obtained by using the North Carolina Medicaid Provider Portal.ResultsThis cohort had a high level of emergency health care use; average lifetime use was 3.18 (standard deviation [SD], 5.58) emergency department visits, 2.02 (SD, 3.42) inpatient visits, and 12.5 (SD, 23.9 ) days as an inpatient. Age group (pediatric or adult), diagnosis, race/ethnicity, and sex were controlled for in all analyses. Results indicate that patients with a high rate of disease self-management had more emergency department visits and hospitalizations and a longer length of stay in the hospital than did those with a low rate. ConclusionIn a group of North Carolina Medicaid recipients with chronic conditions, better self-management is associated with more health care use. This is likely the result of many factors, including more interactions with health care professionals, greater ability to recognize the need for emergency medical attention, and the use of the emergency department for primary health care

Viral Networks: Connecting Digital Humanities and Medical History

This volume of original essays explores the power of network thinking and analysis for humanities research. Contributing authors are all scholars whose research focuses on a medical history topic—from the Black Death in fourteenth-century Provence to psychiatric hospitals in twentieth-century Alabama. The chapters take readers through a variety of situations in which scholars must determine if network analysis is right for their research; and, if the answer is yes, what the possibilities are for implementation. Along the way, readers will find practical tips on identifying an appropriate network to analyze, finding the best way to apply network analysis, and choosing the right tools for data visualization. All the chapters in this volume grew out of the 2018 Viral Networks workshop, hosted by the History of Medicine Division of the National Library of Medicine (NIH), funded by the Office of Digital Humanities of the National Endowment for the Humanities, and organized by Virginia Tech

The DEEP Groth Strip Survey VI. Spectroscopic, Variability, and X-ray Detection of AGN

We identify active galactic nuclei (AGN) in the Groth-Westphal Survey Strip (GSS) using the independent and complementary selection techniques of optical spectroscopy and photometric variability. We discuss the X-ray properties of these AGN using Chandra/XMM data for this region. From a sample of 576 galaxies with high quality spectra we identify 31 galaxies with AGN signatures. Seven of these have broad emission lines (Type 1 AGNs). We also identify 26 galaxies displaying nuclear variability in HST WFPC2 images of the GSS separated by ~7 years. The primary overlap of the two selected AGN samples is the set of broad-line AGNs, of which 80% appear as variable. Only a few narrow-line AGNs approach the variability threshold. The broad-line AGNs have an average redshift of z~1.1 while the other spectroscopic AGNs have redshifts closer to the mean of the general galaxy population (z~0.7). Eighty percent of the identified broad-line AGNs are detected in X-rays and these are among the most luminous X-ray sources in the GSS. Only one narrow-line AGN is X-ray detected. Of the variable nuclei galaxies within the X-ray survey, 27% are X-ray detected. We find that 1.9+/-0.6% of GSS galaxies to V=24 are broad-line AGNs, 1.4+/-0.5% are narrow-line AGNs, and 4.5+/-1.4% contain variable nuclei. The fraction of spectroscopically identified BLAGNs and NLAGNs at z~1 reveals a marginally significant increase of 1.3+/-0.9% when compared to the local population.Comment: 29 pages, 8 figures, accepted for publication in ApJ

Progress in authority management of people names for collections

The concept of building a network of relationships between entities, a knowledge graph, is one of the most effective methods to understand the relations between data. By organizing data, we facilitate the discovery of complex patterns not otherwise evident in the raw data. Each datum at the nodes of a knowledge graph needs a persistent identifier (PID) to reference it unambiguously. In the biodiversity knowledge graph, people are key elements (Page 2016). They collect and identify specimens, they publish, observe, work with each other and they name organisms. Yet biodiversity informatics has been slow to adopt PIDs for people and people are currently represented in collection management systems as text strings in various formats. These text strings often do not separate individuals within a collecting team and little biographical information is collected to disambiguate collectors. In March 2019 we organised an international workshop to find solutions to the problem of PIDs for people in collections with the aim of identifying people unambiguously across the world's natural history collections in all of their various roles. Stakeholders were represented from 11 countries, representing libraries, collections, publishers, developers and name registers. We want to identify people for many reasons. Cross-validation of information about a specimen with biographical information on the specimen can be used to clean data. Mapping specimens from individual collectors across multiple herbaria can geolocate specimens accurately. By linking literature to specimens through their authors and collectors we can create collaboration networks leading to a much better understanding of the scientific contribution of collectors and their institutions. For taxonomists, it will be easier to identify nomenclatural type and syntype material, essential for reliable typification. Overall, it will mean that geographically dispersed specimens can be treated much more like a single distributed infrastructure of specimens as is envisaged in the European Distributed Systems of Scientific Collections Infrastructure (DiSSCo). There are several person identifier systems in use. For example, the Virtual International Authority File (VIAF) is a widely used system for published authors. The International Standard Name Identifier (ISNI), has broader scope and incorporates VIAF. The ORCID identifier system provides self-registration of living researchers. Also, Wikidata has identifiers of people, which have the advantage of being easy to add to and correct. There are also national systems, such as the French and German authority files, and considerable sharing of identifiers, particularly on Wikidata. This creates an integrated network of identifiers that could act as a brokerage system. Attendees agreed that no one identifier system should be recommended, however, some are more appropriate for particular circumstances. Some difficulties have still to be resolved to use those identifier schemes for biodiversity : 1) duplicate entries in the same identifier system; 2) handling collector teams and preserving the order of collectors; 3) how we integrate identifiers with standards such as Darwin Core, ABCD and in the Global Biodiversity Information Facility; and 4) many living and dead collectors are only known from their specimens and so they may not pass notability standards required by many authority systems. The participants of the workshop are now working on a number of fronts to make progress on the adoption of PIDs for people in collections. This includes extending pilots that have already been trialed, working with identifier systems to make them more suitable for specimen collectors and talking to service providers to encourage them to use ORCID iDs to identify their users. It was concluded that resolving the problem of person identifiers for collections is largely not a lack of a solution, but a need to implement solutions that already exist

Data In, Data Out

Catalog for the exhibition Data In, Data Out held at the Seton Hall University Walsh Gallery, October 31 - December 16, 2011. Curated by Jeanne Brasile. Includes an essay by Jeanne Brasile. Includes color illustrations

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD

CB1 Expression Is Attenuated in Fallopian Tube and Decidua of Women with Ectopic Pregnancy

BACKGROUND: Embryo retention in the Fallopian tube (FT) is thought to lead to ectopic pregnancy (EP), a considerable cause of morbidity. In mice, genetic/pharmacological silencing of cannabinoid receptor Cnr1, encoding CB1, causes retention of embryos in the oviduct. The role of the endocannabinoids in tubal implantation in humans is not known. METHODS AND FINDINGS: Timed FT biopsies (n = 18) were collected from women undergoing gynecological procedures for benign conditions. Endometrial biopsies and whole blood were collected from women undergoing surgery for EP (n = 11); management of miscarriage (n = 6), and termination of pregnancy (n = 8). Using RT-PCR and immunohistochemistry, CB1 mRNA and protein expression levels/patterns were examined in FT and endometrial biopsies. The distribution of two polymorphisms of CNR1 was examined by TaqMan analysis of genomic DNA from the whole blood samples. In normal FT, CB1 mRNA was higher in luteal compared to follicular-phase (p<0.05). CB1 protein was located in smooth muscle of the wall and of endothelial vessels, and luminal epithelium of FT. In FT from women with EP, CB1 mRNA expression was low. CB1 mRNA expression was also significantly lower (p<0.05) in endometrium of women with EP compared to intrauterine pregnancies (IUP). Although of 1359G/A (rs1049353) polymorphisms of CNR1 gene suggests differential distribution of genotypes between the small, available cohorts of women with EP and those with IUP, results were not statistically significant. CONCLUSIONS: CB1 mRNA shows temporal variation in expression in human FT, likely regulated by progesterone. CB1 mRNA is expressed in low levels in both the FT and endometrium of women with EP. We propose that aberrant endocannabinoid-signaling in human FT leads to EP. Furthermore, our finding of reduced mRNA expression along with a possible association between polymorphism genotypes of the CNR1 gene and EP, suggests a possible genetic predisposition to EP that warrants replication in a larger sample pool

ĭn΄tər-ăk\u27tĭv

Catalog for the exhibition ĭn΄tər-ăk\u27tĭv held at the Seton Hall University Walsh Gallery, November 8 - December 15, 2006. Curated by Gianluca Bianchino, Jeanne Brasile and Asha Ganpat. Includes an essay by Jeanne Brasile. Includes illustrations

Intervention trial with calcium montmorillonite clay in a south Texas population exposed to aflatoxin

South Texas currently has the highest incidence of hepatocellular carcinoma (HCC) in the United States, a disease that disproportionately affects Latino populations in the region. Aflatoxin B(1) (AFB(1)) is a potent liver carcinogen that has been shown to be present in a variety of foods in the U.S., including corn and corn products. Importantly, it is a dietary risk factor contributing to a higher incidence of HCC in populations frequently consuming AFB(1)-contaminated diets. In a randomized double-blind placebo controlled trial, we evaluated the effects of a three-month administration of ACCS100 (refined calcium montmorillonite clay) on serum AFB(1)-lysine adduct level and serum biochemistry in 234 healthy men and women residing in Bexar and Medina Counties, Texas. Participants recruited from 2012–2014 received either a Placebo, 1.5 g, or 3 g ACCS100 each day for three months, and no treatment during the 4(th) month. Adverse event rates were similar across treatment groups and no significant differences were observed for serum biochemistry and hematology parameters. Differences in levels of AFB(1)-lysine adduct at 1, 3, and 4 months were compared between Placebo and active treatment groups. Although serum AFB(1)-lysine adduct levels were decreased by month 3 for both treatment groups, the Low dose was the only treatment that was significant (p=0.0005). In conclusion, the observed effect in the Low dose treatment group suggests that the use of ACCS100 may be a viable strategy to reduce dietary AFB(1) bioavailability during aflatoxin outbreaks and potentially in populations chronically exposed to this carcinogen

Level of agreement between frequently used cardiovascular risk calculators in people living with HIV

Objectives The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH). Methods PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into ‘low’ ( 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland–Altman plots. Results The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49–59] years. The median calculated 10‐year CVD risk was 11.9% (IQR 6.8–18.4%), 8.9% (IQR 4.6–15.0%), 8.5% (IQR 4.8–14.6%) and 6.9% (IQR 4.1–11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50–0.60 range. Conclusions Estimates of predicted 10‐year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone