Improving Tobacco Cessation Counseling Documentation in the Primary Care Setting

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation intervention as a Quality Payment Program (QPP) measure. One family medicine clinic in central Kentucky noted low rates of documentation of smoking cessation counseling and chose this as one of six quality measures to improve. Previous work revealed a root cause of the problem was providers not knowing how and where to document smoking cessation counseling. Initial efforts to address this knowledge deficit occurred until the healthcare enterprise changed the EHR systems which altered the process of smoking cessation documentation. The clinic leadership team requested the principal investigator of this study lead the evaluation of changes in tobacco cessation counseling documentation after implementation of the new EHR. PURPOSE: The purpose of this project was to evaluate the effect of an EHR change from Allscripts to Epic on tobacco cessation counseling documentation among primary care providers at a central KY family medicine clinic. METHODS: This project was a single-center quality improvement project conducted from October 2020 to October 2021. The project was guided by the FOCUS-PDSA model for improvement. The focus of this paper is on PDSA cycle three, conducted from May 2021 until October 2021. Four randomly selected providers from the previous PDSA cycles were evaluated via chart review on frequencies of tobacco screening and counseling, and billing information using one of four approved documentation methods needed to meet the quality metric for tobacco screening and counseling. RESULTS:PDSA cycle three had a significant increase in tobacco screening and cessation counseling documentation across all PDSA time periods from October 2020 to October 2021 (F=37.7, p CONCLUSIONS: An EHR change to Epic improved tobacco cessation counseling documentation performance rates among all providers in the central KY clinic. Future investigation should include a more robust evaluation of performance rates over a longer period of time, and include evaluation of billable counseling rates and smart phrases usage specifically in primary care provider notes

The Estimated Value of a Premium Division One Football Player: The Argument Supporting Pay for Play

Abstract The gap between the revenue generated by division one football players and the value of an athletic scholarship is the marginal revenue product of these athletes. Because of the monopsonistic behavior of the NCAA, division one institutions capture an economic rent from their student athletes. This paper measures the rents generated by NCAA division one football players in the six powerhouse conferences by using linear regressions based on variables such as university revenue, future NFL draft picks, undergraduate population, and weekly AP Top-25 rankings. This paper will inform its readers on how much money these student athletes are generating for the NCAA and their respective schools, and will provide understanding as to why there has been so much controversy regarding the payment of NCAA athletes

Noves troballes sobre diabetis tipus 2 a nivell cel·lular

Els autors d'aquest treball van analitzar una proteïna present en el teixit muscular: el transportador de glucosa 4 o GLUT4, molt important en la regulació dels nivells de glucosa de la sang. Les conclusions de l'estudi permeten conèixer amb més profunditat els mecanismes cel·lulars implicats en el desenvolupament de la diabetis tipus 2.Los autores de este trabajo analizaron una proteína presente en el tejido muscular: el transportador de glucosa 4 o GLUT4, de gran importancia en la regulación de los niveles de glucosa en la sangre. Las conclusiones del estudio permiten conocer con más profundidad los mecanismos celulares implicados en el desarrollo de la diabetes tipo 2

Sustavna infekcija s oštećenjem jednog ili više organa uzrokovanim neadekvatno liječenim kroničnim ranama: prikaz slučajeva

Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID -19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID -19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID -19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.Kronične rane predstavljaju podcijenjeno stanje koje je povezano sa značajnim rastućim troškovima bolničkog i ambulantnog liječenja. Znajući da je populacija pacijenata s kroničnim ranama vrlo heterogena te obuhvaća populaciju dijabetičara, pacijente s kroničnom venskom insuficijencijom, perifernom arterijskom bolesti, te uvažavajući dodatne razlike vezane uz spol, dob te prethodnu medicinsku dokumentaciju, liječenje kroničnih rana je visoko personaliziran postupak i ovisan je o nizu različitih čimbenika. U ovome radu naglašen je problem populacije s kroničnim ranama tijekom pandemije COVID -19 u smislu veće vjerojatnosti neželjenog ishoda bolesti primarno zbog ograničenog pristupa liječnicima primarne zdrastvene zaštite, kao i regularne skrbi zbog drugih prilažećih kroničnih stanja. U radu su opisani prikazi slučajeva tri bolesnika s kroničnim ranama koji su imali značajno pogoršanje uslijed pandemije COVID -19. Isto se moglo prevenirati pravilnom i regularnom brigom, stoga smatramo da za sve pacijente tijekom pandemije COVID -19, bez obzira na trenutno stanje zdrastvenog sustava i postojeća ograničenja, prepreke nisu nesavladive, u cilju nadzora ovih pandemijskih problema koji postaju sindemija

Sustavna infekcija s oštećenjem jednog ili više organa uzrokovanim neadekvatno liječenim kroničnim ranama: prikaz slučajeva

Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID -19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID -19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID -19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.Kronične rane predstavljaju podcijenjeno stanje koje je povezano sa značajnim rastućim troškovima bolničkog i ambulantnog liječenja. Znajući da je populacija pacijenata s kroničnim ranama vrlo heterogena te obuhvaća populaciju dijabetičara, pacijente s kroničnom venskom insuficijencijom, perifernom arterijskom bolesti, te uvažavajući dodatne razlike vezane uz spol, dob te prethodnu medicinsku dokumentaciju, liječenje kroničnih rana je visoko personaliziran postupak i ovisan je o nizu različitih čimbenika. U ovome radu naglašen je problem populacije s kroničnim ranama tijekom pandemije COVID -19 u smislu veće vjerojatnosti neželjenog ishoda bolesti primarno zbog ograničenog pristupa liječnicima primarne zdrastvene zaštite, kao i regularne skrbi zbog drugih prilažećih kroničnih stanja. U radu su opisani prikazi slučajeva tri bolesnika s kroničnim ranama koji su imali značajno pogoršanje uslijed pandemije COVID -19. Isto se moglo prevenirati pravilnom i regularnom brigom, stoga smatramo da za sve pacijente tijekom pandemije COVID -19, bez obzira na trenutno stanje zdrastvenog sustava i postojeća ograničenja, prepreke nisu nesavladive, u cilju nadzora ovih pandemijskih problema koji postaju sindemija

The effect of plant extract on mortality, feeding and oviposition of Frankliniella occidentalis Pergande, 1895

Kalifornijski trips (Frankliniella occidentalis Pergande, 1895) jedan je od najvažnijih polifagnih štetnika zaštićenih prostora diljem svijeta. Problem u suzbijanju ovog štetnika javio se razvojem rezistentnosti izazvan nepravilnom primjenom kemijskih sredstava. Jedna od alternativnih i ekološki povoljnih metoda u suzbijanju jest primjena biljnih ojačivača. S obzirom na vrlo mali broj podataka o izravnom utjecaju biljnih ojačivača na štetne kukce, cilj ovog istraživanja je utvrditi utjecaj biljnih ekstrakata na mortalitet, ishranu i ovipoziciju kalifornijskog tripsa te na debljinu stanične stijenke i epiderme lista krastavca. Rezultati pokazuju kako biljni ojačivači nemaju izravan utjecaj na mortalitet drugog stadija ličinke niti na ovipoziciju ženki. Kod odabira odraslog oblika tripsa između listova krastavca tretiranim biljnim ekstraktima i listova tretiranih vodom nema signifikantne razlike. Ishrana tripsa po listu signifikantno je veća na listovima tretiranim ekstraktom koprive. Signifikantne razlike u debljini stanične stijenke nisu utvrđene dok je debljina epiderme signifikatno veća kod listova tretiranim ekstraktom koprive i preslice.The western flower thrips (Frankliniella occidentalis Pergande, 1895) is one of the most important polyphage pests in greenhouse production worldwide. A problem with the control of this pest has arisen through the development of resistance caused by the improper use of chemicals. One of the alternative and environmentally friendly methods of suppression is the use of plant extracts. Due to the lack of literature on the direct impact of plant extract on insect pests, the aim of this study is to determine the effect of plant extracts on mortality, feeding and oviposition of western flower thrips as well as the effect on thickness of the cell wall and epidermis of cucumber. The results show that plant extracts do not have a direct effect on second-stage larval mortality nor on oviposition of females. There is no significant difference in the choice of adult thrips form between plant extract treated cucumber leaves and water treated leaves. The feeding of thrips per leaf is significantly higher on leaves treated with stinging nettle extract. There is no significant difference in the thickness of the cell wall, whereas the thickness of the epidermis is significantly higher in leaves treated with stinging nettle and horsetail extract

The effect of plant extract on mortality, feeding and oviposition of Frankliniella occidentalis Pergande, 1895

Kalifornijski trips (Frankliniella occidentalis Pergande, 1895) jedan je od najvažnijih polifagnih štetnika zaštićenih prostora diljem svijeta. Problem u suzbijanju ovog štetnika javio se razvojem rezistentnosti izazvan nepravilnom primjenom kemijskih sredstava. Jedna od alternativnih i ekološki povoljnih metoda u suzbijanju jest primjena biljnih ojačivača. S obzirom na vrlo mali broj podataka o izravnom utjecaju biljnih ojačivača na štetne kukce, cilj ovog istraživanja je utvrditi utjecaj biljnih ekstrakata na mortalitet, ishranu i ovipoziciju kalifornijskog tripsa te na debljinu stanične stijenke i epiderme lista krastavca. Rezultati pokazuju kako biljni ojačivači nemaju izravan utjecaj na mortalitet drugog stadija ličinke niti na ovipoziciju ženki. Kod odabira odraslog oblika tripsa između listova krastavca tretiranim biljnim ekstraktima i listova tretiranih vodom nema signifikantne razlike. Ishrana tripsa po listu signifikantno je veća na listovima tretiranim ekstraktom koprive. Signifikantne razlike u debljini stanične stijenke nisu utvrđene dok je debljina epiderme signifikatno veća kod listova tretiranim ekstraktom koprive i preslice.The western flower thrips (Frankliniella occidentalis Pergande, 1895) is one of the most important polyphage pests in greenhouse production worldwide. A problem with the control of this pest has arisen through the development of resistance caused by the improper use of chemicals. One of the alternative and environmentally friendly methods of suppression is the use of plant extracts. Due to the lack of literature on the direct impact of plant extract on insect pests, the aim of this study is to determine the effect of plant extracts on mortality, feeding and oviposition of western flower thrips as well as the effect on thickness of the cell wall and epidermis of cucumber. The results show that plant extracts do not have a direct effect on second-stage larval mortality nor on oviposition of females. There is no significant difference in the choice of adult thrips form between plant extract treated cucumber leaves and water treated leaves. The feeding of thrips per leaf is significantly higher on leaves treated with stinging nettle extract. There is no significant difference in the thickness of the cell wall, whereas the thickness of the epidermis is significantly higher in leaves treated with stinging nettle and horsetail extract

El mundo en efervescencia

This work, which has an abstract tendency, is conceived as an attempt to capture the dizziness in which the present occurs and  the world changes. I stop and reflect that in the face of the pandemic, citizens of the city have never been immersed in the same and complex circumstance, in the same compulsory “fashion”, that of having to confine ourselves and wear a garment over the mouth and nose not to put yourself at risk, or risk the health of others, among other vast precautions. Then one of the illusory sensations that I want to represent more strongly in this painting comes to my mind and flows, and that is precisely "vertigo", that internal agitation that causes the state of uncertainty; that moment when we suddenly perceive that the external is rotating and moving around us in space while the oscillation and instability of the present occurs. Thus, from the collective imagination, a city located at any latitude in the world appears in the lower angle of the painting, experiencing that instant of effervescence that comes with everything that moves and that seeks to return to its balance. In that order, with circles, sinuous lines and the use of primary colors, I also let the work surprise me while I do it from what some call “the controlled accident”. It is then that I try to represent above that blue city and through a kind of fog, smoke or some kind of "quintessence", the unexpected consequences that are unleashed by the intense activity behind the accelerated rhythm that we as humanity carried on the planet, but now is seeking to find its place in an atmosphere no longer chaotic, but a loophole to be able to dissipate. The hope that we will find a haven in the aftermath unleashed by a virus that we are still dealing with as a single species.Esta obra, de tendencia abstracta, la concibo como un intento por plasmar lo vertiginoso en que el presente ocurre y los cambios del mundo suceden. Me detengo, y reflexiono que ante la pandemia nunca los ciudadanos de la urbe nos habíamos visto inmersos en una misma circunstancia así de compleja, en una misma “moda” obligatoria, la de tener que confinarse y usar una prenda sobre la boca y la nariz para no situarse en riesgo, ni arriesgar la salud de los demás, entre otras vastas precauciones. Luego viene a mi mente y fluye una de las sensaciones ilusorias que deseo representar con mayor ahínco en esta pintura, y que es precisamente “el vértigo”, esa agitación interna que causa el estado de la incertidumbre; ese momento en que percibimos de pronto que lo externo está rotando y desplazándose alrededor de uno en el espacio mientras ocurre la oscilación e inestabilidad que ha traído la actualidad. Así, desde el imaginario colectivo aparece en el ángulo inferior de la pintura una ciudad ubicada en cualquier latitud del mundo, viviendo ese instante de efervescencia que viene aparejado de todo aquello que se mueve y que busca regresar a su equilibrio. En ese orden, con círculos, trazos sinuosos y el uso de colores primarios, dejo también que la obra me sorprenda mientras la realizo desde lo que algunos llaman “el accidente controlado”. Es entonces que trato de representar por encima de esa ciudad azul y mediante una suerte de niebla, humo o algún tipo de “quintaesencia”, las consecuencias inesperadas que se desatan por haber ocurrido la actividad intensa que hay detrás del ritmo acelerado que como humanidad llevábamos en el planeta, pero que ahora busca encontrar su lugar en una atmósfera ya no caótica, sino un resquicio para poder disiparse. La esperanza de que hallaremos un remanso a las secuelas desatadas por un virus con el que aún seguimos lidiando como una sola especie

Nanodelivery Systems as New Tools for Immunostimulant or Vaccine Administration : Targeting the Fish Immune System

Fish disease treatments have progressed significantly over the last few years and have moved from the massive use of antibiotics to the development of vaccines mainly based on inactivated bacteria. Today, the incorporation of immunostimulants and antigens into nanomaterials provide us with new tools to enhance the performance of immunostimulation. Nanoparticles are dispersions or solid particles designed with specific physical properties (size, surface charge, or loading capacity), which allow controlled delivery and therefore improved targeting and stimulation of the immune system. The use of these nanodelivery platforms in fish is in the initial steps of development. Here we review the advances in the application of nanoparticles to fish disease prevention including: the type of biomaterial, the type of immunostimulant or vaccine loaded into the nanoparticles, and how they target the fish immune system