Public Health Policy: Internet Access to Advance Health Equity

Internet access could be the 21st century’s great equalizer, interrupting access barriers that negatively impact health. Mississippi reigns as the poorest state in the nation (CB, 2020), with some of the country’s worst health outcomes (UHF, 2022), particularly among rural populations. The Community Engagement Center (CEC), one of three Jackson Heart Study (JHS) centers, leverages community partnerships and connections to improve public health. In these times of public health crises, connections are relevant - that is, internet connections. Internet, or broadband, access is the far upstream approach needed to improve the social determinants that negatively impact Mississippians’ health. The National Academy of Medicine says it best, “Everyone in this country deserves the opportunity to be healthy and reach their full potential no matter who they are or where they live” (NAM, 2021, para 1). Simply living in the beautiful state of Mississippi should not be an automatic predictor of excess morbidity and early mortality. Mississippi public health advocates must promote increased internet access, to break down long-standing barriers and maximize the health and well-being of all Mississippians

How does patient experience fit into the overall healthcare picture?

Understanding the experience of patients provides insight into health care as well as being a crucial first step towards partnering with patients to drive improvement. Increasingly, health care organizations gain feedback from patients about their experience through surveys. Patients are also turning to other avenues, including the internet, to document their experiences. Although long recognised as a domain of quality, evidence of the link between patient experience and clinical outcomes has emerged more recently. Organizations that succeed in improving patient experience have adopted a strategic approach to patient focus that incorporates both patient feedback and consumer engagement. Adopting a patient perspective sees leading organizations moving beyond ‘episodic’ care approaches to an extended patient continuum. The use of patient portals and access to electronic records foster a much needed two-way communication. For the patient’s and provider’s perception of the care continuum to coincide, the ‘continuum’ definition needs to expand to complement population health management. Similarly health care delivery models and payment models will need to change to reflect the care continuum. Patient experience fits into the overall healthcare picture more today than it ever has. As population health management, accountable care, and healthcare reform mature, the efficacy of those efforts depend more and more on how well providers can integrate the design of patient experience and empowerment into the expanding care continuum

Review: The Role of Wnt/β-Catenin Signalling in Neural Crest Development in Zebrafish

This is the final version. Available on open access from Frontiers Media via the DOI in this recordThe neural crest (NC) is a multipotent cell population in vertebrate embryos with extraordinary migratory capacity. The NC is crucial for vertebrate development and forms a myriad of cell derivatives throughout the body, including pigment cells, neuronal cells of the peripheral nervous system, cardiomyocytes and skeletogenic cells in craniofacial tissue. NC induction occurs at the end of gastrulation when the multipotent population of NC progenitors emerges in the ectodermal germ layer in the neural plate border region. In the process of NC fate specification, fate-specific markers are expressed in multipotent progenitors, which subsequently adopt a specific fate. Thus, NC cells delaminate from the neural plate border and migrate extensively throughout the embryo until they differentiate into various cell derivatives. Multiple signalling pathways regulate the processes of NC induction and specification. This review explores the ongoing role of the Wnt/β-catenin signalling pathway during NC development, focusing on research undertaken in the Teleost model organism, zebrafish (Danio rerio). We discuss the function of the Wnt/β-catenin signalling pathway in inducing the NC within the neural plate border and the specification of melanocytes from the NC. The current understanding of NC development suggests a continual role of Wnt/β-catenin signalling in activating and maintaining the gene regulatory network during NC induction and pigment cell specification. We relate this to emerging models and hypotheses on NC fate restriction. Finally, we highlight the ongoing challenges facing NC research, current gaps in knowledge, and this field's potential future directions.Biotechnology and Biological Sciences Research Council (BBSRC)Living Systems Institute, University of Exete

06 Effect of Empathy Development on Service-Learning - Andrews University Nursing School/Community Partnership – Benton Harbor Program.

Background: Andrews University’s administration acknowledges the university’s obligation to seek higher levels of community engagement. The relatively recent adoption of the motto—Seek knowledge, Affirm faith, Change the world—speaks to the intent of the organization to become an agent for positive change. Consequently, educators are encouraged to understand and support community engagement efforts to mold students into World Changers. It is with this backdrop that Andrews University embarked on a pilot project with the School of Nursing to see the effect of empathy development on a service-learning program at Benton Harbor High School. Aim of Project: To determine the level of empathy among selected nursing students; evaluate the effectiveness of community engagement activities on nursing students’ level of empathy, and to evaluate the effect of Andrews University’s nursing students’ community engagement activities on the community’s perception of empathy or readiness to engage. Method: Andrews University School of Nursing sought partnership with Benton Harbor High School (BHHS) through Andrews University Community Engagement Office. With the approval of the BHHS and parents of BHHS students, School of Nursing Students (NS) completed 5 visits to BHHS for the service-learning project. The project consisted of Ice breaker sessions, Hands-only CPR training; one to one bonding experiences; First Aid Training; and project completion celebration event. NS completed cultural competency, mentoring, and applicable health training before the start of the project implementation. They also completed the Empathy Quotient (EQ) questionnaire pre and post-project implementation. BHHS student volunteers completed pre and post knowledge questions related to first aid and hands-only CPR. Both groups had focus group interviews pre and post-project. Pre and post-test scores for EQ and knowledge questions were compared by the t-test. Focus groups interviews manually analyzed by themes. The project was completed during 1-hour sessions on 5 Fridays in the Fall 2018 semester. Results: 15 NS participated in the project and 13 successfully complete the project. Though 23 BHHS students volunteered for the project, only three completed the project. Initial analysis revealed no significant difference in the NS EQ scores for empathy. The number of BHHS students who completed the project (3) versus 15 made knowledge scores comparison difficult. There was an observed increase in scores from pre to post knowledge tests for the three students that completed the project. NS and BHHS students made positive and encouraging comments about the service-learning project via the focus interviews. Limitations and plans: Empathy is part of the nursing profession, so this may account for the lack of increase in NS EQ scores observed in the project. There were competing activities during the project implementation at BHHS, and this may account for decreased participation. The number of interactions may not be sufficient to see tangible results. We plan to conduct a needs assessment at BHHS, increase the number of NS-BHHS Students’ interactions, and utilize a more sensitive indicator to measure the effect in future projects

Formyl Peptide Receptor as a Novel Therapeutic Target for Anxiety-Related Disorders

Formyl peptide receptors (FPR) belong to a family of sensors of the immune system that detect microbe-associated molecules and inform various cellular and sensorial mechanisms to the presence of pathogens in the host. Here we demonstrate that Fpr2/3-deficient mice show a distinct profile of behaviour characterised by reduced anxiety in the marble burying and light-dark box paradigms, increased exploratory behaviour in an open-field, together with superior performance on a novel object recognition test. Pharmacological blockade with a formyl peptide receptor antagonist, Boc2, in wild type mice reproduced most of the behavioural changes observed in the Fpr2/3(-/-) mice, including a significant improvement in novel object discrimination and reduced anxiety in a light/dark shuttle test. These effects were associated with reduced FPR signalling in the gut as shown by the significant reduction in the levels of p-p38. Collectively, these findings suggest that homeostatic FPR signalling exerts a modulatory effect on anxiety-like behaviours. These findings thus suggest that therapies targeting FPRs may be a novel approach to ameliorate behavioural abnormalities present in neuropsychiatric disorders at the cognitive-emotional interface

Biological variation of measured and estimated glomerular filtration rate in patients with chronic kidney disease

When assessing changes in glomerular filtration rate (GFR) it is important to differentiate pathological change from intrinsic biological and analytical variation. GFR is measured using complex reference methods (e.g. iohexol clearance). In clinical practice measurement of creatinine and cystatin C is used in equations (e.g. Modification of Diet in Renal Disease [MDRD] or Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) to provide estimated GFR. We studied biological variability of measured and estimated GFR in twenty nephrology outpatients (10 male, 10 female; median age 71, range 50-80 years) with moderate CKD (GFR 30-59 mL/min/1.73 m2). Patients underwent weekly GFR measurement by iohexol clearance over four consecutive weeks. Simultaneously GFR was estimated using the MDRD, CKD-EPIcreatinine, CKD-EPIcystatinC and CKD-EPIcreatinine+cystatinC equations. Within-subject biological variation (CVI) expressed as a percentage [95% CI] for the MDRD (5.0% [4.3-6.1]), CKD-EPIcreatinine (5.3% [4.5-6.4]), CKD-EPIcystatinC (5.3% [4.5-6.5]), and CKD-EPIcreatinine+cystatinC (5.0% [4.3-6.2]) equations were broadly equivalent. CVI values for MDRD and CKD- EPIcreatinine+cystatinC were lower (p=0.027 and p=0.022 respectively) than that of measured GFR (6.7% [5.6-8.2]). Reference change values (RCV), the point at which a true change in a biomarker in an individual can be inferred to have occurred with 95% probability were calculated: using the MDRD equation, positive and negative RCVs were 15.1% and 13.1% respectively. If an individual’s baseline MDRD estimated GFR (mL/min/1.73 m2) was 59, significant increases or decreases would be to values >68 or <51 respectively. Within-subject variability of estimated GFR is lower than measured GFR. RCVs can be used to understand GFR changes in clinical practice

Measuring Generalization of Visuomotor Perturbations in Wrist Movements Using Mobile Phones

Recent studies in motor control have shown that visuomotor rotations for reaching have narrow generalization functions: what we learn during movements in one direction only affects subsequent movements into close directions. Here we wanted to measure the generalization functions for wrist movement. To do so we had 7 subjects performing an experiment holding a mobile phone in their dominant hand. The mobile phone's built in acceleration sensor provided a convenient way to measure wrist movements and to run the behavioral protocol. Subjects moved a cursor on the screen by tilting the phone. Movements on the screen toward the training target were rotated and we then measured how learning of the rotation in the training direction affected subsequent movements in other directions. We find that generalization is local and similar to generalization patterns of visuomotor rotation for reaching

Serotonin Differentially Regulates Short- and Long-Term Prediction of Rewards in the Ventral and Dorsal Striatum

BACKGROUND: The ability to select an action by considering both delays and amount of reward outcome is critical for maximizing long-term benefits. Although previous animal experiments on impulsivity have suggested a role of serotonin in behaviors requiring prediction of delayed rewards, the underlying neural mechanism is unclear. METHODOLOGY/PRINCIPAL FINDINGS: To elucidate the role of serotonin in the evaluation of delayed rewards, we performed a functional brain imaging experiment in which subjects chose small-immediate or large-delayed liquid rewards under dietary regulation of tryptophan, a precursor of serotonin. A model-based analysis revealed that the activity of the ventral part of the striatum was correlated with reward prediction at shorter time scales, and this correlated activity was stronger at low serotonin levels. By contrast, the activity of the dorsal part of the striatum was correlated with reward prediction at longer time scales, and this correlated activity was stronger at high serotonin levels. CONCLUSIONS/SIGNIFICANCE: Our results suggest that serotonin controls the time scale of reward prediction by differentially regulating activities within the striatum

Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

<p>Abstract</p> <p>Background</p> <p>Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs.</p> <p>The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase.</p> <p>Methods</p> <p>A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA).</p> <p>Results</p> <p>The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows.</p> <p>Conclusions</p> <p>The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.</p

Cost effectiveness of first-line oral therapies for pulmonary arterial hypertension: A modelling study

Background: In recent years, a significant number of costly oral therapies have become available for the treatment of pulmonary arterial hypertension (PAH). Funding decisions for these therapies requires weighing up their effectiveness and costs. Objective: The aim of this study was to assess the cost effectiveness of monotherapy with oral PAH-specific therapies versus supportive care as initial therapy for patients with functional class (FC) II and III PAH in Canada. Methods: A cost-utility analysis, from the perspective of a healthcare system and based on a Markov model, was designed to estimate the costs and quality-adjusted life-years (QALYs) associated with bosentan, ambrisentan, riociguat, tadalafil, sildenafil and supportive care for PAH in treatment-naïve patients. Separate analyses were conducted for cohorts of patients commencing therapy at FC II and III PAH. Transition probabilities, based on the relative risk of improving and worsening in FC with treatment versus placebo, were derived from a recent network meta-analysis. Utility values and costs were obtained from published data and clinical expert opinion. Extensive sensitivity analyses were conducted. Results: Analysis suggests that sildenafil is the most cost-effective therapy for PAH in patients with FC II or III. Sildenafil was both the least costly and most effective therapy, thereby dominating all other treatments. Tadalafil was also less costly and more effective than supportive care in FC II and III; however, sildenafil was dominant over tadalafil. Even given the uncertainty within the clinical inputs, the probabilistic sensitivity analysis showed that apart from sildenafil and tadalafil, the other PAH therapies had negligible probability of being the most cost effective. Conclusion: The results show that initiation of therapy with sildenafil is likely the most cost-effective strategy in PAH patients with either FC II or III disease.This research was supported by funds from the Canadian Agency for Drugs and Technologies in Health (CADTH)