Applying Choosing Wisely: Antinuclear Antibody (ANA) and Sub-Serology Testing in a Safety Net Hospital System.

ObjectiveIn 2013, the American College of Rheumatology (ACR) participated in the Choosing Wisely campaign and devised a recommendation to avoid testing antinuclear antibody (ANA) subserologies without a positive ANA and clinical suspicion of disease. The goals of our study were to describe ANA and subserology ordering practices and predictors of ordering concurrent ANA and subserologies in a safety-net hospital.MethodsWe identified ANA and subserologies (dsDNA, Sm, RNP, SSA, SSB, Scl-70 and centromere) completed at Denver Health between 1/1/2005 and 12/31/2011. Variables included demographics, primary insurance, service, and setting from which the test was ordered. We performed multivariable logistic regression to determine predictors of concurrent ordering of ANA and subserologies.ResultsDuring seven years, 3221 ANA were performed in 2771 individuals and 211 (6.6%) were performed concurrently with at least one subserology. The most common concurrent subserologies were dsDNA (21.8%), SSA (20.8%), and SSB (19.7%). In the multivariable logistic analysis, significant predictors of concurrent ANA and subserologies were the labs being ordered from subspecialty care (OR 8.12, 95% CI 5.27-12.50, p-value <0.0001) or from urgent/inpatient care (OR 3.86, 95% CI 1.78-8.38, p-value 0.001). A significant predictor of decreased odds was male gender (OR 0.32, 95% CI 0.21-0.49, p-value <0.0001). Five individuals (2.2% of the negative ANA with subserologies ordered) had a negative ANA but positive subserologies.ConclusionOf 3221 ANA, 6.6% were performed concurrently with subserologies, and subspecialists were more likely to order concurrent tests. A negative ANA predicted negative subserologies with rare exceptions, which validates the ACR's recommendations

Vascular Response to Sildenafil Citrate in Aging and Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) - the leading cause of vision loss in the elderly - share many risks factors as atherosclerosis, which exhibits loss of vascular compliance resulting from aging and oxidative stress. Here, we attempt to explore choroidal and retinal vascular compliance in patients with AMD by evaluating dynamic vascular changes using live ocular imaging following treatment with oral sildenafil citrate, a phosphodiesterase type 5 (PDE5) inhibitor and potent vasodilator. Enhanced-depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A) were performed on 46 eyes of 23 subjects, including 15 patients with non-exudative AMD in one eye and exudative AMD in the fellow eye, and 8 age-matched control subjects. Choroidal thickness, choroidal vascularity, and retinal vessel density were measured across the central macula at 1 and 3 hours after a 100 mg oral dose of sildenafil citrate. Baseline choroidal thickness was 172.1 ± 60.0 μm in non-exudative AMD eyes, 196.4 ± 89.8 μm in exudative AMD eyes, and 207.4 ± 77.7 μm in control eyes, with no difference between the 3 groups (P = 0.116). After sildenafil, choroidal thickness increased by 6.0% to 9.0% at 1 and 3 hours in all groups (P = 0.001-0.014). Eyes from older subjects were associated with choroidal thinning at baseline (P = 0.005) and showed less choroidal expansion at 1 hour and 3 hours after sildenafil (P = 0.001) regardless of AMD status (P = 0.666). The choroidal thickening appeared to be primarily attributed to expansion of the stroma rather than luminal component. Retinal vascular density remained unchanged after sildenafil in all 3 groups (P = 0.281-0.587). Together, our studies suggest that vascular response of the choroid to sildenafil decreases with age, but is not affected by the presence of non-exudative or exudative AMD, providing insight into changes in vessel compliance in aging and AMD

The Name of the Game: Utilizing Experiential Learning in the Classroom to Engage, Empower and Reflect on Student Learning and Assessment

In the modern post-secondary classroom, there is a push for more experiential and active learning activities for students. A variety of benefits such as engagement, improved learning and self regulated learning have ensued with these different types of learning. Studies regarding these benefits have mostly centered on experiences carefully orchestrated by instructors, rather than experiences that were created by students under the guidance of instructors. Herein is a study of the benefits and efficiency, of the latter type of activity, which requires students to generate chemical puzzles in a large post-secondary classroom. The authors determined that not only is a puzzle generation activity possible, but students’ reflections on instructor examples highlights the potential for learning and for a new form of assessment. Going forward, however, the study also shows more support and examples are required in future iterations of the puzzle framework, to help students create a meaningful experience

Hypoxia Augments Outgrowth Endothelial Cell (OEC) Sprouting and Directed Migration in Response to Sphingosine-1-Phosphate (S1P)

Therapeutic angiogenesis provides a promising approach to treat ischemic cardiovascular diseases through the delivery of proangiogenic cells and/or molecules. Outgrowth endothelial cells (OECs) are vascular progenitor cells that are especially suited for therapeutic strategies given their ease of noninvasive isolation from umbilical cord or adult peripheral blood and their potent ability to enhance tissue neovascularization. These cells are recruited to sites of vascular injury or tissue ischemia and directly incorporate within native vascular endothelium to participate in neovessel formation. A better understanding of how OEC activity may be boosted under hypoxia with external stimulation by proangiogenic molecules remains a challenge to improving their therapeutic potential. While vascular endothelial growth factor (VEGF) is widely established as a critical factor for initiating angiogenesis, sphingosine-1-phosphate (S1P), a bioactive lysophospholipid, has recently gained great enthusiasm as a potential mediator in neovascularization strategies. This study tests the hypothesis that hypoxia and the presence of VEGF impact the angiogenic response of OECs to S1P stimulation in vitro. We found that hypoxia altered the dynamically regulated S1P receptor 1 (S1PR1) expression on OECs in the presence of S1P (1.0 mu M) and/or VEGF (1.3 nM). the combined stimuli of S1P and VEGF together promoted OEC angiogenic activity as assessed by proliferation, wound healing, 3D sprouting, and directed migration under both normoxia and hypoxia. Hypoxia substantially augmented the response to S1P alone, resulting in similar to 6.5-fold and similar to 25-fold increases in sprouting and directed migration, respectively. Overall, this report highlights the importance of establishing hypoxic conditions in vitro when studying ischemia-related angiogenic strategies employing vascular progenitor cells.University of California, DavisAmerican Heart Association (AHA)Univ Calif Davis, Dept Biomed Engn, Davis, CA 95616 USAUniversidade Federal de São Paulo, Dept Biophys, São Paulo, BrazilUniv Calif Davis, Dept Neurobiol Physiol & Behav, Davis, CA 95616 USAUniversidade Federal de São Paulo, Dept Biophys, São Paulo, BrazilAmerican Heart Association (AHA): 15PRE22930044Web of Scienc

Finding what works: Identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam

Abstract Background Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers. Methods Our process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science. Results Barriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers. Conclusions Key programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings

Review on green building rating tools worldwide : recommendations for Australia

Buildings could be led to adverse impacts on environment, such as generation of construction and demolition waste, and emission of greenhouse gases (GHG). Therefore, promotion on development of green buildings is in need. With the increasing awareness in sustainable development, various rating tools are promoted to evaluate the performance of green buildings. Nowadays, these tools function as a guideline for green building development. There are various green building rating tools developed worldwide, and various countries follow different rules, incentives and regulations. However, despite of promotion of green building rating tools, environmental issues from buildings are still significant in Australia. This research compared green building rating tools in Australia and other countries or regions around the world. This research found that rating tools in Australia lack of (1) mandatory criteria and (2) regulations and incentives. This paper recommended that governmental incentives should be promoted

Experimental and survey-based data on willingness to pay for seafood safety and environmental sustainability certification in Nigeria

Aquatic foods, including fish, are a substantial component of animal source foods globally, and make a critical nutritional contribution to diets in many contexts. In the global North, concern among consumers and regulators over the safety and environmental sustainability of seafood, particularly in developed nations, has led to the development of increasingly stringent seafood safety standards. While such standards may constitute regularity, logistical, and economic barriers to participation in export markets by small-scale producers, they have in other contexts catalysed upgrades to production and post-harvest handling practices within value chains associated with both capture fisheries and aquaculture. The health burden of foodborne illnesses is a major concern in developing countries. As incomes rise, consumers in developing countries are increasingly willing to pay a premium for safer and environmentally sustainable foods. However, there is little empirical evidence on consumers' willingness to pay for seafood safety in developing countries, particularly in sub-Saharan Africa. Data on demand for seafood safety and environmental sustainability certification in African countries are largely unavailable in the public domain. In this paper, we describe data collected in Lagos State, Nigeria in October and November 2019. Experiments in the form of Becker-DeGroote-Marschak (BDM) auction mechanism, and post experiment surveys were conducted with 200 fish consumers in fish markets. These data can be used to assess whether consumers' demand for safe and healthy seafood from local markets can be harnessed to generate positive economic returns to producers. (C) 2020 The Author(s). Published by Elsevier Inc

Are consumers in developing countries willing to pay for aquaculture food safety certification? Evidence from a field experiment in Nigeria

Many developing countries face challenges in managing food safety risks associated with consumption of animalsource foods. Efforts to address these challenges increasingly recognize the role of certification in agri-food systems governance. Understanding consumers' willingness to pay (WTP) for food safety certification is fundamental to determining the appropriate design and implementation of programs to reduce the burden of foodborne illnesses in developing countries. To address this need, we implemented a framed field experiment with consumers of eight farm-raised African Catfish (Clarias gariepinus) products varying in certification status (safety certified versus uncertified) and product forms (live versus smoked) to examine their WTP for food safety certification in Nigeria. We applied a mixed-effects model to account for the hierarchical structure of the data with one participant entering multiple bids, and estimated a model with participant fixed effects as a robustness check. We found that consumers were willing to pay between 3.1% and 18.8% more for fish certified as safe compared to uncertified fish. Furthermore, there was an asymmetry in food safety certification valuation, with consumers paying significant premiums for high-value larger-sized certified live and smoked catfish, but not smaller-sized certified live and smoked catfish. The results are robust to a specification in which consumer fixed effects are included. Our findings suggest there exists consumer demand for certification programs to upgrade the food safety standards of higher-value fish products in Nigeria's domestic markets. Lower-value fish products typically consumed by lower-income consumers show less potential for certification. Alternative safety regulation is needed to ensure safety practices for low-end fish products

The Effect of a Multi-Level Intervention on the Initiation of Antiretroviral Therapy (ART) among HIV-Infected Men Who Inject Drugs and Were Diagnosed Late in Thai Nguyen, Vietnam

In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART

A Simple Two-Dimensional Model System to Study Electrostatic-Self-Assembly

This paper surveys the variables controlling the lattice structure and charge in macroscopic Coulombic crystals made from electrically charged, millimeter-sized polymer objects (spheres, cubes, and cylinders). Mechanical agitation of these objects inside planar, bounded containers caused them to charge electrically through contact electrification, and to self-assemble. The processes of electrification and self-assembly, and the characteristics of the assemblies, depended on the type of motion used for agitation, on the type of materials used for the objects and the dish, on the size and shape of the objects and the dish, and on the number of objects. Each of the three different materials in the system (of the dish and of the two types of spheres) influenced the electrification. Three classes of structures formed by self-assembly, depending on the experimental conditions: two-dimensional lattices, one-dimensional chains, and zero-dimensional ‘rosettes’. The lattices were characterized by their structure (disordered, square, rhombic, or hexagonal) and by the electrical charges of individual objects; the whole lattices were approximately electrically neutral. The lattices observed in this study were qualitatively different from ionic crystals; the charge of objects had practically continuous values which changed during agitation and self-assembly, and depended on experimental conditions which included the lattice structure itself. The relationship between charge and structure led to the coexistence of regions with different lattice structures within the same assembly, and to transformations between different lattice structures during agitation.Chemistry and Chemical Biolog