Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

<p>Abstract</p> <p>Background</p> <p>Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project.</p> <p>Methods</p> <p>This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers.</p> <p>Results</p> <p>Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers.</p> <p>Conclusion</p> <p>Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions.</p

Buried hurricane legacies: increased nutrient limitation and decreased root biomass in coastal wetlands

Plant identity and cover in coastal wetlands is changing in worldwide, and many subtropical salt marshes dominated by low-stature herbaceous species are becoming woody mangroves. Yet, how changes affect coastal soil biogeochemical processes and belowground biomass before and after storms is uncertain. We experimentally manipulated the percent mangrove cover (Avicennia germinans) in 3 × 3 m cells embedded in 10 plots (24 × 42 m) comprising a gradient of marsh (e.g., Spartina alterniflora, Batis maritima) and mangrove cover in Texas, USA. Hurricane Harvey made direct landfall over our site on 25 August 2017, providing a unique opportunity to test how plant composition mitigates hurricane effects on surface sediment accretion, soil chemistry (carbon, C; nitrogen, N; phosphorus, P; and sulfur, S), and root biomass. Data were collected before (2013 and 2016), one-month after (2017), and one-year after (2018) Hurricane Harvey crossed the area, allowing us to measure stocks before and after the hurricane. The accretion depth was higher in fringe compared with interior cells of plots, more variable in cells dominated by marsh than mangrove, and declined with increasing plot-scale mangrove cover. The concentrations of P and δ34S in storm-driven accreted surface sediments, and the concentrations of N, P, S, and δ34S in underlying soils (0–30 cm), decreased post-hurricane, whereas the C concentrations in both compartments were unchanged. Root biomass in both marsh and mangrove cells was reduced by 80% in 2017 compared with previous dates and remained reduced in 2018. Post-hurricane loss of root biomass in plots correlated with enhanced nutrient limitation. Total sulfide accumulation as indicated by δ34S, increased nutrient limitation, and decreased root biomass of both marshes and mangroves after hurricanes may affect ecosystem function and increase vulnerability in coastal wetlands to subsequent disturbances. Understanding how changes in plant composition in coastal ecosystems affects responses to hurricane disturbances is needed to assess coastal vulnerability

Transfer of Information from Personal Health Records: A Survey of Veterans Using My HealtheVet

Abstract Objective: Personal health records provide patients with ownership of their health information and allow them to share information with multiple healthcare providers. However, the usefulness of these records relies on patients understanding and using their records appropriately. My HealtheVet is a Web-based patient portal containing a personal health record administered by the Veterans Health Administration. The goal of this study was to explore veterans' interest and use of My HealtheVet to transfer and share information as well as to identify opportunities to increase veteran use of the My HealtheVet functions. Materials and Methods: Two waves of data were collected in 2010 through an American Customer Satisfaction Index Web-based survey. A random sample of veterans using My HealtheVet was invited to participate in the survey conducted on the My HealtheVet portal through a Web-based pop-up browser window. Results: Wave One results (n=25,898) found that 41% of veterans reported printing information, 21% reported saving information electronically, and only 4% ever sent information from My HealtheVet to another person. In Wave Two (n=18,471), 30% reported self-entering medication information, with 18% sharing this information with their Veterans Affairs (VA) provider and 9.6% sharing with their non-VA provider. Conclusion: Although veterans are transferring important medical information from their personal health records, increased education and awareness are needed to increase use. Personal health records have the potential to improve continuity of care. However, more research is needed on both the barriers to adoption as well as the actual impact on patient health outcomes and well-being.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98490/1/tmj%2E2011%2E0109.pd

3D Collagen Alignment Limits Protrusions to Enhance Breast Cancer Cell Persistence

Patients with mammographically dense breast tissue have a greatly increased risk of developing breast cancer. Dense breast tissue contains more stromal collagen, which contributes to increased matrix stiffness and alters normal cellular responses. Stromal collagen within and surrounding mammary tumors is frequently aligned and reoriented perpendicular to the tumor boundary. We have shown that aligned collagen predicts poor outcome in breast cancer patients, and postulate this is because it facilitates invasion by providing tracks on which cells migrate out of the tumor. However, the mechanisms by which alignment may promote migration are not understood. Here, we investigated the contribution of matrix stiffness and alignment to cell migration speed and persistence. Mechanical measurements of the stiffness of collagen matrices with varying density and alignment were compared with the results of a 3D microchannel alignment assay to quantify cell migration. We further interpreted the experimental results using a computational model of cell migration. We find that collagen alignment confers an increase in stiffness, but does not increase the speed of migrating cells. Instead, alignment enhances the efficiency of migration by increasing directional persistence and restricting protrusions along aligned fibers, resulting in a greater distance traveled. These results suggest that matrix topography, rather than stiffness, is the dominant feature by which an aligned matrix can enhance invasion through 3D collagen matrices

Ages at menarche- and menopause-related genetic variants in relation to terminal duct lobular unit involution in normal breast tissue

PURPOSE: Reduced levels of terminal duct lobular unit (TDLU) involution, as reflected by higher numbers of TDLUs and acini per TDLU, have been associated with higher breast cancer risk. Younger age at menarche and older age at menopause have been previously related to lower levels of TDLU involution. To determine a possible genetic link, we examined whether single nucleotide polymorphisms (SNPs) previously established in genome-wide association studies (GWAS) for ages at menarche and menopause are associated with TDLU involution. METHODS: We conducted a pooled analysis of 862 women from two studies. H&E tissue sections were assessed for numbers of TDLUs and acini/TDLU. Poisson regression models were used to estimate associations of 36 menarche- and 21 menopause-SNPs with TDLU counts, acini counts/TDLU, and the product of these two measures, adjusting for age and study site. RESULTS: Fourteen percent of evaluated SNPs (8 SNPs) were associated with TDLU counts at p<0.05, suggesting an enrichment of associations with TDLU counts. However, only menopause-SNPs had >50% that were either significantly or nonsignficantly associated with TDLU measures in the directions consistent with their relationships shown in GWAS. Among 10 SNPs that were statistically significantly associated with at least one TDLU involution measure (p<0.05), seven SNPs (rs466639: RXRG; rs2243803: SLC14A2; rs2292573: GAB2; rs6438424: 3q13.32; rs7606918: METAP1D; rs11668344: TMEM150B; rs1635501: EXO1) were associated in the consistent directions. CONCLUSIONS: Our data suggest that the loci associated with ages at menarche and menopause may influence TDLU involution, suggesting some shared genetic mechanisms. However, larger studies are needed to confirm the results

Investigating the DART Impact Event with the Lucy LOng Range Reconnaissance Imager

NASA’s Lucy mission is the first to provide flyby reconnaissance of the Jovian trojan asteroids, which are thought to be primordial small bodies that formed at a variety of heliocentric distances during the early stages of the solar system’s formation and were subsequently captured into Jupiter’s L4 and L5 Lagrange stability zones. Since its successful launch on 2021-Oct-16, the Lucy spacecraft has been orbiting the sun within the inner solar system. On 2022-Oct-16, Lucy executes the first of three Earth Gravity Assists (EGAs) that put the spacecraft on the correct trajectory to achieve its encounters with the Jovian trojans. The DART kinetic impact on the secondary body of the Didymos-Dimorphos binarysystem occurs 20 days prior to EGA1, at a time when the Lucy spacecraft is well-placed to observe it. Lucy carries a sensitive panchromatic camera, the Lucy LOng Range Reconnaissance Imager (L’LORRI), which is capable of detecting the binary system with high signal-to-noise ratio (SNR) and with temporal cadences as fast as once per second. The observing geometry from Lucy is similar to that from the Earth: the range to the Didymos system is 0.126 au from Lucy vs 0.0757 au from Earth, and the solar phase angle is 31.9 deg vs 53.2 deg. The L’LORRI investigation of the DART impact event is divided into eight separate observational phases, starting 12 hr before the impact and ending 24 hr afterwards. L’LORRI cannot resolve the binary, but instead records the total brightness, which is expected to increase after the DART impact due to reflected sunlight from the ejecta. The first two phases are designed to obtain baseline photometry of the Didymos system covering both the Didymos-Dimorphos mutual orbit period (11.92 hr) and the rotational period of Didymos (2.26 hr). Phase 3 covers the impact event itself at one second cadence, starting 3 minutes beforeimpact and ending 4 minutes afterwards. Lucy has a clear view of the predicted DART impact site, theoretically enablingL’LORRI to detect an optical flash in the unlikely event it is brighter than Didymos itself. L’LORRI observations during phases 4 through 8 are designed to monitor the temporal and spatial evolution of ejecta associated with the impact event, but ejecta don’t leave the central pixel during Lucy’s observing period unless their speed is greater than about 2 m/s

A Kinome RNAi Screen Identified AMPK as Promoting Poxvirus Entry through the Control of Actin Dynamics

Poxviruses include medically important human pathogens, yet little is known about the specific cellular factors essential for their replication. To identify genes essential for poxvirus infection, we used high-throughput RNA interference to screen the Drosophila kinome for factors required for vaccinia infection. We identified seven genes including the three subunits of AMPK as promoting vaccinia infection. AMPK not only facilitated infection in insect cells, but also in mammalian cells. Moreover, we found that AMPK is required for macropinocytosis, a major endocytic entry pathway for vaccinia. Furthermore, we show that AMPK contributes to other virus-independent actin-dependent processes including lamellipodia formation and wound healing, independent of the known AMPK activators LKB1 and CaMKK. Therefore, AMPK plays a highly conserved role in poxvirus infection and actin dynamics independent of its role as an energy regulator

Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants, respectively1-3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity