Longitudinal Analysis of Electronic Health Records on Staffing Mix in Community Health Centers

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications

Do Years of Experience with Electronic Health Records Matter for Productivity in CHCs?

OBJECTIVE Community health centers’ (CHCs) patient panels are expected to increase in the coming years. This study investigated to what the years of experience with an electronic health record (EHR) was related to the productivity of CHCs. DATA/SETTING We primarily drew from the 2012 Uniform Data System, an annual reporting system of 1198 CHCs receiving federal Section 330 grants. We also used the “Readiness Survey” to categorize CHCs by years of experience with an EHR. DESIGN/METHODS We estimated a log-linear model of average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. We compared the productivity of each type of medical staff by presence of an EHR, EHR vendor, and years of EHR experience. RESULTS Physician productivity significantly improved in CHCs with three to four years of EHR experience. Nurses experienced a notable negative productivity impact in the early years of EHR adoption, although the trend was not statistically significant. CONCLUSIONS Attention should be paid as to whether nurses are diverted away from clinical duties to manage administrative tasks related to EHRs, and whether staffing levels are sufficient to support the implementation of EHRs. CHCs may need additional support and training especially for nurses in order to maintain the CHCs’ current patient panel, and even more so if the patient population expands as Medicaid coverage expands under the Affordable Care Act

The long noncoding RNA, treRNA, decreases DNA damage and is associated with poor response to chemotherapy in chronic lymphocytic leukemia.

The study of long noncoding RNAs (lncRNAs) is an emerging area of cancer research, in part due to their ability to serve as disease biomarkers. However, few studies have investigated lncRNAs in chronic lymphocytic leukemia (CLL). We have identified one particular lncRNA, treRNA, which is overexpressed in CLL B-cells. We measured transcript expression in 144 CLL patient samples and separated samples into high or low expression of treRNA relative to the overall median. We found that high expression of treRNA is significantly associated with shorter time to treatment. High treRNA also correlates with poor prognostic indicators such as unmutated IGHV and high ZAP70 protein expression. We validated these initial findings in samples collected in a clinical trial comparing the nucleoside analog fludarabine alone or in combination with the alkylating agent cyclophosphamide in untreated CLL samples collected prior to starting therapy (E2997). High expression of treRNA was independently prognostic for shorter progression free survival in patients receiving fludarabine plus cyclophosphamide. Given these results, in order to study the role of treRNA in DNA damage response we generated a model cell line system where treRNA was over-expressed in the human B-CLL cell line OSU-CLL. Relative to the vector control line, there was less cell death in OSU-CLL over-expressing treRNA after exposure to fludarabine and mafosfamide, due in part to a reduction in DNA damage. Therefore, we suggest that treRNA is a novel biomarker in CLL associated with aggressive disease and poor response to chemotherapy through enhanced protection against cytotoxic mediated DNA damage

Growth and optical characterization of indirect-gap AlxGa1−xAs alloys

Nonintentionally doped AlxGa1−xAs layers with 0.38 x 0.84 were grown on (100) GaAs substrates by liquid phase epitaxy (LPE) under near-equilibrium conditions. The crystalline quality of the samples was studied by photoluminescence at 2 K and room temperature Raman spectroscopy. The peculiar behavior in the photoluminescence intensities of the indirect bound exciton line and the donor–acceptor pair transition is explained from the evolution of the silicon donor binding energy according to the aluminum composition. It was also possible to observe the excitonic transition corresponding to the AlxGa1−xAs/GaAs interface, despite the disorder and other factors which are normally involved when growing high-aluminum-content layers by this technique. Furthermore, Raman measurements show the quadratic variations of longitudinal optical phonon frequencies with aluminum concentration in good agreement with previous experimental results. In this work we show that high quality indirect-gap AlxGa1−xAs samples can be grown by LPE under near-equilibrium [email protected]

Long-term microcarrier suspension cultures of human embryonic stem cells

AbstractThe conventional method of culturing human embryonic stem cells (hESC) is on two-dimensional (2D) surfaces, which is not amenable for scale up to therapeutic quantities in bioreactors. We have developed a facile and robust method for maintaining undifferentiated hESC in three-dimensional (3D) suspension cultures on matrigel-coated microcarriers achieving 2- to 4-fold higher cell densities than those in 2D colony cultures. Stable, continuous propagation of two hESC lines on microcarriers has been demonstrated in conditioned media for 6 months. Microcarrier cultures (MC) were also demonstrated in two serum-free defined media (StemPro and mTeSR1). MC achieved even higher cell concentrations in suspension spinner flasks, thus opening the prospect of propagation in controlled bioreactors

Oxidized phospholipids are proinflammatory and proatherogenic in hypercholesterolaemic mice.

Oxidized phospholipids (OxPL) are ubiquitous, are formed in many inflammatory tissues, including atherosclerotic lesions, and frequently mediate proinflammatory changes 1 . Because OxPL are mostly the products of non-enzymatic lipid peroxidation, mechanisms to specifically neutralize them are unavailable and their roles in vivo are largely unknown. We previously cloned the IgM natural antibody E06, which binds to the phosphocholine headgroup of OxPL, and blocks the uptake of oxidized low-density lipoprotein (OxLDL) by macrophages and inhibits the proinflammatory properties of OxPL2-4. Here, to determine the role of OxPL in vivo in the context of atherogenesis, we generated transgenic mice in the Ldlr-/- background that expressed a single-chain variable fragment of E06 (E06-scFv) using the Apoe promoter. E06-scFv was secreted into the plasma from the liver and macrophages, and achieved sufficient plasma levels to inhibit in vivo macrophage uptake of OxLDL and to prevent OxPL-induced inflammatory signalling. Compared to Ldlr-/- mice, Ldlr -/- E06-scFv mice had 57-28% less atherosclerosis after 4, 7 and even 12 months of 1% high-cholesterol diet. Echocardiographic and histologic evaluation of the aortic valves demonstrated that E06-scFv ameliorated the development of aortic valve gradients and decreased aortic valve calcification. Both cholesterol accumulation and in vivo uptake of OxLDL were decreased in peritoneal macrophages, and both peritoneal and aortic macrophages had a decreased inflammatory phenotype. Serum amyloid A was decreased by 32%, indicating decreased systemic inflammation, and hepatic steatosis and inflammation were also decreased. Finally, the E06-scFv prolonged life as measured over 15 months. Because the E06-scFv lacks the functional effects of an intact antibody other than the ability to bind OxPL and inhibit OxLDL uptake in macrophages, these data support a major proatherogenic role of OxLDL and demonstrate that OxPL are proinflammatory and proatherogenic, which E06 counteracts in vivo. These studies suggest that therapies inactivating OxPL may be beneficial for reducing generalized inflammation, including the progression of atherosclerosis, aortic stenosis and hepatic steatosis

MicroRNA-7 inhibits epithelial-to-mesenchymal transition and metastasis of breast cancer cells via targeting FAK expression

10.1371/journal.pone.0041523PLoS ONE78