Use of Robots on Cardiac Surgery

Surgical robots are computer-assisted electromechanical devices that aid surgeons and are designed to replicate human movements into more steady precise motions, giving more accurate and delicate operations. The purpose of this research was to study the evolution of technical features of surgical robots on cardiology to determine technical advantages and barriers of these technologies. In one study out of all 50 patients that had endoscopic atraumatic coronary artery bypass robotic surgery, 49 reported they would recommend the surgery to another. Features make instrument manipulation more intuitive by eliminating the fulcrum effect, which removes the surgeon from twisting and turning in awkward positions. In another research, operative times were longer with robot-assisted surgery with an average of 97.1 minutes compared to traditional laparoscopy with an average of 82.1 minutes. Additionally, scars are eliminated with robot-assisted surgeries, which decrease blood loss, length of stay, postoperative pain, and narcotic use. The results of this study suggest that the benefits of advancement in technical features of robotic cardiac surgery outweigh the barriers

Utilization of 340b Program in a Rural Hospital

Introduction: The 340B is a federal program that provides eligible rural hospitals, providers, and clinics the capability to purchase medications at reduced prices for outpatient use. Enrollment in the 340B program requires drug manufacturers to supply covered healthcare entities and eligible healthcare organizations medications at substantially reduced prices and has allowed covered entities to extend federal resources by offering more comprehensive services and reaching more of the vulnerable populations. The purpose of this research study was to examine utilization of 340B program within provider based clinics of a university medical school affiliated with a rural hospital to assess the benefits and barriers of its utilization. Methodology: The methodology for this study was a literature review complemented with a semi-structured interview of an expert in 340B program. Seven electronic databases were utilized with a total of 21 sources referenced for this review. Results: The type and volume of care provided in rural areas has been expanded as a result of the 340B program leading to median savings of $10,000 per month in prescription purchases. Pharmacy savings have ranged from$600 to $158,000 per month depending upon whether chemotherapy was available on an outpatient basis or not. In 2010, total cost of drug discounts equaled$6 billion dollars, and has been projected to be $12 billion by 2016 with a discount range between 30% to 50%. Discussion/Conclusion: The results of this study suggest that the benefits in the types and volume of services provided outweigh the barriers of maintaining separate drug inventories and difficulties in the management of the outpatient pharmacy that include audits at the state and federal levels as well as audits from pharmaceutical manufacturers

All Payer Hospital Regulations

Introduction: An all-payer system is a price setting system where rates of payment for healthcare services have not been negotiated between a hospital or health system or a payer but instead by a third party organization, such as Maryland’s Health Services Cost Review Commission (HSCRC), who sets most hospital rates that all payers agree to honor. All payer hospitals focus is on legislative principles in an effort to control costs. Methods: The methodology for this study was a literature review compiled with overview of All-payer hospital systems and its utilization in a hospital setting. All articles prior to 2000 were eliminated from the search. Twenty-eight references were examined and concluded to have mitigated the inclusion parameters along with benefits and disadvantages of the system. Results: Since 1976 Maryland has successfully kept hospital costs under control using an all-payer system. Additionally, improvements in length of stay and other health measures have improved. While an all payer system works for Maryland that has a large population in urban areas, other states may not see an improvement if they are larger or more rural. Even with lower controlled rates, Maryland still ranks less favorably in per capita health spending and regional variations than other states. Discussion/Conclusion: The majority of states are not utilizing the benefits of all payer systems. Implementation can improve healthcare in the US by impeding escalating costs, distinguishing fair payment systems, and increasing the access to care. This research study did not extensively compare other nations all payer systems to Maryland or how it could be implemented in the US. The all payer system has practical implications in the US healthcare system. If programs to cut spending are implemented too quickly, national healthcare could be compromised

Leptospirosis: Skin Wounds and Control Strategies, Thailand, 1999

After an outbreak of leptospirosis in workers who participated in cleaning a pond during September 1999 in Thailand, a serologic survey was conducted. Among a cohort of 104 persons from one village who participated in pond cleaning activity, 43 (41.3%) were seropositive for immunoglobulin M antibodies against Leptospira, indicating recent infection. Only 17 (39.5%) of 43 seropositive persons reported a recent febrile illness; the remaining seropositive persons were considered asymptomatic, suggesting that asymptomatic leptospirosis infection may be common where leptospirosis is endemic. Multivariable logistic regression indicated that wearing long pants or skirts was independently protective against leptospirosis infection (ORadjusted = 0.217), while the presence of more than two wounds on the body was independently associated with infection (ORadjusted = 3.97). Educational efforts should be enhanced in areas where leptospirosis is endemic to encourage the use of protective clothing. In addition wound management and avoidance of potentially contaminated water when skin wounds are present should be included in health education programs

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Effect of a primary care walking intervention with and without nurse support on physical activity levels in 45- to 75-year-olds: The pedometer and consultation evaluation (PACE-UP) cluster randomised clinical trial

Background Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. Methods and Findings A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17–49) and 35 for nurse support (95% CI 19–51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. Conclusions A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.The PACE-UP trial was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02 ISRCTN42122561) and will be published in full in Health Technology Assessment. The funders had no role in study design (beyond the commissioned call outline), data collection and analysis, decision to publish, or preparation of the manuscript

Genomic reconstruction of the SARS-CoV-2 epidemic in England.

The evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus leads to new variants that warrant timely epidemiological characterization. Here we use the dense genomic surveillance data generated by the COVID-19 Genomics UK Consortium to reconstruct the dynamics of 71 different lineages in each of 315 English local authorities between September 2020 and June 2021. This analysis reveals a series of subepidemics that peaked in early autumn 2020, followed by a jump in transmissibility of the B.1.1.7/Alpha lineage. The Alpha variant grew when other lineages declined during the second national lockdown and regionally tiered restrictions between November and December 2020. A third more stringent national lockdown suppressed the Alpha variant and eliminated nearly all other lineages in early 2021. Yet a series of variants (most of which contained the spike E484K mutation) defied these trends and persisted at moderately increasing proportions. However, by accounting for sustained introductions, we found that the transmissibility of these variants is unlikely to have exceeded the transmissibility of the Alpha variant. Finally, B.1.617.2/Delta was repeatedly introduced in England and grew rapidly in early summer 2021, constituting approximately 98% of sampled SARS-CoV-2 genomes on 26 June 2021

Review: Microglia in motor neuron disease

Motor Neuron Disease (MND) is a fatal neurodegenerative condition, which is characterized by the selective loss of the upper and lower motor neurons. At the sites of motor neuron injury, accumulation of activated microglia, the primary immune cells of the central nervous system, is commonly observed in both human post mortem studies and animal models of MND. Microglial activation has been found to correlate with many clinical features and importantly, the speed of disease progression in humans. Both anti‐inflammatory and pro‐inflammatory microglial responses have been shown to influence disease progression in humans and models of MND. As such, microglia could both contribute to and protect against inflammatory mechanisms of pathogenesis in MND. While murine models have characterized the microglial response to MND, these studies have painted a complex and often contradictory picture, indicating a need for further characterization in humans. This review examines the potential role microglia play in MND in human and animal studies. Both the pro‐inflammatory and anti‐inflammatory responses will be addressed, throughout the course of disease, followed by the potential of microglia as a target in the development of disease‐modifying treatments for MND