Hypertension: Care Management Program and Medication Adherence

Practice Problem: Medication adherence is a major concern in healthcare as it is a contributing factor to uncontrolled hypertension and resistant hypertension. Uncontrolled hypertension can lead to strokes, heart attacks, kidney failure, and even death. PICOT: The PICOT question that guided this project was in Medicare Advantage members with hypertension located in Kansas, who were admitted to the hospital or emergency room identified by stratification (P), does care management utilization using hypertension clinical guidelines (I), compared to the stand-alone hypertension clinical practice guideline (C), improve medication adherence (O) over 10 weeks (T)? Evidence: Hypertension is one of the leading preventable causes of death. Medication adherence is around 50% in half of individuals diagnosed with hypertension and annual cost of unnecessary visits for hypertension is in the billions. A care management program is a cost-effective way to help individuals with a chronic condition manage their health and medications, decreasing the rate of complications. Intervention: A care management program utilizes medical professionals to assist members with chronic diseases, such as hypertension, to become more knowledgeable and autonomous with their healthcare. This program provides members with support in ensuring medications are taken and their chronic condition is being monitored to prevent complications and unnecessary emergency room and re-hospitalization visits. Outcome: There was a lack of data due to the lack of participant participation, therefore, no blood pressure data was collected. The emergency room visits or re-hospitalization, including financial reports, were not available. Medication adherence percentages did not show any clinical significance. Conclusion: It was difficult to assess clinical significance due to lack of data at the closure of this pilot program

Adaptive Silviculture for Climate Change in the Mississippi National River and Recreation Area, an Urban National Park in the Twin Cities Area, Minnesota

The Adaptive Silviculture for Climate Change (ASCC) Network is a collaborative effort to establish a series of experimental silvicultural trials across different forest ecosystem types. A variety of partners have developed trial sites as part of this multi-regional study researching long-term ecosystem responses to a range of climate change adaptation actions. We are currently implementing an affiliate trial within the Mississippi National River and Recreation Area, a national park along the Mississippi River in the Twin Cities Metro Area of Minnesota

Efficient Generalized Least Squares Method for Mixed Population and Family‐based Samples in Genome‐wide Association Studies

Genome‐wide association studies (GWAS) that draw samples from multiple studies with a mixture of relationship structures are becoming more common. Analytical methods exist for using mixed‐sample data, but few methods have been proposed for the analysis of genotype‐by‐environment (G×E) interactions. Using GWAS data from a study of sarcoidosis susceptibility genes in related and unrelated African Americans, we explored the current analytic options for genotype association testing in studies using both unrelated and family‐based designs. We propose a novel method—generalized least squares (GLX)—to estimate both SNP and G×E interaction effects for categorical environmental covariates and compared this method to generalized estimating equations (GEE), logistic regression, the Cochran–Armitage trend test, and the W QLS and M QLS methods. We used simulation to demonstrate that the GLX method reduces type I error under a variety of pedigree structures. We also demonstrate its superior power to detect SNP effects while offering computational advantages and comparable power to detect G×E interactions versus GEE. Using this method, we found two novel SNPs that demonstrate a significant genome‐wide interaction with insecticide exposure—rs10499003 and rs7745248, located in the intronic and 3' UTR regions of the FUT9 gene on chromosome 6q16.1.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107571/1/gepi21811.pd

History of Being in Government Care Associated with Younger Age at Injection Initiation Among a Cohort of Street-involved Youth

Introduction and Aims: Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18.   Design and Methods: Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care.   Results: Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18 years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio = 1.69; 95% confidence interval: 1.15–2.48).   Discussion and Conclusions: Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher-risk and suggest interventions are needed to prevent transitions into high-risk substance use among this population

Biological and economic management strategy evaluations of the eastern king prawn fishery

Stock assessment of the eastern king prawn (EKP) fishery, and the subsequent advice to management and industry, could be improved by addressing a number of issues. The recruitment dynamics of EKP in the northern (i.e., North Reef to the Swain Reefs) parts of the fishery need to be clarified. Fishers report that the size of the prawns from these areas when they recruit to the fishing grounds is resulting in suboptimal sizes/ages at first capture, and therefore localised growth overfishing. There is a need to assess alternative harvest strategies of the EKP fishery, via computer simulations, particularly seasonal and monthly or lunar-based closures to identify scenarios that improve the value of the catch, decrease costs and reduce the risk of overfishing, prior to implementing new management measures

Single Cell Transcriptomics Implicate Novel Monocyte and T Cell Immune Dysregulation in Sarcoidosis

Sarcoidosis is a systemic inflammatory disease characterized by infiltration of immune cells into granulomas. Previous gene expression studies using heterogeneous cell mixtures lack insight into cell-type-specific immune dysregulation. We performed the first single-cell RNA-sequencing study of sarcoidosis in peripheral immune cells in 48 patients and controls. Following unbiased clustering, differentially expressed genes were identified for 18 cell types and bioinformatically assessed for function and pathway enrichment. Our results reveal persistent activation of circulating classical monocytes with subsequent upregulation of trafficking molecules. Specifically, classical monocytes upregulated distinct markers of activation including adhesion molecules, pattern recognition receptors, and chemokine receptors, as well as enrichment of immunoregulatory pathways HMGB1, mTOR, and ephrin receptor signaling. Predictive modeling implicated TGFβ and mTOR signaling as drivers of persistent monocyte activation. Additionally, sarcoidosis T cell subsets displayed patterns of dysregulation. CD4 naïve T cells were enriched for markers of apoptosis and Th17/T(reg) differentiation, while effector T cells showed enrichment of anergy-related pathways. Differentially expressed genes in regulatory T cells suggested dysfunctional p53, cell death, and TNFR2 signaling. Using more sensitive technology and more precise units of measure, we identify cell-type specific, novel inflammatory and regulatory pathways. Based on our findings, we suggest a novel model involving four convergent arms of dysregulation: persistent hyperactivation of innate and adaptive immunity via classical monocytes and CD4 naïve T cells, regulatory T cell dysfunction, and effector T cell anergy. We further our understanding of the immunopathology of sarcoidosis and point to novel therapeutic targets

Small and Medium-Sized Towns in Europe: Conceptual, Methodological and Policy Issues

© 2017 Royal Dutch Geographical Society KNAG Despite that small and medium-sized towns (SMSTs) have been, and continue to be, a central part of the history of Europe, these places have largely been neglected by urban research. The ESPON TOWN project, on which this Special Issue builds, sought to redress this neglect performing a comparative analysis of their position and role across Europe. In this introductory paper we discuss some of the theoretical and methodological challenges when it came to identifying, studying and analysing SMSTs and the theoretical framework developed to inform our understanding of SMSTs. In particular, three themes are discussed. The first one is about the ontological problem of defining a town. Administrative, morphological and functional perspectives are considered. The second one reflects on a wide array of interpretative approaches about the relationship between towns and their regional context. The third one is about the thematic and multi-scalar perspectives that can characterise the policy approach to towns

Detrimental effects of duplicate reads and low complexity regions on RNA- and ChIP-seq data

Background Adapter trimming and removal of duplicate reads are common practices in next-generation sequencing pipelines. Sequencing reads ambiguously mapped to repetitive and low complexity regions can also be problematic for accurate assessment of the biological signal, yet their impact on sequencing data has not received much attention. We investigate how trimming the adapters, removing duplicates, and filtering out reads overlapping low complexity regions influence the significance of biological signal in RNA- and ChIP-seq experiments. Methods We assessed the effect of data processing steps on the alignment statistics and the functional enrichment analysis results of RNA- and ChIP-seq data. We compared differentially processed RNA-seq data with matching microarray data on the same patient samples to determine whether changes in pre-processing improved correlation between the two. We have developed a simple tool to remove low complexity regions, RepeatSoaker, available at https://github.com/mdozmorov/RepeatSoaker, and tested its effect on the alignment statistics and the results of the enrichment analyses. Results Both adapter trimming and duplicate removal moderately improved the strength of biological signals in RNA-seq and ChIP-seq data. Aggressive filtering of reads overlapping with low complexity regions, as defined by RepeatMasker, further improved the strength of biological signals, and the correlation between RNA-seq and microarray gene expression data. Conclusions Adapter trimming and duplicates removal, coupled with filtering out reads overlapping low complexity regions, is shown to increase the quality and reliability of detecting biological signals in RNA-seq and ChIP-seq data