Project #4: The Effects of a Pharmacist-Led Transitions of Care Program after Hospital Discharge

Our program is designed to help facilitate the transitions of care (TOC) of select patients discharged from Henry Ford Hospital (HFH) with the aim of preventing 30-day readmissions, as well as improving cost avoidance measures. TOC, as defined by the Centers of Medicare and Medicaid, is a complex process requiring several actions and multiple disciplines to work together to ensure effective communication and coordination of care. Transitioning from the hospital setting to home, specifically, exposes vulnerability within our health systems, and errors have a high chance of occurring. Medication management and follow-up care are included in “the seven essential elements” needed for successful TOC. According to Burke and colleagues, an ideal framework for establishing successful transitions of care includes 10 domains, amongst which are: medication safety, educating patients to promote self-management, enlisting help of social and community supports, coordinating care among team members and monitoring and managing symptoms after discharge and outpatient follow-up, all of which are embedded into our program.https://scholarlycommons.henryford.com/qualityexpo2022/1000/thumbnail.jp

Hydrogen-Poor Disks in Compact X-Ray Binaries

We show that accretion disks in several compact X-ray binaries with hydrogen-depleted donors are likely subject to a thermal ionization instability, unless they are strongly irradiated. These disks are particularly interesting in that their MHD-turbulent properties in the neutral phase may be quite different from those of standard, hydrogen-rich disks.Comment: 10 pages, accepted for publication in ApJ

COVID-19 vaccine acceptance in older Syrian refugees : Preliminary findings from an ongoing study

Funding source This work was supported by ELRHA’s Research for Health in Humanitarian Crisis (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR). The views expressed herein should not be taken, in any way, to reflect the official opinion of the NRC or ELRHA. The funding agency was not involved in the data collection, analysis or interpretation.Peer reviewedPublisher PD

Racial/Ethnic Disparities in Prostate Cancer 5-Year Survival: The Role of Health-Care Access and Disease Severity

Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods: The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan–Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the relationship between county-level SES and PCa survival. Multivariate regression analysis was performed to examine the role of healthcare utilization and severity. Results: A total of 239,613 PCa records were extracted, and 5-year PCa-specific survival was 94%. Overall, living in counties in the worst poverty/income quintile and the worst high-school level education increased PCa mortality by 38% and 33%, respectively, while the best bachelor’s-level education rates decreased mortality risk by 23%. Associations varied considerably upon racial/ethnic stratification. Multilevel analyses showed varying contributions of individual and area-level factors to survival within minorities. The relationship between SES and PCa survival appeared to be influenced by healthcare utilization and disease stage/grade. Discussion: Racial/ethnic categories responded differently under similar county-level SES and individual-level factors to the point where disparities reversed in Hispanic populations. The inclusion of healthcare utilization and severity factors may provide partial early support for their role as intermediaries. Healthcare access (insurance) might not necessarily be associated with better PCa survival through the performance of biopsy and or/surgery. County-level education plays an important role in PCa decision making as it might elucidate discussions of other non-invasive management options. Conclusions: The findings of this study demonstrate that interventions need to be tailored according to each group’s needs. This potentially informs the focus of public health efforts in terms of planning and prioritization. This study could also direct further research delving into pathways between area-level characteristics with PCa survival

Primary Klebsiella pneumoniae Osteomyelitis with Bacteremia and Sepsis in a Patient with Cirrhosis

Osteomyelitis is commonly caused by Staphylococci, Streptococci, Escherichia coli, and anaerobes. There have been cases of rare organisms like Klebsiella pneumoniae (Kp) being initially overlooked as causes of osteomyelitis. We report a case of an elderly cirrhotic adult male transferred for further management of liver failure, who was subsequently diagnosed with Kp osteomyelitis and sepsis. He had a history of blunt leg trauma, and MRI of the leg revealed osteomyelitis, with a negative workup for other sources of infection. Kp osteomyelitis is reported in less than 100 cases, mainly in pediatric and sickle-cell patients. There are no pathognomonic imaging findings. Lesions may be metastatic, with rapid widespread destruction and exuberant periosteal reaction. Kp is a rare, under recognized cause of osteomyelitis in immune-suppressed adults. Given its pathogenicity, early identification is critical

The effect of entomopathogenic nematodes and fungi against four xylophagous pests

The effects of entomopathogenic nematodes EPN (Steinernematidae and Heterorhabditidae) and fungi EPF (Beauveria bassiana) strains were evaluated in laboratory assays against larvae of four xylophagous pests: the Asparagus moth Parahypopta caestrum, the European goat moth Cossus cossus, the pine longhorn Arhopalus syriacus and the black Buprestid Capnodis tenebrionis. Due to their biology and ethology, these insects may be included in the category of pests residing in cryptic habitats. The control of these species is considered difficult, due to the inability of chemical pesticides to penetrate the cryptic habitats and reach the targets. The pathogenicity of the entomopathogenic nematodes and fungi was tested in vitro against the pests. Two experimental models were considered and aimed to imitate the natural environment of the pests, in Petri dishes filled with plant material and inside wood galleries respectively. Main results showed that the majority of the tested strains of nematodes and fungi affected the insects’ survival rate. Steinernema feltiae and B. bassiana caused the highest percentage of larval mortality (80–100%). Considering the lack of effective chemical control means, the microbial control of the xylophagous pests by EPN and EPF reveals promising perspectives. Nematodes and fungi are able to penetrate the cryptic habitats because they are living organisms and may be horizontally transmitted by infected hosts. The distribution of EPF as preventive control method and the injection of EPN suspensions to reach and infect the larvae inside the wood galleries can be a combined sustainable control system

ELN and FBN2 gene variants as risk factors for two sports-related musculoskeletal injuries

The proteins ELN and FBN2 are important in extracellular matrix function. The ELN rs2071307 and FBN2 rs331079 gene variants have been associated with soft tissue pathologies. We aimed to determine whether these variants were predisposing factors for both Achilles tendinopathy (AT) and anterior cruciate ligament (ACL) ruptures. For the AT study, 135 cases (TEN group) and 239 asymptomatic controls were recruited. For the ACL rupture study our cohort consisted of 141 cases (ACL group) and 219 controls. Samples were genotyped for both the ELN rs2071307 and FBN2 rs331079 variants using TaqMan assays. Analysis of variance and chi-squared tests were used to determine whether either variant was associated with AT or ACL rupture with significance set at p<0.05. The GG genotype of the FBN2 variant was significantly over-represented within the TEN group (p=0.035; OR=1.83; 95% CI 1.04–3.25) compared to the CON group. We also found that the frequency of the G allele was significantly different between the TEN (p=0.017; OR=1.90; 95% CI 1.11–3.27) and ACL groups (p=0.047; OR=1.76; 95% CI 1.00–3.10) compared to controls. The ELN rs207137 variant was not associated with either AT or ACL rupture. In conclusion, DNA sequence variation within the FBN2 gene is associated with both AT and ACL rupture

Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing

The paper presents an application of a reliability analysis for evaluating the risk associated with passing sight distance (PSD) standards in terms of the expected probability of noncompliance. Calculation of PSD is required to determine where drivers can safely execute passing maneuvers. Traditional PSD standards are based on deterministic, theoretical models, which are calibrated with conservative percentile values for uncertain design inputs to account for uncertainty. The PSD standards do not provide information about the risk of deviation from them. Reliability analysis is a technique that is based on limit state design and that accounts for the propagation of variability from input random parameters to the design outputs. A total of 1,098 passing maneuvers were observed on several two-lane highways in Spain; two data collection methodologies were used: external observations and an instrumented vehicle. The most significant factors affecting PSD were impeding-vehicle speed, passing-vehicle acceleration, and head-ways between impeding and passing vehicles. A uniform acceleration model described the passing-vehicle trajectory. The characterized input parameters and the passing model were used to perform a reliability analysis. The results showed the probability of noncompliance in different scenarios, defined as the proportion of cases in which the required PSD would exceed the available sight distance. American and Spanish PSD standards were evaluated. Geometric design standards presented a probability of noncompliance of about 0.15, whereas some marking standards had a probability of noncompliance exceeding 0.85. These standards may be associated with higher risk levels if they are followed by drivers. As well, PSD risk levels were not consistent for different design speeds, since they underestimated operating speed at some locationsThis paper was developed as a result of a mobility study at the University of British Columbia funded by the Erasmus Mundus Program of the European Commission under the Transatlantic Partnership for Excellence in Engineering project. The authors thank the Spanish Ministry of Economy and Competitiveness, which subsidized the research project, and the Spanish Directorate General of Traffic, Spanish Ministry of Public Works, Valencia Regional Department of Transport, and Valencia province road department for their collaboration during the field study.Llorca Garcia, C.; Moreno Chou, AT.; Sayed, T.; García García, A. (2014). Sight Distance Standards Based On Observational Data Risk Evaluation Of Passing. Transportation research record. 2404:18-26. doi:10.3141/2404-03S18262404Ismail, K., & Sayed, T. (2009). Risk-based framework for accommodating uncertainty in highway geometric design. Canadian Journal of Civil Engineering, 36(5), 743-753. doi:10.1139/l08-146Ismail, K., & Sayed, T. (2010). Risk-Based Highway Design. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 3-13. doi:10.3141/2195-01Richl, L., & Sayed, T. (2006). Evaluating the Safety Risk of Narrow Medians Using Reliability Analysis. Journal of Transportation Engineering, 132(5), 366-375. doi:10.1061/(asce)0733-947x(2006)132:5(366)Harwood, D. W., Gilmore, D. K., & Richard, K. R. (2010). Criteria for Passing Sight Distance for Roadway Design and Marking. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 36-46. doi:10.3141/2195-05Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Llorca, C., & García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record: Journal of the Transportation Research Board, 2262(1), 42-51. doi:10.3141/2262-05Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Llorca, C., Moreno, A. T., García, A., & Pérez-Zuriaga, A. M. (2013). Daytime and Nighttime Passing Maneuvers on a Two-Lane Rural Road in Spain. Transportation Research Record: Journal of the Transportation Research Board, 2358(1), 3-11. doi:10.3141/2358-01Easa, S. M. (1993). Reliability‐Based Design of Intergreen Interval at Traffic Signals. Journal of Transportation Engineering, 119(2), 255-271. doi:10.1061/(asce)0733-947x(1993)119:2(255)Selvanathan, E. A., & Selvanathan, S. (1994). The demand for transport and communication in the United Kingdom and Australia. Transportation Research Part B: Methodological, 28(1), 1-9. doi:10.1016/0191-2615(94)90027-2Easa, S. M. (2000). Reliability Approach to Intersection Sight Distance Design. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 42-52. doi:10.3141/1701-06Ibrahim, S. E.-B., & Sayed, T. (2011). Developing safety performance functions incorporating reliability-based risk measures. Accident Analysis & Prevention, 43(6), 2153-2159. doi:10.1016/j.aap.2011.06.006Khoury, J. E., & Hobeika, A. G. (2007). Assessing the Risk in the Design of Passing Sight Distances. Journal of Transportation Engineering, 133(6), 370-377. doi:10.1061/(asce)0733-947x(2007)133:6(370)Khoury, J. E., & Hobeika, A. G. (2012). Integrated Stochastic Approach for Risk and Service Estimation: Passing Sight Distance Application. Journal of Transportation Engineering, 138(5), 571-579. doi:10.1061/(asce)te.1943-5436.0000366Kim, S., & Choi, J. (2013). Effects of preceding geometric conditions on operating speed consistency of multilane highways. Canadian Journal of Civil Engineering, 40(6), 528-536. doi:10.1139/cjce-2012-005

MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: attempted replication study in a British case–control cohort

Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work

TIMP2 and GDF-5 gene variants and achilles tendon pathology: replication study in a British case-control population

Introduction: Achilles tendon pathology (ATP) encompasses a range of tendon overuse injuries that can be sub-classified into separate pathologies [Weinfeld, 2014]. To date, a number of single nucleotide polymorphisms (SNPs) have been associated with ATP [Raleigh and Collins, 2012] but, with the exception of the COL5A1 rs12722 variant, limited work has been published on attempting to replicate these findings in cohorts other than those recruited from either South Africa or Australia. We selected variants within the TIMP2 (rs4789932) and GDF-5 (rs143383) genes, that have previously been shown to associate with ATP [El Khoury et al, 2013 and Posthumus et al, 2010], and attempted to replicate previous associations in a newly recruited British-based, case-control, Caucasian cohort. Methods: We recruited 133 ATP Caucasian patients from the County Clinic in Northampton along with 131 physically active controls from various sports clubs within the East Midlands region. DNA samples were collected from saliva (DNA genotek Ltd) and Taqman technology, using allele specific probes and primers, was used to genotype all DNA samples. Reactions were run on a StepOne Plus real-time PCR instrument (ABI). Genotypes were called according to post run cluster profiles and data were analysed using Chi-squared (c2) analysis or Fisher’s exact test. Significance was accepted at p < 0.05. All procedures were approved by the University of Northampton Research Ethics Committee. Results: For the TIMP2 rs4789932 variant we found no association between genotype and case or control status in the entire cohort (p = 0.279). However, in sex specific analysis we did find that the CC genotype was associated (p = 0.043) with male ATP cases compared to controls (Table 1). For the GDF-5 rs143383 variant, we found no association between genotype and case or control status in the entire cohort (p = 0.538) or in either male (p = 0.319) or female (p = 0.737) specific analysis (data not shown). Genotypes did not associate with any other potential confounding variables. Conclusions: The TIMP2 rs478992 CC genotype was associated with male cases of ATP. Although this locus was previously associated with ATP in cohorts recruited from the Southern Hemisphere it was the CT genotype that was the risk factor and the association was not sex specific [El Khoury et al, 2013]. This result might be related to differences in unknown environmental exposures between the cohorts investigated that may modify the effect of the genotype. We found no evidence of an association between ATP and the GDF-5 variant. These data should be viewed as preliminary findings and will need to be repeated in a larger cohort