A Cascade of Care of Patients with Hepatitis C Infection in a Rural State

Introduction: The substance misuse epidemic has fueled an increase in hepatitis C virus (HCV) infections. Despite the availability of sensitive screening and curative treatment, relatively few people are aware of their diagnosis and engaged in care. In this study, we aimed to identify local gaps in HCV care and inform strategies for improvement. Methods: In this retrospective study, we assessed adult patients seen at a tertiary care center from 2015 to 2019 and who were eligible for HCV screening based on recommendations from the Centers for Disease Control and Prevention. Inclusion criteria were birth from 1945 to 1965, long-term dialysis treatment, alanine aminotransferase greater than 35 U/L for 6 months or more, and/or a diagnosis of opioid use disorder (OUD), HIV/AIDS, or hepatitis B virus (HBV) infection. We summarized the HCV cascade of care with descriptive statistics and used logistic regression to identify factors associated with HCV screening. Results: We identified 4948 patients eligible for HCV screening, of whom 47% were female, 54% were male; 7% were Black, 83% were White, and 10% were Other/Unknown; and 87% were born between 1945 and 1965. Among the patients, 2791/4948 (56%) were screened and 124/2791 (4%) were identified to have chronic HCV infection, of whom 12/124 (10%) were linked to care, ever treated, and cured. Patients with HCV included 63/124 (51%) with OUD and 65/124 (52%) with HBV coinfection. All risk factors for HCV were independently associated with HCV screening, except OUD (aOR, 1.2; 95% CI, 0.9-1.6; P = .28). Discussion: We identified multiple gaps in the HCV cascade of care at our institution. Our findings, paired with data from the Veterans Health Administration and national research, indicate a need for more comprehensive strategies for HCV screening and intervention. Conclusions: Our findings will help to direct strategies for improving HCV detection and subsequent enrollment into care, particularly for patients with OUD

Strategies To Improve Control Of Blood A1C In Diabetics

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less. A root cause analysis identified several deficiencies to includelack of essential equipment, variations in staff education and the absence of daily reminders. Post KPI implementations, an overall decrease in the percentage of patients with poorly controlled diabetes was attained. Next steps include ongoing monthly reviews of patients with A1c \u3e9 or have not been seen in 12 month

Increasing Advanced Care Planning in an Ambulatory Care Setting

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows. The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC. Baseline metrics demonstrated that ACP discussion rates were less than 12%. A root cause analysis demonstrated several reasons for this low percentage. Several countermeasures were instituted to include a KPI that addressed intern/resident education, daily reminders at morning huddles and email reminders that ACP should be included in pre-visit planning. In the seven months since the start of this performance improvement project, the documented ACP discussion rate increased to 22.2%. Next steps include continued compliance monitoring, teach providers to review ACP related reports and ongoing data vigilance

Phosphorothioate backbone modifications of nucleotide-based drugs are potent platelet activators

Nucleotide-based drug candidates such as antisense oligonucleotides, aptamers, immunoreceptor-activating nucleotides, or (anti)microRNAs hold great therapeutic promise for many human diseases. Phosphorothioate (PS) backbone modification of nucleotide-based drugs is common practice to protect these promising drug candidates from rapid degradation by plasma and intracellular nucleases. Effects of the changes in physicochemical properties associated with PS modification on platelets have not been elucidated so far. Here we report the unexpected binding of PS-modified oligonucleotides to platelets eliciting strong platelet activation, signaling, reactive oxygen species generation, adhesion, spreading, aggregation, and thrombus formation in vitro and in vivo. Mechanistically, the platelet-specific receptor glycoprotein VI (GPVI) mediates these platelet-activating effects. Notably, platelets from GPVI function-deficient patients do not exhibit binding of PS-modified oligonucleotides, and platelet activation is fully abolished. Our data demonstrate a novel, unexpected, PS backbone-dependent, platelet-activating effect of nucleotide-based drug candidates mediated by GPVI. This unforeseen effect should be considered in the ongoing development programs for the broad range of upcoming and promising DNA/RNA therapeutics

Painting the Nation:Examining the Intersection Between Politics and the Visual Arts Market in Emerging Economies

Politics and art have throughout history, intersected in diverse and complex ways. Ideologies and political systems have used the arts to create a certain image and, depending on the form of government this has varied from clear-cut state propaganda, to patronage, to more indirect arms-length funding procedures. Therefore, artists working within the macro-level socio-political context cannot help but be influenced, inspired and sometimes restricted by these policies and political influences. This article examines the contemporary art markets of two emerging, Socialist economies to investigate the relationship between state pol-itics and the contemporary visual arts market. We argue that the respective governments and art worlds are trying to construct a brand narrative for their nations, but that these discourses are often at cross-purposes. In doing so, we illustrate that it is impos-sible to separate a consideration of the artwork from the macro-level context in which it is produced, distributed, and consumed

HST Grism Confirmation of 16 Structures at 1.4<z<2.8 from the Clusters Around Radio-Loud AGN (CARLA) Survey

We report spectroscopic results from our 40-orbit Hubble Space Telescope slitless grism spectroscopy program observing the 20 densest CARLA candidate galaxy clusters at 1.41.4

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Multidifferential study of identified charged hadron distributions in ZZ-tagged jets in proton-proton collisions at s=\sqrt{s}=13 TeV

Jet fragmentation functions are measured for the first time in proton-proton collisions for charged pions, kaons, and protons within jets recoiling against a $Z$ boson. The charged-hadron distributions are studied longitudinally and transversely to the jet direction for jets with transverse momentum 20 $< p_{\textrm{T}} < 100$ GeV and in the pseudorapidity range $2.5 < \eta < 4$. The data sample was collected with the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 1.64 fb$^{-1}$. Triple differential distributions as a function of the hadron longitudinal momentum fraction, hadron transverse momentum, and jet transverse momentum are also measured for the first time. This helps constrain transverse-momentum-dependent fragmentation functions. Differences in the shapes and magnitudes of the measured distributions for the different hadron species provide insights into the hadronization process for jets predominantly initiated by light quarks.Comment: All figures and tables, along with machine-readable versions and any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-013.html (LHCb public pages