Promising Flex Program Initiatives to Support Critical Access Hospitals during the COVID-19 Pandemic

This brief reports on promising State Flex Program (SFP) strategies to support Critical Access Hospitals during the COVID-19 pandemic. SFPs adapted existing initiatives and implemented new activities to address the emerging needs of CAHs during the pandemic. With approval from the Federal Office of Rural Health, the SFPs redirected funds and activities to address the evolving COVID-19 needs of CAHs while maintaining fidelity to Flex Program goals. Based on qualitative interviews with seven SFPs, the authors, members of the Flex Monitoring Team, discuss initiatives such as resiliency training for frontline staff; packaging and dissemination of COVID-19 information; public health messaging; infection prevention and pharmacy consultations; and financial technical assistance and programs. The authors also highlight ongoing COVID-19 needs of CAHs as described by the SFPs, which include increased financial vulnerability, rural workforce shortages, and support for telehealth. FMI: Celia Jewell, [email protected]

Evaluating State Flex Program Population Health Activities

The Medicare Rural Hospital Flexibility (Flex) Program funds initiatives to improve the health of rural communities under Program Area 3: Population Health Improvement, in order to build the capacity of Critical Access Hospitals (CAHs) to achieve measurable improvements in the health outcomes of their communities. Th authors provide an overview of the expectations for Program Area 3; summarize State Flex Program (SFP) initiatives under this Program Area; describe promising population health strategies implemented by SFPs; and discusse outcome measurement issues for population health, including providing an example a chain of short, intermediate, and long-term outcome measures for a potential population health activity. Th authors also portray a pathway to connect Flex Program population health efforts to the U.S. Department of Health and Human Services’ Healthy Rural Hometown Initiative (HRHI), a five-year multi-program effort to address the factors driving rural disparities in heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Finally, the brief provides resources for outcome measurement in population health. A companion brief, An Inventory of State Flex Program Population Health Initiatives for Fiscal Years 2019-2023, provides a detailed description of population health initiatives proposed by the 45 SFPs. This brief is available at: https://www.flexmonitoring.org/sites/flexmonitoring.umn.edu/files/media/InventoryofSFPPopHealthActivities_0.pdf For more information, please contact John Gale at [email protected]

Dimensional analysis of MINMOD leads to definition of the disposition index of glucose regulation and improved simulation algorithm

BACKGROUND: Frequently Sampled Intravenous Glucose Tolerance Test (FSIVGTT) together with its mathematical model, the minimal model (MINMOD), have become important clinical tools to evaluate the metabolic control of glucose in humans. Dimensional analysis of the model is up to now not available. METHODS: A formal dimensional analysis of MINMOD was carried out and the degree of freedom of MINMOD was examined. Through re-expressing all state variable and parameters in terms of their reference scales, MINMOD was transformed into a dimensionless format. Previously defined physiological indices including insulin sensitivity, glucose effectiveness, and first and second phase insulin responses were re-examined in this new formulation. Further, the parameter estimation from FSIVGTT was implemented using both the dimensional and the dimensionless formulations of MINMOD, and the performances were compared utilizing Monte Carlo simulation as well as real human FSIVGTT data. RESULTS: The degree of freedom (DOF) of MINMOD was found to be 7. The model was maximally simplified in the dimensionless formulation that normalizes the variation in glucose and insulin during FSIVGTT. In the new formulation, the disposition index (Dl), a composite parameter known to be important in diabetes pathology, was naturally defined as one of the dimensionless parameters in the system. The numerical simulation using the dimensionless formulation led to a 1.5–5 fold gain in speed, and significantly improved accuracy and robustness in parameter estimation compared to the dimensional implementation. CONCLUSION: Dimensional analysis of MINMOD led to simplification of the model, direct identification of the important composite factors in the dynamics of glucose metabolic control, and better simulations algorithms

Locality in Theory Space

Locality is a guiding principle for constructing realistic quantum field theories. Compactified theories offer an interesting context in which to think about locality, since interactions can be nonlocal in the compact directions while still being local in the extended ones. In this paper, we study locality in "theory space", four-dimensional Lagrangians which are dimensional deconstructions of five-dimensional Yang-Mills. In explicit ultraviolet (UV) completions, one can understand the origin of theory space locality by the irrelevance of nonlocal operators. From an infrared (IR) point of view, though, theory space locality does not appear to be a special property, since the lowest-lying Kaluza-Klein (KK) modes are simply described by a gauged nonlinear sigma model, and locality imposes seemingly arbitrary constraints on the KK spectrum and interactions. We argue that these constraints are nevertheless important from an IR perspective, since they affect the four-dimensional cutoff of the theory where high energy scattering hits strong coupling. Intriguingly, we find that maximizing this cutoff scale implies five-dimensional locality. In this way, theory space locality is correlated with weak coupling in the IR, independent of UV considerations. We briefly comment on other scenarios where maximizing the cutoff scale yields interesting physics, including theory space descriptions of QCD and deconstructions of anti-de Sitter space.Comment: 40 pages, 11 figures; v2: references and clarifications added; v3: version accepted by JHE

The CEACAM1 expression is decreased in the liver of severely obese patients with or without diabetes

<p>Abstract</p> <p>Background</p> <p>Type 2 diabetes is mainly caused by insulin resistance. The carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is an important candidate for causing insulin resistance.</p> <p>Methods</p> <p>The CEACAM1 expression was evaluated immunohistochemically in the liver tissues of 99 severely obese or non-obese subjects with or without diabetes. The CEACAM1 expression was classified into two categories: a normal expression or a decreased expression.</p> <p>Results</p> <p>The CEACAM1 expression was markedly decreased in the hepatocytes with macrovesicular steatosis. A decreased CEACAM1 expression was noted in 29 (29%) of 99 cases. The incidence of a decreased CEACAM1 expression was significantly higher in high grade fatty liver as well as severe obesity with or without diabetes (p < 0.05). The incidence of a decreased CEACAM1 expression was not different between the diabetic and non-diabetic groups.</p> <p>Conclusions</p> <p>This data supports that a decreased CEACAM1 expression is related to obesity and a fatty liver.</p

Massage Therapy and Canadians’ Health Care Needs 2020: Proceedings of a National Research Priority Setting Summit

Background: The health care landscape in Canada is changing rapidly as forces, such as an aging population, increasingly complex health issues and treatments, and economic pressure to reduce health care costs, bear down on the system. A cohesive national research agenda for massage therapy (MT) is needed in order to ensure maximum benefit is derived from research on treatment, health care policy, and cost effectiveness.Setting: A one-day invitational summit was held in Toronto, Ontario to build strategic alliances among Canadian and international researchers, policy makers, and other stakeholders to help shape a national research agenda for MT.Method: Using a modified Delphi method, the summit organizers conducted two pre-summit surveys to ensure that time spent during the summit was relevant and productive. The summit was facilitated using the principles of Appreciative Inquiry which included a “4D” strategic planning approach (defining, discovery, dreaming, designing) and application of a SOAR framework (strengths, opportunities, aspirations, and results).Participants: Twenty-six researchers, policymakers, and other stakeholders actively participated in the events.Results: Priority topics that massage therapists believe are important to the Canadian public, other health care providers, and policy makers and massage therapists themselves were identified. A framework for a national massage therapy (MT) research agenda, a grand vision of the future for MT research, and a 12-month action plan were developed.Conclusion: The summit provided an excellent opportunity for key stakeholders to come together and use their experience and knowledge of MT to develop a much-needed plan for moving the MT research and professionalization agenda forward

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

Advantages of the single delay model for the assessment of insulin sensitivity from the intravenous glucose tolerance test

The Minimal Model, (MM), used to assess insulin sensitivity (IS) from Intra-Venous Glucose-Tolerance Test (IVGTT) data, suffers from frequent lack of identifiability (parameter estimates with Coefficients of Variation (CV) less than 52%). The recently proposed Single Delay Model (SDM) is evaluated as a practical alternative

Aryl hydrocarbon receptor nuclear translocator (ARNT) gene as a positional and functional candidate for type 2 diabetes and prediabetic intermediate traits: Mutation detection, case-control studies, and gene expression analysis

<p>Abstract</p> <p>Background</p> <p>ARNT, a member of the basic helix-loop-helix family of transcription factors, is located on human chromosome 1q21–q24, a region which showed well replicated linkage to type 2 diabetes. We hypothesized that common polymorphisms in the <it>ARNT </it>gene might increase the susceptibility to type 2 diabetes through impaired glucose-stimulated insulin secretion.</p> <p>Methods</p> <p>We selected 9 single nucleotide polymorphisms to tag common variation across the <it>ARNT </it>gene. Additionally we searched for novel variants in functional coding domains in European American and African American samples. Case-control studies were performed in 191 European American individuals with type 2 diabetes and 187 nondiabetic European American control individuals, and in 372 African American individuals with type 2 diabetes and 194 African American control individuals. Metabolic effects of <it>ARNT </it>variants were examined in 122 members of 26 European American families from Utah and in 225 unrelated individuals from Arkansas. Gene expression was tested in 8 sibling pairs discordant for type 2 diabetes.</p> <p>Results</p> <p>No nonsynonymous variants or novel polymorphisms were identified. No SNP was associated with type 2 diabetes in either African Americans or European Americans, but among nondiabetic European American individuals, <it>ARNT </it>SNPs rs188970 and rs11204735 were associated with acute insulin response (AIR_g; p =< 0.005). SNP rs2134688 interacted with body mass index to alter β-cell compensation to insulin resistance (disposition index; p = 0.004). No significant difference in <it>ARNT </it>mRNA levels was observed in transformed lymphocytes from sibling pairs discordant for type 2 diabetes.</p> <p>Conclusion</p> <p>Common <it>ARNT </it>variants are unlikely to explain the linkage signal on chromosome 1q, but may alter insulin secretion in nondiabetic subjects. Our studies cannot exclude a role for rare variants or variants of small (< 1.6) effect size.</p