Improving undergraduate education in immunology through assessment of interdisciplinary scientific knowledge.

The interdisciplinary nature of immunology can make studying not only engaging but also challenging, as understanding immunologic processes and immune system components requires foundational knowledge from several science disciplines. The University of Alabama at Birmingham has a unique, 4-year, Undergraduate Immunology Program (UIP) that provides a comprehensive curriculum in immunology that includes five core courses starting in the second year, at which point, students are in the process of completing basic science sequences. For this study, students in courses across the UIP curriculum were asked to identify basic science topics that relate to four immunology concepts. In addition, students were surveyed on their confidence in understanding each of the basic science topics and were asked to identify the course in which they felt that they had fully learned the topic. Data from this study did not demonstrate a change in students' interdisciplinary science competency from the second to fourth year. Importantly, students reported that they fully understood 11 out of 12 basic science concepts in courses offered in their first and second years, with confidence in basic science topics significantly improving from the second to third year. The lack of demonstrated improvement in interdisciplinary understanding across the curriculum may be attributed to the fact that students are able to integrate basic science topics with foundational immunologic concepts as early as their second year. Importantly, these findings suggest that the integration or review of basic science topics in an immunology course may improve students' comprehension of foundational immunology concepts and interdisciplinary science competency.

Phylogenomic and molecular marker based studies to clarify the evolutionary relationships amongst Anoxybacillus species and demarcation of the family Anoxybacillaceae and some of its constituent genera.

The family Anoxybacillaceae was recently proposed encompassing the genera Anoxybacillus, Geobacillus, Parageobacillus, Saccharococcus and Thermolongibacillus. Of these genera, Anoxybacillus contains >50% of the Anoxybacillaceae species. However, Anoxybacillus species form multiple unrelated clades in phylogenetic trees and their evolutionary relationships are unclear. To clarify the evolutionary relationships of Anoxybacillus and other Anoxybacillaceae species, detailed phylogenomic and comparative analyses were conducted on 38 Anoxybacillaceae species with available genomes. In a phylogenomic tree based on 1148 core proteins, all Anoxybacillus, Geobacillus, Parageobacillus, Saccharococcus and Thermolongibacillus species, excepting Anoxybacillus sediminis, formed a strongly supported clade representing the family Anoxybacillaceae. Five conserved signature indels (CSIs) reported here are also uniquely found in these species, providing robust means for the demarcation of family Anoxybacillaceae in molecular terms. In our phylogenomic tree and in the Genomic Taxonomy Database, Anoxybacillus species formed four distinct clades designated as Anoxybacillus sensu stricto (containing the type species A. pushchinoensis), Anoxybacillus_A, Anoxybacillus_B and Anoxybacillus_C. Our analyses have identified 17 novel CSIs which offer means to reliably distinguish species from these clades based upon multiple uniquely shared molecular characteristics. Additionally, we have identified three and seven CSIs specific for the genera Geobacillus and Brevibacillus, respectively. All seven Brevibacillus-specific CSIs are also shared by Anoxybacillus sediminis, which branches reliably with this genus. Based on the strong phylogenetic and molecular evidence presented here, we are proposing that the genus Anoxybacillus should be restricted to only the species from Anoxybacillus sensu stricto clade, whereas the species from Anoxybacillus_A, Anoxybacillus_B, and Anoxybacillus_C clades should be transferred into three novel genera Anoxybacteroides gen. nov., Paranoxybacillus gen. nov. and Thermaerobacillus gen. nov., respectively. Additionally, we are also proposing the transfer of Anoxybacillus sediminis to the genus Brevibacillus. The proposed changes, which reliably depict the evolutionary relationships among Anoxybacillaceae species, should be helpful in the studies of these organisms.

Using the social cognitive theory to examine spontaneous attempts to quit illicit substance use.

Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.

Virulence, antimicrobial susceptibility and phylogenetic analysis of Cronobacter sakazakii isolates of food origins from Jordan.

AIMS: The aim was to characterize a collection of Cronobacter sakazakii isolates collected from various origins in Jordan. METHODS AND RESULTS: The isolates were characterized using 16S rRNA sequencing, DNA microarray, multi-locus sequence typing (MLST), O-serotyping, virulence gene identification and antibiotic susceptibility testing. The identities and phylogenetic relatedness revealed that C. sakazakii sequence type 4 (ST4) and Csak O:1 serotype were the most prevalent STs and serovars amongst these C. sakazakii strains. PCR screening of putative virulence genes showed that the siderophore-interacting protein gene (sip) and iron acquisition gene clusters (eitCBAD and iucABCD/iutA) were the most detected genes with noticeable variability in the type 6 secretion system (T6SS) and filamentous hemagglutinin/adhesion (FHA) gene loci. The antibiotic resistance profiles revealed that the majority of the isolates were susceptible to all antibiotics used despite harbouring a class C ß-lactamase resistance gene. CONCLUSIONS: The results described in this report provide additional insights about the considerable genotypic and phenotypic heterogeneity within C. sakazakii. SIGNIFICANCE AND IMPACT OF THE STUDY: The information reported in this study might be of great value in understanding the origins of C. sakazakii isolates, in addition to their diversity and variability, which might be helpful in preventing future outbreaks of this pathogen.

Development and validation of an improved method for the detection of Salmonella in cinnamon bark and oregano leaves using the adsorbent beta zeolite in the pre-enrichment media.

The detection of Salmonella in spices is challenging due to the presence of antibacterial components. In this study, we evaluated the use of an adsorbent beta zeolite in pre-enrichment media to improve the recovery of Salmonella from cinnamon bark and oregano leaves. Samples (25 g) were spiked with varying levels of S. Montevideo or S. Senftenberg. After 2 weeks of stabilization at RT, betazeolite was added to cinnamon and oregano samples prior to the addition of 225 mL or 475 mL of pre-enrichment media, respectively. Detection sensitivity and rate of the test method were compared to the FDA Bacteriological Analytical Manual (BAM) method which requires the use of 2.5 L pre-enrichment broth. While Salmonella could not be detected in the test method using the reduced volume of pre-enrichment media alone, the addition of beta zeolite resulted in a positivity rate of 62% and 72.6% for cinnamon bark and oregano leaves respectively (all spike levels and both serovars combined). Furthermore, while there were differences in the LOD50 compared to the BAM method, there was no significant difference in the minimum level of detection between the betazeolite and the BAM methods. Our results demonstrate that the use of betazeolite in the pre-enrichment media offers a method with reduced media volumes without compromising on the sensitivity or efficiency of Salmonella detection in cinnamon bark and oregano leaves.

Insular Microbiogeography: Three Pathogens as Exemplars.

Traditional taxonomy in biology assumes that life is organized in a simple tree. Attempts to classify microorganisms in this way in the genomics era led microbiologists to look for finite sets of 'core' genes that uniquely group taxa as clades in the tree. However, the diversity revealed by large-scale whole genome sequencing is calling into question the long-held model of a hierarchical tree of life, which leads to questioning of the definition of a species. Large-scale studies of microbial genome diversity reveal that the cumulative number of new genes discovered increases with the number of genomes studied as a power law and subsequently leads to the lack of evidence for a unique core genome within closely related organisms. Sampling 'enough' new genomes leads to the discovery of a replacement or alternative to any gene. This power law behaviour points to an underlying self-organizing critical process that may be guided by mutation and niche selection. Microbes in any particular niche exist within a local web of organism interdependence known as the microbiome. The same mechanism that underpins the macro-ecological scaling first observed by MacArthur and Wilson also applies to microbial communities. Recent metagenomic studies of a food microbiome demonstrate the diverse distribution of community members, but also genotypes for a single species within a more complex community. Collectively, these results suggest that traditional taxonomic classification of bacteria could be replaced with a quasispecies model. This model is commonly accepted in virology and better describes the diversity and dynamic exchange of genes that also hold true for bacteria. This model will enable microbiologists to conduct population-scale studies to describe microbial behaviour, as opposed to a single isolate as a representative.

Culture-Based Quantification with Molecular Characterization of Non-O157 and O157 Enterohemorrhagic Escherichia coli Isolates from Rectoanal Mucosal Swabs of Feedlot Cattle.

Enterohemorrhagic Escherichia coli (EHEC) strains are foodborne pathogens carried in the intestinal tracts of ruminants and shed in the feces. High concentrations (≥104 colony-forming units [CFU]/g) of EHEC in cattle feces are associated with contamination of hides, and subsequently, carcasses and beef. Several studies using agar media have quantified O157 but few have quantified non-O157 EHEC in samples from cattle. Thus, the objective of this study was to determine the concentration of O157 and non-O157 EHEC in cattle, and to characterize the associated EHEC isolates for their virulence potential. Two hundred feedlot steers were sampled by rectoanal mucosal swab (RAMS) every 35 days over four sampling periods, and a spiral plating method using modified Possé differential agar was used to quantify EHEC organisms in these samples. Bacterial colonies from agar plates were tested by multiplex PCR for Shiga toxin and intimin genes (stx and eae, respectively), and confirmed EHEC isolates (i.e., positive for both stx and eae) were serotyped and characterized for virulence genes using a microarray. Organisms detected in this study included O26, O101, O103, O109, O121, O145, O157, and O177 EHEC, with all except O121 quantifiable and measuring within a range from 9.0 × 102 to 3.0 × 105 CFU/g of RAMS sample. Organisms of the same EHEC serogroup were not detected in quantifiable concentrations from a single animal more than once. EHEC organisms most commonly detected at quantifiable levels were O26, O157, and O177. Interestingly, O26 EHEC isolates tested negative for stx1 but positive for stx2a. High concentrations of EHEC were detected in 11 (5.5%) of the steers at least once over the sampling period. These results indicate that in addition to O157, non-O157 EHEC are transiently present in high concentrations in the rectoanal mucosal region of cattle.

FDA Escherichia coli Identification (FDA-ECID) Microarray: a Pangenome Molecular Toolbox for Serotyping, Virulence Profiling, Molecular Epidemiology, and Phylogeny.

UNLABELLED: Most Escherichia coli strains are nonpathogenic. However, for clinical diagnosis and food safety analysis, current identification methods for pathogenic E. coli either are time-consuming and/or provide limited information. Here, we utilized a custom DNA microarray with informative genetic features extracted from 368 sequence sets for rapid and high-throughput pathogen identification. The FDA Escherichia coli Identification (FDA-ECID) platform contains three sets of molecularly informative features that together stratify strain identification and relatedness. First, 53 known flagellin alleles, 103 alleles of wzx and wzy, and 5 alleles of wzm provide molecular serotyping utility. Second, 41,932 probe sets representing the pan-genome of E. coli provide strain-level gene content information. Third, approximately 125,000 single nucleotide polymorphisms (SNPs) of available whole-genome sequences (WGS) were distilled to 9,984 SNPs capable of recapitulating the E. coli phylogeny. We analyzed 103 diverse E. coli strains with available WGS data, including those associated with past foodborne illnesses, to determine robustness and accuracy. The array was able to accurately identify the molecular O and H serotypes, potentially correcting serological failures and providing better resolution for H-nontypeable/nonmotile phenotypes. In addition, molecular risk assessment was possible with key virulence marker identifications. Epidemiologically, each strain had a unique comparative genomic fingerprint that was extended to an additional 507 food and clinical isolates. Finally, a 99.7% phylogenetic concordance was established between microarray analysis and WGS using SNP-level data for advanced genome typing. Our study demonstrates FDA-ECID as a powerful tool for epidemiology and molecular risk assessment with the capacity to profile the global landscape and diversity of E. coli IMPORTANCE: This study describes a robust, state-of-the-art platform developed from available whole-genome sequences of E. coli and Shigella spp. by distilling useful signatures for epidemiology and molecular risk assessment into one assay. The FDA-ECID microarray contains features that enable comprehensive molecular serotyping and virulence profiling along with genome-scale genotyping and SNP analysis. Hence, it is a molecular toolbox that stratifies strain identification and pathogenic potential in the contexts of epidemiology and phylogeny. We applied this tool to strains from food, environmental, and clinical sources, resulting in significantly greater phylogenetic and strain-specific resolution than previously reported for available typing methods.

Comparison of Salmonella enterica serovar Bovismorbificans 2011 hummus outbreak strains with non-outbreak strains.

Eleven Salmonella enterica serovar Bovismorbificans isolates obtained from the U.S. District of Columbia during a 2011 hummus-associated foodborne outbreak were compared to 12 non-outbreak isolates. All isolates from the outbreak demonstrated a single PFGE pattern that was distinctly different from other isolates of S. Bovismorbificans as recorded in the PulseNet Database. Results from molecular analyses of the hummus-associated S. Bovismorbificans isolates indicate that the isolates from the outbreak were unique and have acquired an 80-90 kb plasmid. The impact of this study is that the information gained will add and expand our knowledge of diversity of the S. Bovismorbificans serovar.

Variability and bias in microbiome metagenomic sequencing: an interlaboratory study comparing experimental protocols.

Several studies have documented the significant impact of methodological choices in microbiome analyses. The myriad of methodological options available complicate the replication of results and generally limit the comparability of findings between independent studies that use differing techniques and measurement pipelines. Here we describe the Mosaic Standards Challenge (MSC), an international interlaboratory study designed to assess the impact of methodological variables on the results. The MSC did not prescribe methods but rather asked participating labs to analyze 7 shared reference samples (5 × human stool samples and 2 × mock communities) using their standard laboratory methods. To capture the array of methodological variables, each participating lab completed a metadata reporting sheet that included 100 different questions regarding the details of their protocol. The goal of this study was to survey the methodological landscape for microbiome metagenomic sequencing (MGS) analyses and the impact of methodological decisions on metagenomic sequencing results. A total of 44 labs participated in the MSC by submitting results (16S or WGS) along with accompanying metadata; thirty 16S rRNA gene amplicon datasets and 14 WGS datasets were collected. The inclusion of two types of reference materials (human stool and mock communities) enabled analysis of both MGS measurement variability between different protocols using the biologically-relevant stool samples, and MGS bias with respect to ground truth values using the DNA mixtures. Owing to the compositional nature of MGS measurements, analyses were conducted on the ratio of Firmicutes: Bacteroidetes allowing us to directly apply common statistical methods. The resulting analysis demonstrated that protocol choices have significant effects, including both bias of the MGS measurement associated with a particular methodological choices, as well as effects on measurement robustness as observed through the spread of results between labs making similar methodological choices. In the analysis of the DNA mock communities, MGS measurement bias was observed even when there was general consensus among the participating laboratories. This study was the result of a collaborative effort that included academic, commercial, and government labs. In addition to highlighting the impact of different methodological decisions on MGS result comparability, this work also provides insights for consideration in future microbiome measurement study design.

Genetic analysis of the roles of agaA, agaI, and agaS genes in the N-acetyl-D-galactosamine and D-galactosamine catabolic pathways in Escherichia coli strains O157:H7 and C.

BACKGROUND: The catabolic pathways of N-acetyl-D-galactosamine (Aga) and D-galactosamine (Gam) in E. coli were proposed from bioinformatic analysis of the aga/gam regulon in E. coli K-12 and later from studies using E. coli C. Of the thirteen genes in this cluster, the roles of agaA, agaI, and agaS predicted to code for Aga-6-P-deacetylase, Gam-6-P deaminase/isomerase, and ketose-aldolase isomerase, respectively, have not been experimentally tested. Here we study their roles in Aga and Gam utilization in E. coli O157:H7 and in E. coli C. RESULTS: Knockout mutants in agaA, agaI, and agaS were constructed to test their roles in Aga and Gam utilization. Knockout mutants in the N-acetylglucosamine (GlcNAc) pathway genes nagA and nagB coding for GlcNAc-6-P deacetylase and glucosamine-6-P deaminase/isomerase, respectively, and double knockout mutants ΔagaA ΔnagA and ∆agaI ∆nagB were also constructed to investigate if there is any interplay of these enzymes between the Aga/Gam and the GlcNAc pathways. It is shown that Aga utilization was unaffected in ΔagaA mutants but ΔagaA ΔnagA mutants were blocked in Aga and GlcNAc utilization. E. coli C ΔnagA could not grow on GlcNAc but could grow when the aga/gam regulon was constitutively expressed. Complementation of ΔagaA ΔnagA mutants with either agaA or nagA resulted in growth on both Aga and GlcNAc. It was also found that ΔagaI, ΔnagB, and ∆agaI ΔnagB mutants were unaffected in utilization of Aga and Gam. Importantly, ΔagaS mutants were blocked in Aga and Gam utilization. Expression analysis of relevant genes in these strains with different genetic backgrounds by real time RT-PCR supported these observations. CONCLUSIONS: Aga utilization was not affected in ΔagaA mutants because nagA was expressed and substituted for agaA. Complementation of ΔagaA ΔnagA mutants with either agaA or nagA also showed that both agaA and nagA can substitute for each other. The ∆agaI, ∆nagB, and ∆agaI ∆nagB mutants were not affected in Aga and Gam utilization indicating that neither agaI nor nagB is involved in the deamination and isomerization of Gam-6-P. We propose that agaS codes for Gam-6-P deaminase/isomerase in the Aga/Gam pathway.

A proteomic and transcriptomic approach reveals new insight into beta-methylthiolation of Escherichia coli ribosomal protein S12.

ß-methylthiolation is a novel post-translational modification mapping to a universally conserved Asp 88 of the bacterial ribosomal protein S12. This S12 specific modification has been identified on orthologs from multiple bacterial species. The origin and functional significance was investigated with both a proteomic strategy to identify candidate S12 interactors and expression microarrays to search for phenotypes that result from targeted gene knockouts of select candidates. Utilizing an endogenous recombinant E. coli S12 protein with an affinity tag as bait, mass spectrometric analysis identified candidate S12 binding partners including RimO (previously shown to be required for this post-translational modification) and YcaO, a conserved protein of unknown function. Transcriptomic analysis of bacterial strains with deleted genes for RimO and YcaO identified an overlapping transcriptional phenotype suggesting that YcaO and RimO likely share a common function. As a follow up, quantitative mass spectrometry additionally indicated that both proteins dramatically impacted the modification status of S12. Collectively, these results indicate that the YcaO protein is involved in ß-methylthiolation of S12 and its absence impairs the ability of RimO to modify S12. Additionally, the proteomic data from this study provides direct evidence that the E. coli specific ß-methylthiolation likely occurs when S12 is assembled as part of a ribosomal subunit.

Global comparative healthcare effectiveness research: evaluating sustainable programmes in low & middle resource settings.

The need to focus healthcare expenditures on innovative and sustainable health systems that efficiently use existing effective therapies are the major drivers stimulating Comparative Effectiveness Research (CER) across the globe. Lack of adequate access and high cost of essential medicines and technologies in many countries increases morbidity and mortality and cost of care that forces people and families into poverty due to disability and out-of-pocket expenses. This review illustrates the potential of value-added global health care comparative effectiveness research in shaping health systems and health care delivery paradigms in the "global south". Enabling the development of effective CER systems globally paves the way for tangible local and regional definitions of equity in health care because CER fosters the sharing of critical assets, resources, skills, and capabilities and the development of collaborative of multi-sectorial frameworks to improve health outcomes and metrics globally.

Risk factors and strategies for prevention of depression, anxiety and eating disorders among adolescents during the coronavirus disease 2019 (COVID-19) pandemic: a review.

The purpose of this review is to identify prevalent trends and risk factors in depression, anxiety, and eating disorders in the adolescent population in the post coronavirus disease 2019 (COVID-19) scenario. We examined the literature published on adolescent mental health since the COVID-19 pandemic. We chose to summarize studies published from 2019 to 2022, using bibliographic search tools. We developed criteria for selecting articles for our review using diagnostic indicators and keywords. Mental health conditions such as depression, anxiety and eating disorders are commonly prevalent in this population and have shown increasing rates in the past three years. Some risk factors associated with these diagnoses include reduction in social interaction, increased workloads, routine shifts, sleep quality, social media usage and parental involvement. Routines, sleep cycles, physical activity, and social media should all be considered as a part of prevention in this population. Approaches that seem to be successful include maintaining social ties and avoiding negative social media usage with harmful content. Increased global public awareness, as well as parental awareness, through media campaigns, is critical to slowing the spread of mental health challenges in adolescents and teenagers in the post-COVID-19 era.

Visual outcome and complications of small-incision cataract surgery.

BACKGROUND AND OBJECTIVES: Small-incision cataract surgery (SICS) is a commonly performed procedure in developing countries. It does not require expensive machines and can be safely done in high-volume centers also yielding good visual outcomes in the majority of patients. The objective of our study was to assess visual outcomes after SICS conducted at a tertiary care center in South Gujarat and also assessment of various complications responsible for poor visual outcomes. MATERIALS AND METHODS: Three hundred and fifteen cataract patients were included in the study. An assessment of intraoperative and postoperative complications was done. Postoperative visual acuity assessment was done and compared with preoperative visual acuity of the patient and factors responsible for poor visual outcomes were assessed. A follow-up examination was done on days 1, 3, 7, 14, and 30. RESULTS: The mean age group of patients was 59.3 years. Females were slightly more (53.3%) in number as compared to males. The most common surgical complication encountered were striate keratopathy (6.35%), followed by iris damage (5.71%), posterior capsular rent (PCR) with vitreous loss (3.14%), hypotony (0.63%), intraocular lens decentration (0.63%), surgery-induced astigmatism (0.63%), choroidal detachment (0.32%), endophthalmitis (0.32%), and hyphema (0.32%). About 95.87% of patients had vision better than 6/18. Complications associated with poor visual outcome (<6/18) were PCR, endophthalmitis, choroidal detachment, and surgical-induced astigmatism. CONCLUSIONS: Although SICS can have a significant chance of complications, good visual outcomes can be attained in the majority of patients.

Palliative care and healthcare utilization among metastatic breast cancer patients in U.S. Hospitals.

There is a lack of research focused on understanding the different characteristics and healthcare utilization of metastatic breast cancer patients by palliative care use. This study aims to investigate trend of in-patient palliative care and its association with healthcare utilization among hospitalized metastatic breast cancer patients in the US. National Inpatient Sample (NIS) was used to identify nationwide metastatic breast cancer patients (n = 5209, weighted n = 25,961) from 2010 to 2014. We examined the characteristics of the study sample by palliative care and its association with healthcare utilization, measured by discounted hospital charges and length of stay. Multivariable survey regression models were used to identify predictors. Among 26,961 breast cancer patients, 19.0% had palliative care. Percentage of receiving palliative care during the period were gradually increased. Social factors including race, insurance types were also associated with a receipt of palliative care. Survey linear regression results showed that patients with palliative care were associated with 31% lower hospital charges, however, length of stays were not significantly associated. This study found evidence of who was associated with the receipt of palliative care and its relationship with healthcare utilization. This study also emphasizes the importance of receiving palliative care in patients with breast cancer, paving the way for future research into ways to improve palliative care in cancer patients. This study also found social differences and gave evidence of programs that could be used to help vulnerable groups in future health policy decisions.

Rapid genomic-scale analysis of Escherichia coli O104:H4 by using high-resolution alternative methods to next-generation sequencing.

Two technologies, involving DNA microarray and optical mapping, were used to quickly assess gene content and genomic architecture of recent emergent Escherichia coli O104:H4 and related strains. In real-time outbreak investigations, these technologies can provide congruent perspectives on strain, serotype, and pathotype relationships. Our data demonstrated clear discrimination between clinically, temporally, and geographically distinct O104:H4 isolates and rapid characterization of strain differences.

Relieving the pruritus of atopic dermatitis: a meta-analysis.

The goal of this study was to perform a meta-analysis on randomized controlled trials of topical therapies compared against their vehicles, and systemic therapies compared against their placebos, and to record how these therapies changed the magnitude of pruritus associated with atopic dermatitis. A systematic search of the literature was performed using Medline, Embase, and the Cochrane Controlled Clinical Trials Register, as well as follow-up references in retrieved articles. Data regarding the magnitude of the change in pruritus was extracted from eligible publications and categorized according to the type of treatment modality. Standard inverse variance fixed-effects meta-analysis was used to calculate the pooled estimates for randomized controlled trials falling under each type of treatment. Overall, the topical treatments were more successful at reducing atopic pruritus compared to the systemic treatments. Calcineurin inhibitors were the most effective antipruritic agent.

Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California.

OBJECTIVE: This study examined the impact of state budget cuts on uncompensated care at general acute care hospital organizations. This study capitalized on the variations in the states of Texas and California to form a natural experiment testing the joint impact of budget cut status on uncompensated care costs, as well as specific charity care costs and bad debt expenses from indigent patients. METHODOLOGY: Budget cuts in the state of Texas occurred in the year 2004. Information was obtained from the Texas Department of Health and the California Department of Health Services regarding financial characteristics of hospitals and from the American Hospital Directory annual survey regarding organizational characteristics of hospitals. We created three dependent variables: R(UC) (the ratio of total uncompensated care costs to gross patient revenue), R(CC) (the ratio of charity care to total patient revenue) and R(BD) (the ratio of bad debt expenses to gross patient revenue). Using a two-period panel data set and individual hospital fixed effects, we captured hospital uncompensated care spending that could also have influenced budget cut status. Additionally, the impact of the state budget cut status on hospitals' uncompensated care spending, charity care spending and bad debt expenses was also estimated using the similar methodology. POPULATION STUDIED: In this study, we included 416 (in Texas) and 352 (in California) public, not-for-profit (NFP) and for-profit (FP) hospitals that completed the annual survey during the study period 2002-2005. FINDINGS: For the state of Texas, results from the fixed effect model confirmed that the year 2005 was directly related to increased R(UC) and R(CC) . The coefficients of 2005 were significantly and positively associated with R(UC) (0.43, p < 0.05) and R(CC) (0.29, p < 0.05). These results supported the findings that the R(UC) and the R(CC) would be more positively associated with 2005 than any other year, with other things being equal. However, for the state of California, even though the coefficient of 2005 was significant and positively associated with R(CC) (0.31, p < 0.05), the coefficient of uncompensated care spending was not statistically significant for 2005. CONCLUSION: The healthcare industry is characterized by increased regulation, a growing number of uninsured patients, increasingly stringent reimbursement and competitive practices among hospitals and other providers. Federal and state healthcare agencies are restricting the criteria for eligibility for outlier payments and uncompensated care provisions. Tax exempt status of many NFP hospitals is being examined and tied to specific performances, particularly the provision of uncompensated care. This study provides evidence of the impact of budget cut pressure on uncompensated care provided in Texas general acute care hospitals.

Low educational quality and trustworthiness of YouTube videos by physiotherapists on shoulder joint mobilization techniques: a descriptive study.

INTRODUCTION: Physiotherapists and students may be vulnerable to false information and may learn faulty treatment techniques due to inadequate educational quality and uncertainty about sources and trustworthiness of YouTube videos. OBJECTIVE: To investigate educational quality, trustworthiness, and content completeness of joint mobilization techniques demonstrating videos available on YouTube. DESIGN: This is a descriptive study. METHODS: We performed a YouTube search on 1st April 2019, using the keyword 'Maitland joint mobilization technique for shoulder joint'. Three academic physiotherapists independently rated each video for educational quality, trustworthiness, and content completeness using the Global Quality Score, Journal of American Medical Association (JAMA) Benchmark Criteria and joint mobilization content completeness scale, respectively. RESULTS: Fifteen videos were included in the study. The median number of views for videos was 1263 (IQR 578-1478), and the median duration was 140 seconds (IQR 71-301 seconds). Most videos had low content quality (87%), poor joint mobilization content completeness (80%), and limited trustworthiness. All videos had low source quality (100%). CONCLUSIONS: There is a lack of quality information on shoulder joint mobilization techniques on YouTube, which makes it a limited educational tool for physiotherapists and students.