Abnormal upregulation of NUBP2 contributes to cancer progression in colorectal cancer.

Colorectal cancer (CRC), a digestive tract malignancy with high mortality and morbidity, lacks effective biomarkers for clinical prognosis due to its complex molecular pathogenesis. Nucleotide binding protein 2 (NUBP2) plays a vital role in the assembly of cytosolic Fe/S protein and has been implicated in cancer progression. In this study, we found that NUBP2 was highly expressed in CRC by TCGA database analysis. Subsequently, we verified the expression of NUBP2 in CRC tumor tissues and para-carcinoma tissues using IHC staining, and further investigated its association with clinicopathological parameters. In vitro cell experiments were conducted to assess the role of NUBP2 in CRC by evaluating cell proliferation, migration, and apoptosis upon NUBP2 dysregulation. Furthermore, we established a subcutaneous CRC model to evaluate the impact of NUBP2 on tumor growth in vivo. Additionally, we performed mechanistic exploration using a Human Phospho-Kinase Array-Membrane. Our results showed higher expression of NUBP2 in CRC tissues, which positively correlated with the pathological stage, indicating its involvement in tumor malignancy. Functional studies demonstrated that NUBP2 knockdown reduced cell proliferation, increased apoptosis, and impaired migration ability. Moreover, NUBP2 knockdown inhibited tumor growth in mice. We also observed significant changes in the phosphorylation level of GSK3ß upon NUBP2 knockdown or overexpression. Additionally, treatment with CHIR-99021 HCl, an inhibitor of GSK3ß, reversed the malignant phenotype induced by NUBP2 overexpression. Overall, this study elucidated the functional role of NUBP2 in CRC progression both in vitro and in vivo, providing insights into the molecular mechanisms underlying CRC and potential implications for targeted therapeutic strategies.

Factors associated with Medicare beneficiaries' perceptions of COVID-19 and preventive health behaviors: results from winter 2021 MCBS survey.

This study evaluates the impact of preferred information sources on Medicare beneficiaries' perception of COVID-19 severity compared with flu and examines factors influencing preventive health behaviors using the Medicare Current Beneficiary Survey (MCBS) winter 2021. Medicare beneficiaries who primarily relied on traditional news, guidance from government officials, and healthcare providers, beneficiaries who were female, older than 65 years, metro residence, or living in the West were more likely to believe that the COVID-19 is more severe than flu and take vaccine than their counterparts. Compared to White, Black and Hispanic were more likely to agree with COVID-19 severity, but less likely to take vaccine. Factors associated with preventive health behavior utilization included perceived severity of COVID-19, primary information source, gender, race, language, annual income, and chronic health conditions. It is crucial to provide accurate information in lay terms to help people understand the importance of taking preventative actions against COVID-19. .

Factors associated with telemedicine utilization among post-transplant patients at a university kidney and pancreas transplant center.

INTRODUCTION: Telemedicine has become prevalent during the novel-coronavirus disease-2019 (COVID-19) pandemic. The study explored patient factors associated with telemedicine utilization among post-kidney and pancreas transplant patients at a university center. METHODS AND RESULTS: After analyzing 2801 patients and their visits using chi-square test and logistic regression, we found that government-insured (P < .0001) post-kidney and pancreas transplant patients were less likely to use telemedicine. Sex (P = .748), patient race (P = .920), age groups (P = .812), and traveling distance (P = .837) were not associated with telemedicine use. CONCLUSION: Centers should consider focusing on the subgroup of government-insured patients to improve telemedicine use and future studies should consider exploring barriers for underutilization of telemedicine in this population.

Donor-reported barriers to living kidney donor follow-up.

BACKGROUND: Despite regulations mandating follow-up laboratory testing for living kidney donors, less than half of transplant centers are in compliance. We sought to understand barriers to follow-up testing from the donors' perspective. METHODS: We surveyed our center's living kidney donors. Binary logistic regression was used to assess factors associated with follow-up testing completion. RESULTS: Of 185 living kidney donors, 110 (59.4%) participated. Among them, 82 (74.5%) completed 6-month laboratory testing, 76 (69.1%) completed 12-month testing, 68 (61.8%) completed both, and 21 (19.0%) completed neither. Six-month testing completion was strongly associated with 12-month testing completion (OR 9.74, 95%CI: 2.23-42.50; p = .002). Those who disagreed with the statements, "Getting labs checked wasn't a priority for me," (OR for completing 6-month testing: 15.05, 95%CI: 3.70-61.18; p < .001; OR for completing 12-month testing: 5.85, 95%CI: 1.94-17.63; p = .002); and, "I forgot to get labs drawn [until I was reminded]" (OR for completing 6-month testing: 6.93, 95%CI: 1.59-30.08; p = .01; OR for completing 12-month testing: 6.55, 95%CI: 1.98-21.63; p = .002) were more likely to complete testing. CONCLUSIONS: To our knowledge, this is the only study providing perspective on donor insights regarding the need for follow-up testing post donation. Interventions to influence living donor attitudes toward follow-up testing may improve follow-up.

Restorative benefits of urban green space: Physiological, psychological restoration and eye movement analysis.

Urban life is associated with a range of health risks. However, urban green spaces have been found to promote health recovery and reduce mental stress. This study sought to assess the influence of the spatial and environmental characteristics of urban green space on environmental restoration. We measured physiological and psychological changes among 60 participants to evaluate the restorative benefits of 12 green spaces in Shenyang. The Perceived Restorativeness Scale and two physiological measures (heart rate variation and skin conductance response) were used to analyze the effects of spatial characteristics on restorative benefits. In addition, eye-tracking was used to explore the influence of environmental components on restorative benefits. The results revealed that, although there were slight differences between physiological and psychological findings, both confirmed that urban green space had a restorative benefit. Partially-open green spaces with a high degree of naturalness had more positive effects than open green spaces with a high degree of hard paved spaces. Eye movement analysis results revealed that trees and shrubs, as well as water, had a positive effect on the environmental restoration benefits, whereas buildings and paving had a negative effect. Among environmental features, trees and shrubs, water, and buildings exerted the strongest effects on environment restoration. In the future, combining spatial characteristics and environmental components will aid improvement of the restorative qualities of urban green space.

Willingness to Get a COVID-19 Vaccine and Reasons for Hesitancy Among Medicare Beneficiaries: Results From a National Survey.

OBJECTIVES: To assess (1) the willingness to get a COVID-19 vaccine among Medicare beneficiaries, (2) the associated factors, and (3) the reasons for vaccine hesitancy. METHODS: Data were taken from the Medicare Current Beneficiary Survey (MCBS) 2020 Fall COVID-19 Supplement, conducted October-November 2020. Willingness to get a COVID-19 vaccine was measured by respondents' answer to whether they would get a COVID-19 vaccine when available. We classified responses of "definitely" and "probably" as "willing to get," and responses "probably not," "definitely not," and "not sure" as "vaccine hesitancy." Reasons for vaccine hesitancy were assessed by a series of yes/no questions focusing on 10 potential reasons. The analytical sample included 6715 adults 65 years and older. We conducted a logistic regression model to assess demographic factors and other factors associated with the willingness to get a COVID-19 vaccine. All analyses were conducted in Stata 14 and accounted for the complex survey design of MCBS. RESULTS: Overall, 61.0% (95% confidence interval [CI], 59.1-63.0) of Medicare beneficiaries would be willing to get a vaccine when available. Among those who were hesitant, more than 40% reported that mistrust of the government and side effects as the main reasons. Logistic regression model results showed that non-Hispanic Blacks (adjusted odds ratio [AOR] = 0.33; 95% CI, 0.24-0.44) and Hispanics (AOR = 0.60; 95% CI, 0.47-0.77) were less willing to get a vaccine than non-Hispanic Whites; beneficiaries with an income of less than $25 000 (AOR = 0.71; 95% CI, 0.62-0.81) were less willing to get the vaccine than those with an income of $25 000 or more; those who did not think that the COVID-19 virus was more contagious (AOR = 0.53; 95% CI, 0.41-0.69) or more deadly (AOR = 0.51; 95% CI, 0.41-0.65) were also less willing to get the vaccine than those who thought that the virus was more contagious or more deadly than the influenza virus. CONCLUSIONS: The 2020 MCBS survey data showed that close to 40% of Medicare beneficiaries were hesitant about getting a COVID-19 vaccine, and the hesitancy was greater in racial/ethnic minorities. Medicare beneficiaries were concerned about the safety of the vaccine, and some appeared to be misinformed. Evidence-based educational and policy-level interventions need to be implemented to further promote COVID-19 vaccination.

Health care utilization among beneficiaries with diabetes from federally qualified health centers: Analysis from a Medicaid managed care organization.

We examined health care utilization among federally qualified health center (FQHCs) users from a Medicaid managed care organization based on 2016 administrative claims data (n = 8,402). FQHC users had fewer primary care visits (Adjusted Incidence Rate Ratios (aIRR): 0.82; 95% CI: 0.76-0.88) compared with non-FQHC users. Statistically significant differences were not observed in emergency department visits (aIRR: 1.19; 95% CI: 0.98-1.46) and hospitalizations (aIRR: 1.03; 95% CI: 0.80-1.34). FQHCs provide comprehensive primary care to Medicaid managed care beneficiaries with diabetes in fewer PCP visits. Results provide evidence to health policy experts and MCOs to increase provider network contracting with FQHCs.

Determining patient needs to enhance exercise program implementation and uptake in rural settings for women after a cancer diagnosis.

PURPOSE: To qualitatively explore exercise barriers and facilitators experienced by rural female cancer survivors from the program interventionist and recipient perspective for the purpose of enhancing exercise program implementation and uptake in rural settings. METHODS: A descriptive qualitative study design was utilized. Focus groups were conducted prior to implementation of an evidence-based exercise program by a rural non-research cancer clinical site. Nineteen rural female cancer survivors (mean age = 61.7 ± 10.9 years) and 11 potential interventionists (mean age = 42.3 ± 15.3 years) completed focus groups (stratified by participant role). Focus groups were audio recorded, transcribed, coded, and analyzed using inductive thematic analysis with NVivo 11. RESULTS: Cancer survivors identified 12 barrier themes (cancer specific adverse effects, lack of support, lack of knowledge, perceived negative aspects of exercise, cost, lack of resources, motivation, inconvenience, lack of program flexibility, time, weather, safety) and eight facilitator themes (knowledge, ease of access, resources, awareness, cost, options, organized, fun) related to exercise. Interventionists identified seven barrier themes (cost, transportation, lack of cancer survivor and interventionist knowledge, fear, motivation, lack of support, lack of resources) and four facilitator themes (resources, support, knowledge, motivation). Narratives revealed differing role-specific perspectives on shared themes between survivors and interventionists as well as potential implementation strategies for enhancing exercise participation and exercise program uptake among rural female cancer survivors. CONCLUSION: Exploring multi-level stakeholder perspectives on cancer survivors' exercise needs and related strategies yields important information for organizations to consider when implementing exercise programs in rural contexts.

Clustering of multiple lifestyle behaviors among migrant, left-behind and local adolescents in China: a cross-sectional study.

BACKGROUND: Influence of migration on externalized behavioral problems (e.g., aggressive) among adolescents has been well assessed, yet lifestyle behaviors of migrant, left-behind and local adolescents have been largely overlooked by researchers and policy-makers. Therefore, this study aimed to identify clustering of multiple lifestyle behaviors and their associations with migrant status among Chinese adolescents. METHODS: A cross-sectional survey was conducted in 2015 in Beijing, and Wuhu city (Anhui province). Adolescents self-reported age, gender, family economic status, migrant situation, and lifestyle behaviors (i.e., physical activity, screen time, sleep, smoke, soft-drink, alcohol, fruit and vegetable consumption) via a battery of validated questionnaires. Latent class analysis was conducted to identify behavioral clusters using Mplus 7.1. ANOVA, and multivariable logistic regression were used to examine associations between migrant situations and behavioral clusters using SPSS 22. RESULTS: Three distinct behavioral clusters were exhibited among 1364 students (mean age: 13.41 ± 0.84 years): "low risk" (N = 847), "moderate risk" (N = 412) and "high risk" (N = 105). The "high-risk" cluster had the highest prevalence of adolescents not meeting healthy behavioral recommendations. There were no significant differences in the prevalence of high-risk lifestyle among migrant, left-behind, rural local and urban local adolescents. But migrant adolescents had the lowest prevalence of low-risk lifestyle, followed by left-behind, rural and urban local adolescents. Moreover, compared with urban local, migrant (OR = 2.72, 95%CI: 1.88,3.94), left-behind (OR = 2.28, 95%CI: 1.46, 3.55), and rural local (OR = 1.76, 95%CI:1.03,3.01) adolescents had a higher risk of moderate-risk lifestyle. CONCLUSIONS: Clustering of assessed lifestyle behaviors differed by the migrant status. Particularly, migrant and left-behind adolescents were more likely to have moderate-risk lifestyle compared with their counterparts. Interventions that promote moderate to vigorous physical activity and consumption of fruits and vegetables simultaneously are needed among them.

Is type of practice setting associated with physician's cultural competency training? Analysis from the National Ambulatory Medical Care Survey.

This study examined whether type of physician practice settings was associated with cultural competency training for newly hired physicians. We used data from the 2016 National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services for Office-based Physician Survey. The survey contains a sample of 397 office-based physician responses completed during the period from August to December 2016 (weighted n = 293306). The outcome variable was whether cultural competency training was required for newly hired physicians. The primary predictor variable was type of physician practice settings. We used logistic regression to analyze the association between physician practice settings and cultural competency training for newly hired physicians adjusting for covariates. About 71% physicians belonged to solo or group practice settings. Among these, only 10.4% required cultural competency training for newly hired physicians. Among other practice settings, 34.8% required the training. Results from logistic regression showed that newly hired physicians in solo or group practices (adjusted odds ratio: 0.22; 95% confidence interval: 0.11-0.44) were less likely to have cultural competency training compared to those in other settings. Practice settings are associated with cultural competency training. Cultural competency training across all practice settings may contribute toward improving patient-physician communication, reducing health disparities, and increasing patient satisfaction.

Increasing HPV Vaccination Support Through a Pilot Film-Based Community Engagement.

Mass media interventions are considered an effective tool to improve support for preventive health behavior. We conducted a retrospective analysis of data collected during 2016-2017 community screenings of the film Someone You Love: The HPV Epidemic to raise public awareness about human papillomavirus (HPV). The objective was to examine the change in participants' support for HPV vaccination after viewing the film. The film was screened five times at four different communities. Each screening was followed by a discussion session with local health care experts. A 9-item structured survey measured the impact of the film on motivation and overall support for HPV vaccine on a 4-point Likert scale. We used Wilcoxon Signed Rank test to examine the change in vaccination support. We obtained 64 survey responses. Participants were informed about the film through word of mouth and friends (20%), flyers (19%), and their health care providers (9.4%). Fifty-five percent were parents/guardians, and 75% were aged 26-65 years. About 28% and 22% of participants reported their daughters or sons had completed all 2 or 3 HPV shots. Results from Wilcoxon Signed Rank Test indicated statistically significant increase in vaccination support (Z = - 5.44, p < 0.001) after viewing the film. The median response from before to after changed from "supportive" to "very supportive". Community film screening followed by discussion with local health care experts is a promising strategy for increasing HPV vaccine support. Future work should address increasing access to the film, examine the film's impact on increasing HPV vaccine uptake and assessing program cost effectiveness.

Are community health centers' chief executive officers' compensation related to clinical performance?

BACKGROUND: Most research of chief executive officer (CEO) compensation in the health care industry has been limited to hospitals. This study expands our knowledge of CEO compensation into the nonhospital areas of the industry, specifically community health centers (CHCs). CHCs are safety-net providers that are an integral part of the U.S. health delivery system for medically underserved populations. Since the passage of the Patient Protection and Affordable Care Act, the federal government has created financial incentives for CHCs to improve care through access and quality performance criteria. To promote quality improvement, CEOs need to set their organization's priorities. One method used to achieve this goal is to tie the CEO's compensation to the organization's quality performance. However, there is a gap in our knowledge if CHCs' CEOs compensation is associated with quality performance outcomes. PURPOSE: The primary aim of this study was to examine the relationship between clinical performance and CEO compensation in CHCs. METHODS/APPROACH: Agency, social comparison, and managerial power theories guided this research, which examines the relationship of clinical performance and CEO compensation. Secondary data on Uniform Data System's CHC clinical performance combined with CEO compensation from Internal Revenue Service Form 990 were analyzed using generalized estimating equations with state and year fixed effects on a national sample of section 330 grant-funded CHCs (N = 984) for the period 2011-2016. RESULTS: We found no evidence that clinical performance was associated with CHCs' CEO compensation. Except for race, all other CEO characteristics were positively associated with CEO compensation and in line with previous research. We found that non-White CEOs were compensated more than White CEOs. In addition, further subanalyses revealed that an increase in the highest paid employees' compensation was associated with an increase in CEO compensation. PRACTICE IMPLICATIONS: The findings of this study can assist Health Resources and Services Administration improve its assessment policies in funding allocation to CHCs, as well as help board members make informed decisions regarding tying CEO compensation to predetermined performance metrics.

Factors associated with the provision of inpatient care in hospices.

BACKGROUND: Hospices provide end-of-life care to patients who have complex health care needs and whose symptoms are difficult to control. Understanding why some hospices offer inpatient hospice care to patients could bring more evidence for policy makers and researchers to focus on the role of inpatient care in hospice. PURPOSE: The purpose of this study was to examine market and organizational factors that are associated with the provision of hospice inpatient care. METHODOLOGY: This study used a retrospective, longitudinal design (2009-2013). The study sample was drawn from three data resources: the Area Health Resources Files, the Provider of Services files, and Hospice Cost Reports from Centers for Medicare & Medicaid Services. The sample size was 2,391 hospices or 10,999 hospice observations over 5 years. A generalized linear mixed-effects model was used to examine the association between market and organizational factors and hospice inpatient services offering. RESULTS: On average, 94.59% of hospices offer inpatient services to patients. Proportion of adults who were over 65 years old (OR = 1.12) and Medicare-managed care penetration (OR = 1.02) were positively associated with the provision of hospice inpatient services. The number of hospitals with hospice program was negatively related to hospice inpatient services offering (OR = .95). Other factors such as nursing skill mix, volunteer dependence, and census region were also associated with inpatient services offering. PRACTICE IMPLICATIONS: The age demand of hospice care and Medicare-managed care penetration are related to hospice inpatient services offering. Hospices located in the market with more competition from hospitals that offer hospice program are less likely to offer inpatient care.

Hospice inpatient services provision, utilization, and financial performance.

BACKGROUND: Hospice performance is an overlooked area in the health care field due to the difficulty of measuring quality of care and the infrequent quality inspection. Based on the daily reimbursement mechanism for different levels of hospice care, inpatient services provision could influence both hospice-level length of stay (LOS) and financial performance. PURPOSE: The objective of this study was to explore the relationship between hospice inpatient services provision and hospice utilization and financial performance. METHODOLOGY/APPROACH: A longitudinal secondary data set (2009-2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare & Medicaid Services, (b) the Provider of Services files, and (c) the Area Health Resources Files. The dependent variable in this study was hospice average LOS and financial performance measured by total operating margin (TOM) and return on assets. The independent variable was hospice inpatient services' offering. Mixed-effects regression models were used in the multivariate regression analyses. RESULTS: When comparing to hospices not providing inpatient services, offering inpatient services by staff was negatively related to average LOS (b = -0.063, p < .05) and TOM (b = -0.022, p < .05). The combination method with providing inpatient services by staff and under arrangement was negatively associated with return on assets (b = -0.073, p < .05). CONCLUSION: Hospice inpatient services provision was associated with average LOS and financial performance. PRACTICE IMPLICATIONS: Offering the inpatient services to patients by staff decreased average LOS and TOM. Hospice agencies may seek strategies to maintain their financial sustainability through outsourcing.

Upregulation of angiotensin converting enzyme 2 by shear stress reduced inflammation and proliferation in vascular endothelial cells.

BACKGROUND: Shear stress (SS) and renin-angiotensin system (RAS) play important roles in endothelium homeostasis. Previous studies demonstrated that pulsatile shear stress (PSS) reduced the expression and activity of angiotensin-converting enzyme (ACE), however, the effect of SS on angiotensin-converting enzyme 2 (ACE2) expression is unclear. METHODS AND RESULTS: We exposed cultured endothelial cells (ECs) to distinct patterns of SS for indicated time points, Western blot and RT-PCR were used to determine the ACE2 expression; En Face staining was used to detect ACE2 expression in vivo; cell proliferation and apoptosis were determined by BrdU staining and TUNEL staining, respectively; the production of NO was detected by a commercial kit; the promoter activity of ACE2 was determined by a Dual-Luciferase Reporter Assay System, inhibitors of ACE2 and signaling pathway were added to the medium 1 h prior for PSS. Our data showed PSS induced a sustained ACE2 expression, but OSS only induced a transient ACE2 expression. The PSS-induced ACE2 expression was higher than that of OSS both in vitro and in vivo. The PSS-induced ACE2 was involved in inhibiting proliferation and inflammation, as well as promoting NO production in ECs. PSS significantly increased ACE2 expression at transcriptional level via activating AMPKα2-KLF2 pathway. CONCLUSIONS: Our results suggest PSS promotes ACE2 expression via AMPKα2-KLF2 pathway to maintain the normal EC functions.

Systematic review of the hospice performance literature.

BACKGROUND: Hospice is the key provider of end-of-life care to patients. As the number of U.S. hospice agencies has rapidly increased, the performance has been scrutinized more deeply. PURPOSE: To foster understanding of how hospice performance is measured and what factors are associated with performance, we conducted a systematic review of empirical research on hospice performance in the United States. METHODS: Both structure-process-outcome and structure-conduct-performance frameworks were applied to categorize and summarize the hospice performance literature. A total of 36 studies were included in the systematic review. RESULTS: Hospice agencies adopted different strategies (e.g., service provision strategy and staffing strategy) to improve performance. Two strategic approaches (innovation and volunteer usage) were associated with better outcomes. Hospice organizational factors, market environment, and patient characteristics were related to hospice strategic conduct and performance. Majority of hospice performance studies have examined the relationship between hospice structure and strategic conduct/process, with fewer studies focusing on structure performance and even fewer concentrating on strategy performance. PRACTICE IMPLICATIONS: Patient, organizational, and market factors are associated with hospice strategic conduct and performance. The majority of the literature considered the impact of hospice organizational characteristics, whereas only a few studies included patient and market factors. The summarization of factors that may influence hospice performance provides insight to different stakeholders.

Patient-centered communication: dissecting provider communication.

PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROACH: This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics. FINDINGS: Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness. PRACTICAL IMPLICATIONS: Investment in patient-centered communication training for providers will improve patient satisfaction and trust. ORIGINALITY/VALUE: The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

Electrospinnability of Poly Lactic-co-glycolic Acid (PLGA): the Role of Solvent Type and Solvent Composition.

PURPOSE: In this study, the electrospinnability of poly(lactic-co-glycolic acid) (PLGA) solutions was investigated, with a focus on understanding the influence of molecular weight of PLGA, solvent type and solvent composition on the physical properties of electrospun nanofibers. METHOD: Various solvents were tested to dissolve two PLGA grades (50 KDa-RG755, 100 KDa-RG750). The viscoelasticity, surface tension, and evaporation rate of the PLGA solutions were characterized prior to the electrospinning process. The resulting electrospun nanofibers were characterized with respect to the morphology and mechanical properties. RESULTS: Two pairs of solvent mixtures, i.e. dimethylformamide (DMF)-tetrahydrofuran (THF) and DMF-chloroform (CHL), were identified to provide a stable cone-jet. Within the polymer concentration range studied (10-30%, w/v), RG750 solutions could be electrospun into uniform fibers at 30% (w/v) or at 20% (w/v) when modifying the solvent composition. In comparison to DMF-THF solution, fibers had larger diameter, higher stiffness and tensile strength when electrospun from DMF-CHL solution. CONCLUSION: The high molecular weight polymer could ensure sufficient intermolecular interaction to generate uniform fibers. The solvent could influence the morphology and mechanical properties of the electrospun fibers by altering the properties of PLGA solution, and drying rate of fibers in the electrospinning process.

Recommend, but also Discuss: Different Patterns of Physician-Perceived Barriers to Discussing HPV Vaccination and Their Association with Vaccine Administration in 11-12 Year-Old Girls.

Objectives We examined variation in primary care physicians' (PCPs') perceptions of barriers to physician-initiated discussion of HPV vaccination, and how this is associated with the rates at which they discuss, initiate and continue to administer vaccination with 11-12 year-old girls. Methods We surveyed 301 PCPs using systematic random sampling. PCP variation in perceived barriers to discussing HPV vaccination was modeled using latent class analysis (LCA). The distinct PCP groups identified were compared with each other using three iterative logistic regression models to predict the likelihood of initiating vaccine discussion and the reported percentages of 11-12 year-old patients who initiated HPV vaccination and received follow-up shots. Results LCA revealed three groups of PCPs who perceived major, moderately significant and relatively minor barriers (17.9, 41.9 and 40.2 % of respondents, respectively). Pediatricians, PCPs who were female, had minority racial/ethnic status and who perceived only minor barriers had significantly higher odds of initiating discussion. PCPs were more likely to initiate HPV vaccination if they had initiated discussion and perceived minor or moderate communication barriers. Increased likelihood to administer follow-up HPV vaccine was associated with having initiated discussion, perceiving only minor barriers and working outside Deep South states, but not with having initiated vaccination. Conclusions for Practice PCPs who discuss HPV vaccination with girls aged 11-12 and their mothers are more likely to start and sustain vaccine administration. However, different PCPs perceive barriers to discussion in different ways. Interventions tailored to different groups of PCPs should assist them in overcoming barriers to discussing their recommendations when necessary.