Pharmacist-driven outreach initiative to increase prescribing of sodium-glucose cotransporter-2 inhibitors in eligible VHA patients with chronic kidney disease: a study protocol.

BACKGROUND: Patients with chronic kidney disease (CKD) are at increased risk for multiple adverse events, several of which have been proven to be less likely with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). As a result, guidelines now recommend SGLT2i be given to those with mild to moderate CKD and type 2 diabetes. The objective of this study is to evaluate if a pharmacist-driven SGLT2i prescribing initiative among eligible patients with CKD and diabetes within the VA could more rapidly improve the adoption of SGLT2i via a pragmatic approach aligned with learning health systems. METHODS: Eligible patients will be identified through an established VA diabetes dashboard. Veterans with an odd social security number (SSN), which is effectively a random number, will be the intervention group. Those with even SSNs will serve as the control while awaiting a second iteration of the same interventional program. The intervention will be implemented in a rolling fashion across one Veterans Integrated Service Network. Our primary outcome is initiation of an SGLT2i. Secondary outcomes will include medication adherence and safety-related outcomes. DISCUSSION: This project tests the impact of a pharmacist-driven medication outreach initiative as a strategy to accelerate initiation of SGLT2i. The results of this work will not only illustrate the effectiveness of this strategy for SGLT2is but may also have implications for increasing other guideline-concordant care. Furthermore, the utilization of SSNs to select Veterans for the first wave of this program has created a pseudo-randomized interventional trial supporting a pragmatic learning health system approach. TRIAL REGISTRATION: ISRCTN12374636.

"Valorar el trabajo de farmworkers": A thematic analysis of input from farmworkers, advocates, and students in a community documentary project about the future of farm work.

Farm work is one of the nation's most hazardous occupations, and migrant and seasonal farmworkers face significant health inequities. Awareness and understanding of the needs of this population are crucial in assuring they receive appropriate support. Documentary programs can raise awareness of community member views to better inform services and advocacy efforts. Visions for the future of farm work were collected from farmworkers and persons supporting them through a community-based, participatory documentary project led by Student Action with Farmworkers (SAF) from 2021 to 2022. Seventy-nine submissions from participants in North and South Carolina, including text responses and file uploads, were collected and thematically analyzed. Five themes were identified: (1) employment benefits and conditions, (2) living conditions, (3) health access and quality, (4) dignity and visibility of farm work, and (5) policy change for a better future. The visions for the future of farm work expressed by these agricultural workers, advocates, and students raise important implications for agricultural communities, public health practitioners, researchers, funders, and policymakers. Application of these findings in the development and delivery of public health services for farmworkers has the potential to positively impact the morbidity and mortality rates of this at-risk population.

Comprehensive quality assessment of peppermint oils and commercial products: An integrated approach involving conventional and chiral GC/MS coupled with chemometrics.

Peppermint essential oil (EO) has a multitude of applications, such as a fragrance in cosmetics, personal care and industrial products, or as a flavoring ingredient in food and beverages. Despite its popularity and economic significance, peppermint EO is often adulterated to reduce production costs and to increase profits. Although the ISO standard for peppermint EO exists, detecting sophisticated forms of adulteration remains challenging.The current study used conventional and chiral GC/MS analysis of volatiles compounds, and chemometric techniques to evaluate an extensive set of authentic peppermint EO (n = 22) and commercial products (n = 36) purported to contain peppermint EO. Specifically, thirty-six terpenoids were examined in each sample and compared with the ISO standard. Fifty-three percent of the selected commercial products did not meet the ISO specifications and the ratio between menthone/isomenthone was proven to be a good indicator for authentication and adulteration detection. Chiral GC/MS was further employed to measure eight terpenoids: α-pinene, ß-pinene, limonene, menthol, menthone, isomenthone, pulegone, and menthyl acetate. The enantiomeric compositions of 27 commercial products were above or below the norm measured from authentic peppermint EOs. Of the 27 samples, eight met the ISO standard. A sample class prediction (SCP) model based on partial least squares-discriminant analysis (PLS-DA) of conventional GC/MS data was constructed using authentic peppermint EOs and cornmint EOs. The model can distinguish the most common types of peppermint EOs (US, India, and US/India blend) and cornmint EOs sold in the US market. After construction, the SCP model was then used to analyze commercial samples. One sample, which passed both ISO specification and chiral analysis, was identified as outlier by the SCP model. Overall, the applicability of combining both conventional and chiral GC/MS along with chemometric tools has been successfully demonstrated to address the overall quality of peppermint EOs in commerce and may help combat sophisticated adulteration.

Antibiotic prescription for outpatients with influenza and subsequent hospitalisation: A cohort study using insurance data.

Background: Whether prophylactic administration of antibiotics to patients with influenza reduces the hospitalisation risk is unknown. We aimed to examine the association between antibiotic prescription in outpatients with influenza infection and subsequent hospitalisation. Methods: We conducted a cohort study using health insurance records of Japanese clinic and hospital visits between 2012 and 2016. Participants were outpatients (age, 0-74 years) with confirmed influenza infection who were prescribed anti-influenza medicine. The primary outcomes were the hospitalisation risk from all causes and pneumonia and the duration of hospitalisation due to pneumonia. Results: We analysed 903,104 outpatient records with 2469 hospitalisations. The risk of hospitalisation was greater in outpatients prescribed anti-influenza medicine plus antibiotics (0.31% for all causes and 0.18% for pneumonia) than in those prescribed anti-influenza medicine only (0.27% and 0.17%, respectively). However, the risk of hospitalisation was significantly lower in patients prescribed peramivir and antibiotics than in those prescribed peramivir only. Patients who received add-on antibiotics had a significantly longer hospital stay (4.12 days) than those who received anti-influenza medicine only (3.77 days). In all age groups, the hospitalisation risk from pneumonia tended to be greater in those who received antibiotics than in those prescribed anti-influenza medicine only. However, among older patients (65-74 years), those provided add-on antibiotics had an average 5.24-day shorter hospitalisation due to pneumonia than those provided anti-influenza medicine only (not significant). Conclusions: In outpatient cases of influenza, patients who are prescribed antibiotics added to antiviral medicines have a higher risk of hospitalisation and longer duration of hospitalisation due to pneumonia.

SIR Flat CAP (Safety In Radiology - Flat-Packed Compact Airborne Precaution): A Low-Cost, Portable, Negative-Pressure Isolation Barrier Shield for Protecting Frontline Healthcare Workers.

Introduction Multiple barrier shields have been described since the start of the COVID-19 pandemic. Most of these are bulky and designed for use in the main anesthetic or radiology departments. We developed a portable, negative-pressure barrier shield designed specifically for portable ultrasound examinations. A novel supine cough generation model was developed together with a reverse qualitative fit test to simulate real-world aerosol droplet generation and dispersion for evaluating the effectiveness of the barrier shield. We report the technical specifications of this design, named "SIR Flat CAP" from Safety In Radiology - Flat-packed Compact Airborne Precaution, as well as its performance in reducing the spread of droplets and aerosols.  Methods The barrier shield was constructed using 1 mm acrylic panels, clear packing tape, foam double-sided tape, and surgical drapes. Negative pressure was provided via hospital wall suction. A supine cough generation model was developed to simulate cough droplet dispersal. A reverse qualitative fit test was used to assess for airborne transmission of microdroplets. Results The supine cough generation model was able to replicate similar results to previously reported supine human cough generation dispersion. The use of the barrier shield with negative-pressure suction prevented the escape of visible droplets, and no airborne microdroplets were detected by reverse qualitative fit testing from the containment area. Conclusions The barrier shield significantly reduces the escape of visible and airborne droplets from the containment area, providing an additional layer of protection to front-line sonographers.

Systematic assessment of long-read RNA-seq methods for transcript identification and quantification.

The Long-read RNA-Seq Genome Annotation Assessment Project (LRGASP) Consortium was formed to evaluate the effectiveness of long-read approaches for transcriptome analysis. The consortium generated over 427 million long-read sequences from cDNA and direct RNA datasets, encompassing human, mouse, and manatee species, using different protocols and sequencing platforms. These data were utilized by developers to address challenges in transcript isoform detection and quantification, as well as de novo transcript isoform identification. The study revealed that libraries with longer, more accurate sequences produce more accurate transcripts than those with increased read depth, whereas greater read depth improved quantification accuracy. In well-annotated genomes, tools based on reference sequences demonstrated the best performance. When aiming to detect rare and novel transcripts or when using reference-free approaches, incorporating additional orthogonal data and replicate samples are advised. This collaborative study offers a benchmark for current practices and provides direction for future method development in transcriptome analysis.

Chemical Characterization and Quality Assessment of Copaiba Oil-Resin Using GC/MS and SFC/MS.

In recent years, the popularity of copaiba oil-resin has increased worldwide due to its medicinal value and wide applications in industry. Despite its popularity, the oil has not been standardized by industry or regulatory agencies. Product adulteration in order to maximize profits has become a problem. To address these issues, the current study describes the chemical and chemometric characterization of forty copaiba oil-resin samples by GC/MS. The results demonstrated, with the exception of commercial samples, that all sample groups contained six characteristic compounds (ß-caryophyllene, α-copaene, trans-α-bergamotene, α-humulene, γ-muurolene, and ß-bisabolene) in varying concentrations. Furthermore, compositional patterns were observed in individual groups which corresponded to sample origin. Within the commercial group, two samples did not contain or contained only one of the characteristic compounds. Principal component analysis (PCA) revealed distinct groups which largely corresponded to sample origin. Moreover, commercial samples were detected by PCA as outliers, and formed a group far removed from the other samples. These samples were further subjected to analysis using a SFC/MS method. Product adulteration with soybean oil was clearly detected, with each individual triglyceride in soybean oil being unambiguously identified. By combining these analytical techniques, the overall quality of copaiba oil-resin can be assessed.

Reactions to a Hypothetical Menthol Cigarette Ban among Sexual- and Gender-Minoritized Communities: A Concept Mapping Study.

Menthol cigarette use is disproportionately higher among sexual- and gender-minoritized (SGM; 36%) individuals compared to cisgender, heterosexual (29%), individuals. The FDA has announced intentions to ban menthol in cigarettes, citing these use and health disparities as partial motivation. This study identified potential outcomes of a menthol cigarette ban among SGM individuals who smoke menthol cigarettes (N = 72). Potential outcomes were identified via concept mapping using the prompt: "If menthol in cigarettes was banned, a specific action I would take related to my tobacco use is…" Participants generated 82 response statements, sorted them, and rated them on personal relevance. Eight thematic clusters were identified: (1) Thoughtful Consideration of the Ban, (2) Negative Reactions to the Ban, (3) Positive Aspects of the Ban, (4) Strategies to Reduce Cravings, (5) Intent to Quit and Cessation Strategies, (6) Support-Seeking and Engagement in Positive Behaviors, (7) Strategies to Maintain Menthol-Flavored Product Use, and (8) Substance Use Alternatives to Menthol Cigarettes. Cluster differences based on sociodemographic factors, smoking behavior, and quitting interest were identified. Results provide insight into potential responses to a menthol cigarette ban and can contribute to public health prevention and intervention efforts, messaging campaigns, and support services for SGM people who smoke menthol cigarettes, specifically.

A low-cost edge AI-chip-based system for real-time algae species classification and HAB prediction.

Harmful Algal Blooms (HAB) are damaging to ecosystem functions and pose challenges to environmental and fisheries management. The key to HAB management and understanding the complex algal growth dynamics is the development of robust systems for real-time monitoring of algae populations and species. Previous algae classification studies mainly rely on the combination of an in-situ imaging flow cytometer and an off-site lab-based algae classification model such as Random Forest (RF) for the analysis of high-throughput images. An on-site AI algae monitoring system on top of an edge AI chip embedded with the proposed Algal Morphology Deep Neural Network (AMDNN) model is developed to achieve real-time algae species classification and HAB prediction. Based on a detailed examination of real-world algae images, dataset augmentation is first performed: consisting of orientation, flipping, blurring, and Resizing with Aspect ratio Preserved (RAP). The dataset augmentation is shown to significantly improve classification performance which is superior to that of the competitive RF model. And the attention heatmaps show that for relatively regular-shaped algal species (e.g., Vicicitus), the model weights the color and texture information heavily; while the shape-related features are more important for complex-shaped algae (e.g., Chaetoceros). The AMDNN is tested on a dataset of 11,250 algae images containing the 25 most common HAB classes in Hong Kong subtropical waters with 99.87% test accuracy. Based on the fast and accurate algae classification, the AI-chip-based on-site system is applied to a one-month dataset in February 2020; the predicted trends of total cell counts and targeted HAB species counts are in good agreement with observations. The proposed edge AI algae monitoring system provides a platform for the development of practical HAB early warning systems that can effectively support environmental risk and fisheries management.

The Cost of Diversity: An Analysis of Representation and Cost Barriers in Stock Photo Libraries for Health Education Materials, 2021.

INTRODUCTION: Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce them. Stock photo libraries are a critical tool for developers of patient education, health education, and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease. METHOD: We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for the following five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images (N = 495) were coded for age, gender presentation, representation of perceived minoritized racial/ethnic identity, skin color using the Massey-Martin skin color scale, markers of high socioeconomic status (SES), and access costs. Results. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and library. Images predominately portrayed young adults and adults, with limited representation of other age groups. Images in libraries with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity and depict darker skin colors, and were significantly less likely to contain markers of high SES identity than images in libraries that were free to use. DISCUSSION: We found that it costs more to develop culturally relevant health education materials for minoritized populations and groups that do not represent high SES populations. This may hinder the development of effective communication interventions.

Tobacco company agreements with tobacco retailers for price discounts and prime placement of products and advertising: a scoping review.

OBJECTIVE: The objectives of this scoping review are to examine existing research on the often-secretive contracts between tobacco manufacturers and retailers, to identify contract requirements and incentives, and to assess the impact of contracts on the sales and marketing of tobacco products in the retail setting. DATA SOURCES: The systematic search was conducted in PubMed/MEDLINE, Web of Science, Scopus, ProQuest Political Science Database, Business Source Premier, ProQuest Agricultural & Environmental Science Collection, and Global Health through December 2020. STUDY SELECTION: We included studies that collected and analysed empirical data related to tobacco contracts, tobacco manufacturers, and tobacco retailers. Two reviewers independently screened all 2786 studies, excluding 2694 titles and abstracts and 65 full texts resulting in 27 (0.97%) included studies. DATA EXTRACTION: Study characteristics, contract prevalence, contract requirements and incentives, and the influence of contracts on the retail environment were extracted from each study. DATA SYNTHESIS: We created an evidence table and conducted a narrative review of included studies. CONCLUSIONS: Contracts are prevalent around the world and handsomely incentivise tobacco retailers in exchange for substantial manufacturer control of tobacco product availability, placement, pricing and promotion in the retail setting. Contracts allow tobacco companies to promote their products and undermine tobacco control efforts in the retail setting through discounted prices, promotions and highly visible placement of marketing materials and products. Policy recommendations include banning tobacco manufacturer contracts and retailer incentives along with more transparent reporting of contract incentives given to retailers.

Tobacco and Alcohol Retailer Availability and Neighborhood Racialized, Economic, and Racialized Economic Segregation in North Carolina.

BACKGROUND: Despite evidence of racialized and socioeconomic inequities in tobacco and alcohol outlet availability, few studies have investigated spatial inequities in areas experiencing both concentrated residential racialized segregation and socioeconomic disadvantage. This study examined whether segregation-racialized, economic or both-was associated with alcohol and tobacco retailer counts in North Carolina (NC). METHODS: The NC Alcoholic Beverage Control Commission provided lists of 2021 off-premise alcohol retailers. We created a list of 2018 probable tobacco retailers using ReferenceUSA. We calculated three census tract-level measures of the Index of Concentrations at the Extremes (ICE), indicating racialized segregation between non-Hispanic White and Black residents and economic segregation based on household income. We used negative binomial regression to test associations between quintiles of each ICE measure and tobacco and, separately, alcohol retailer counts. RESULTS: Tracts with the greatest racialized disadvantage had 38% (IRR, 1.38; 95% CI, 1.15-1.66) and 65% (IRR, 1.65; 95% CI, 1.34-2.04) more tobacco and alcohol outlets, respectively, as tracts with the lowest. Tracts with the highest racialized economic disadvantage had a predicted count of 1.51 tobacco outlets per 1000 people while those in the lowest had nearly one fewer predicted outlet. Similar inequities existed in the predicted count of alcohol outlets. DISCUSSION: Tobacco and alcohol outlet availability are higher in NC places experiencing concentrated racialized and economic segregation. A centralized agency overseeing tobacco and alcohol outlet permits and strategies to reduce the retail availability of these harmful products (e.g., capping the number of permits) are needed to intervene upon these inequities.

An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders.

AIMS: The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS: This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS: A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION: A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.

Uncertainty evaluation and performance assessment of water quality model for mariculture management.

Ecosystem based water quality models are important tools for prognostic site assessment and evaluation of ecosystem-performance of marine fish farms. We present the development and application of a comprehensive Fish Culture Zone Water Quality Model using continuous bi-weekly field data over a six-year period (2012-2017). The model simulates five interacting subsystems: phytoplankton, phosphorus and nitrogen cycles, and the dissolved oxygen (DO) and particulate organic carbon balance. The application of the model to two fish culture zones in Hong Kong shows the model captures the trends of nutrient and DO variation and the performance in quantitative prediction of algal biomass is challenging. The effect of errors in the specification of primary model inputs are evaluated using dimensionless sensitivity coefficients based on First Order Variance Analysis reveals the relative importance of fish stock (loading), physical size (volume), tidal flushing rate and boundary conditions in the prediction of key water quality variables.

Rates and correlates of medicine disposal program implementation at pharmacies in North Carolina: A longitudinal study, 2016-2021.

BACKGROUND: Unused prescription opioids from family and friends continue to be the primary access point to prescription opioids for nonmedical use among youth. Implementation of medicine disposal boxes at pharmacies is one approach to facilitate removal of unused prescription opioids from the home to prevent diversion. OBJECTIVES: We sought to examine the implementation rates of disposal boxes at pharmacies in North Carolina from 2016 to 2021 and place-based health disparities in availability. METHODS: We identified pharmacies with a disposal box in 2016, 2018, and 2021 among licensed pharmacies in North Carolina in 2018 (N = 2587). We computed descriptive statistics to describe disposal box implementation rates over time and used geographic information systems to identify spatial trends. We used separate logistic regression models in 2018 and 2021 to assess the relationship between neighborhood characteristics and the likelihood of a pharmacy implementing a disposal box. RESULTS: We found an increase in disposal boxes over time with 43 pharmacies (1.7%) in 2016, 144 (5.6%) in 2018, and 350 (13.5%) in 2021 implementing a disposal box. In 2018, independent pharmacies were more likely than chains to have a disposal box. In 2021, medical-affiliated and pharmacies defined as "other" were less likely than chains to have a disposal box. In both 2018 and 2021, pharmacies in census tracts with a higher percentage of the population below the federal poverty line were more likely to have a disposal box. In 2021, pharmacies in tracts with a higher percentage of the population unemployed were less likely to have a disposal box. In 2018, pharmacies located in counties with a greater number of opioid overdose deaths were more likely to have a disposal box. CONCLUSION: Our findings highlight the growth of disposal boxes in North Carolina over time and the potential for continued expansion to provide opportunities to prevent prescription opioid diversion.

Creating information resources and trainings for farmworker-serving community health workers.

BACKGROUND: Farmworker-serving community health workers have limited access to farmworker health research findings, training, and education resources. With funding from the National Library of Medicine, we are working to improve the health information literacy of both community health workers and farmworkers. We conducted focus group discussions with community health workers to explore their experiences providing health education and information to farmworkers, their information-seeking behaviors, and their technology and information needs. Data from the focus groups provided insights into the main areas in which community health workers would like to receive professional development. CASE PRESENTATION: Our team, which includes health sciences librarians, developed a resource list of educational materials for farmworker health, videos to increase community health workers' skills finding health information online, and webinars to introduce these resources to community health workers. Videos, available in Spanish and English, included instruction on finding and evaluating online health information, accessing reputable online consumer health information sources, and advanced searching tips for Google and PubMed. Through three webinars, we introduced the resource list, videos, and design software for creating handouts and infographics to community health workers. CONCLUSIONS: Community health workers have a critical role in providing health education and information to farmworkers, and our efforts represent a first step in addressing community health workers' limited access to professional development. Health sciences librarians are well positioned to partner with interdisciplinary teams working to reduce health disparities and provide resources and training to community health workers, farmworkers, and other underserved communities.