Unexpected capacity-building experiences of multicultural, multilingual participants in a public health initiative.

AIMS: This study of a levy-voter funded public health initiative program (1) identifies capacity-building concerns, (2) summarizes those concerns at the community-based organization (CBO) level, and (3) documents the desired CBO capacity-building outcome. PARTICIPANTS: Nineteen participants from nine CBOs were included, representing 95% of participants (19/20) and 90% of CBOs (9/10) from the initiative's program population. METHODS: Interviews were conducted. A focus group validated data. Demographic surveys were completed. METHODOLOGY AND ANALYSIS: Data were analyzed using demographic and inductive content analyses. Fifteen capacity-building unexpected concerns were identified. Participants from eight out of nine (88.8%) CBOs shared at least ten concerns. Seven CBO capacity-building outcomes were identified. RESULTS: Capacity-building providers helped participants mitigate the Initiative's capacity-building testing of the National Implementation Research Network (NIRN) model. Participants' NIRN processes were Western and mainstream. Participants wanted community-designed processes and the funder to understand CBO clients' backgrounds, cultures, and languages. The contract money did not match the needed capacity-building processes, time, and workload. DISCUSSION: The funder's pre-selected the NIRN Western majority approach did not fit. Participants wanted to lead. Capacity-building only for home-based program development was less desired. Social justice leadership could have made a difference.

Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review.

ABSTRACT: Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.

Organizational contexts, implementation process, and capacity outcomes of multicultural, multilingual Home-Based Programs in public initiatives: A Mixed-Methods study.

AIMS: The study aim was to examine the impact of a home-based programme intervention on organizational contexts, implementation processes and organizational capacity outcomes from multicultural, multilingual participants working at community-based organizations. DESIGN: This was a sequential exploratory, mixed-methods longitudinal study using community-based participatory research principles. SAMPLE: Twenty participants from nine multicultural, multilingual community-based organizations were in this public health initiative's intervention to develop community-designed, home-based programmes. METHODS: Capacity building providers delivered the intervention selected by the funders. Workshop outcomes were descriptively measured in April/May 2019. In April/May and November 2019, participants completed surveys about organizational contexts, implementation processes and organizational capacity outcomes, which were analysed with t-tests using the organization as the unit of analysis. Qualitative data were analysed using content analysis. RESULTS: Seven programmes were new and two were modified. As workshop outcomes, 59% of participants reported increased overall implementation knowledge and 74% reported capacity building providers as the most helpful resource. After 6 to 7 months, no statistically significant changes were noted in organizational contexts, implementation processes or organizational capacity outcomes. Participants benefited from capacity building because they had programmes developed, formed partnerships with capacity building providers, gained implementation knowledge, and engaged in networking. CONCLUSION: Participants reported excellent individual and organizational strengths. Many Initiative factors contributed to no statistical changes. Namely, there was no opportunity for baseline data; limited community-based organization engagement in the intervention model selection, timeline and processes; the Initiative's timeline did not fit participants' timeline; insufficient time to develop culturally and linguistically appropriate programmes; late literature review abstracts; lack of adequate, planful and paid capacity building time; and a contract requirement to have the programme due when it was not implementable. These Initiative design factors, as reported by participants, limited the Initiative's home-based programme development. IMPACT: This study highlights the strengths of participants, community-based organizations and capacity building providers. Model selection, timeline and budget were identified as key factors for equitable implementation in multicultural, multilingual organizations.

Institutional procedural discrimination, institutional racism, and other institutional discrimination: A nursing research example.

Institutional discrimination matters. The purpose of this longitudinal community-based participatory research study was to examine institutional procedural discrimination, institutional racism, and other institutional discrimination, and their relationships with participants' health during a maternal and child health program in a municipal initiative. Twenty participants from nine multilingual, multicultural community-based organizations were included. Overall reported incidences of institutional procedural discrimination decreased from April 2019 (18.6%) to November 2019 (11.8%) although changes were not statistically significant and participants reporting incidences remained high (n = 15 in April and n = 14 in November). Participants reported experiencing significantly less "[when] different cultural ways of doing things were shared, the project did not support my way" from April 2019 (23.5%, n = 4) to November 2019 (0%, n = 0), Wilcoxon signed-rank test Z = -2.00, p < 0.05. Some participants reported experiencing institutional racism (29.4%, n = 5) and other institutional discrimination (5.9%, n = 1). Participants experiencing institutional racism, compared to those who did not, reported a higher impact of the Initiative's program on their quality of life (t = 3.62, p < 0.01). Participatory survey designs enable nurse researchers to identify hidden pathways of institutional procedural discrimination, describe the impacts experienced, and examine types of institutional discrimination in health systems.

Developmental trajectory and relationships between Adolescents' social capital, self-esteem, and depressive symptoms: A latent growth model.

The aim of this study was to evaluate the longitudinal influence of social capital and self-esteem on depressive symptoms among adolescents. A multivariate latent growth model was used to test secondary data obtained from the Korea Youth Panel Survey. Social capital and self-esteem tended to increase over periods of four years, whereas depressive symptoms had a tendency to decrease in the same periods. In the case of indirect effects on depressive symptoms by way of self-esteem, significant indirect associations were identified. The results indicated that the intercept of social capital had a significant indirect effect and total effect on the intercept of depressive symptoms. In addition, the slope of social capital had a significant indirect effect and total effect on the slope of depressive symptom. The initial development of social capital and self-esteem is shown to be effective for reducing adolescents' depressive symptoms.

High-throughput analysis and protein engineering using microcapillary arrays.

We describe a multipurpose technology platform, termed µSCALE (microcapillary single-cell analysis and laser extraction), that enables massively parallel, quantitative biochemical and biophysical measurements on millions of protein variants expressed from yeast or bacteria. µSCALE spatially segregates single cells within a microcapillary array, enabling repeated imaging, cell growth and protein expression. We performed high-throughput analysis of cells and their protein products using a range of fluorescent assays, including binding-affinity measurements and dynamic enzymatic assays. A precise laser-based extraction method allows rapid recovery of live clones and their genetic material from microcapillaries for further study. With µSCALE, we discovered a new antibody against a clinical cancer target, evolved a fluorescent protein biosensor and engineered an enzyme to reduce its sensitivity to its inhibitor. These protein analysis and engineering applications each have unique assay requirements and different host organisms, highlighting the flexibility and technical capabilities of the µSCALE platform.

Overweight or obesity in children aged 0 to 6 and the risk of adult metabolic syndrome: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: To identify an association between overweight or obesity in early childhood and metabolic syndrome in adults. BACKGROUND: Early childhood overweight or obesity is important because it can predict metabolic syndrome in adulthood. A longer period of overweight or obesity leads to the accumulation of more risk factors. However, there are insufficient and inconsistent studies on this issue. DESIGN: A systematic review and meta-analysis. METHODS: We followed the Meta-Analysis of Observational Studies in Epidemiology guideline, MEDLINE, EMBASE, Cochrane library and CINAHL electronic databases as well as reference lists of included studies were searched, without published date restriction. We used the Newcastle-Ottawa Scale to assess the quality of the observational studies in the systematic review, and the meta-analysis was performed using random-effects models. RESULTS: All of the included studies were published from 2008-2014, and the participants of this study were only Asians or Europeans. A total of 12 results from five studies were included in the meta-analysis. Overweight or obesity in early childhood was associated with a higher risk of adult metabolic syndrome compared with the controls. When confirmed in each age group (at birth, 0-2 and 2-6 years), there was a statistically significant difference before and after the age of 2 years. As a result of the meta-regression, when the age of the children increased, the effect size of adult metabolic syndrome for overweight or obesity also increased. CONCLUSIONS: The results confirm that the aetiology of metabolic syndrome includes long-term impacts from the early stage of life and indicate that early intervention for overweight or obesity is needed. RELEVANCE TO CLINICAL PRACTICE: these findings could help community and clinical health nurses recognize the risk of overweight or obesity in early life, and provide evidence to develop and implement the preventive intervention for early childhood.

Effect of Mandatory and Voluntary Overtime Hours on Stress Among 9-1-1 Telecommunicators.

BACKGROUND: 9-1-1 telecommunicators are frequently exposed to indirect traumatic events that impact their mental and physical health and are often required to work overtime with rotating shifts. Previous studies reported various harmful effects of overtime on the health and well-being of workers, such as musculoskeletal injuries, burnout, low job satisfaction, fatigue, and intent to leave. However, there is limited research on the impact of overtime hours on 9-1-1 telecommunicators' stress symptoms, especially mandatory overtime hours. This study aimed to examine the relationship between overtime hours-mandatory and voluntary-and the level of stress symptoms among 9-1-1 telecommunicators. METHODS: We used secondary data from the surveys of the "Multi-tasking to hyper-tasking: Investigating the impact of Next Generation 9-1-1" study for analysis. Linear mixed-effects regression was applied to examine the association of overtime hours with the stress level. RESULTS: Of the 403 participants, 47.6% reported that they were required to work mandatory overtime, and the mean mandatory overtime was 7.51 (SD = 12.78) hours in the past month. 58.3% reported working voluntary overtime, and the mean voluntary overtime was 11.63 (SD = 17.48) hours. This study found that mandatory overtime hours were associated with an increase in self-reported stress symptoms (ß = 0.30, p = .002), whereas no significant association was found between voluntary overtime and the level of stress symptoms (ß = -0.01, p = .885). CONCLUSION/APPLICATION TO PRACTICE: Study results highlight the importance of reducing mandatory overtime in call centers as one possible strategy for reducing stress levels among this critical workforce.

Multimodal machine learning models identify chemotherapy drugs with prospective clinical efficacy in dogs with relapsed B-cell lymphoma.

Dogs with B-cell lymphoma typically respond well to first-line CHOP-based chemotherapy, but there is no standard of care for relapsed patients. To help veterinary oncologists select effective drugs for dogs with lymphoid malignancies such as B-cell lymphoma, we have developed multimodal machine learning models that integrate data from multiple tumor profiling modalities and predict the likelihood of a positive clinical response for 10 commonly used chemotherapy drugs. Here we report on clinical outcomes that occurred after oncologists received a prediction report generated by our models. Remarkably, we found that dogs that received drugs predicted to be effective by the models experienced better clinical outcomes by every metric we analyzed (overall response rate, complete response rate, duration of complete response, patient survival times) relative to other dogs in the study and relative to historical controls.

ML-based sequential analysis to assist selection between VMP and RD for newly diagnosed multiple myeloma.

Optimal first-line treatment that enables deeper and longer remission is crucially important for newly diagnosed multiple myeloma (NDMM). In this study, we developed the machine learning (ML) models predicting overall survival (OS) or response of the transplant-ineligible NDMM patients when treated by one of the two regimens-bortezomib plus melphalan plus prednisone (VMP) or lenalidomide plus dexamethasone (RD). Demographic and clinical characteristics obtained during diagnosis were used to train the ML models, which enabled treatment-specific risk stratification. Survival was superior when the patients were treated with the regimen to which they were low risk. The largest difference in OS was observed in the VMP-low risk & RD-high risk group, who recorded a hazard ratio of 0.15 (95% CI: 0.04-0.55) when treated with VMP vs. RD regimen. Retrospective analysis showed that the use of the ML models might have helped to improve the survival and/or response of up to 202 (39%) patients among the entire cohort (N = 514). In this manner, we believe that the ML models trained on clinical data available at diagnosis can assist the individualized selection of optimal first-line treatment for transplant-ineligible NDMM patients.

Analytic approaches to assess the impact of local spending on sexually transmitted diseases.

OBJECTIVE: To compare the estimated associations between annual sexually transmitted diseases (STD) expenditures per capita and STD incidence rates among Florida and Washington local health departments (LHDs) from 2001 to 2017, using two approaches-a longitudinal regression model with lagged STD spending and a regression model with the Arellano-Bond panel estimator. DATA SOURCES: Secondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government. STUDY DESIGN: We examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017, with LHDs as the unit of analysis. We compared two regression models: generalized estimating equations (GEE) and the Arellano-Bond panel estimator (an instrumental variable approach). DATA COLLECTION: The secondary data were combined to build a longitudinal panel database for LHDs in Florida and Washington from 2001 to 2017. PRINCIPAL FINDINGS: In the GEE model with both states, greater STD spending in a prior year was associated unexpectedly with greater STD incidence rates in succeeding years. The Arellano-Bond models for both states had the expected inverse associations but were not significant. In the Arellano-Bond models for Florida, a $1 increase in STD spending in previous years was followed by decreases in STD incidence rates ranging between 29 and 58 points in succeeding years (0.09 ≥ p ≥ 0.04). CONCLUSIONS: In longitudinal panel data for LHDs in two states, the Arellano-Bond estimator, or other instrumental variable approach, is preferred over conventional regression models to obtain unbiased estimates of the relationship between annual STD spending rates and annual STD rates. Future studies will require accurate, standardized, and detailed longitudinal data and rigorous analytic approaches, such as those illustrated in our study.

Quantification of physical stress experienced by obstetrics and gynecology sonographers: A comparative study of two ultrasound devices.

This study aims to quantify the stresses of sonographers using two different ultrasound devices, one of conventional and one of ergonomic design. A total of 20 obstetricians and gynecologists participated in this study, and two types of tasks (scanning and positioning) were evaluated while using the two different devices. To quantify workload, four dependent variables (muscle activity, estimated grip force, subjective comfort rating, and task time) were measured. The muscular activity required while using the conventional device was 14.4% MVC (Maximum voluntary contraction) for the scanning task, which was significantly higher than that of the ergonomic device. The subjective comfort rating for the conventional design was lower than that of the ergonomic design. For the positioning task, the ergonomic device (33.2% MVC) resulted in significantly higher muscle activity in the extensor digitorum (ED) and flexor digitorum superficialis (FDS) than the conventional design (22.2% MVC), whereas the deltoid muscle showed significantly lower activity than in users of conventional design (4.5% MVC). Ergonomically-designed ultrasound devices improve ease of moving and the probe's supporters, reduce physical load and increase ease of use for sonographers. Our results may be used as guidelines for usability testing of ultrasound devices.

Predicting Dynamic Clinical Outcomes of the Chemotherapy for Canine Lymphoma Patients Using a Machine Learning Model.

First-line treatments of cancer do not always work, and even when they do, they cure the disease at unequal rates mostly owing to biological and clinical heterogeneity across patients. Accurate prediction of clinical outcome and survival following the treatment can support and expedite the process of comparing alternative treatments. We describe the methodology to dynamically determine remission probabilities for individual patients, as well as their prospects of progression-free survival (PFS). The proposed methodology utilizes the ex vivo drug sensitivity of cancer cells, their immunophenotyping results, and patient information, such as age and breed, in training machine learning (ML) models, as well as the Cox hazards model to predict the probability of clinical remission (CR) or relapse across time for a given patient. We applied the methodology using the three types of data obtained from 242 canine lymphoma patients treated by (L)-CHOP chemotherapy. The results demonstrate substantial enhancement in the predictive accuracy of the ML models by utilizing features from all the three types of data. They also highlight superior performance and utility in predicting survival compared to the conventional stratification method. We believe that the proposed methodology can contribute to improving and personalizing the care of cancer patients.

Predicting likelihood of in vivo chemotherapy response in canine lymphoma using ex vivo drug sensitivity and immunophenotyping data in a machine learning model.

We report a precision medicine platform that evaluates the probability of chemotherapy drug efficacy for canine lymphoma by combining ex vivo chemosensitivity and immunophenotyping assays with computational modelling. We isolated live cancer cells from fresh fine needle aspirates of affected lymph nodes and collected post-treatment clinical responses in 261 canine lymphoma patients scheduled to receive at least 1 of 5 common chemotherapy agents (doxorubicin, vincristine, cyclophosphamide, lomustine and rabacfosadine). We used flow cytometry analysis for immunophenotyping and ex vivo chemosensitivity testing. For each drug, 70% of treated patients were randomly selected to train a random forest model to predict the probability of positive Veterinary Cooperative Oncology Group (VCOG) clinical response based on input variables including antigen expression profiles and treatment sensitivity readouts for each patient's cancer cells. The remaining 30% of patients were used to test model performance. Most models showed a test set ROC-AUC > 0.65, and all models had overall ROC-AUC > 0.95. Predicted response scores significantly distinguished (P < .001) positive responses from negative responses in B-cell and T-cell disease and newly diagnosed and relapsed patients. Patient groups with predicted response scores >50% showed a statistically significant reduction (log-rank P < .05) in time to complete response when compared to the groups with scores <50%. The computational models developed in this study enabled the conversion of ex vivo cell-based chemosensitivity assay results into a predicted probability of in vivo therapeutic efficacy, which may help improve treatment outcomes of individual canine lymphoma patients by providing predictive estimates of positive treatment response.

Estimating Lifetime Dental Care Expenditure in South Korea: An Abridged Life Table Approach.

The aim of this study was to measure the magnitude and distribution of a Korean's lifetime dental expenses depending on age and sex, by constructing a hypothetical lifetime and life table of survival. Additionally, we estimated the difference in life expectancy between men and women and its impact on dental expenses. We used the 2015 Korea Health Panel Survey to calculate the total dental expenditure, including expenses paid directly by patients and those paid by insurers. We generated survival profiles to simulate dental expenses during a typical lifetime (from birth to age 95) using the abridged life table (five-year intervals for age groups) in 2015 from the South Korean Statistical Information Service. We independently calculated the remaining dental expenses for survivors of all ages. The results showed that an estimate of average lifetime dental expenditure was $31,851 per capita: $31,587 for men and $32,318 for women. Nearly 33% of the average per capita lifetime dental expenditure was attributable to the longer life expectancy of women, with no statistically significant difference in lifetime dental expenditure between men and women. Many survivors incurred 70% of their lifetime dental expenses before age 65. The results highlighted the need for policymakers to address spending on age-specific dental care owing to extended life expectancy, given the disproportionate share of healthcare resources supporting the elderly.

Children's Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007-2015).

We evaluated the effect of the National Health Insurance (NHI) policy including dental sealant on changes in the prevalence of sealant and caries, and examined how NHI affected sealant utilization and untreated caries in children from diverse income groups in South Korea. We used a multivariate logistic regression analysis to explore the effects of three stages of dental sealant policy (pre-policy: 2007-2009, first post-policy: 2010-2012, and second post-policy: 2013-2015) on the prevalence of dental sealant and untreated caries. Participant data (N = 8161, aged 6-14 years) were derived from the Korea National Health and Nutrition Examination Survey (2007-2015). We also conducted subgroup analysis to determine the effects of the NHI policy on dental sealant and untreated caries by income level. Implementation of dental insurance coverage was associated with higher likelihood of using dental sealant (odds ratio (OR) = 1.39 (95% confidence interval (CI): 1.18-1.63) for the first period and OR = 1.58 (95% CI: 1.33-1.87) for the second period) and lower odds of having untreated caries (OR = 0.79 (95% CI: 0.64-0.98) for the first period and OR = 0.65 (95% CI: 0.51-0.83) for the second period) after controlling for covariates. Results revealed that there was a greater prevalence of dental sealant and a lower prevalence of untreated caries in both middle- and low-income households compared to high-income households. The higher prevalence of dental sealant and lower untreated caries after the policy implementation. Moreover, we demonstrated children from low-or middle-income households were more associated with increasing dental sealant use and a declining prevalence of caries.

Socioeconomic disparities in household secondhand smoke exposure among non-smoking adolescents in the Republic of Korea.

This nationally representative study examined (a) gender and age differences in household secondhand smoke exposure (HSHSE) and (b) associations between socioeconomic status (SES) and HSHSE among non-smoking Korean adolescents. Two subsamples were analysed: males (n = 25,648) and females (n = 30,240). The HSHSE measures were incidence of HSHSE (yes/no) and number of days of HSHSE (1-7 days); the SES measures were parental education, perceived economic status, and family wealth. For the first aim, chi-square test, t-test, and bivariate negative binomial regression analysis were performed; For the second aim, multivariate logistic regression and negative binomial regression analyses were performed. The incidence and number of days of HSHSE were significantly higher among females (32.35% and 3.48 days) than males (26.83% and 3.08 days). The HSHSE incidence was significantly higher among younger adolescents (23.32% to 31.08% of males and 26.58% to 37.03% of females). Lower SES was associated with (a) greater odds of HSHSE (odds ratio: 1.12-1.58 among males and 1.19-1.85 among females) and (b) greater incidence rates of HSHSE (incidence rate ratio: 1.05-1.17 among males and 1.10-1.14 among females). Efforts should be made to decrease HSHSE among adolescents, particularly low-SES youth.

Effectiveness of Capsule Endoscopy Compared with Other Diagnostic Modalities in Patients with Small Bowel Crohn's Disease: A Meta-Analysis.

BACKGROUND/AIMS: As a result of the rapid development of medical diagnostic tools, physicians require concrete evidence to evaluate the effectiveness of the tools. We aimed to investigate the effectiveness and additional diagnostic benefits of capsule endoscopy (CE) in patients with small bowel Crohn's disease (CD). METHODS: We performed a systematic search of databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases. Two reviewers independently screened all references. Diagnostic data from the studies were collected, and a meta-analysis was performed. RESULTS: Twenty-four studies were included. In cases of suspected CD, CE demonstrated a superior diagnostic yield compared with small bowel follow-through (SBFT) and enteroclysis (EC); however, there was no difference compared with computed tomography enterography or magnetic resonance enterography. In cases with established CD, CE demonstrated a higher diagnostic yield only compared with EC. In the detection of terminal ileum lesions, CE exhibited a significantly increased detection rate compared with ileoscopy. CONCLUSIONS: The findings of our meta-analysis indicate that CE is superior to SBFT and EC in the evaluation of suspected CD cases. CE is also a more effective diagnostic modality in patients with established CD compared with EC.

Dual display of proteins on the yeast cell surface simplifies quantification of binding interactions and enzymatic bioconjugation reactions.

Yeast surface display, a well-established technology for protein analysis and engineering, involves expressing a protein of interest as a genetic fusion to either the N- or C-terminus of the yeast Aga2p mating protein. Historically, yeast-displayed protein variants are flanked by peptide epitope tags that enable flow cytometric measurement of construct expression using fluorescent primary or secondary antibodies. Here, we built upon this technology to develop a new yeast display strategy that comprises fusion of two different proteins to Aga2p, one to the N-terminus and one to the C-terminus. This approach allows an antibody fragment, ligand, or receptor to be directly coupled to expression of a fluorescent protein readout, eliminating the need for antibody-staining of epitope tags to quantify yeast protein expression levels. We show that this system simplifies quantification of protein-protein binding interactions measured on the yeast cell surface. Moreover, we show that this system facilitates co-expression of a bioconjugation enzyme and its corresponding peptide substrate on the same Aga2p construct, enabling enzyme expression and catalytic activity to be measured on the surface of yeast.