Culpability Framing Influences on Community Support for Those Managing Illness: A Multi-Malady Comparison of Mediated Health Stigma.

Prior research demonstrates an influence of culpability framing on news consumers' perceptions about, and willingness to provide support for, those managing illness. Framing research of this sort has typically focused on the effect of frames on a particular health context (e.g. cancer). It is necessary to examine how three health frames which are overwhelmingly represented in health news could be uniquely influencing perceptions about those managing illness in a number of disparate health contexts. Specifically, we explore the nature of health frame influence as it relates to news reports regarding alcoholism, morbid obesity, and cancer. These illnesses represent the three of the most prominent health concerns for Americans that also vary in terms of how they relate to four chief cues for stigma communication. Experimental findings reveal unique ways in which culpability framing influences social support dispositions for those managing illness, as a function of intergroup anxiety perceptions.

A Medicaid-Funded Statewide Diabetes Quality Improvement Collaborative: Ohio 2020‒2022.

We used a collective impact model to form a statewide diabetes quality improvement collaborative to improve diabetes outcomes and advance diabetes health equity. Between 2020 and 2022, in collaboration with the Ohio Department of Medicaid, Medicaid Managed Care Plans, and Ohio's seven medical schools, we recruited 20 primary care practices across the state. The percentage of patients with hemoglobin A1c greater than 9% improved from 25% to 20% over two years. Applying our model more broadly could accelerate improvement in diabetes outcomes. (Am J Public Health. 2023;113(12):1254-1257. https://doi.org/10.2105/AJPH.2023.307410).

Quality of Care Program Reduces Unplanned Health Care Utilization in Patients With Inflammatory Bowel Disease.

INTRODUCTION: There is significant variation in processes and outcomes of care for patients with inflammatory bowel disease (IBD), suggesting opportunities to improve quality of care. We aimed to determine whether a structured quality of care program can improve IBD outcomes, including the need for unplanned health care utilization. METHODS: We used a structured approach to improve adult IBD care in 27 community-based gastroenterology practices and academic medical centers. Patient-reported outcomes (PRO) and health care utilization were collected at clinical visits. Outcomes were monitored monthly using statistical process control charts; improvement was defined by special cause (nonrandom) variation over time. Multivariable logistic regression was applied to patient-level data. Nineteen process changes were offered to improve unplanned health care utilization. Ten outcomes were assessed, including disease activity, remission status, urgent care need, recent emergency department use, hospitalizations, computed tomography scans, health confidence, corticosteroid or opioid use, and clinic phone calls. RESULTS: We collected data prospectively from 20,382 discrete IBD visits. During the 15-month project period, improvement was noted across multiple measures, including need for urgent care, hospitalization, steroid use, and opioid utilization. Adjusted multivariable modeling showed significant improvements over time across multiple outcomes including urgent care need, health confidence, emergency department utilization, hospitalization, corticosteroid use, and opioid use. Attendance at monthly coached webinars was associated with improvement. DISCUSSION: Outcomes of IBD care were improved using a structured quality improvement program that facilitates small process changes, sharing of best practices, and ongoing feedback. Spread of these interventions may facilitate broad improvement in IBD care when applied to a large population.

Pulmonary Alveolar Proteinosis in Association with Secondary Hemophagocytic Lymphohistiocytosis.

Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease in the pediatric population. There are currently few cases documenting hemophagocytic lymphohistiocytosis as a cause for secondary PAP. We describe an ex-preterm child with secondary hemophagocytic lymphohistiocytosis, complicated by PAP and hypoxemic respiratory failure.

Genotype-phenotype characterization in 13 individuals with chromosome Xp11.22 duplications.

We report 13 new individuals with duplications in Xp11.22-p11.23. The index family has one male and two female members in three generations with mild-severe intellectual disability (ID), speech delay, dysmorphic features, early puberty, constipation, and/or hand and foot abnormalities. Affected individuals were found to have two small duplications in Xp11.22 at nucleotide position (hg19) 50,112,063-50,456,458 bp (distal) and 53,160,114-53,713,154 bp (proximal). Collectively, these two regions include 14 RefSeq genes, prompting collection of a larger cohort of patients, in an attempt to delineate critical genes associated with the observed phenotype. In total, we have collected data on nine individuals with duplications overlapping the distal duplication region containing SHROOM4 and DGKK and eight individuals overlapping the proximal region including HUWE1. Duplications of HUWE1 have been previously associated with non-syndromic ID. Our data, with previously published reports, suggest that duplications involving SHROOM4 and DGKK may represent a new syndromic X-linked ID critical region associated with mild to severe ID, speech delay +/- dysarthria, attention deficit disorder, precocious puberty, constipation, and motor delay. We frequently observed foot abnormalities, 5th finger clinodactyly, tapering fingers, constipation, and exercise intolerance in patients with duplications of these two genes. Regarding duplications including the proximal region, our observations agree with previous studies, which have found associations with intellectual disability. In addition, expressive language delay, failure to thrive, motor delay, and 5th finger clinodactyly were also frequently observed in patients with the proximal duplication.

Rethinking critical care: decreasing sedation, increasing delirium monitoring, and increasing patient mobility.

BACKGROUND: Sedation management, delirium monitoring, and mobility programs have been addressed in evidence-based critical care guidelines and care bundles, yet implementation in the ICU remains variable. As critically ill patients occupy higher percentages of hospital beds in the United States and beyond, it is increasingly important to determine mechanisms to deliver better care. The Institute for Healthcare Improvement's Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. Case studies of a convenience sample of five participating hospitals/health systems chosen in advance of the determination of their clinical outcomes are presented in terms of how they got started and process improvements in sedation management, delirium management, and mobility. METHODS: The IHI-RCC program involved one live case study and five iterations of an in-person seminar in a 33-month period (March 2011-November 2013) that emphasized interdisciplinary teamwork and culture change. RESULTS: Qualitative descriptions of the changes tested at each of the five case study sites demonstrate improvements in teamwork, processes, and reliability of daily work. Improvement in ICU length of stay and length of stay on the ventilator between the pre- and postimplementation periods varied from slight to substantial. CONCLUSION: Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The key lessons of the IHI-RCC program are as follows: the importance of testing changes on a small scale, feeding back data regularly and providing sufficient education, and building will through seeing the work in action.

The relationship of bedside nurses' emotional intelligence with quality of care.

Emotional intelligence, a predictor of productivity and success, may impact behaviors responsible for quality of care. This study examined if emotional intelligence of units' bedside nurses is related to the quality of care delivered to the patients. In this study, emotional intelligence was found to be correlated to the number of Clostridium difficile infections, MRSA infections, patient falls with injury, and pressure ulcer screenings (P < .001) in the inpatient acute care setting.

Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study.

BACKGROUND: Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored. OBJECTIVES: To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality. DESIGN: A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth. PARTCIPANTS: Home dialysis patients and their carers. MEASURUEMENTS: Suveys and qualitative interviews. METHODS: A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth. RESULTS: Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants. CONCLUSION: This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.

Characterization of 12 polymorphic microsatellite markers in the liverwort Marchantia inflexa (Marchantiaceae).

PREMISE OF THE STUDY: Microsatellite markers were developed in Marchantia inflexa, a haploid liverwort with unisexual individuals, to identify clonal genotypes and measure population genetic variability. METHODS AND RESULTS: Twelve polymorphic primer sets were developed from three enriched genomic libraries. Primers were fluorescently labeled, and alleles were identified by fragment analysis. These primers were tested in four natural populations and revealed a moderate level of genetic variation within four populations, as indicated by the number of alleles per locus (range = 1-5). CONCLUSIONS: Development of polymorphic markers is crucial to the identification of individuals and will allow additional research into this species, particularly on its population genetics and metapopulation dynamics.

Highly sensitive detection of exocytotic dopamine release using a gold-nanoparticle-network microelectrode.

Here we report a new type of microelectrode sensor for single-cell exocytotic dopamine release. The new microsensor is built by forming a gold-nanoparticle (AuNP) network on a carbon fiber microelectrode. First a gold surface is obtained on a carbon fiber microdisk electrode by partially etching away the carbon followed by electrochemical deposition of gold into the pore. The gold surface is chemically functionalized with a sol-gel silicate network derived from (3-mercaptopropyl)trimethoxysilane (MPTS). A AuNP network is formed by immobilizing Au nanoparticles onto the thiol groups in the sol-gel silicate network. The AuNP-network microelectrode has been characterized by scanning electron microscopy (SEM) and steady-state voltammetry. The AuNP-network microelectrode has been used for amperometric detection of exocytotic dopamine secretion from individual pheochromocytoma (PC12) cells. The results show significant differences in the kinetic peak parameters including shorter rise time, decay time, and half-width as compared to a bare carbon fiber electrode equivalent. These results indicate AuNP-network microelectrodes possess an excellent sensing activity for single-cell exocytotic catecholamine release, specifically dopamine. Moreover, key advantageous properties inherent to bare carbon fiber microelectrodes (i.e., rigidity, flexibility, and small size) are maintained in addition to an observed prolonged shelf life stability and resistance to cellular debris fouling and dopamine polymerization.

Steady-state electrochemical determination of lipidic nanotube diameter utilizing an artificial cell model.

By exploiting the capabilities of steady-state electrochemical measurements, we have measured the inner diameter of a lipid nanotube using Fick's first law of diffusion in conjunction with an imposed linear concentration gradient of electroactive molecules over the length of the nanotube. Fick's law has been used in this way to provide a direct relationship between the nanotube diameter and the measurable experimental parameters Deltai (change in current) and nanotube length. Catechol was used to determine the Deltai attributed to its flux out of the nanotube. Comparing the nanotube diameter as a function of nanotube length revealed that membrane elastic energy was playing an important role in determining the size of the nanotube and was different when the tube was connected to either end of two vesicles or to a vesicle on one end and a pipet tip on the other. We assume that repulsive interaction between neck regions can be used to explain the trends observed. This theoretical approach based on elastic energy considerations provides a qualitative description consistent with experimental data.

Estradiol inhibits depolarization-evoked exocytosis in PC12 cells via N-type voltage-gated calcium channels.

Fast neuromodulatory effects of 17-ß-estradiol (E2) on cytosolic calcium concentration ([Ca(2+)](i)) have been reported in many cell types, but little is known about its direct effects on vesicular neurotransmitter secretion (exocytosis). We examined the effects of E2 on depolarization-evoked [Ca(2+)](i) in PC12 cells using fluorescence measurements. Imaging of [Ca(2+)](i) with FURA-2 revealed that depolarization-evoked calcium entry is inhibited after exposure to 10 nM and 10 µM E2. Calcium entry after exposure to 50 µM E2 decreases slightly, but insignificantly. To relate E2-induced changes in [Ca(2+)](i) to functional effects, we measured exocytosis using amperometry. It was observed that E2 in some cells elicits exocytosis upon exposure. In addition, E2 inhibits depolarization-evoked exocytosis with a complex concentration dependence, with inhibition at both physiological and pharmacological concentrations. This rapid inhibition amounts to 45% at a near physiological level (10 nM E2), and 50% at a possible pharmacological concentration of 50 µM. A small percentage (22%) of cells show exocytosis during E2 exposure ("Estrogen stimulated"), thus vesicle depletion could possibly account (at least partly) for the E2-induced inhibition of depolarization-evoked exocytosis. In cells that do not exhibit E2-stimulated release ("Estrogen quiet"), the E2-induced inhibition of exocytosis is abolished by a treatment that eliminates the contribution of N-type voltage-gated calcium channels (VGCCs) to exocytosis. Overall, the data suggest that E2 can act on N-type VGCCs to affect secretion of neurotransmitters. This provides an additional mechanism for the modulation of neuronal communication and plasticity by steroids.

Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study.

BACKGROUND: There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients. AIM: The aim of this study was to test the feasibility of implementing the Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD) curriculum in real clinical practice settings. METHODS: This study used mixed methods including questionnaires and semi-structured interviews (pretraining and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over 6 months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis. RESULTS: Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 h (range 6-17) and 24.9 h (range 15-35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow-up. Three (21%) patients were transferred to haemodialysis due to non-PD-related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient). CONCLUSION: This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.

Advance Care Planning and End-of-Life Issues in Head and Neck Cancer.

Advance Care Planning and End of Life discussions are critical in all cancers but are often overlooked or delayed. Head and Neck Cancer patients have the added stigma of visible morbidity and negative quality of life issues. We present a case example and discussion of these issues in the Head and Neck cancer clinic.

Effect of Increased Blood Flow Rate on Hemodialysis Tolerability and Achieved Urea Reduction Ratio.

Long-term hemodialysis (HD) imposes a significant burden on the quality of life of end-stage kidney disease patients. Optimizing dialysis dose is an important consideration in this population; however, evidence exists that suggests that attainment of population dialysis targets is associated with increased intradialytic complications. In this prospective, before-after study, the blood flow rate (BFR) of 63 maintenance HD patients was increased by 100 mL/min to a maximum BFR of 400 mL/min to determine the impact on patient tolerability and urea reduction ratio (URR) of an increased BFR. Tolerability was assessed by time to recovery (TTR) after dialysis, a validated measure of patient tolerability, and intradialytic complications. Median pre-increase BFR was 252 mL/min compared to 349 mL/min post-increase. Mean TTR decreased from 4.67 h to 4.03 h (P = 0.688). No association was observed between percentage change in BFR (R2 = 0.0) or post-increase BFR (R2 = 0.0) and absolute change in TTR. A significant, positive association was observed between both the absolute and relative changes to BFR and the achieved URR. We found no evidence that increasing BFR by 100 mL/min diminishes patient tolerability.

Bronchodilator responsiveness assessed by forced oscillometry and multiple breath washout techniques in preschool children.

IMPORTANCE: The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function, and are reliable for preschool-age children. There has not been comparison testing to determine which test could more accurately differentiate between healthy controls and poorly controlled asthmatics, or differentiate a response to bronchodilator administration. OBJECTIVE: To determine whether the MBW and/or FOT could differentiate between healthy controls and poorly controlled asthmatics, and whether the two tests could detect a response to bronchodilator administration. METHODS: Twenty-eight healthy controls and 23 poorly controlled asthmatics 3-6 years of age participated. All subjects were administered the MBW followed by the FOT. A bronchodilator was then administered and testing was repeated. Wilcoxon Rank Sum tests were used to compare the difference between healthy controls and poorly controlled asthmatics. Wilcoxon Signed Rank tests were used to compare the pre- and post-bronchodilator values. RESULTS: Neither MBW nor FOT differentiated healthy controls from poorly controlled asthmatics (pre-bronchodilator data); both groups had similar baseline gas mixing and airway mechanics. There was no improvement in any MBW outcomes post-bronchodilator administration. FOT detected a significant and similar degree of improvement in the airway mechanics in both groups. INTERPRETATION: Neither MBW nor FOT differentiated between poorly controlled asthmatics (when well) and healthy controls. MBW did not detect a significant bronchodilator response in either subject group, whereas FOT detected a similar degree of bronchodilator responsiveness in both groups. This discrepancy may reflect differential changes in airway mechanics and gas mixing properties in response to bronchodilators.

High osmolarity and L-DOPA augment release via the fusion pore in PC12 cells.

We have amperometrically measured dopamine release from rat pheochromocytoma cells (PC12 cells) in high osmolarity conditions with and without L-3,4-dihydroxyphenylalanine (L-DOPA) treatment. We observe an increase in the number of release events displaying a prespike feature or "foot" when the cells are stimulated in high osmolarity saline. We also see an increase in foot area and duration when cells are stimulated in high osmolarity saline, or high osmolarity saline subsequent to incubation with the dopamine precursor L-DOPA in isotonic saline, which serves to increase the vesicle size. The data suggest that membrane biophysics are an important component in defining the rate, duration and amount of neurotransmitter release via the fusion pore.

Status of nutrition education in medical schools.

BACKGROUND: Numerous entreaties have been made over the past 2 decades to improve the nutrition knowledge and skills of medical students and physicians. However, most graduating medical students continue to rate their nutrition preparation as inadequate. OBJECTIVE: The objective was to determine the amount and type of nutrition instruction at US medical schools, especially including the instruction that occurs outside designated nutrition courses. DESIGN: A 12-item survey asked nutrition educators to characterize nutrition instruction at their medical schools (required, optional, or not offered) and to quantify nutrition contact hours occurring both inside and outside designated nutrition courses. During 2004, we surveyed all 126 US medical schools accredited at that time. RESULTS: A total of 106 surveys were returned for a response rate of 84%. Ninety-nine of the 106 schools responding required some form of nutrition education; however, only 32 schools (30%) required a separate nutrition course. On average, students received 23.9 contact hours of nutrition instruction during medical school (range: 2-70 h). Only 40 schools required the minimum 25 h recommended by the National Academy of Sciences. Most instructors (88%) expressed the need for additional nutrition instruction at their institutions. CONCLUSION: With the move to a more integrated curriculum and problem-based learning at many medical schools, a substantial portion of the total nutrition instruction is occurring outside courses specifically dedicated to nutrition. The amount of nutrition education in medical schools remains inadequate.