Family Medicine Team Perspectives on Screening for Health-Related Social Needs.

INTRODUCTION: Social drivers of health (SDH) strongly influence health outcomes and disparities. Although systemic level change is vital to address the disparities driven by SDH, it is also crucial that health care organizations develop the ability to care for patients in a manner that accounts for social factors and their influence on patient health. Although primary care is a natural fit for health-related social needs (HRSN) screening and intervention, significant barriers can impede primary care's effectiveness in this area. METHODS: We conducted 3 focus groups with family medicine clinicians, clinical staff, and social care workers in an academic medical center using a semistructured discussion guide to explore current practices, perceived benefits, barriers, and potential opportunities and approaches for integrating routine HRSN screening in primary care. RESULTS: 3 primary themes emerged from the focus groups. They included 1) the barriers to routine screening in primary care, including time, workload, emotional burden, patient factors, and team members' fear of inadequacy of resources or their own ability; 2) the importance and benefit of HRSN screening, including the opportunity to improve patient care through increased care team awareness of the patient's context, interventions to address HRSN, and improved relationships between the care team and the patient; and 3) recommendations for implementing routine screening in primary care, including opportunities to optimize workflow and technology, the importance of an electronic medical record (EMR)-integrated resource database, and the centrality of teamwork. DISCUSSION: Family medicine health care teams embrace the importance of HRSN screening and the potential for positive impact. However, there are vital barriers and considerations to address for HRSN screening to be effectively integrated into primary care visits.

Differences between surfactant-free Au@Ag and CTAB-stabilized Au@Ag star-like nanoparticles in the preparation of nanoarrays to improve their surface-enhanced Raman scattering (SERS) performance.

In this study, we assessed the controlled synthesis and efficacy of surface-enhanced Raman scattering (SERS) on two distinct types of star-like Au@Ag core-shell nanoarrays. These nanoarrays were designed based on gold nanostars (AuNSs), which were synthesized with and without CTAB surfactant (AuNSs-CTAB and AuNSs-FS, respectively). The AuNS-FS nanoparticles were synthesized via a novel modification process, which helped overcome the previous limitations in the free-surfactant preparation of AuNSs by significantly increasing the number of branches, increasing the sharpness of the branches and minimizing the adsorption of the surfactant on the surface of AuNSs. Furthermore, the differences in the size and morphology of these AuNSs in the created nanoarrays were studied. To create the nanoarrays, a three-step method was employed, which involved the controlled synthesis of gold nanostars, covering them with a silver layer (AuNSs-FS@Ag and AuNSs-CTAB@Ag), and finally self-assembling the AuNS@Ag core-shelled nanoparticles via the liquid/liquid self-assembly method. AuNSs-FS@Ag showed higher ability in forming self-assembled nanoarrays than the nanoparticles prepared using CTAB, which can be attributed to the decrease in the repulsion between the nanoparticles at the interface. The nano-substrates developed with AuNSs-FS@Ag possessed numerous "hot spots" on their surface, resulting in a highly effective SERS performance. AuNSs-FS featured a significantly higher number of sharp branches than AuNSs-CTAB, making it the better choice for creating nanoarrays. It is worth mentioning that AuNSs-CTAB did not exhibit the same benefits as AuNSs-FS. The morphology of AuNSs with numerous branches was formed by controlling the seed boiling temperature and adding a specific amount of silver ions. To compare the SERS activity between the as-prepared nano-substrates, i.e., AuNS-CTAB@Ag and AuNS-FS@Ag self-assembled nanoarrays, low concentrations of crystal violet aqueous solution were characterized. The results showed that the developed AuNSs-FS@Ag could detect CV at trace concentrations ranging from 1.0 ng mL-1 to 10 ng mL-1 with a limit of detection (LOD) of 0.45 ng mL-1 and limit of quantification (LOQ) of 1.38 ng mL-1. The nano-substrates remained stable for 42 days with a decrease in the intensity of the characteristic Raman peaks of CV by less than 7.0% after storage. Furthermore, the spiking method could detect trace amounts of CV in natural water from the Dong Nai River with concentrations as low as 1 to 100 ng mL-1, with an LOD of 6.07 ng mL-1 and LOQ of 18.4 ng mL-1. This method also displayed good reproducibility with an RSD value of 5.71%. To better understand the impact of CTAB stabilization of the Au@Ag star-like nanoparticles on their surface-enhanced Raman scattering (SERS) performance, we conducted density functional theory (DFT) calculations. Our research showed that the preparation of AuNSs-FS@Ag via self-assembly is an efficient, simple, and fast process, which can be easily performed in any laboratory. Furthermore, the research and development results presented herein on nanoarrays have potential application in analyzing and determining trace amounts of organic compounds in textile dyeing wastewater.

Factors influencing the readiness to tackle the burden of ischaemic heart disease in India: a systematic review protocol.

INTRODUCTION: Ischaemic heart disease (IHD) is one of the leading causes of death and disease burden in India affecting all age groups. To reduce the deaths and tackle the burden of existing IHD, the government approach has been mostly through the National Health Policy (2017) and National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke. This paper offers a protocol for the systematic review of studies exploring the factors influencing service readiness of the public health system of India to tackle the burden of IHD. METHODS AND ANALYSIS: Electronic databases of Embase (Ovid), AMED (Ovid), HMIC (Ovid), BNI (ProQuest), CINAHL (EBSCO), EMCARE (Ovid), PsycINFO (ProQuest), MEDLINE/PubMed and Web of Science (Clarivate Analytics) will be searched till 2020 for primary studies. Grey literature will be accessed through OpenGrey, TRIP Medical, WHO database, MoHFW website, Open Government Data (OGD) Platform of India and Google Scholar (between 2010 and 2020). Primary studies meeting the eligibility criteria and grey literature published in English between 2010 and 2020 will be included. Data will be analysed through a conceptual framework, and the primary outcome will constitute both quantitative and qualitative data. The quality of included studies will be assessed based on study design. Data will be managed on the COVIDENCE platform. All authors will be involved in data extraction, quality appraisal, data synthesis and formulation of the final draft. ETHICS AND DISSEMINATION: This study, being a systematic review, does not involve any clinical trial, primary data collection or empirical study involving humans or animals. Therefore, no ethical permissions were sought by reviewers. PROSPERO REGISTRATION NUMBER: CRD42020219490.

A frequent nonsense mutation in exon 1 across certain HLA-A and -B alleles in leukocytes of patients with acquired aplastic anemia.

Leukocytes that lack HLA allelic expression are frequently detected in patients with acquired aplastic anemia (AA) who respond to immunosuppressive therapy (IST), although the exact mechanisms underlying the HLA loss and HLA allele repertoire likely to acquire loss-of-function mutations are unknown. We identified a common nonsense mutation at position 19 (c.19C>T, p.R7X) in exon 1 (Exon1mut) of different HLA-A and -B alleles in HLA-lacking granulocytes from AA patients. A droplet digital PCR (ddPCR) assay capable of detecting as few as 0.07% Exon1mut HLA alleles in total DNA revealed the mutation was present in 29% (101/353) of AA patients, with a median allele frequency of 0.42% (range, 0.071% to 21.3%). Exon1mut occurred in only 12 different HLA-A (n=4) and HLA-B (n=8) alleles, including B*40:02 (n=31) and A*02:06 (n=15), which correspond to 4 HLA supertypes (A02, A03, B07, and B44). The percentages of patients who possessed at least one of these 12 HLA alleles were significantly higher in the 353 AA patients (92%, P.

Effects of B2O3 doping on the crystalline structure and performance of DC-magnetron-sputtered, transparent ZnO thin films.

The transparent-conducting performance is estimated through figure-of-merit (FOM) value. To improve poor FOM value of pure ZnO thin films, boron (B) as a donor impurity was doped into the films. Direct-current magnetron sputtering was used to prepare B-doped ZnO (BZO) thin films from sintered ZnO targets with variable B2O3 content changing from 0 to 2 wt. %. The x ray diffraction analysis confirmed the preferably c-axis-oriented structure of hexagonal wurtzite ZnO host. The results also showed variation in the film structure versus the B2O3 content through calculations of crystal size and residual stress. Depending on the B2O3 content, a competition of interstitial and substitutional B3+ ions induced more stress or relaxation in lattice structure of the films. At 1% B2O3, the BZO thin film had the best crystalline characterization with the lowest stress and large crystal size. In consequence, the BZO 1% film obtained the lowest resistivity of 2.7×10-3Ωcm, average transmittance of 82.1%, and the best FOM value of 18.8×102Ω-1cm-1. The transparent-conducting performance of the ZnO thin films deposited by direct-current (DC) magnetron sputtering was significantly enhanced through B doping. The good-performance BZO film at 1% B2O3 is believed to be of use as electrodes in thin-film solar cells.

Using GARDEN-NET and ChAseR to explore human haematopoietic 3D chromatin interaction networks.

We introduce an R package and a web-based visualization tool for the representation, analysis and integration of epigenomic data in the context of 3D chromatin interaction networks. GARDEN-NET allows for the projection of user-submitted genomic features on pre-loaded chromatin interaction networks, exploiting the functionalities of the ChAseR package to explore the features in combination with chromatin network topology properties. We demonstrate the approach using published epigenomic and chromatin structure datasets in haematopoietic cells, including a collection of gene expression, DNA methylation and histone modifications data in primary healthy myeloid cells from hundreds of individuals. These datasets allow us to test the robustness of chromatin assortativity, which highlights which epigenomic features, alone or in combination, are more strongly associated with 3D genome architecture. We find evidence for genomic regions with specific histone modifications, DNA methylation, and gene expression levels to be forming preferential contacts in 3D nuclear space, to a different extent depending on the cell type and lineage. Finally, we examine replication timing data and find it to be the genomic feature most strongly associated with overall 3D chromatin organization at multiple scales, consistent with previous results from the literature.

The small regulatory RNA FasX enhances group A Streptococcus virulence and inhibits pilus expression via serotype-specific targets.

Bacterial pathogens commonly show intra-species variation in virulence factor expression and often this correlates with pathogenic potential. The group A Streptococcus (GAS) produces a small regulatory RNA (sRNA), FasX, which regulates the expression of pili and the thrombolytic agent streptokinase. As GAS serotypes are polymorphic regarding (a) FasX abundance, (b) the fibronectin, collagen, T-antigen (FCT) region of the genome, which contains the pilus genes (nine different FCT-types), and (c) the streptokinase-encoding gene (ska) sequence (two different alleles), we sought to test whether FasX regulates pilus and streptokinase expression in a serotype-specific manner. Parental, fasX mutant and complemented derivatives of serotype M1 (ska-2, FCT-2), M2 (ska-1, FCT-6), M6 (ska-2, FCT-1) and M28 (ska-1, FCT-4) isolates were compared. While FasX reduced pilus expression in each serotype, the molecular basis differed, as FasX bound, and inhibited the translation of, different FCT-region mRNAs. FasX enhanced streptokinase expression in each serotype, although the degree of regulation varied. Finally, we established that the regulation afforded by FasX enhances GAS virulence, assessed by a model of bacteremia using human plasminogen-expressing mice. Our data are the first to identify and characterize serotype-specific regulation by an sRNA in GAS, and to show an sRNA directly contributes to GAS virulence.

Natural disruption of two regulatory networks in serotype M3 group A Streptococcus isolates contributes to the virulence factor profile of this hypervirulent serotype.

Despite the public health challenges associated with the emergence of new pathogenic bacterial strains and/or serotypes, there is a dearth of information regarding the molecular mechanisms that drive this variation. Here, we began to address the mechanisms behind serotype-specific variation between serotype M1 and M3 strains of the human pathogen Streptococcus pyogenes (the group A Streptococcus [GAS]). Spatially diverse contemporary clinical serotype M3 isolates were discovered to contain identical inactivating mutations within genes encoding two regulatory systems that control the expression of important virulence factors, including the thrombolytic agent streptokinase, the protease inhibitor-binding protein-G-related α2-macroglobulin-binding (GRAB) protein, and the antiphagocytic hyaluronic acid capsule. Subsequent analysis of a larger collection of isolates determined that M3 GAS, since at least the 1920s, has harbored a 4-bp deletion in the fasC gene of the fasBCAX regulatory system and an inactivating polymorphism in the rivR regulator-encoding gene. The fasC and rivR mutations in M3 isolates directly affect the virulence factor profile of M3 GAS, as evident by a reduction in streptokinase expression and an enhancement of GRAB expression. Complementation of the fasC mutation in M3 GAS significantly enhanced levels of the small regulatory RNA FasX, which in turn enhanced streptokinase expression. Complementation of the rivR mutation in M3 GAS restored the regulation of grab mRNA abundance but did not alter capsule mRNA levels. While important, the fasC and rivR mutations do not provide a full explanation for why serotype M3 strains are associated with unusually severe invasive infections; thus, further investigation is warranted.

Clinical features and treatment of 108 patients with mandibullar fracture in the Institute of Maxillo facio Dentology

Observe clinical fractures and management of 108 cases treated of maxcillary fractures at the institutes of Odontostomatology in Hanoi during 2 years (2000-2001), we reported as follow: 1. The main cause of maxillary fractures was traffic accident (92.66%). Of which motorbikes were attributed the highest percentage (64.44%) of total cases. 2. Clinical features: Age also influenced the incidence of maxillary fractures, of which the age group 18-39 toped the rank 75%. The age average 29.52+/- 10.38 years. - Male predominated over female with the ratio of 6/1.- The main object maxillary fractures is farm rice. Regarding the classification of maxillary fractures: complete bilateral maxillary fractures Le Fort II ranked the first with 9.25%. The compounds maxillary fractures with other bones and organs are the highest percentage. 3. Methods: there are 3 ways were applied for maxillary fractures. At the present time often use osteosynthesis with wires and miniplate, fixed stable maxillary follow Miton Adam. 4. The result of treatment: 100% of good results after 1 week. 93.66% of good result after 6 week. 92.21% of good result after 3 months