Cross-sectional analysis of primary care clinics' policies, practices, and availability of patient support services during the COVID-19 pandemic.

BACKGROUND: Healthcare accessibility and utilization are important social determinants of health. Lack of access to healthcare, including missed or no-show appointments, can have negative health effects and be costly to patients and providers. Various office-based approaches and community partnerships can address patient access barriers. OBJECTIVES: (1) To understand provider perceptions of patient barriers; (2) to describe the policies and practices used to address late or missed appointments, and (3) to evaluate access to patient support services, both in-clinic and with community partners. METHODS: Mailed cross-sectional survey with online response option, sent to all Nebraska primary care clinics (n = 577) conducted April 2020 and January through April 2021. Chi-square tests compared rural-urban differences; logistic regression of clinical factors associated with policies and support services computed odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Response rate was 20.3% (n = 117), with 49 returns in 2020. Perceived patient barriers included finances, higher among rural versus urban clinics (81.6% vs. 56.1%, p =.009), and time (overall 52.3%). Welcoming environment (95.5%), telephone appointment reminders (74.8%) and streamlined admissions (69.4%) were the top three clinic practices to reduce missed appointments. Telehealth was the most commonly available patient support service in rural (79.6%) and urban (81.8%, p =.90) clinics. Number of providers was positively associated with having a patient navigator/care coordinator (OR = 1.20, CI = 1.02-1.40). For each percent increase in the number of privately insured patients, the odds of providing legal aid decreased by 4% (OR = 0.96, CI = 0.92-1.00). Urban clinics were less likely than rural clinics to provide social work services (OR = 0.16, CI = 0.04-0.67) or assist with applications for government aid (OR = 0.22, CI = 0.06-0.90). CONCLUSIONS: Practices to reduce missed appointments included a variety of reminders. Although finances and inability to take time off work were the most frequently reported perceived barriers for patients' access to timely healthcare, most clinics did not directly address them. Rural clinics appeared to have more community partnerships to address underlying social determinants of health, such as transportation and assistance applying for government aid. Taking such a wholistic partnership approach is an area for future study to improve patient access.

Loneliness status transitions and risk of cardiovascular disease among middle-aged and older adults.

BACKGROUND AND AIMS: Loneliness is a risk factor for cardiovascular disease (CVD), and the levels at which individuals experience it can transition over time. However, the impact of increased loneliness or decreased loneliness on later CVD risk remains unexplored. We aimed to identify the age-specific association between loneliness status transitions and subsequent CVD incidences in middle-aged and older adults. METHODS AND RESULTS: Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS) on 8463 adults to evaluate how loneliness status transitions across two data collection points were associated with the subsequent CVD incidence at a five-year follow-up. Loneliness status transitions were divided into four categories: stable low loneliness, decreased loneliness, increased loneliness, and stable high loneliness. Data were analyzed using a Cox-proportional hazards model with age subgroups, accounting for covariates at baseline. During follow-up, the incidence rate of CVD per 1000 person-years was lower for the stable low loneliness group and decreased loneliness group compared to the increased loneliness and stable high loneliness group. Increased loneliness is associated with the highest risk of overall CVD and heart disease (HR 2.44, P < 0.001; HR 2.34, P < 0.001), while stable high loneliness is associated with the highest risk of stroke among the four loneliness categories (HR 4.29, P < 0.05). The age-specific analyses revealed no statistically significant interaction in terms of loneliness status transitions and age group. CONCLUSION: Increased loneliness and stable high loneliness are associated with higher CVD risk. In clinical practice, it is important to monitor patients' loneliness status transitions to reduce CVD incidences.

Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer.

PURPOSE: The treatment approach for non-metastatic bladder cancer is guided by an invasion of the muscular layer of the bladder wall. Radical cystectomy is the recommended treatment for muscle-invasive disease. However, it has considerable morbidity and mortality and is not suited for many patients. Trimodality therapy consisting of chemoradiation after transurethral resection of bladder tumor offers a definitive approach with bladder-sparing potential. However, there is a lack of research defining the optimal combination of chemotherapy and radiation in this setting. MATERIALS AND METHODS: We extracted patient data from the National Cancer Database to compare survival outcomes and demographic factors in 2,227 non-metastatic bladder cancer patients who were treated with chemotherapy sequential to or concurrently with radiation. Sequential treatment was defined as chemotherapy beginning >14 days before radiation, and concurrent was defined as beginning within 14 days of the first radiation. RESULTS: The sequential treatment group patients were younger (mean age, 74 vs. 78 years; p < 0.001) with more advanced disease. We found no difference in overall survival between patients who received chemotherapy sequential to radiation and those who received concurrent chemoradiation only (p = 0.533). CONCLUSION: Our data are concordant with a previous prospective study, and support that chemotherapy prior to radiation does not decrease survival outcomes relative to patients receiving only concurrent chemoradiation. Given that the sequential group had an overall higher stage but no difference in survival, downstaging chemotherapy prior to radiation may be helpful in these patients. Further studies including a larger, multi-institutional clinical trial are indicated to support clinical decision-making.

Clinical and epidemiological features of high-risk human papillomavirus infection in patients with cervical intraepithelial lesions.

OBJECTIVE: In this study, we analyzed the clinical and epidemiological features of high-risk human papillomavirus (HR-HPV) infection in patients with cervical intraepithelial lesions. METHODS: Retrospective analysis was performed on the clinical data of 240 cases of histologically confirmed cervical squamous intraepithelial lesions to determine any correlation between HPV infection characteristics, age distribution, and cervical epithelial lesions. RESULTS: Patients between the ages of 31 and 40 with cervical intraepithelial lesions were more likely to have high-grade squamous intraepithelial lesions (HSIL; 40.7%) than low-grade squamous intraepithelial lesions (LSIL; 31.3%) (P < 0.05). In patients with HSIL, HR-HPV16, HR-HPV33, and HR-HPV52 were the most common types of HPV infection, while in patients with LSIL, HR-HPV16, HR-HPV52, and HR-HPV58 were the most common types of HPV infection. The highest percentage of single infections occurred in the HSIL group (69.6%), followed by the LSIL group (68.8%). HSIL was present in a significant number of patients (28.6%) aged 30 years and above who tested positive for 12 HPV types but negative for TCT. CONCLUSION: The prevalence of HSIL is greatest in younger patients. Patients with cervical epithelial lesions typically have a single infection of a high-risk HPV genotype-HR-HPV16, HR-HPV33, HR-HPV52, or HR-HPV58. Patients aged 30 years and above who test positive for one of 12 types of HPV but negative for TCT are at increased risk for developing HSIL. In order to detect cervical lesions early and begin treatment without delay, colposcopy should be performed regardless of whether or not a high-risk HPV infection is present.

Comparison of droplet digital PCR and real-time quantitative PCR for quantitative detection of the parasitic ciliate Ichthyophthirius multifiliis in the water environment.

Ichthyophthiriasis, caused by the parasitic ciliate Ichthyophthirius multifiliis (Ich), is considered one of the most harmful diseases affecting freshwater fish globally. It can cause mass mortalities of fish in intensive farming systems. In such systems, it is thus necessary to detect and quantify the number of Ich in the water so that control measures can be implemented before Ichthyophthiriasis breaks out. In recent years, molecular diagnostic methods have become increasingly important in aquaculture. Real-time quantitative polymerase chain reaction (qPCR) and droplet digital polymerase chain reaction (ddPCR) have become robust assays for detecting pathogens. In this study, a set of specific primers and a TaqMan-minor groove binder probe targeting the small-subunit rDNA (SSU rDNA) of Ich were developed. They were used in qPCR and ddPCR assays to compare the performance of these two different methods in quantitatively detecting Ich. After optimizing the reaction conditions, both qPCR and ddPCR assays were found to have high linearity and quantitative correlations for standard plasmid DNA. When used for the detection of Ich eDNA in water samples, the qPCR assay had a wider detection range, making it a suitable method to screen for the prevalence of Ichthyophthiriasis. However, the ddPCR approach had higher sensitivity, which would help provide advance notice of the disease in complex water environmental samples.

In Vitro Assessment of Berberine against Ichthyophthirius multifiliis in Goldfish.

Ichthyophthirius multifiliis is a pathogenic ciliate parasite, which infects almost all freshwater teleost fish and leads to significant economic losses. The present study aimed to evaluate the acute toxicity of berberine to the free-living stages of I. multifiliis, that is, theronts and tomonts. Our results indicated that 99.30% of I. multifiliis theronts were killed by a concentration of 15 mg/L berberine during the 4 h exposure time, while berberine had no effect on protomonts. Nevertheless, berberine at a concentration of 5 mg/L could effectively reduce the release of theronts from tomonts treated for 4 h. Additionally, according to the transmission electron microscopy results, berberine at 15 mg/L could strongly change the shape of protomonts, destroy their organelles, and significantly decrease the number of ribosomes. The median lethal concentration (LC50) of berberine for goldfish at 96 h was 528.44 mg/L, which was almost 67 times the median effective concentration (EC50) of berberine for killing theronts (7.86 mg/L). The results demonstrated that berberine could be an effective and safe potential parasiticide for killing I. multifiliis.

Strong Anisotropic Optical Properties by Rolling up MoS2 Nanoflake.

Although anisotropic two-dimensional materials have attracted great scientific interest, the anisotropy of those materials is limited to particular crystallographic directions. Herein, with dimension confining, MoS2 nanoscrolls are successfully fabricated by a rolling-up process after dropping an ethanol-water solution on a chemical vapor deposition-grown MoS2 monolayer. The anisotropic vibrational and optical properties are systematically studied by angle-resolved polarized spectroscopy, including Raman, photoluminescence, and reflection measurements. Upon comparing the photoluminescence results between MoS2 nanoscrolls and nanosheets, an obvious PL quenching phenomenon is observed, indicating the efficient separation of photon-induced carriers. Moreover, the time-resolved PL test identifying the lifetime of the carriers is decreased to 303 ps in the nanoscrolls, indicating a higher carrier-transfer efficiency. In summary, our work demonstrates the strong anisotropic optical properties of MoS2 nanorolls, showing the nanoscrolls are a promising candidate for the fabrication of multifunctional devices.

Visible light waveband Dammann grating based on all-dielectric metasurface.

Dammann gratings (DGs) can generate a spot array in a particular arrangement. In recent years, DGs have been used in many fields such as laser beam splitting and optical coupling. Nanograting encoding technology can achieve a high signal-to-noise ratio and high-efficiency diffraction distribution; it also provides new design ideas for realizing the miniaturization and deviceization of DGs. In this work, we have comprehensively studied the DG based on an all-dielectric metasurface, which can produce a 5×5 diffraction spot array with a diffraction angle of 20∘×20∘. In an operation waveband from 650 to 690 nm, the DG has superior performance with high efficiency ≥60%; meanwhile, it achieves a relative low contrast ratio ≤0.33. Owing to high efficiency, wide waveband performance, and polarization insensitive property, the all-dielectric metasurface DG can provide possibilities for various application, including laser technology and optical information processing.

A new species of Trichodina lishuiensis n. sp. (Ciliophora: Trichodinidae) in urinary bladder of Odorrana schmackeri (Amphibia: Ranidae) from Zhejiang, China.

Endoparasitic trichodinids are rather rare ciliates. In this study we describe a new species named Trichodina lishuiensis from the bladder of Odorrana schmackeri collected in Zhejiang, China, with the prevalence of 20% (9/45). We identified T. lishuiensis as a new species by morphological comparison and molecular analysis. The ciliates were observed using the dry-silver and protargol staining methods, as well as SEM (scanning electron microscopy). Trichodina lishuiensis is a small species (cell diameter 31.8-43.9 µm), with incompact denticles connection, medium-wide blades and thick rays. We also sequenced a 1712 bp-long fragment of the small subunit ribosomal RNA gene (SSU rRNA). Phylogenetic analyses showed that the new species clustered with Trichodina unionis. The route of transmission of Trichodina species in the urinary bladder remains a mystery. We hypothesize that the transmisison takes place during the amplexus, with eggs and sperm discharged from the cloaca, and that trichodinids 'accompany' the amphibian through its whole life cycle, but further studies are needed to test this hypothesis.

Redescription of Opalina triangulata (Heterokonta, Opalinea) from Fejervarya limnocharis based on morphological and molecular data.

Opalinids are a large group of anaerobic protists, mainly inhabiting the cloacae of amphibians (frogs and toads). The classification of this group has not been fully resolved, because of a lack of molecular information. Here, we give a redescription of Opalina triangulata Metcalf, 1923, collected from the rectum of the frog Fejervarya limnocharis, based on detailed morphological and molecular data. Our phylogenetic analyses confirmed the monophyly of Opalinata. Within it, Opalinea were monophyletic with O. triangulata and O. undulata as well as two Protoopalina species grouping together. Karotomorpha and Proteromonas did not group together confirming the paraphyly of Proteromonadea. Meanwhile, the ITS2 secondary structural similarities as well as G-C content revealed greater similitudes between Opalina species and P. lacertae than with Blastocystis hominis, which is in accordance with their position as sister clades in the SSU rDNA-based phylogenies.

Epidemiology and identification of two species of Chilodonella affecting farmed fishes in China.

The genus Chilodonella includes free-living ciliated protozoa as well as pathogenic species for freshwater fish, with Chilodonella hexasticha and Chilodonella piscicola being the most important ones. These parasites cause outbreaks with high mortalities among farmed freshwater fishes with great economic losses. There are few reports of these species in China, and their identification has been based mostly on their morphological characteristics. In the present work, the parasites causing five outbreaks occurring in China between 2014 and 2017 have been identified by morphological and genetic analysis. We provide the first records of Ctenopharingodon idella and Siniperca chuatsi as hosts of C. hexasticha, and of Procypris rabaudi and Schizothorax wangchiachii as hosts of C. piscicola. There are no differences in the gross pathological findings produced by C. hexasticha and C. piscicola, consisting in desquamation and necrosis of epithelial cells in the skin and gills and in severe fusion of gill lamellae. However, both species differ in their geographic distribution: C. piscicola was found in farms located at altitudes over 1500 m above sea level and with a water temperature ≤18 °C, while C. hexasticha was found in farms located at altitudes under 50 m above sea level and with a water temperature ≥21 °C. Present results confirm that C. hexasticha and C. piscicola are two different species that can be differenced by their morphology; however, their biological variability may lead to erroneous identifications and the diagnosis should be preferably based in genetic analysis including nuclear LSU rDNA and mitochondrial SSU rDNA sequences.

Sicuophora (Syn. Wichtermania) multigranularis from Quasipaa spinosa (Anura): morphological and molecular study, with emphasis on validity of Sicuophora (Armophorea, Clevelandellida).

Morphological studies of Sicuophora (Syn. Wichtermania) multigranularis Xiao et al., 2002, from the rectum of the frog, Quasipaa spinosa, performed using silver impregnation and scanning electron microscopy, confirmed the following newly recognized features: (1) only one apical suture on the right surface; (2) two naked regions at the posterior end of both the left and the right side of the body. Phylogenetic analysis based on the SSU-rRNA gene showed that S. multigranularis is a sister to a clade comprising all other Clevelandellida, strongly supporting the validity of the genus Sicuophora. This is also the first molecular data obtained for the genus Sicuophora. Because of the lack of molecular data, it will be necessary to obtain more genetic data from the family Sicuophoridae to discuss the question of the taxonomic status of the genus Sicuophora.

Balantidium grimi n. sp. (Ciliophora, Litostomatea), a new species inhabiting the rectum of the frog Quasipaa spinosa from Lishui, China.

Balantidium grimi n. sp. is described from the rectum of the frog Quasipaa spinosa (Amphibia, Dicroglossidae) from Lishui, Zhejiang Province, China. The new species is described by both light microscopy (LM) and scanning electron microscopy (SEM), and a molecular phylogenetic analysis is also presented. This species has unique morphological features in that the body shape is somewhat flattened and the vestibulum is "V"-shaped, occupying nearly 3/8 to 4/7 of the body length. Only one contractile vacuole, situated at the posterior body, was observed. The phylogenetic analysis based on SSU-rDNA indicates that B. grimi groups together with B. duodeni and B. entozoon. In addition, the genus Balantidium is clearly polyphyletic.

Expression profiles of stemness genes in gastrointestinal stromal tumor.

Gastrointestinal stromal tumor (GIST) is believed to originate from intestinal cells of Cajal or their stem cell precursors, and expresses stemness-related markers, such as CD117, CD34, DOG1 and nestin. To further characterize phenotypic features of GISTs, we examined expression profiles of a panel of stemness genes in GISTs, by analyzing existing gene expression profiling datasets. Our results showed that mRNA levels of B-lymphoma moloney murine leukaemia virus insertion region-1 (BMI1), kruppel-like factor 4 (KLF4), sal-like protein 4 (SALL4) and telomerase reverse transcriptase (TERT) were significantly unregulated in GISTs. Subsequently, protein expression of BMI1 and TERT was identified in GIST specimens by immunohistochemistry. Especially, we found that high expression of nuclear BMI1 was associated with large tumor size (P = .0239), high mitotic count (P < .01), high Ki-67 index (P = .0357), advanced National Institute of Health (NIH) criteria (P = .0025) and advanced World Health Organization (WHO) classification (P < .01) in GISTs. Functional and pathway enrichment analysis showed that most of BMI1's coexpressed genes were involved in tumor growth-related process, such as regulation of cell cycle and proliferation. Furthermore, we confirmed RAS oncogene family (RAB18) and limb development membrane protein 1 (LMBR1) genes as novel targets for BMI1 in GIST cells. These results provide valuable information for the expression profiles of stemness genes in GISTs, and identified nuclear BMI1 as an important marker of GIST cell proliferation and progression.

Unveiling the signals from extremely noisy microseismic data for high-resolution hydraulic fracturing monitoring.

Microseismic method is an essential technique for monitoring the dynamic status of hydraulic fracturing during the development of unconventional reservoirs. However, one of the challenges in microseismic monitoring is that those seismic signals generated from micro seismicity have extremely low amplitude. We develop a methodology to unveil the signals that are smeared in the strong ambient noise and thus facilitate a more accurate arrival-time picking that will ultimately improve the localization accuracy. In the proposed technique, we decompose the recorded data into several morphological multi-scale components. In order to unveil weak signal, we propose an orthogonalization operator which acts as a time-varying weighting in the morphological reconstruction. The orthogonalization operator is obtained using an inversion process. This orthogonalized morphological reconstruction can be interpreted as a projection of the higher-dimensional vector. We first test the proposed technique using a synthetic dataset. Then the proposed technique is applied to a field dataset recorded in a project in China, in which the signals induced from hydraulic fracturing are recorded by twelve three-component (3-C) geophones in a monitoring well. The result demonstrates that the orthogonalized morphological reconstruction can make the extremely weak microseismic signals detectable.