Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 278
Filtrar
1.
Insects ; 15(5)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38786872

RESUMO

Prior to the recent implementation of the Mpp51Aa2 pesticidal protein (ThryvOn), transgenic cotton cultivars have historically offered no control of the cotton fleahopper (Pseudatomocelis seriatus (Reuter)). To evaluate the feeding behavior of cotton fleahoppers on ThryvOn cotton, electropenetrography (EPG) using a Giga-8 DC instrument was used to monitor the probing activity of fourth- and fifth-instar cotton fleahopper nymphs on both ThryvOn and non-ThryvOn cotton squares. Nymphs were individually placed on an excised cotton square for 8 h of EPG recording, after which resulting waveforms were classified as non-probing, cell rupturing, or ingestion. Although there were significantly more cell rupturing events per insect on ThryvOn (mean ± SEM, 14.8 ± 1.7) than on non-ThryvOn squares (mean ± SEM, 10.3 ± 1.6), there was no difference attributable to ThryvOn in the average number of ingestion events per insect. However, the average duration of ingestion events was significantly shorter on squares with ThryvOn (mean ± SEM, 509 ± 148 s) than on squares without (mean ± SEM, 914 ± 135 s). This suggests that cotton fleahoppers continued to probe despite their inability to sustain ingestion. These results provide conclusive evidence that the Mpp51Aa2 pesticidal protein affects the feeding behavior of cotton fleahopper nymphs.

2.
J Shoulder Elbow Surg ; 33(8): e403-e414, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38325556

RESUMO

BACKGROUND: Preoperative biomedical patient characteristics are known to affect the time to achievement of clinically significant outcomes (CSOs) following arthroscopic rotator cuff repair (RCR). However, less is known about the association between preoperative mental status and the time to achievement of CSOs. We hypothesize that higher preoperative mental status is associated with faster achievement of CSOs following arthroscopic RCR. METHODS: Patient-reported outcome measures (PROMs) were collected preoperatively and at postoperative intervals up to 2 years. PROMs included pain visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and Veterans RAND 12-Item Health Survey (VR-12) scores. Threshold values for CSOs were obtained from previous literature. Mean time to achievement of CSOs was calculated using a Kaplan-Meier analysis. A Cox proportional hazards regression analysis was performed to identify preoperative variables associated with earlier achievement of CSOs. RESULTS: Sixty-nine patients with an average age of 59 ± 8 years were included. Patients with higher preoperative mental status, as measured by VR-12 mental component summary (MCS), experienced significantly earlier substantial pain improvement postoperatively (P = .0471). Patients with higher preoperative mental status also achieved CSOs for physical health at earlier time points (P = .0187). Preoperative VR-12 MCS scores ≥ 40 were associated with earlier achievement of CSOs for pain (P = .0005) and physical health (P = .0015). Ninety-eight percent of patients with preoperative MCS scores ≥40 achieved acceptable pain relief at 4.5 months vs. 56% of all other patients at 12.3 months (P = .0001). Patients with preoperative MCS scores ≥40 experienced significantly faster improvement in physical health compared to patients with preoperative MCS scores <40 (P = .0006). CONCLUSIONS: Higher preoperative mental status, especially a preoperative MCS score ≥40, is associated with significantly faster improvement in pain and physical function following arthroscopic RCR. Nearly all patients (98%) with preoperative MCS score ≥40 achieved an acceptable state of pain relief compared with only 56% of patients with preoperative MCS score <40. These findings indicate that a holistic approach with equal consideration of preoperative mental health and rotator cuff pathophysiology is vital to the successful management of rotator cuff tendinopathy.


Assuntos
Artroscopia , Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Lesões do Manguito Rotador , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia , Idoso , Período Pré-Operatório , Medição da Dor , Benchmarking , Manguito Rotador/cirurgia , Resultado do Tratamento
3.
Community Ment Health J ; 60(4): 826-831, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38019371

RESUMO

Peer Recovery Support Services (PRSS) have the potential to be an economically valuable intervention. To investigate this potential, we conducted a scoping review to summarize existing research on the economic impact of PRSS. We searched relevant electronic databases for peer-reviewed articles and grey literature between January 2000 and February 2023 that examined an economic outcome related to PRSS. Following a comprehensive search, screening, and full-text evaluation, eight articles were selected for review. The majority of the studies we identified focused on healthcare cost-avoidance. Some studies supported PRSS as a method of avoiding costly medical services, while others had mixed results. Our scoping review revealed limited studies addressing cost savings associated with PRSS and further research on the economic impact of PRSS is warranted.


Assuntos
Custos de Cuidados de Saúde , Grupo Associado , Humanos
4.
Cell Rep ; 42(12): 113574, 2023 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-38100356

RESUMO

Multiple sclerosis (MS) is an inflammatory disease characterized by myelin loss. While therapies exist to slow MS progression, no treatment currently exists for remyelination. Remyelination, linked to reduced disability in MS, relies on microglia and monocyte-derived macrophages (MDMs). This study aims to understand the role of microglia during remyelination by lineage tracing and depleting them. Microglial lineage tracing reveals that both microglia and MDMs initially accumulate, but microglia later dominate the lesion. Microglia and MDMs engulf equal amounts of inhibitory myelin debris, but after microglial depletion, MDMs compensate by engulfing more myelin debris. Microglial depletion does, however, reduce the recruitment and proliferation of oligodendrocyte progenitor cells (OPCs) and impairs their subsequent differentiation and remyelination. These findings underscore the essential role of microglia during remyelination and offer insights for enhancing this process by understanding microglial regulation of remyelination.


Assuntos
Doenças Desmielinizantes , Esclerose Múltipla , Remielinização , Humanos , Bainha de Mielina/patologia , Microglia/patologia , Doenças Desmielinizantes/patologia , Macrófagos/patologia , Esclerose Múltipla/patologia
5.
Toxins (Basel) ; 15(11)2023 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-37999507

RESUMO

The cotton fleahopper (Pseudatomoscelis seriatus Reuter) is considered a highly economically damaging pest of cotton (Gossypium hirsutum L.) in Texas and Oklahoma. Current control methods rely heavily on the use of foliar-applied chemical insecticides, but considering the cost of insecticides and the critical timeliness of applications, chemical control methods are often not optimized to reduce potential yield losses from this pest. The Bacillus thuringiensis (Bt) Mpp51Aa2 (formerly Cry51Aa2.834_16) protein has proven effective against thrips and plant bugs with piercing and sucking feeding behaviors, but the impact of this toxin on cotton fleahoppers has not been investigated. To evaluate the Mpp51Aa2 trait effectiveness towards the cotton fleahopper, field trials were conducted in 2019, 2020, and 2021, comparing a cotton cultivar containing the Mpp51Aa2 trait to a non-traited isoline cultivar under insecticide-treated and untreated conditions. Populations of cotton fleahopper nymphs and adults were estimated weekly by visually inspecting cotton terminals. Square retention was also assessed during the first week of bloom to provide some insight on how the Bt trait may influence yield. While cotton fleahopper population differences between the traited and non-traited plants were not consistently noted during the pre-bloom squaring period, there was a consistent increase in square retention in cotton expressing Mpp51Aa2 relative to non-traited cotton. Additionally, cotton expressing Mpp51Aa2 offered similar square protection relative to non-traited cotton treated with insecticides for the cotton fleahopper. These findings indicate that the Mpp51Aa2 protein should provide benefits of delayed nymphal growth, population suppression, and increased square retention.


Assuntos
Bacillus thuringiensis , Heterópteros , Inseticidas , Animais , Gossypium/genética , Inseticidas/farmacologia , Texas , Comportamento Alimentar , Plantas Geneticamente Modificadas/genética , Endotoxinas , Proteínas de Bactérias/genética , Proteínas Hemolisinas
6.
Mol Neurodegener ; 17(1): 82, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514132

RESUMO

BACKGROUND: Microglia regulate the response to injury and disease in the brain and spinal cord. In white matter diseases microglia may cause demyelination. However, how microglia respond and regulate demyelination is not fully understood. METHODS: To understand how microglia respond during demyelination, we fed mice cuprizone-a potent demyelinating agent-and assessed the dynamics of genetically fate-mapped microglia. We then used single-cell RNA sequencing to identify and track the microglial subpopulations that arise during demyelination. To understand how microglia contribute to the clearance of dead oligodendrocytes, we ablated microglia starting at the peak of cuprizone-induced cell death and used the viability dye acridine orange to monitor apoptotic and lytic cell morphologies after microglial ablation. Lastly, we treated serum-free primary microglial cultures to model distinct aspects of cuprizone-induced demyelination and assessed the response. RESULTS: The cuprizone diet generated a robust microglial response by week 4 of the diet. Single-cell RNA sequencing at this time point revealed the presence of several cuprizone-associated microglia (CAM) clusters. These clusters expressed a transcriptomic signature indicative of cytokine regulation and reactive oxygen species production with altered lysosomal and metabolic changes consistent with ongoing phagocytosis. Using acridine orange to monitor apoptotic and lytic cell death after microglial ablation, we found that microglia preferentially phagocytose lytic carcasses. In culture, microglia exposed to lytic carcasses partially recapitulated the CAM state, suggesting that phagocytosis contributes to this distinct microglial state during cuprizone demyelination. CONCLUSIONS: Microglia serve multiple roles during demyelination, yet their transcriptomic state resembles other neurodegenerative conditions. The phagocytosis of cellular debris is likely a universal cause for a common neurodegenerative microglial state.


Assuntos
Cuprizona , Doenças Desmielinizantes , Animais , Camundongos , Cuprizona/toxicidade , Cuprizona/metabolismo , Microglia/metabolismo , Doenças Desmielinizantes/induzido quimicamente , Doenças Desmielinizantes/metabolismo , Transcriptoma , Laranja de Acridina/efeitos adversos , Laranja de Acridina/metabolismo , Camundongos Endogâmicos C57BL , Modelos Animais de Doenças
7.
JAMA ; 328(2): 173-183, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35819424

RESUMO

Importance: Patient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade. Objective: To determine the change in the rate of adverse events in hospitalized patients. Design, Setting, and Participants: This serial cross-sectional study used data from the Medicare Patient Safety Monitoring System from 2010 to 2019 to assess in-hospital adverse events in patients. The study included 244 542 adult patients hospitalized in 3156 US acute care hospitals across 4 condition groups from 2010 through 2019: acute myocardial infarction (17%), heart failure (17%), pneumonia (21%), and major surgical procedures (22%); and patients hospitalized from 2012 through 2019 for all other conditions (22%). Exposures: Adults aged 18 years or older hospitalized during each included calendar year. Main Outcomes and Measures: Information on adverse events (abstracted from medical records) included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls). The outcomes were the total change over time for the observed and risk-adjusted adverse event rates in the subpopulations. Results: The study sample included 190 286 hospital discharges combined in the 4 condition-based groups of acute myocardial infarction, heart failure, pneumonia, and major surgical procedures (mean age, 68.0 [SD, 15.9] years; 52.6% were female) and 54 256 hospital discharges for the group including all other conditions (mean age, 57.7 [SD, 20.7] years; 59.8% were female) from 3156 acute care hospitals across the US. From 2010 to 2019, the total change was from 218 to 139 adverse events per 1000 discharges for acute myocardial infarction, from 168 to 116 adverse events per 1000 discharges for heart failure, from 195 to 119 adverse events per 1000 discharges for pneumonia, and from 204 to 130 adverse events per 1000 discharges for major surgical procedures. From 2012 to 2019, the rate of adverse events for all other conditions remained unchanged at 70 adverse events per 1000 discharges. After adjustment for patient and hospital characteristics, the annual change represented by relative risk in all adverse events per 1000 discharges was 0.94 (95% CI, 0.93-0.94) for acute myocardial infarction, 0.95 (95% CI, 0.94-0.96) for heart failure, 0.94 (95% CI, 0.93-0.95) for pneumonia, 0.93 (95% CI, 0.92-0.94) for major surgical procedures, and 0.97 (95% CI, 0.96-0.99) for all other conditions. The risk-adjusted adverse event rates declined significantly in all patient groups for adverse drug events, hospital-acquired infections, and general adverse events. For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly. Conclusions and Relevance: In the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.


Assuntos
Hospitalização , Segurança do Paciente , Acidentes por Quedas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/epidemiologia , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Segurança do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Úlcera por Pressão/epidemiologia , Medição de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia
8.
J Patient Saf ; 18(6): 521-525, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35443253

RESUMO

OBJECTIVES: A lack of consensus around definitions and reporting standards for diagnostic errors limits the extent to which healthcare organizations can aggregate, analyze, share, and learn from these events. In response to this problem, the Agency for Healthcare Research and Quality (AHRQ) began the development of the Common Formats for Event Reporting for Diagnostic Safety Events (CFER-DS). We conducted a usability assessment of the draft CFER-DS to inform future revision and implementation. METHODS: We recruited a purposive sample of quality and safety personnel working in 8 U.S. healthcare organizations. Participants were invited to use the CFER-DS to simulate reporting for a minimum of 5 cases of diagnostic safety events and then provide written and verbal qualitative feedback. Analysis focused on participants' perceptions of content validity, ease of use, and potential for implementation. RESULTS: Estimated completion time was 30 to 90 minutes per event. Participants shared generally positive feedback about content coverage and item clarity but identified reporter burden as a potential concern. Participants also identified opportunities to clarify several conceptual definitions, ensure applicability across different care settings, and develop guidance to operationalize use of CFER-DS. Findings led to refinement of content and supplementary materials to facilitate implementation. CONCLUSIONS: Standardized definitions of diagnostic safety events and reporting standards for contextual information and contributing factors can help capture and analyze diagnostic safety events. In addition to usability testing, additional feedback from the field will ensure that AHRQ's CFER-DS is useful to a broad range of users for learning and safety improvement.


Assuntos
Design Centrado no Usuário , Interface Usuário-Computador , Coleta de Dados , Pesquisa sobre Serviços de Saúde , Humanos
9.
Hosp Pract (1995) ; 50(2): 124-131, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35253585

RESUMO

OBJECTIVES: To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as 'geographic rounding,' and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. METHODS: The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. RESULTS: Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. CONCLUSION: Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.


Assuntos
Esgotamento Profissional , Médicos Hospitalares , Esgotamento Profissional/prevenção & controle , Unidades Hospitalares , Humanos , Satisfação no Emprego , Inquéritos e Questionários
10.
J R Soc Interface ; 18(184): 20210703, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34814730

RESUMO

Reef squids belong to a group reputed for polarization sensitivity, yet polarization patterns of reef squid have not been quantified in situ. To quantify polarization patterns from video polarimetric data, we developed a protocol to map two-dimensional polarization data onto squid-shaped three-dimensional tessellated surfaces. This protocol provided a robust data container used to investigate three-dimensional regions-of-interest, producing data lineouts derived from the squid's geometry. This protocol also extracted polarimeter and squid body orientations and the solar heading from polarization images. When averaged over the solar heading, the ventral midline gave a low degree of polarization (2.4 ± 5.3%), and the area between the ventral and flank midlines had higher values (9.0 ± 5.3%). These averaged data had a large discontinuity in the angle of polarization (AoP) at the mantle's ventral midline (64 ± 55°), with larger discontinuities measured on individual squid. Ray-tracing calculations demonstrated that the AoP pattern was not related to the squid's surface-normal geometry. However, the AoP followed virtual striation axes on the squid's surface oriented 24° to the squid's long axis, similar in angle (27°) to the striations of birefringent collagen fibres documented in other squid species' skin.

11.
Transl Behav Med ; 11(7): 1339-1347, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34132810

RESUMO

The COVID-19 pandemic has rapidly altered ambulatory health care delivery and may have worsened disparities in health care access. To assess the telehealth implementation experiences of ambulatory personnel in different disciplines and their perspectives on potential telehealth disparities, and to make recommendations for more equitable telehealth delivery. We used a convergent parallel mixed-methods design. Clinic managers from geriatric medicine, internal medicine, and psychiatry e-mailed a survey to clinicians and staff regarding experiences with telehealth care delivery. Quantitative survey responses were analyzed with Fisher's Exact tests. Qualitative responses were coded thematically. Recommendations were categorized by type of implementation strategy. Quantitative and qualitative findings on telehealth disparities were merged in a joint data display. Respondents (n = 147, 57% response rate) were distributed across three specialties: 66% internal medicine, 19% psychiatry, and 14% geriatric medicine. Prior to 2020, 77% of clinicians had never delivered telehealth services. By Spring 2020, 78% reported conducting more than half of clinic visits by telehealth. Among clinicians, 52% agreed/strongly agreed that rapid telehealth implementation exacerbated access to care disparities to: older adult patients, those with limited internet access, and those needing interpretation services. Staff expressed similar difficulties with telehealth set-up especially for these patients. To improve telehealth equity, clinicians recommended to: (i) change infrastructure; (ii) train and educate stakeholders; and (iii) support clinicians. Clinicians and staff reported specific subpopulations had challenges in accessing telehealth visits. To avoid perpetuating telehealth access disparities, further co-discovery of equitable implementation strategies with patients and clinics are urgently needed.


Assuntos
COVID-19 , Telemedicina , Idoso , Acessibilidade aos Serviços de Saúde , Humanos , Pandemias , SARS-CoV-2
12.
Glia ; 69(12): 2771-2797, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34115410

RESUMO

The dynamic expansions and contractions of the microglia population in the central nervous system (CNS) to achieve homeostasis are likely vital for their function. Microglia respond to injury or disease but also help guide neurodevelopment, modulate neural circuitry throughout life, and direct regeneration. Throughout these processes, microglia density changes, as does the volume of area that each microglia surveys. Given that microglia are responsible for sensing subtle alterations to their environment, a change in their density could affect their capacity to mobilize rapidly. In this review, we attempt to synthesize the current literature on the ligands and conditions that promote microglial proliferation across development, adulthood, and neurodegenerative conditions. Microglia display an impressive proliferative capacity during development and in neurodegenerative diseases that is almost completely absent at homeostasis. However, the appropriate function of microglia in each state is critically dependent on density fluctuations that are primarily induced by proliferation. Proliferation is a natural microglial response to insult and often serves neuroprotective functions. In contrast, inappropriate microglial proliferation, whether too much or too little, often precipitates undesirable consequences for nervous system health. Thus, fluctuations in the microglia population are tightly regulated to ensure these immune cells can execute their diverse functions.


Assuntos
Microglia , Doenças Neurodegenerativas , Adulto , Sistema Nervoso Central , Homeostase , Humanos , Microglia/fisiologia , Dinâmica Populacional
13.
J Patient Saf ; 17(3): e234-e240, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-27768654

RESUMO

ABSTRACT: The explicit declaration in the landmark 1999 Institute of Medicine report "To Err Is Human" that, in the United States, 44,000 to 98,000 patients die each year as a consequence of "medical errors" gave widespread validation to the magnitude of the patient safety problem and catalyzed a number of U.S. federal government programs to measure and improve the safety of the national healthcare system. After more than 10 years, one of those federal programs, the Medicare Patient Safety Monitoring System (MPSMS), has reached a level of maturity and stability that has made it useful for the consistent measurement of the safety of inpatient care. The MPSMS is a chart review-based national patient safety surveillance system that provides rates of 21 specific hospital inpatient adverse event measures, which have been divided into 4 clinical domains (general, hospital-acquired infections, postprocedure adverse events, and adverse drug events) for analysis. The 2014 MPSMS national sample was drawn from 1109 hospitals and includes approximately 20,000 medical records of patients admitted to the hospital (all payors) for at least 1 of the 4 conditions of congestive heart failure, acute myocardial infarction, pneumonia, and major surgical procedures as defined by the Centers for Medicare and Medicaid Services Surgical Care Improvement Project. The MPSMS is now going through a major transformation to capture additional types of adverse events and is being redeveloped as the Quality and Safety Review System (QSRS). As an example of this transformation, QSRS will electronically import electronic data, which are standardized according to the Centers for Medicare and Medicaid Services billing definitions and will be updated and evolve over time to incorporate expanded standardized data available from electronic health records. This article reviews the development of MPSMS, the strengths and limitations of MPSMS, and expected future directions in patient safety measurement, focusing on those issues that are informing the development and implementation of QSRS.


Assuntos
Medicare , Segurança do Paciente , Idoso , Centers for Medicare and Medicaid Services, U.S. , Hospitalização , Hospitais , Humanos , Estados Unidos
14.
J Patient Saf ; 17(8): e1685-e1690, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30747860

RESUMO

OBJECTIVES: Despite endorsements for greater use of systems approaches and reports from national consensus bodies calling for closer engineering/health care partnerships to improve care delivery, there has been a scarcity of effort of actually engaging the design and engineering disciplines in patient safety projects. The article describes a grant initiative undertaken by the Agency for of Healthcare Research and Quality that brings these disciplines together to test new ideas that could make health care safer. METHODS: Collectively known as patient safety learning laboratories, grantee teams engage in phase-based activities that parallel a systems engineering process-problem analysis, design, development, implementation, and evaluation-to gain an in-depth understanding of related patient safety problems, generate fresh ideas and rapid prototypes, develop the prototypes, ensure that developed components are implemented as an integrated working system, and evaluate the system in a simulated or clinical setting. FINDINGS: Obstacles are described that can derail the best of intentions in deploying the systems engineering methodology. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer than anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team. CONCLUSIONS: Three narratives are generated in terms of what success might look like. Much is yet to be learned about the limitations and successes of the ongoing learning laboratory initiative, which should be relevant to the broader scale interest in learning health systems.


Assuntos
Sistema de Aprendizagem em Saúde , Segurança do Paciente , Atenção à Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Estudos Longitudinais
15.
J Subst Abuse Treat ; 115: 108042, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32600623

RESUMO

The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.


Assuntos
Prisões Locais , Prisioneiros , Analgésicos Opioides/uso terapêutico , Análise Custo-Benefício , Humanos , Metadona , New Mexico , Tratamento de Substituição de Opiáceos , Prisões
16.
Open Forum Infect Dis ; 6(10): ofz411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31660369

RESUMO

BACKGROUND: HIV prevalence is 3 times greater for those in the criminal justice system than the general population, with an assumed increase in sexual risk behaviors (SRBs) postrelease. HIV viral suppression impacts HIV transmission; however, studies of SRBs among persons with HIV leaving the criminal justice system are limited, and no studies have examined viral suppression in relation to SRBs in persons leaving the criminal justice system. METHODS: Data were examined from 2 double-blind placebo-controlled trials of extended-release naltrexone among persons with HIV and alcohol use or opioid use disorder. Participants self-reported sexual activity, including number of sexual partners, sex type, and condom use. HIV viral suppression was evaluated prerelease and at 6 months. RESULTS: Thirty days before incarceration, 60% reported having sex compared with 41% and 46%, respectively, at months 1 and 6 postrelease. The number of sex partners and sexual intercourse events decreased from pre-incarceration to months 1 and 6 postrelease. Condom use increased but was not statistically significant. Of the 11 (9.7%) who reported having sex without a condom 1 month postrelease, only 2 did not have viral suppression (VS; HIV VL <200 copies/mL), whereas the 7 (6.5%) who reported SRBs at 6 months all had VS. CONCLUSIONS: After release, SRBs decreased, and among those who reported SRBs, most were virally suppressed, and thus risk of transmitting HIV was low.

17.
Data Brief ; 25: 104086, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31294052

RESUMO

Stable and conservative numerical boundary schemes, for both compact and explicit (central) finite differences require a number of parameters that must be tuned for stability. Values of these coefficients for 4th, 6th, and 8th boundary schemes are given in this article. The stability of the schemes is demonstrated through a series of numerical tests in "High-Order, Stable, and Conservative Boundary Schemes for Central and Compact Finite Differences" Brady and Livescu, 2019. These tests include: a neutrally stable constant coefficient hyperbolic system, a two-dimensional varying coefficient hyperbolic scalar equation and, examining the transport of an inviscid vortex using the compressible Euler equations. The error norms for the variety of tests associated with different the schemes for different grid resolutions and time-step constraints are given in the accompanying databases.

18.
J Telemed Telecare ; 25(6): 353-364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29754561

RESUMO

INTRODUCTION: In this paper the economic costs associated with a growing, multi-state telepsychiatry intervention serving rural American Indian/Alaska Native populations were compared to costs of travelling to provide/receive in-person treatment. METHODS: Telepsychiatry costs were calculated using administrative, information-technology, equipment and technology components, and were compared to travel cost models. Both a patient travel and a psychiatrist travel model were estimated utilising ArcGIS software and unit costs gathered from literature and government sources. Cost structure and sensitivity analysis was also calculated by varying modeling parameters and assumptions. RESULTS AND DISCUSSION: It is estimated that per-session costs were $93.90, $183.34, and $268.23 for telemedicine, provider-travel, and patient-travel, respectively. Restricting the analysis to satellite locations with a larger number of visits reduced telemedicine per-patient encounter costs (50 or more visits: $83.52; 100 or more visits: $80.41; and 150 or more visits: $76.25). The estimated cost efficiencies of telemedicine were more evident for highly rural communities. Finally, we found that a multi-state centre was cheaper than each state operating independently. CONCLUSIONS: Consistent with previous research, this study provides additional evidence of the economic efficiency associated with telemedicine interventions for rural American Indian/Alaska Native populations. Our results suggest that there are economies of scale in providing behavioural telemedicine and that bigger, multi-state telemedicine centres have lower overall costs compared to smaller, state-level centres. Additionally, results suggest that telemedicine structures with a higher number of per-satellite patient encounters have lower costs, and telemedicine centres delivering care to highly rural populations produce greater economic benefits.


Assuntos
Serviços de Saúde do Indígena/economia , Indígenas Norte-Americanos/estatística & dados numéricos , Serviços de Saúde Mental/economia , População Rural/estatística & dados numéricos , Telemedicina/economia , Viagem/economia , Serviços de Saúde Comunitária/economia , Custos de Cuidados de Saúde , Humanos
19.
BMC Plant Biol ; 18(1): 360, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563461

RESUMO

BACKGROUND: Grape phylloxera (Daktulosphaira vitifoliae Fitch) is a major insect pest that negatively impacts commercial grapevine performance worldwide. Consequently, the use of phylloxera resistant rootstocks is an essential component of vineyard management. However, the majority of commercially available rootstocks used in viticulture production provide limited levels of grape phylloxera resistance, in part due to the adaptation of phylloxera biotypes to different Vitis species. Therefore, there is pressing need to develop new rootstocks better adapted to specific grape growing regions with complete resistance to grape phylloxera biotypes. RESULTS: Grapevine rootstock breeding material, including an accession of Vitis cinerea and V. aestivalis, DRX55 ([M. rotundifolia x V. vinifera] x open pollinated) and MS27-31 (M. rotundifolia specific hybrid), provided complete resistance to grape phylloxera in potted plant assays. To map the genetic factor(s) of grape phylloxera resistance, a F1 V. cinerea x V. vinifera Riesling population was screened for resistance. Heritability analysis indicates that the V. cinerea accession contained a single allele referred as RESISTANCE TO DAKTULOSPHAIRA VITIFOLIAE 2 (RDV2) that confers grape phylloxera resistance. Using genetic maps constructed with pseudo-testcross markers for V. cinerea and Riesling, a single phylloxera resistance locus was identified in V. cinerea. After validating SNPs at the RDV2 locus, interval and linkage mapping showed that grape phylloxera resistance mapped to linkage group 14 at position 16.7 cM. CONCLUSION: The mapping of RDV2 and the validation of markers linked to grape phylloxera resistance provides the basis to breed new rootstocks via marker-assisted selection that improve vineyard performance.


Assuntos
Hemípteros , Melhoramento Vegetal/métodos , Polimorfismo de Nucleotídeo Único , Vitis/genética , Alelos , Animais , Mapeamento Cromossômico , Reprodutibilidade dos Testes
20.
Am J Drug Alcohol Abuse ; 44(6): 611-618, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30024783

RESUMO

BACKGROUND: The US has the highest incarceration rate in the world and spends $40-$80 billion to house inmates per year. It is well-known that a significant correlation is present between substance use and crime, especially over recent years as opioid use disorder (OUD) has grown exponentially. To mitigate OUD, methadone maintenance treatment (MMT) has demonstrated effectiveness in numerous randomized and quasi-experimental studies. A potentially fruitful environment for MMT is correctional facilities, particularly short-term facilities, such as city and county jails. However, little is known about the economic implications of MMT within correctional facilities. OBJECTIVE: The aim of the present study was to estimate the economic costs of jail-based MMT using data from a novel, established MMT program located within a large urban jail in New Mexico. METHODS: Data were collected using administrative records and by interviewing program administrators using a modified version of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Both sensitivity analysis and cost-structure analysis were conducted to gauge the robustness of the findings. RESULTS: The average (per patient) weekly cost of MMT is $115 and the total treatment cost for an average treatment episode is $689. These costs are generally in-line with non-jail-based MMT programs of similar size. Weekly cost estimates range from $86 to $185 depending on the size of the treatment facility, with larger programs exhibiting lower per-patient costs. CONCLUSION: Results provide a valuable economic benchmark to policy makers, criminal justice officials, and program administrators considering establishing and/or expanding MMT in jail settings.


Assuntos
Analgésicos Opioides/economia , Metadona/economia , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/economia , Prisões , Analgésicos Opioides/uso terapêutico , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...