Changing high-risk asthma in Memphis through partnership: Results from the CHAMP program.

BACKGROUND: Children in metro Shelby County, Tennessee, have disproportionally high asthma-related health care resource use (HRU) compared with those in other regions in Tennessee. OBJECTIVE: To describe the goals, logistics, and outcomes of the Changing High-Risk Asthma in Memphis through Partnership (CHAMP) program implemented to improve pediatric asthma care in Shelby County. METHODS: CHAMP established a multidisciplinary team with dedicated medical staff and community health workers, implemented a 24/7 call line to improve access to care, established a patient data registry to address fragmented care, assigned community health educators to improve asthma education and social needs, and partnered with services to address environmental triggers and social determinants of health. Patients eligible for CHAMP are Shelby County residents aged 2 to 18 years with high-risk asthma enrolled in Tennessee's Medicaid managed care program. Health care resource use outcomes 1-year pre- and post-CHAMP enrollment were analyzed for patients who had completed 1 year of CHAMP between January 2013 and December 2022. The 24/7 call line data between November 2013 and December 2022 were analyzed. RESULTS: CHAMP has enrolled 1348 children; 945 have completed 1 year (63% male; 90% identified as Black). At 1-year post-CHAMP enrollment, patients had 58%, 68%, 42%, and 53% reductions in emergency department visits, inpatient and observation visits, urgent care visits, and total asthma exacerbations, respectively. The number of asthma exacerbations per patient significantly decreased from 2.97 to 1.40 at 1-year post-CHAMP enrollment. Of the calls made to the 24/7 call line, 58% occurred after hours and 52% led to issue resolution without a medical facility visit. CONCLUSION: CHAMP successfully decreased asthma HRU in children with high-risk asthma in Shelby County by implementing initiatives that targeted barriers to asthma care.

How We Do It: Otolaryngology Applicant Impressions of Virtual Meet and Greets at a Single Institution.

BACKGROUND: The COVID-19 pandemic altered residency recruitment in the 2021 application cycle. As a result, many programs adapted by creating virtual opportunities to connect with applicants such as clerkships, open houses, meet and greets, and interviews. Recent research has explored applicant impressions on virtual interviews and open houses, but none have assessed the utility of meet and greets, optimal structure, or desired topics to be addressed. METHODS: We hosted two virtual meet and greets for otolaryngology applicants and subsequently conducted a structured survey to assess the benefit, gather insight into desired topics, and determine how future sessions could be optimized. RESULTS: Twenty of 65 participants responded to the survey (31% response rate). The majority of participants learned about the event through social media (n = 15) or online resources such as OtoMatch or HeadMirror (n = 12). Desired topics to be addressed included faculty-resident relationships (85%), research (80%), the city of Madison (75%), breadth and depth of faculty (75%), and ability to train residents for future positions and fellowships (75%), among others. Overall, participants found the events helpful in conveying the culture and environment, exposure to faculty and residents, addressing questions, and providing insight into intangible aspects of the program. The main area of improvement identified was related to having breakout rooms, longer sessions, and varying the topics for breakout rooms. CONCLUSION: Virtual meet and greets facilitate outreach and provide opportunities for applicants to engage with residency programs and demonstrate interest. While initially implemented due to the COVID-19 pandemic, they will likely remain helpful in generating interest, reaching broader audiences, and possibly facilitating a successful match. It is critical to understand and incorporate the content that applicants wish to learn about at virtual meet and greets to best address questions, highlight key features, and demonstrate the intangible aspects of a residency program.

Hospital re-admission after critical care survival: a systematic review and meta-analysis.

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Recovering the phase and amplitude of X-ray FEL pulses using neural networks and differentiable models.

Dynamics experiments are an important use-case for X-ray free-electron lasers (XFELs), but time-domain measurements of the X-ray pulses themselves remain a challenge. Shot-by-shot X-ray diagnostics could enable a new class of simpler and potentially higher-resolution pump-probe experiments. Here, we report training neural networks to combine low-resolution measurements in both the time and frequency domains to recover X-ray pulses at high-resolution. Critically, we also recover the phase, opening the door to coherent-control experiments with XFELs. The model-based generative neural-network architecture can be trained directly on unlabeled experimental data and is fast enough for real-time analysis on the new generation of MHz XFELs.

Experimental demonstration of novel beam characterization using a polarizable X-band transverse deflection structure.

The PolariX TDS (Polarizable X-Band Transverse Deflection Structure) is an innovative TDS-design operating in the X-band frequency-range. The design gives full control of the streaking plane, which can be tuned in order to characterize the projections of the beam distribution onto arbitrary transverse axes. This novel feature opens up new opportunities for detailed characterization of the electron beam. In this paper we present first measurements of the Polarix TDS at the FLASHForward beamline at DESY, including three-dimensional reconstruction of the charge-density distribution of the bunch and slice emittance measurements in both transverse directions. The experimental results open the path toward novel and more extensive beam characterization in the direction of multi-dimensional-beam-phase-space reconstruction.

Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care.

BACKGROUND: Enteral tubes are prevalent among children with medical complexity (CMC), and complications can lead to costly health care use. Our objective was to design and test the usability of a mobile application (app) to support family-delivered enteral tube care. METHODS: Human-centered design methods (affinity diagramming, persona development, and software development) were applied with family caregivers of CMC to develop a prototype. During 3 waves of usability testing with design refinement between waves, screen capture software collected user-app interactions and inductive content analysis of narrative feedback identified areas for design improvement. The National Aeronautics and Space Administration Task Load Index and the System Usability Scale quantified mental workload and ease of use. RESULTS: Design participants identified core app functions, including displaying care routines, reminders, tracking inventory and health data, caregiver communication, and troubleshooting. Usability testing participants were 80% non-Hispanic white, 28% lived in rural settings, and 20% had not completed high school. Median years providing enteral care was 2 (range 1-14). Design iterations improved app function, simplification, and user experience. The mean System Usability Scale score was 76, indicating above-average usability. National Aeronautics and Space Administration Task Load Index revealed low mental demand, frustration, and effort. All 14 participants reported that they would recommend the app, and that the app would help with organization, communication, and caregiver transitions. CONCLUSIONS: Using a human-centered codesign process, we created a highly usable mobile application to support enteral tube caregiving at home. Future work involves evaluating the feasibility of longitudinal use and effectiveness in improving self-efficacy and reduce device complications.

Delicate seafloor landforms reveal past Antarctic grounding-line retreat of kilometers per year.

A suite of grounding-line landforms on the Antarctic seafloor, imaged at submeter horizontal resolution from an autonomous underwater vehicle, enables calculation of ice sheet retreat rates from a complex of grounding-zone wedges on the Larsen continental shelf, western Weddell Sea. The landforms are delicate sets of up to 90 ridges, <1.5 meters high and spaced 20 to 25 meters apart. We interpret these ridges as the product of squeezing up of soft sediment during the rise and fall of the retreating ice sheet grounding line during successive tidal cycles. Grounding-line retreat rates of 40 to 50 meters per day (>10 kilometers per year) are inferred during regional deglaciation of the Larsen shelf. If repeated today, such rapid mass loss to the ocean would have clear implications for increasing the rate of global sea level rise.

Response to "Built and Natural Environment Barriers and Facilitators to Physical Activity in Rural, Suburban, and Small Urban Neighborhoods".

DeGuzman et al. (2019) should be commended for their article "Built and Natural Environment Barriers and Facilitators to Physical Activity in Rural, Suburban, and Small Urban Neighborhoods." The work is a meaningful contribution to the oncology field, given the health disparity among patients with cancer living in rural and suburban communities. Nurses need to be part of the larger conversation and advocate for patients through policy reform that supports access to an equitable built environment. DeGuzman et al.'s (2019) article starts this conversation. In this letter, I wish to build on that initial conversation by deepening the discussion of built environment and costs as significant barriers to physical activity in cancer survivors.

Evaluación de conocimientos sobre su enfermedad en pacientes con diabetes tipo 2 de un hospital de Lima, Perú y su asociación con la adherencia al tratamiento / An assessment of knowledge about their condition in type II diabetes patients in a hospital in Lima, Peru, and its association with adherence to therapy

Objetivo. Evaluar si el nivel de conocimiento sobre la diabetes mellitus 2 (DM2) se asocia con adherencia al tratamiento. Materiales y métodos. Se determinó el nivel de conocimientos sobre la enfermedad en pacientes con DM2 por medio del Diabetes Knowledge Questionnaire (DKQ-24) y se evaluó si existía asociación con adherencia al tratamiento, medida por la prueba de Morisky-Green-Levine (MGL). Se tomó una muestra consecutiva de 210 pacientes. Resultados. El conocimiento sobre DM2 fue considerado adecuado en el 78,1% de los pacientes y se verificó que el 25,7% de ellos estaban adheridos al tratamiento farmacológico. Se halló asociación positiva entre adherencia y conocimientos (OR: 1,12; IC 95%:1,01-1,25) y edad > 65 años (OR: 1,14; IC 95%: 1,03-1,28). Además, se halló una diferencia significativa entre las medias de los puntajes obtenidos entre adherentes versus no adherentes (15,3 vs 16,37; p<0,05). La adherencia al tratamiento de diabetes en nuestro estudio fue de 25%. Conclusiones. Existe asociación de la adherencia al tratamiento con las variables conocimiento adecuado y edad > 65 años. Existen resultados mixtos (no significancia bivariada y sí multivariada) respecto a nivel educativo secundario o superior y procedencia rural de los pacientes; lo que indica que se requieren realizar mayores estudios al respecto.

Objective: To assess whether knowledge about type II diabetes mellitus (T2DM) is associated with adherence to therapy. Materials and Methods: Knowledge about T2DM was assessed by using the Diabetes Knowledge Questionnaire (DKQ-24), and it was determined whether there was an association with adherence to treatment, which was measured using the Morisky-Green-Levine Test (MGL). A consecutive sample including 210 patients was taken. Results: Knowledge about T2DM was considered adequate in 78.1% of patients and it was verified that 25.7% of them were adherent to pharmacological treatment. A positive association between knowledge and adherence was found (OR= 1.12, 95% IC: 1.01-1.25), as well as for age >65 years old (OR: 1.14; 95% IC: 1.03-1.28). Also, a significant difference was found between mean scores obtained when adherent versus non-adherent subjects were compared (15.3 vs. 16.37; p<0.05). Adherence to diabetes treatment in our study was 25%. Conclusions: Factors associated with better adherence to therapy were knowledge level and being more of 65 years old. There are some mixed results (no bivariate significance, presence of multivariate significance) with respect to having gone to high school or college, and for having come from a rural area. Our findings indicate further studies need to be performed.

Airway Epithelial Repair by a Prebiotic Mannan Derived from Saccharomyces cerevisiae.

In asthmatic airways, repeated epithelial damage and repair occur. No current therapy directly targets this process. We aimed to determine the effects of mannan derived from S. cerevisiae (SC-MN) on airway epithelial wound repair, in vitro. The presence of functional mannose receptors in bronchial epithelial cells was shown by endocytosis of colloidal gold-Man BSA via clathrin-coated pits in 16HBE cells. In primary normal human bronchial epithelial cells (NHBEC), SC-MN significantly facilitated wound closure. Treatment with SC-MN stimulated cell spreading as indicated by a significant increase in the average lamellipodial width of wound edge 16HBE cells. In addition, NHBEC treated with SC-MN showed increased expression and activation of Krüppel-like factors (KLFs) 4 and 5, transcription factors important in epithelial cell survival and regulation of epithelial-mesenchymal transition. We conclude that SC-MN facilitates wound repair in human bronchial epithelium, involving mannose receptors.

Beneficial Effects of Prebiotic Saccharomyces cerevisiae Mannan on Allergic Asthma Mouse Models.

One of the unmet needs for asthma management is a new therapeutic agent with both anti-inflammatory and anti-smooth muscle (ASM) remodeling effects. The mannose receptor (MR) family plays an important role in allergen uptake and processing of major allergens Der p 1 and Fel d 1. We have previously reported that ASM cells express a mannose receptor (ASM-MR) and that mannan derived from Saccharomyces cerevisiae (SC-MN) inhibits mannosyl-rich lysosomal hydrolase-induced bovine ASM cell proliferation. Using a humanized transgenic mouse strain (huASM-MRC2) expressing the human MRC2 receptor in a SM tissue-specific manner, we have demonstrated that ASM hyperplasia/hypertrophy can occur as early as 15 days after allergen challenge in this mouse model and this phenomenon is preventable with SC-MN treatment. This proof-of-concept study would facilitate future development of a potential asthma therapeutic agent with dual function of anti-inflammatory and anti-smooth muscle remodeling effects.

Evaluation of B lymphocyte deficiencies.

The most common of the primary immunodeficiency diseases are those that involve inadequate antibody production. The characteristic presentation of these disorders is recurrent sinopulmonary infections. An arrest in B cell development at the pre-B cell stage leads to agammaglobulinemia and an insignificant number of B cells. X-linked agammaglobulinemia is the most common of these developmental arrests while the autosomal recessive agammaglobulinemias comprise a small minority of the total cases. Likewise, the most common form of the hyper-IgM syndromes (CD40 ligand deficiency) is X-linked. Of the autosomal recessive forms, CD40 deficiency is basically identical to the X-linked form in its clinical phenotype where, in addition to inadequate antibody production, there is defective T cell signaling through the CD40-CD40L interaction. Aside from CD40 deficiency, the other recessive forms of hyper-IgM syndrome have adequate T cell function. IgA deficiency is the most common and the most benign of the B cell disorders. Common variable immunodeficiency is diverse in its presentation and clinical course. The pathophysiology of this disease is multifactorial and frequently ill defined, often making it a diagnosis of exclusion. A working knowledge of identifiable PIDDs is essential in both recognizing when to suspect immunodeficiency and making a diagnosis.

Case report of a young child with disseminated histoplasmosis and review of hyper immunoglobulin e syndrome (HIES).

Type 1 hyper IgE syndrome (HIES), also known as Job's Syndrome, is an autosomal dominant disorder due to defects in STAT3 signaling and Th17 differentiation. Symptoms may present during infancy but diagnosis is often made in childhood or later. HIES is characterized by immunologic and non-immunologic findings such as recurrent sinopulmonary infections, recurrent skin infections, multiple fractures, atopic dermatitis and characteristic facies. These manifestations are accompanied by elevated IgE levels and reduced IL-17 producing CD3+CD4+ T cells. Diagnosis in young children can be challenging as symptoms accumulate over time along with confounding clinical dilemmas. A NIH clinical HIES scoring system was developed in 1999, and a more recent scoring system with fewer but more pathogonomonic clinical findings was reported in 2010. These scoring systems can be used as tools to help in grading the likelihood of HIES diagnosis. We report a young child ultimately presenting with disseminated histoplasmosis and a novel STAT3 variant in the SH2 domain.

Vancomycin hypersensitivity diagnosed by lymphocyte blast transformation.

A 15-year-old male admitted for Pott's puffy tumor developed recurrent episodes of fever, diffuse morbilliform rash, eosinophilia, and tubulointerstitial nephritis while on multiple antibiotics. Lymphocyte blast transformation (LBT), a method of detecting cellular immune response by measuring levels of interferon-γ (IFN-γ), was used to diagnose vancomycin hypersensitivity and guide antibiotic selection.

Non-allergic rhinitis: a case report and review.

Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency. Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR.

More than "just a joke": the prejudice-releasing function of sexist humor.

The results of two experiments supported the hypothesis that, for sexist men, exposure to sexist humor can promote the behavioral release of prejudice against women. Experiment 1 demonstrated that hostile sexism predicted the amount of money participants were willing to donate to a women's organization after reading sexist jokes but not after reading nonhumorous sexist statements or neutral jokes. Experiment 2 showed that hostile sexism predicted the amount of money participants cut from the budget of a women's organization relative to four other student organizations upon exposure to sexist comedy skits but not neutral comedy skits. A perceived local norm of approval of funding cuts for the women's organization mediated the relationship between hostile sexism and discrimination against the women's organization.

Population genetics of wolf spiders of fragmented habitat in the wheat belt of New South Wales.

Possible effects of habitat fragmentation on the population genetics of a species of wolf spider (Lycosidae) from remnant Callitris woodland in the wheat belt of central western New South Wales in Australia are examined. Single-strand conformational analysis of mitochondrial cytochrome oxidase (subunit 1) was used to characterize the haplotypes of 295 spiders in six blocks each of four woodland sites. DNA sequences were collected from 119 of these spiders to confirm haplotype scoring, allow phylogeny estimation and permit calculation of sequence-based statistics. Intra-block tests do not suggest widespread effects of fragmentation. Genetic diversity is high in all blocks, with 25 haplotypes being identified. Nucleotide diversity is relatively low, as all of the haplotypes are closely related. One block had a significantly low value for the Ewens/Watterson test of neutrality and one block's value was nearly significantly high. Two blocks had nearly significant values of the Harpending Raggedness Index testing for recent population bottlenecks. No other intrablock tests approach significance. Interpopulation comparisons show significant nonhomogeneity of haplotype frequencies globally and in all pairwise comparisons. Relationships between woodland blocks based on haplotype frequencies are discordant with geographical proximity. Haplotype distribution patterns suggest that population structuring existed prior to fragmentation. We develop two measures of genetic distinctiveness to identify subpopulations of interest for conserving evolutionary processes in a species' regional population. One is based on the sum of pairwise FST values and one on the spatial distribution of genetic variation. High values of the measure suggest a subpopulation might have been recently perturbed and low values that it is relatively undisturbed. The two measures identify different blocks as being of particular interest.

Barriers to sexual reproduction in Polygonum viviparum: a comparative developmental analysis of P. viviparum and P. bistortoides.

Polygonum viviparum is widely distributed in arctic and alpine regions of the northern hemisphere. Fruit set has never been observed in North American populations and has been reported only very rarely in Europe. Although this species is extremely well studied, the impediments to successful fruit production are unknown. We investigated the sexual reproductive process in P. viviparum growing in the southern Colorado Rocky Mountains. For comparison, we also examined this process in the sympatric congener P. bistortoides, in which reproduction is exclusively sexual. Lack of viable fruit production in P. viviparum has no single developmental explanation; defects occur in each of the processes and structures associated with sexual reproduction studied, yet, these processes and structures also appear to function normally in at least some flowers or individuals. Development is abnormal in many ovules of P. viviparum, however, comparison with P. bistortoides shows that these abnormalities do not contribute to differences in seed production between the two species. The virtual absence of sexual reproduction in P. viviparum appears to be due largely to a low rate of fertilization and to embryo/fruit abortion.