Using SPI-Hub™ to Promote the Key Role of Prepublishing in Healthcare.

With the need to quickly advance knowledge dissemination in rapid-paced fields, and more recently in response to the urgency of the COVID-19 pandemic, prepublishing has been brought to the forefront. SPI-Hub™, a publicly available journal selection decision support tool, is being strategically enhanced to address prospective authors' critical needs in navigating and selecting the most appropriate preprint or traditional publication venue.

Pharmacotherapies for Post-Bariatric Weight Regain: Real-World Comparative Outcomes.

OBJECTIVE: This study aimed to compare outcomes of treatment strategies for weight regain after bariatric surgery. METHODS: This is a retrospective analysis of 207 individuals treated for post-bariatric weight regain at an academic center from January 1, 2014, through November 25, 2019. Percentage body weight loss was compared after 3, 6, 9, and 12 months of treatment among an intensive lifestyle modification (ILM) group, a non-glucagon-like-1 receptor agonist (GLP-1-RA)-based weight-loss pharmacotherapy (WLP) group, and a GLP-1-RA-based WLP group (the latter two groups in conjunction with ILM). RESULTS: The percentage body weight loss was significantly different between groups after 3 months (1.4% vs. 2.2% vs. 4.5% [P < 0.001] for ILM, non-GLP-1-RA-based WLP, and GLP-1-RA-based WLP groups, respectively), 6 months (0.8% vs. 2.9% vs. 6.7% [P < 0.001]), and 9 months (-1.6% vs. 5.6% vs. 6.9% [P = 0.007]). There was a significant difference in the percentage of individuals achieving ≥5% weight loss after 3, 6, and 9 months, with most occurring in the GLP-1-RA-based WLP group. In a multiple regression analysis including bariatric surgery type, treatment group was the only significant predictor of percentage weight change. CONCLUSIONS: GLP-1-RA-based WLP therapies were found to be more effective for treating post-bariatric weight regain than non-GLP-1-RA-based WLP or ILM, regardless of surgery type.

SPI-Hub™: a gateway to scholarly publishing information.

BACKGROUND: Advances in the health sciences rely on sharing research and data through publication. As information professionals are often asked to contribute their knowledge to assist clinicians and researchers in selecting journals for publication, the authors recognized an opportunity to build a decision support tool, SPI-Hub: Scholarly Publishing Information Hub™, to capture the team's collective publishing industry knowledge, while carefully retaining the quality of service. CASE PRESENTATION: SPI-Hub's decision support functionality relies on a data framework that describes journal publication policies and practices through a newly designed metadata structure, the Knowledge Management Journal Record™. Metadata fields are populated through a semi-automated process that uses custom programming to access content from multiple sources. Each record includes 25 metadata fields representing best publishing practices. Currently, the database includes more than 24,000 health sciences journal records. To correctly capture the resources needed for both completion and future maintenance of the project, the team conducted an internal study to assess time requirements for completing records through different stages of automation. CONCLUSIONS: The journal decision support tool, SPI-Hub, provides an opportunity to assess publication practices by compiling data from a variety of sources in a single location. Automated and semi-automated approaches have effectively reduced the time needed for data collection. Through a comprehensive knowledge management framework and the incorporation of multiple quality points specific to each journal, SPI-Hub provides prospective users with both recommendations for publication and holistic assessment of the trustworthiness of journals in which to publish research and acquire trusted knowledge.

Bayesian analysis of isothermal titration calorimetry for binding thermodynamics.

Isothermal titration calorimetry (ITC) is the only technique able to determine both the enthalpy and entropy of noncovalent association in a single experiment. The standard data analysis method based on nonlinear regression, however, provides unrealistically small uncertainty estimates due to its neglect of dominant sources of error. Here, we present a Bayesian framework for sampling from the posterior distribution of all thermodynamic parameters and other quantities of interest from one or more ITC experiments, allowing uncertainties and correlations to be quantitatively assessed. For a series of ITC measurements on metal:chelator and protein:ligand systems, the Bayesian approach yields uncertainties which represent the variability from experiment to experiment more accurately than the standard data analysis. In some datasets, the median enthalpy of binding is shifted by as much as 1.5 kcal/mol. A Python implementation suitable for analysis of data generated by MicroCal instruments (and adaptable to other calorimeters) is freely available online.

SNOMED CT Concept Hierarchies for Sharing Definitions of Clinical Conditions Using Electronic Health Record Data.

BACKGROUND: Defining clinical conditions from electronic health record (EHR) data underpins population health activities, clinical decision support, and analytics. In an EHR, defining a condition commonly employs a diagnosis value set or "grouper." For constructing value sets, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) offers high clinical fidelity, a hierarchical ontology, and wide implementation in EHRs as the standard interoperability vocabulary for problems. OBJECTIVE: This article demonstrates a practical approach to defining conditions with combinations of SNOMED CT concept hierarchies, and evaluates sharing of definitions for clinical and analytic uses. METHODS: We constructed diagnosis value sets for EHR patient registries using SNOMED CT concept hierarchies combined with Boolean logic, and shared them for clinical decision support, reporting, and analytic purposes. RESULTS: A total of 125 condition-defining "standard" SNOMED CT diagnosis value sets were created within our EHR. The median number of SNOMED CT concept hierarchies needed was only 2 (25th-75th percentiles: 1-5). Each value set, when compiled as an EHR diagnosis grouper, was associated with a median of 22 International Classification of Diseases (ICD)-9 and ICD-10 codes (25th-75th percentiles: 8-85) and yielded a median of 155 clinical terms available for selection by clinicians in the EHR (25th-75th percentiles: 63-976). Sharing of standard groupers for population health, clinical decision support, and analytic uses was high, including 57 patient registries (with 362 uses of standard groupers), 132 clinical decision support records, 190 rules, 124 EHR reports, 125 diagnosis dimension slicers for self-service analytics, and 111 clinical quality measure calculations. Identical SNOMED CT definitions were created in an EHR-agnostic tool enabling application across disparate organizations and EHRs. CONCLUSION: SNOMED CT-based diagnosis value sets are simple to develop, concise, understandable to clinicians, useful in the EHR and for analytics, and shareable. Developing curated SNOMED CT hierarchy-based condition definitions for public use could accelerate cross-organizational population health efforts, "smarter" EHR feature configuration, and clinical-translational research employing EHR-derived data.

Efficiency of Stratification for Ensemble Docking Using Reduced Ensembles.

Molecular docking can account for receptor flexibility by combining the docking score over multiple rigid receptor conformations, such as snapshots from a molecular dynamics simulation. Here, we evaluate a number of common snapshot selection strategies using a quality metric from stratified sampling, the efficiency of stratification, which compares the variance of a selection strategy to simple random sampling. We also extend the metric to estimators of exponential averages (which involve an exponential transformation, averaging, and inverse transformation) and minima. For docking sets of over 500 ligands to four different proteins of varying flexibility, we observe that, for estimating ensemble averages and exponential averages, many clustering algorithms have similar performance trends: for a few snapshots (less than 25), medoids are the most efficient, while, for a larger number, optimal (the allocation that minimizes the variance) and proportional (to the size of each cluster) allocation become more efficient. Proportional allocation appears to be the most consistently efficient for estimating minima.

Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes.

AIMS/HYPOTHESIS: Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. METHODS: This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017. The setting was 422 primary care practices and ten National Health Service specialist antenatal diabetes clinics. A multifaceted approach was taken to engage women with diabetes and community healthcare teams. This included identifying and sending PPC information leaflets to all eligible women, electronic preconception care templates, online education modules and resources, and regional meetings and educational events. Key outcomes were preconception folic acid supplementation, maternal HbA1c level, use of potentially harmful medications at conception and gestational age at first presentation, before and during/after the PPC programme. RESULTS: A total of 306 (73%) primary care practices actively participated in the PPC programme. Primary care databases were used to identify 5075 women with diabetes aged 18-45 years. PPC leaflets were provided to 4558 (89.8%) eligible women. There were 842 consecutive pregnancies in women with diabetes: 502 before and 340 during/after the PPC intervention. During/after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target HbA1c levels ≤48 mmol/mol (6.5%) (44.4% of women before vs 58.5% of women during/after PPC intervention; p = 0.016) and to take 5 mg folic acid daily (23.5% and 41.8%; p = 0.001). There was an almost threefold improvement in 'optimal' pregnancy preparation in women with type 2 diabetes (5.8% and 15.1%; p = 0.021). Women with type 1 diabetes presented for earlier antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks' gestation; p = 0.003) with no other changes. CONCLUSIONS/INTERPRETATION: A pragmatic community-based PPC programme was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes. To our knowledge, this is the first community-based PPC intervention to improve pregnancy preparation for women with type 2 diabetes. DATA AVAILABILITY: Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/our-clinical-audits-and-registries/national-pregnancy-in-diabetes-audit .

Health Promotion at the Construction Work Site: The Lunch Truck Pilot Study.

The transient nature of construction work makes it difficult to conduct longitudinal worksite-based health promotion activities. As part of a workplace health assessment pilot study, we worked with a commercial lunch truck company to disseminate four types of health education materials including cancer screening, workplace injury prevention, fruit and vegetable consumption, and smoking cessation to construction workers purchasing food items from the truck during their job breaks. Two weeks following the worksite assessment, we followed up with these workers to ascertain their use of the health promotion materials. Of the 54 workers surveyed, 83% reported reviewing and sharing the cancer screening materials with their families, whereas 44% discussed the cancer screening materials with coworkers. Similar proportions of workers reviewed, shared, and discussed the other health promotion materials with their family. Lunch trucks may be an effective strategy and delivery method for educating construction workers on healthy behaviors and injury prevention practices.

Medical student attitudes to the autopsy and its utility in medical education: a brief qualitative study at one UK medical school.

Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the "emerging patient"-an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy-based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho-social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy-based teaching represents a low-cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact.

Exposure to polycyclic aromatic hydrocarbons and serum inflammatory markers of cardiovascular disease.

Polycyclic aromatic hydrocarbons (PAHs) are environmental and occupational carcinogens produced by the incomplete combustion of organic materials, such as coal and petroleum product combustion, tobacco smoking, and food cooking, that may be significant contributors to the burden of cardiovascular disease in human populations. The purpose of this study was to investigate associations between ten monohydroxy urinary metabolites of four PAHs and three serum biomarkers of cardiovascular disease (fibrinogen, homocysteine, and white blood cell count). Using data on 3219 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 dataset, the associations between PAH metabolites and serum inflammatory markers were analyzed using the Spearman correlations and multiple linear regression modeling. The PAH metabolites of naphthalene, fluorene, phenanthrene, and pyrene each showed both positive and negative correlations with homocysteine, fibrinogen, and white blood cell count (correlation coefficient range: -0.077-0.143) in nonsmoking participants. Using multiple linear regression models adjusted for age, gender, race/ethnicity, and body mass index, estimates of weighted geometric means of inflammatory marker levels were not significantly different between high and low levels (75th vs. 25th percentiles) for all PAH metabolites in nonsmoking subjects. The results of this study do not provide evidence for a relationship between PAH exposure (as measured by urinary levels of PAH metabolites) and serum biomarkers of cardiovascular disease after controlling for tobacco use.

Toward improved statistical methods for analyzing Cotinine-Biomarker health association data.

BACKGROUND: Serum cotinine, a metabolite of nicotine, is frequently used in research as a biomarker of recent tobacco smoke exposure. Historically, secondhand smoke (SHS) research uses suboptimal statistical methods due to censored serum cotinine values, meaning a measurement below the limit of detection (LOD). METHODS: We compared commonly used methods for analyzing censored serum cotinine data using parametric and non-parametric techniques employing data from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES). To illustrate the differences in associations obtained by various analytic methods, we compared parameter estimates for the association between cotinine and the inflammatory marker homocysteine using complete case analysis, single and multiple imputation, "reverse" Kaplan-Meier, and logistic regression models. RESULTS: Parameter estimates and statistical significance varied according to the statistical method used with censored serum cotinine values. Single imputation of censored values with either 0, LOD or LOD/√2 yielded similar estimates and significance; multiple imputation method yielded smaller estimates than the other methods and without statistical significance. Multiple regression modelling using the "reverse" Kaplan-Meier method yielded statistically significant estimates that were larger than those from parametric methods. CONCLUSIONS: Analyses of serum cotinine data with values below the LOD require special attention. "Reverse" Kaplan-Meier was the only method inherently able to deal with censored data with multiple LODs, and may be the most accurate since it avoids data manipulation needed for use with other commonly used statistical methods. Additional research is needed into the identification of optimal statistical methods for analysis of SHS biomarkers subject to a LOD.

Cardiovascular fitness levels among American workers.

OBJECTIVE: To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population. METHODS: Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations. RESULTS: Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others. CONCLUSIONS: Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.

Utilization of the National Health and Nutrition Examination (NHANES) Survey for Symptoms, Tests, and Diagnosis of Chronic Respiratory Diseases and Assessment of Second hand Smoke Exposure.

BACKGROUND: Respiratory diseases encompass a number of complex disorders that constitute a major cause of both morbidity and mortality worldwide with a major burden to the afflicted as well as the health care systems that care for them. Although the prevalence of chronic respiratory diseases (CRDs) has been decreasing in industrialized countries due to a decreasing number of smokers and stricter laws aimed at reducing exposure to secondhand smoke (SHS), the burden of CRDs in developing world populations is expected to worsen due to communicable disease prevention programs, aging populations, environmental air pollution, and continued tobacco smoke exposure. Although tobacco smoking has been shown to be significantly associated with many CRDs, evidence linking SHS exposure to different CRDs is mixed, especially with low levels of SHS exposure. METHODS: The National Health and Nutrition Examination Survey (NHANES) is a series of studies designed to assess the health and nutritional status of non-institutionalized adults and children in the United States (U.S.). In addition to being used to monitor the health of the U.S. population, NHANES data allow for research into prevalent health problems and their risk factors in the population, such with CRDs and SHS exposure. NHANES data can be utilized to explore a variety of issues related to the assessment of SHS exposure and its association to respiratory symptoms and illnesses. RESULTS: First, we provide a brief review of NHANES including its strengths and limitations. We then provide a summary of the variables and publically available population based data that can be used to study associations between SHS exposure and CRD symptoms, testing and diagnoses. CONCLUSION: Rich and cost effective, NHANES data provide a unique opportunity for research into the risk factors for CRDs in the U.S. population, particularly into the possible health effects of low levels of SHS exposure.

Food label use and awareness of nutritional information and recommendations among persons with chronic disease.

BACKGROUND: Because of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. OBJECTIVE: This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. DESIGN: A total of 5603 respondents aged > or =17 y from the 2005-2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. RESULTS: Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. CONCLUSIONS: People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.

Accuracy of self-reported smoking and secondhand smoke exposure in the US workforce: the National Health and Nutrition Examination Surveys.

OBJECTIVES: Occupational health studies often rely on self-reported secondhand smoke (SHS) exposure. This study examines the accuracy of self-reported tobacco use and SHS exposure. METHODS: Data on serum cotinine, self-reported tobacco use, and SHS exposure for US workers were extracted from three National Health and Nutrition Examination Surveys (n = 17,011). Serum cotinine levels were used to classify workers into SHS exposure categories. The percent agreement between self-reported tobacco use and SHS exposure with the cotinine categories was calculated. RESULTS: Workers reporting tobacco use were 88% accurate whereas workers reporting work, home, or home+work exposures were 87% to 92% accurate. Workers reporting no SHS exposure were only 28% accurate. CONCLUSIONS: Workers accurately reported their smoking status and workplace-home SHS exposures, but substantial numbers reporting "no exposures" had detectable levels of cotinine in their blood, indicating exposure to SHS.

Inflammatory markers and secondhand tobacco smoke exposure among U.S. workers.

BACKGROUND: Self-reported exposure to secondhand smoke (SHS) has been associated with elevated inflammatory markers in adults. The association between SHS indicated by serum cotinine and markers of inflammation has not been investigated in adult workers. METHODS: Using the subpopulation of employed participants (20 years and older) who were non-smokers and denied home SHS exposure from the National Health and Nutrition Examination Survey (NHANES) 1999-2002, the association between serum cotinine and inflammatory markers (C-reactive protein, fibrinogen, homocysteine, and white blood cells) was analyzed. Inflammatory marker values were log-transformed and expressed as geometric means with 95% confidence intervals (CI). Serum cotinine was categorized as either no cotinine (below the detection limit), low cotinine (above the detection limit and <0.2 ng/ml), or high cotinine (>or=0.2 and <15.0 ng/ml). The association between serum cotinine and inflammatory markers was analyzed using univariate and multivariate-adjusted linear regression. RESULTS: Geometric mean serum cotinine was significantly higher among non-smokers reporting SHS exposure in the workplace (0.17 vs. 0.10 ng/ml, P < 0.01). Workers exposed to low and high levels of cotinine had significantly higher homocysteine levels relative to non-exposed workers; mean homocysteine differences remained significant in the multivariable model (i.e., 0.363 and 0.491 mg/dl increase, respectively). CONCLUSION: Exposure to SHS as measured by serum cotinine may result in increased homocysteine levels among adult workers. These results provide further evidence in support of universal workplace smoking restrictions in order to protect worker health. Further research is required to determine the adverse effects of workplace SHS exposure on cardiovascular risk.

Respiratory effects of secondhand smoke exposure among young adults residing in a "clean" indoor air state.

The objective of this study is to estimate the prevalence of self-reported secondhand smoke (SHS) exposures and its association with respiratory symptoms in a sample of young adults residing in a state with a partial clean indoor air law. A cross-sectional telephone survey of Florida households and a single state University was conducted in 2005. Enrolled participants between 18 and 24 years of age completed a 15-20 min interview assessing past and current SHS exposure and current respiratory symptoms (n = 1858). Approximately 60% of the sample were female; nearly 70% were non-Hispanic white, 10% were non-Hispanic Black, and 11% were Hispanic. Over two-thirds reported completing at least some college; 23% reported smoking in the past month. Nearly two-thirds (64%) reported visiting a bar or nightclub which exposed them to SHS in the previous month; nearly half (46%) reported SHS exposure while riding in automobiles; 15% reported occupational SHS exposure; and nearly 9% reported living with at least one smoker. In multivariable models, personal smoking behavior, parental smoking history, and exposure to SHS in automobiles and in bars or nightclubs were significantly associated with increased reports of respiratory symptoms. Despite residing in a "clean" indoor air state, the majority of surveyed young adults continue to report exposure to SHS, especially in automobiles and in bars, and these exposures adversely impact respiratory health. All municipalities should pursue clean indoor air legislation which does not exempt bars and restaurants. Educational campaigns directed at reducing SHS exposure in motor vehicles also are needed.

Declining trends in serum cotinine levels in US worker groups: the power of policy.

OBJECTIVE: To explore trends in cotinine levels in US worker groups. METHODS: Using NHANES III data, serum cotinine levels of US workers not smokers nor exposed to secondhand smoke (SHS) at home were evaluated for trends by occupational/industrial and race/ethnicity-gender sub-groups. RESULTS: Decreases from 1988 to 2002 ranged from 0.08 to 0.30 ng/mL (67% to 85% relative decrease), with largest absolute reductions in: blue-collar and service occupations; construction/manufacturing industrial sectors; non-Hispanic Black male workers. CONCLUSIONS: All worker groups had declining serum cotinine levels. Most dramatic reductions occurred in sub-groups with the highest before cotinine levels, thus disparities in SHS workforce exposure are diminishing with increased adoption of clean indoor laws. However, Black male workers, construction/manufacturing sector workers, and blue-collar and service workers have the highest cotinine levels. Further reductions in SHS exposure will require widespread adoption of workplace clean air laws without exemptions.

Managed clinical networks: what are they and how do they work?

UNLABELLED: Managed clinical networks (MCNs) play an increasingly important part in the delivery of effective healthcare. This paper describes what they are and how they work, based on the experience of MCNs in Scotland and, in particular, CleftSiS, the National Managed Clinical Network for Cleft Lip and Palate Services in Scotland. CLINICAL RELEVANCE: The basic principles of MCNs described in this paper will assist clinicians in all specialties, with the development of MCNs that modernize and integrate the delivery of effective healthcare.