Search

Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach.Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views postdischarge ADEs as the outcome of professional and patient home work systems.Thirty-eight professionals participated (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers). Hazards were classified into 6 groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information.From the perspective of hospital-based frontline health care professionals, hazards for medication-related harms during care transitions were multifactorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.

SUMMARY This article summarizes the study of Rozario, Vasarhelyi, and Wang (2022), which examines the use of consumer tweets in improving the prediction and error detection performance of preliminary analytical procedures for the revenue account for firms that belong to consumer-oriented industries. They find that consumer tweets about product or brand interest increase the prediction and error detection ability of analytical procedures compared to analytical procedures that do not include it. These results suggest that this new source of external nonfinancial information is incrementally informative to auditors in developing assessments for the risk of misstated revenue in the planning stage of the audit. The findings of this study have important implications that may be relevant to the audits of other financial statement accounts.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) and comorbid conditions require patients to take complex medication regimens. Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear. OBJECTIVES: Our objectives were: (1) to examine associations between regimen complexity (with the Medication Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare overall MRCI with other measures of regimen complexity (overall and diabetes-specific medication count) and diabetes-specific MRCI. METHODS: This was a secondary data analysis of cross-sectional data from a parent trial. Participants were patients with T2DM taking at least 3 chronic medications followed in safety net clinics in the Chicago area. The MRCI measures complexity based on dosing frequency, route of administration, and special instructions for prescribed medications. MRCI scores were created for overall regimens and diabetes-specific medications. Sociodemographics and outpatient visit utilization were included in models as covariates. Linear regression was used to examine the associations between variables of interest and hemoglobin A1C. RESULTS: Participants (N = 432) had a mean age of 56.9 years, most were female (66.0%), and Hispanic or Latino (73.3%). Regimen complexity was high based on overall medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). Higher diabetes-specific MRCI was associated with higher A1C in bivariate and multivariable models. In multivariable models, overall MRCI greater than 14, fewer outpatient health care visits, male gender, and absence of health insurance were independently associated with higher A1C. The variance in A1C explained by MRCI was higher compared to medication count for overall and diabetes-specific regimen complexity. CONCLUSIONS: More complex regimens are associated with worse A1C and measuring complexity with MRCI may have advantages. Deprescribing, increasing insurance coverage, and promoting engagement in health care may improve A1C among underserved populations with complex regimens.

Advances in time-resolved structural techniques, mainly in macromolecular crystallography and small-angle X-ray scattering (SAXS), allow for a detailed view of the dynamics of biological macromolecules and reactions between binding partners. Of particular promise, are mix-and-inject techniques, which offer a wide range of experimental possibility as microfluidic mixers are used to rapidly combine two species just prior to data collection. Most mix-and-inject approaches rely on diffusive mixers, which have been effectively used within crystallography and SAXS for a variety of systems, but their success is dependent on a specific set of conditions to facilitate fast diffusion for mixing. The use of a new chaotic advection mixer designed for microfluidic applications helps to further broaden the types of systems compatible with time-resolved mixing experiments. The chaotic advection mixer can create ultra-thin, alternating layers of liquid, enabling faster diffusion so that even more slowly diffusing molecules, like proteins or nucleic acids, can achieve fast mixing on timescales relevant to biological reactions. This mixer was first used in UV–vis absorbance and SAXS experiments with systems of a variety of molecular weights, and thus diffusion speeds. Careful effort was also dedicated to making a loop-loading sample-delivery system that consumes as little sample as possible, enabling the study of precious, laboratory-purified samples. The combination of the versatile mixer with low sample consumption opens the door to many new applications for mix-and-inject studies.

Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states’ IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states’ racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states’ White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not “centered at the margins” but is instead responsive to characteristics in states’ White populations.

Mesenchymal breast tumors are a rare and diverse group of tumors that present some of the most challenging cases for multidisciplinary breast cancer teams. As a result of overlapping morphologies and a lack of large-scale studies on these tumors, practices are often heterogeneous and slow to evolve. Herein, we present a non-systematic review that focuses on progress, or lack thereof, in the field of mesenchymal breast tumors. We focus on tumors originating from fibroblastic/myofibroblastic cells and tumors originating from less common cellular origins (smooth muscle, neural tissue, adipose tissue, vascular tissue, etc.).

Stratocumulus clouds cover about a fifth of Earths surface, and due to their albedo and low-latitude location, they have a strong effect on Earths radiation budget. Previous studies using Large Eddy Simulations have shown that multiple equilibria (both cloud-covered and cloud-free states) exist as a function of fixed-SST, with relevance to equatorward advected air masses. Multiple equilibria have also been found as a function of atmospheric CO2, with a subtropical SST nearly 10 K higher in the cloud-free state, and with suggested relevance to warm-climate dynamics. In this study, we use a mixed-layer model with an added surface energy balance and the ability to simulate both the cloud-covered and cloud-free states to study both types of multiple equilibria and the corresponding hysteresis. The model's simplicity and computational efficiency allow us to explore the mechanisms critical to the stratocumulus cloud instability and hysteresis as well as isolate key processes that allow for multiple equilibria via mechanism denial experiments not possible with a full-complexity model. For the hysteresis in fixed-SST, we find that decoupling can occur due to either enhanced entrainment warming or a reduction in cloud-top longwave cooling. The critical SST at which decoupling occurs is highly sensitive to precipitation and entrainment parameterizations. In the CO2 hysteresis, decoupling occurs in the simple model used even without the inclusion of an active SST and SST-cloud cover feedbacks, and the width of the hysteresis displays the same sensitivities as the fixed-SST case. Overall, the simple model analysis and results motivate further studies using higher complexity models., Submitted to Journal of Climate 06-12-2022

Cost-effectiveness analyses of new cancer treatments in real-world settings (e.g., post-clinical trials) inform healthcare decision makers about their healthcare investments for patient populations. The results of these analyses are often, though not always, presented with statistical uncertainty. This paper identifies five ways to characterize statistical uncertainty: (1) a 95% confidence interval (CI) for the incremental cost-effectiveness ratio (ICER); (2) a 95% CI for the incremental net benefit (INB); (3) an INB by willingness-to-pay (WTP) plot; (4) a cost-effectiveness acceptability curve (CEAC); and (5) a cost-effectiveness scatterplot. It also explores their usage in 22 articles previously identified by a rapid review of real-world cost effectiveness of novel cancer treatments. Seventy-seven percent of these articles presented uncertainty results. The majority those papers (59%) used administrative data to inform their analyses while the remaining were conducted using models. Cost-effectiveness scatterplots were the most commonly used method (34.3%), with 40% indicating high levels of statistical uncertainty, suggesting the possibility of a qualitatively different result from the estimate given. Understanding the necessity for and the meaning of uncertainty in real-world cost-effectiveness analysis will strengthen knowledge translation efforts to improve patient outcomes in an efficient manner.

Most foods derived from plant origin are very nutritious but highly perishable products. Nowadays, the food industry is focusing on the development of efficient preservation strategies as viable alternatives to traditional packaging and chemical treatments. Hence, polysaccharide-based edible coatings have been proposed because of their properties of controlled release of food additives and the protection of sensitive compounds in coated foods. Thus, this technology has allowed for improving the quality parameters and extends the shelf life of fruits and vegetables through positive effects on enzyme activities, physicochemical characteristics (e.g., color, pH, firmness, weight, soluble solids), microbial load, and nutritional and sensory properties of coated foods. Additionally, some bioactive compounds have been incorporated into polysaccharide-based edible coatings, showing remarkable antioxidant and antimicrobial properties. Thus, polysaccharide-based edible coatings incorporated with bioactive compounds can be used not only as an efficient preservation strategy but also may play a vital role in human health when consumed with the food. The main objective of this review is to provide a comprehensive overview of materials commonly used in the preparation of polysaccharide-based edible coatings, including the main bioactive compounds that can be incorporated into edible coatings, which have shown specific bioactivities.

Hartmut Rosa has grown to international celebrity thanks to his theory of social acceleration as a new interpretation of modernity, linked with the imperative of growth and the idea of alienation. His recent work has revolved around the concept of resonance, and although this has raised significant interest, its positioning within contemporary sociological theory still needs further study. This article starts situating the notion of resonance in the wider context of Rosa’s theoretical enterprise (section 1). The following section outlines the key concepts and the main argument comprising his theory of resonance, and briefly examines some specific challenges to resonance emerging in the current predicament (section 2). Finally, the article ends by connecting idea of resonance with a few pivotal themes in contemporary sociological theory, with a special focus on Margaret Archer’s morphogenetic approach and her theory of the Self and personal reflexivity (section 3). The core thesis of the article is that the notion of resonance still calls for better understanding within social theory, precisely because of the specific type of critique of modernity inherent in such a concept.

There are limited data on trends in nationwide cardiac electrophysiology (EP) procedures in the US before and during the global COVID-19 pandemic.We aimed to understand contemporary EP procedural trends, and how the COVID-19 pandemic impacted them.Trends were obtained from publicly reported Centers for Medicare and Medicaid Services data from 2013 to 2020 (latest available). Rates of catheter-based EP procedures (EP studies and ablations) and cardiac implantable electronic device (CIED) procedures were analyzed. All procedural rates were calculated per 100,000 Medicare beneficiaries (year specific). Procedure physician subspecialty was also reported.From 2013 to 2019, annual rate of all cardiac EP procedures increased from 817.91 to 1089.68 per 100,000 beneficiaries. Catheter-based EP procedures increased from 323.73 to 675.01, while CIED rates decreased from 494.18 to 414.67. While all ablation procedures increased over time, relative proportion of ablation procedures being pulmonary vein isolation (PVI) increased (9.9% of ablations in 2013, to 18.2% in 2019). In 2020, rates of both catheter-based EP procedures and CIED procedures decreased; however, PVI share of ablation continued to increase in 2020 comprising 25.2% of ablation procedures.Rates of EP procedures have increased among Medicare beneficiaries, with catheter-based procedures now eclipsing CIEDs. Additionally, a greater proportion of catheter-based EP procedures are PVI, but they still represent a minority of all ablations. In 2020, rates of EP procedures were attenuated, yet proportion of PVI ablations increased to over one-fourth of ablation procedures. These data have important implications for the EP workforce.

Objective Pelvic floor dysfunction can manifest as a spectrum including anorectal dysfunction, vaginal prolapse, and urinary incontinence. Sacrospinous fixation is a procedure performed by gynecologists to treat vaginal prolapse. The present study aims to evaluate the impact of transvaginal prolapse surgery on anorectal function. Materials and Methods We conducted a retrospective review of patients undergoing sacrospinous fixation surgery for vaginal prolapse between 2014 to 2020. Those with anorectal dysfunction who had also been evaluated by the colorectal service preoperatively and postoperatively were included for analysis. These patients were assessed with symptom-specific validated questionnaires. The effect of surgery on constipation and fecal incontinence symptoms was analyzed. Results A total of 22 patients were included for analysis. All patients underwent transvaginal sacrospinous fixation, and 95.4% also had posterior colporrhaphy for vaginal prolapse. There were a statistically significant improvements in the Fecal Incontinence Severity Index (FISI), the St. Mark's Incontinence Score (Vaizey), the embarrassment and lifestyle components of the Fecal Incontinence Quality of Life Score, the Constipation Scoring System, the Obstructed Defecation Score, and components of the Patient Assessment of Constipation Quality of Life score. Conclusion Transvaginal prolapse surgery leads to a favorable effect on anorectal function, with improvements in both obstructed defecation and fecal incontinence scores in this small series.

Early initiation of chemotherapy after surgery for colon cancer has survival benefits. Immediate adjuvant chemotherapy (IAC) involves giving chemotherapy during surgical resection and immediately postoperatively. This novel approach has been shown to be safe, eliminating delays in adjuvant treatment that could increase the risk of micro-metastatic spread. The aim of this study was to assess the willingness of the general public to accept IAC.Between March and April 2021, 800 telephone interviews were conducted with a sample of adult New York State residents. The Survey Research Institute of Cornell University conducted all surveys. Kruskal-Wallis, chi-squared, and Fisher's tests were conducted using R 4.0.2.Three scenarios were presented: (1) receiving IAC resulting in improved survival and quality of life, (2) finishing chemotherapy earlier without survival impact, and (3) finishing chemotherapy earlier but with possible side effects. Respondents with higher education were more likely to accept (1)(2), males were more likely to accept (2)(3), higher income respondents were more likely to accept (1)(3), and those with more work hours were more likely to accept (2). Lastly, 16% responded they would be very or extremely likely, and 52% respondents would be somewhat likely or likely to accept intraoperative chemotherapy, even if it may not be necessary.Respondents were likely to accept IAC if offered. Given the known risk of delayed adjuvant chemotherapy (AC) in colon cancer, further research is warranted to determine the survival and quality of life (QOL) benefits of IAC.

Background Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation. Methods PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques. Results Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique. Conclusions The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.

This paper describes the development, properties, and evaluation of a musculoskeletal model that reflects the anatomical and prosthetic properties of a transtibial amputee using OpenSim. Average passive prosthesis properties were used to develop CAD models of a socket, pylon, and foot to replace the lower leg. Additional degrees of freedom (DOF) were included in each joint of the prosthesis for potential use in a range of research areas, such as socket torque and socket pistoning. The ankle has three DOFs to provide further generality to the model. Seven transtibial amputee subjects were recruited for this study. 3D motion capture, ground reaction force, and electromyographic (EMG) data were collected while participants wore their prescribed prosthesis, and then a passive prototype prosthesis instrumented with a 6-DOF load cell in series with the pylon. The model’s estimates of the ankle, knee, and hip kinematics comparable to previous studies. The load cell provided an independent experimental measure of ankle joint torque, which was compared to inverse dynamics results from the model and showed a 7.7% mean absolute error. EMG data and muscle outputs from OpenSim’s Static Optimization tool were qualitatively compared and showed reasonable agreement. Further improvements to the muscle characteristics or prosthesis-specific foot models may be necessary to better characterize individual amputee gait. The model is open-source and available at (https://simtk.org/projects/biartprosthesis) for other researchers to use to advance our understanding and amputee gait and assist with the development of new lower limb prostheses.

Associations between mood and drinking are part of many theoretical models of problematic alcohol use. Laboratory and ecological momentary assessment (EMA) research on associations between mood and drinking behavior has produced mixed findings, and these constructs are often measured using different methods depending on research context. The present study compares associations between mood and alcohol consumption across research contexts (laboratory vs. daily life) and measurement methods (breathalyzer vs. self-report).Forty-five young adults (53% women,We identified discrepant mood-BrAC associations across laboratory and EMA contexts. Momentary excitement was negatively associated with BrAC in the lab, but positively associated with BrAC during EMA (Studies testing theoretical models involving directional mood-alcohol associations (e.g., affective reinforcement models) need to carefully consider how research context and methods may influence findings of associations between mood and drinking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Research suggests that personality traits are associated with mild cognitive impairment (MCI), dementia, and mortality risk, but the timing of when traits are most important in the progression to dementia and the extent to which they are associated with years of cognitive health span are unclear. This project applied secondary data analysis to the Rush Memory and Aging Project (

The COVID-19 pandemic and related social and economic emergencies induced massive public spending and increased global debt. Economic recovery is now an opportunity to rebuild natural capital alongside financial, physical, social and human capital, for long-term societal benefit. Yet, current decision-making is dominated by economic imperatives and information systems that do not consider society’s dependence on natural capital and the ecosystem services it provides. New international standards for natural capital accounting (NCA) are now available to integrate environmental information into government decision-making. By revealing the effects of policies that influence natural capital, NCA supports identification, implementation and monitoring of Green Recovery pathways, including where environment and economy are most positively interlinked.

Background: The comparative real-world outcomes of older patients with atrial fibrillation (AF) treated with anticoagulation compared with left atrial appendage occlusion (LAAO) may be different from those in clinical trials because of differences in anticoagulation strategies and patient demographics, including a greater proportion of women. We sought to compare real-world outcomes between older patients with AF treated with anticoagulation and those treated with LAAO by sex. Methods: Using Medicare claims data from 2015 to 2019, we identified LAAO-eligible beneficiaries and divided them into sex subgroups. Patients receiving LAAO were matched 1:1 to those receiving anticoagulation alone through propensity score matching. The risks of mortality, stroke or systemic embolism, and bleeding were compared between matched groups with adjustment for potential confounding characteristics in Cox proportional hazards models. Results: Among women, 4085 LAAO recipients were matched 1:1 to those receiving anticoagulation; among men, 5378 LAAO recipients were similarly matched. LAAO was associated with a significant reduction in the risk of mortality for women and men (hazard ratio [HR], 0.509 [95% CI, 0.447–0.580]; and HR, 0.541 [95% CI, 0.487–0.601], respectively; P P P Conclusions: In a real-world population of older Medicare beneficiaries with AF, compared with anticoagulation, LAAO was associated with a reduction in the risk of death, stroke, and long-term bleeding among women and men. These findings should be incorporated into shared decision-making with patients considering strategies for reduction in AF-related stroke.

Adrenal insufficiency (AI) is a severe endocrine disorder characterized by insufficient glucocorticoid (GC) and/or mineralocorticoid (MC) secretion by the adrenal glands, due to impaired adrenal function (primary adrenal insufficiency, PAI) or to insufficient adrenal stimulation by pituitary ACTH (secondary adrenal insufficiency, SAI) or tertiary adrenal insufficiency due to hypothalamic dysfunction. In this review, we describe rare genetic causes of PAI with isolated GC or combined GC and MC deficiencies and we also describe rare syndromes of isolated MC deficiency. In children, the most frequent cause of PAI is congenital adrenal hyperplasia (CAH), a group of adrenal disorders related to steroidogenic enzyme deficiencies, which will not be included in this review. Less frequently, several rare diseases can cause PAI, either affecting exclusively the adrenal glands or with systemic involvement. The diagnosis of these diseases is often challenging, due to the heterogeneity of their clinical presentation and to their rarity. Therefore, the current review aims to provide an overview on these rare genetic forms of paediatric PAI, offering a review of genetic and clinical features and a summary of diagnostic and therapeutic approaches, promoting awareness among practitioners, and favoring early diagnosis and optimal clinical management in suspect cases.

We study the equilibrium implications of a multi-asset economy in which asset managers are subject to different benchmarks, and demonstrate how heterogeneous benchmarking generates a mechanism through which fundamental shocks propagate across assets. Fluctuations in asset managers' capital invested for benchmarking purposes, scaled by the size of the economy, induce price pressure that can result in negative spillovers across asset returns. We highlight the economic significance of these benchmarking-induced spillovers by analyzing shock elasticities and cross-elasticities of price-dividend ratios, and characterize a rich structure of asset price comovements within and across benchmarks. Heterogeneous benchmarking also induces return predictability, generating both reversal and momentum.