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Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments.The objective of this study was to explore community engagement and representation in CHNAs and IPs.The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021.For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified.Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies.Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses “American Hospital Associations’ 2020 Annual Survey” data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, “the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives” plays in hospitals’ choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

Nonprofit hospitals frequently partner with their local health department on developing community health needs assessments (CHNAs); yet, little is known about the role that such partnerships play in strengthening the alignment between needs identified in hospitals' assessments and the strategies adopted by hospitals to address identified needs. Using data for 486 hospitals from the third round of CHNAs (spanning the years 2018-2021), this study showed strong alignment between the health needs identified in the CHNAs and those addressed in hospitals' implementation strategies, independent of collaboration with the local health department. One noteworthy exception to this finding was that hospital-public health collaboration remained important for improved alignment of needs related to substance use. Involvement of the local health department may strengthen hospitals' capacity to address needs outside their traditional areas of expertise, such as substance use.

To review the outcomes of patients who underwent autologous oocyte thaw after planned oocyte cryopreservation.Retrospective cohort study.Large urban university-affiliated fertility center.All patients who underwent ≥1 autologous oocyte thaw before December 31, 2020.None.The primary outcome was the final live birth rate (FLBR) per patient, and only patients who had a live birth (LB) or consumed all remaining inventory (cryopreserved oocytes and resultant euploid/untested/no result embryos) were included. The secondary outcomes were laboratory outcomes and LB rates per transfer.A total of 543 patients underwent 800 oocyte cryopreservations, 605 thaws, and 436 transfers. The median age at the first cryopreservation was 38.3 years. The median time between the first cryopreservation and thaw was 4.2 years. The median numbers of oocytes and metaphase II oocytes (M2s) thawed per patient were 14 and 12, respectively. Overall survival of all thawed oocytes was 79%. Of all patients, 61% underwent ≥1 transfer. Among euploid (n = 262) and nonbiopsied (n = 158) transfers, the LB rates per transfer were 55% and 31%, respectively. The FLBR per patient was 39%. Age at cryopreservation and the number of M2s thawed were predictive of LB; the FLBR per patient was50% for patients aged38 years at cryopreservation or who thawed ≥20 M2s. A total of 173 patients (32%) have remaining inventory.Autologous oocyte thaw resulted in a 39% FLBR per patient, which is comparable with age-matched in vitro fertilization outcomes. Studies with larger cohorts are necessary.

Large transformer-based language models have achieved incredible success at various tasks which require narrative comprehension, including story completion, answering questions about stories, and generating stories ex nihilo. However, due to the limitations of finite context windows, these language models struggle to produce or understand stories longer than several thousand tokens. In order to mitigate the document length limitations that come with finite context windows, we introduce a novel architecture that augments story processing with an external dynamic knowledge graph. In contrast to static commonsense knowledge graphs which hold information about the real world, these dynamic knowledge graphs reflect facts extracted from the story being processed. Our architecture uses these knowledge graphs to create information-rich prompts which better facilitate story comprehension than prompts composed only of story text. We apply our architecture to the tasks of question answering and story completion. To complement this line of research, we introduce two long-form question answering tasks, LF-SQuAD and LF-QUOREF, in which the document length exceeds the size of the language model's context window, and introduce a story completion evaluation method that bypasses the stochastic nature of language model generation. We demonstrate broad improvement over typical prompt formulation methods for both question answering and story completion using GPT-2, GPT-3 and XLNet.

Obesity is variably associated with treatment response in biologic-treated patients with inflammatory bowel diseases (IBD). We evaluated the association between obesity and risk of hospitalization, surgery, or serious infections in patients with IBD in new users of biologic agents in a large, multicenter, electronic health record (EHR)-based cohort (CA-IBD).We created an EHR-based cohort of adult patients with IBD who were new users of biologic agents (tumor necrosis factor [TNF-α] antagonists, ustekinumab, and vedolizumab) between January 1, 2010, and June 30, 2017, from 5 health systems in California. Patients were classified as those with normal body mass index (BMI), overweight, or obese based on the World Health Organization classification. We compared the risk of all-cause hospitalization, IBD-related surgery, or serious infections among patients with obesity vs those overweight vs those with normal BMI, using Cox proportional hazard analyses, adjusting for baseline demographic, disease, and treatment characteristics.Of 3,038 biologic-treated patients with IBD (69% with Crohn's disease and 76% on TNF-α antagonists), 28.2% (n = 858) were overweight, and 13.7% (n = 416) were obese. On a follow-up after biologic initiation, obesity was not associated with an increased risk of hospitalization (adjusted hazard ratio [aHR] vs normal BMI, 0.90; [95% confidence interval, 0.72-1.13]); IBD-related surgery (aHR, 0.62 [0.31-1.22]); or serious infection (aHR, 1.11 [0.73-1.71]). Similar results were observed on stratified analysis by disease phenotype (Crohn's disease vs ulcerative colitis) and index biologic therapy (TNF-α antagonists vs non-TNF-α antagonists).In a multicenter, EHR-based cohort of biologic-treated patients with IBD, obesity was not associated with hospitalization, surgery, or serious infections. Further studies examining the effect of visceral obesity on patient-reported and endoscopic outcomes are needed.

Hospitals have the ability to serve as anchor institutions that not only provide clinical care but make important community investments through employment, and outreach, and engagement efforts that address the social determinants of health. In doing so, hospitals may partner with community members and community-based organizations, but the extent to which local residents participate in directing local investments varies across organizations. This study looks at the role of hospitals as anchor institutions and the best practices for leveraging community participation in planning investments to improve social and economic health in communities. We used an inductive, qualitative approach to understand the incentives hospitals have to anchor themselves within their communities and how best practices can be leveraged. We conducted 28 in-depth interviews with 27 hospital leaders and personnel, and one interview with a member of a for-profit hospital advocacy organization. Drawing on thematic analysis, three primary themes were identified as critical to leveraging community-driven anchor activities: strong and intentional community-oriented leadership; direct community involvement; and non-regulatory incentives, including incentive programs. The more institutions, organizations, communities, and individuals expect community-oriented anchor activities from hospitals, the more likely they are to engage in such activities. Critical to this work is ensuring that community members themselves are able to help direct the investments of hospitals in alignment with community health needs. Community stakeholders, including elected officials, public health offices, and policymakers, have important leverage in creating expectations for hospitals to engage in anchor activities and facilitate community-based partnerships as a part of this process.

Expression of Fc receptors on primary human monocytes

UV-inactivated reovirus induces monocyte activation

Immunotherapy is showing promise for otherwise incurable cancers. Oncolytic viruses (OVs), developed as direct cytotoxic agents, mediate their antitumor effects via activation of the immune system. However, OVs also stimulate antiviral immune responses, including the induction of OV-neutralizing antibodies. Current dogma suggests that the presence of preexisting antiviral neutralizing antibodies in patients, or their development during viral therapy, is a barrier to systemic OV delivery, rendering repeat systemic treatments ineffective. However, we have found that human monocytes loaded with preformed reovirus–antibody complexes, in which the reovirus is fully neutralized, deliver functional replicative reovirus to tumor cells, resulting in tumor cell infection and lysis. This delivery mechanism is mediated, at least in part, by antibody receptors (in particular FcγRIII) that mediate uptake and internalization of the reovirus/antibody complexes by the monocytes. This finding has implications for oncolytic virotherapy and for the design of clinical OV treatment strategies. Cancer Immunol Res; 6(10); 1161–73. ©2018 AACR.

Hand-off of reoNAb by monocytes is contact-dependent

Serum from mice immunized against reovirus is highly neutralizing

Patient-derived neutralizing antibodies favor routing of virus to CD14+ cells in whole blood

FcγRIII receptor blockade impairs reoNAb loading of monocytes

ReoNAb induce increased FcR RNA levels in monocytes

Patient-derived serum is highly neutralizing

This chapter explores the vast differential diagnosis for an infant with vomiting from the most common benign etiologies to more serious pathology, such as pyloric stenosis and focuses on one of the most devastating etiologies: abusive head trauma. The normal anatomy present on an infants CT are reviewed and the pathophysiology and classification of subdural hemorrhage, epidural hemorrhage, and subarachnoid hemorrhage are described, as well as findings on computerized tomography. Details regarding the variable presentation of abusive head trauma, medical management in the acute phase, differential diagnosis, and recommended workup for non-accidental trauma are included. Guidance on mandated reporting are discussed, as well as pearls for management and common pitfalls.

Physicians are on the front lines of the U.S. opioid epidemic, providing care in multiple treatment settings. Very little is known, however, about whether this experience has contributed to physician burnout. This information is critical for guiding efforts to expand the relatively low level of training on opioid misuse currently available in medical education.We surveyed 408 board-certified physicians practicing in Ohio about their experiences working with patients who misuse opioids. We also collected quantitative measures of physicians' burnout and their level of contact with this patient population. We coded and analyzed open-ended responses and calculated a partial correlation between contact and burnout, controlling for relevant factors.Physicians experienced three primary barriers when working with patients who misuse opioids: inadequate knowledge and training, limited external resources and partnerships in their communities, and an incomplete context for understanding problematic patient behaviors. 70% of physicians experienced negative emotions when working with this patient population and 19% mentioned experiencing burnout specifically. Contact with patients who misuse opioids was significantly and positively associated with burnout scores.Our findings underscore the need for medical educators to take a proactive approach to equipping physicians with the knowledge, skills, and resources needed to effectively work with patients who misuse opioids.

Many students with learning disabilities (LD) do not master basic reading skills, which affects later reading fluency and reading comprehension development. Single-case experimental design (SCED) research yields unique opportunities to better understand which aspects of a basic reading intervention are effective with a particular student, including the individual’s rate of growth, stability, or maintenance of acquired skills, and whether or not modifications need to be made to the intervention under study. In this article, we use a case study illustration to highlight unique considerations for using SCED research to investigate basic reading interventions for students with LD. Finally, we provide a discussion of future directions and a potential shift in SCED methodology that is responsive to the comprehensive and multiple skill nature of reading instruction.

Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models.This survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth.Of 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p .0001). Most responding physicians (46/57; 80.7%) reported being a member of NSTs, compared with 56.5% (88/156) of dietitians. Of those not practicing in NSTs (N = 81/235, 34.4%), 12.3% (10/81) reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (115/235; 48.9%), followed by leadership (72/235; 30.6%), and healthcare professional (HCP) interest (55/235; 23.4%). A majority (173/235; 73.6%) of all respondents wanted additional training in nutrition but reported insufficient protected time, ability to travel, or support from administrators or other HCPs.Core actions resulting from this survey focused on formalizing physician roles, increasing interdisciplinary nutrition support expertise, utilizing cost-effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

Title: Channels to realityPublisher Warsaw, Poland: Sciendo (Walter de Gruyter)Is Part Of Mindsponge Theory, 2022, p.51-72Identifier EISBN: 9788367405157EISBN: 8367405153DOI: 10.2478/9788367405157-006https://berkeley.primo.exlibrisgroup.com/permalink/01UCS_BER/s4lks2/cdi_walterdegruyter_books_10_2478_9788367405157_006

Introduction Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. Methods We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018). Results Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. Conclusions Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.

Throughout the COVID-19 pandemic, hospitals and their staffs have been pushed to their limits. Hospitals have had to rethink how they support community health while also providing critical acute care services to combat the morbidity and mortality associated with COVID-19. As anchor institutions, hospitals have a significant effect on not only community health and well-being but also on local economies as primary employers and contractors. This study aimed to understand how the pandemic reshaped interactions with community members, staff, and other community organizations and changed the nature of hospital-community engagement among for-profit hospitals.We recruited leaders of for-profit hospitals, systems, and a business association that represents for-profit hospitals. We interviewed 28 participants in various leadership roles via telephone or videoconferencing and then thematically coded interview transcriptions. The themes identified in early interviews guided the structure of forthcoming interviews.For-profit hospitals appear motivated to address community health needs as anchor institutions in their communities, and these efforts have strengthened and changed in important ways as a result of the COVID-19 pandemic. In this study, three themes emerged regarding the influence of COVID-19 on hospital-community relationships: Hospitals refocused outreach and engagement efforts to support employees, found essential new ways to safely engage with the community through partnerships and collaborations, and were reminded of the critical roles of social and cultural factors in the health and well-being of individuals and communities.Hospitals may be able to use lessons learned during the pandemic to support the growing need for community engagement and attention to social determinants of health. The themes that emerged from this study present valuable opportunities for hospitals to carry forward the lessons learned over the course of the pandemic, as they have the potential to improve the delivery of healthcare and community engagement in day-to-day operations as well as in crises.

Additional file 1: Appendix Table 1. Sample state policy characteristics.

The Data Science Education Repository is a Community of Practice repository hosted by UC Berkeley that provides a space for data science education instructors, researchers, and scholars to share materials and showcase their work. Data science education materials can be utilized in the development of curriculum and in education research.

We present Trieste, an open-source Python package for Bayesian optimization and active learning benefiting from the scalability and efficiency of TensorFlow. Our library enables the plug-and-play of popular TensorFlow-based models within sequential decision-making loops, e.g. Gaussian processes from GPflow or GPflux, or neural networks from Keras. This modular mindset is central to the package and extends to our acquisition functions and the internal dynamics of the decision-making loop, both of which can be tailored and extended by researchers or engineers when tackling custom use cases. Trieste is a research-friendly and production-ready toolkit backed by a comprehensive test suite, extensive documentation, and available at https://github.com/secondmind-labs/trieste.

Supplemental Digital Content is available in the text., Background and Purpose: Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage. Methods: Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage. Results: OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0. Conclusions: Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.

BackgroundIndividual differences in functional brain connectivity can be used to predict both the presence of psychiatric illness and variability in associated behaviors. However, despite evidence for sex differences in functional network connectivity and in the prevalence, presentation, and trajectory of psychiatric illnesses, the extent to which disorder-relevant aspects of network connectivity are shared or unique across the sexes remains to be determined.MethodsIn this work, we used predictive modelling approaches to evaluate whether shared or unique functional connectivity correlates underlie the expression of psychiatric illness-linked behaviors in males and females in data from the Adolescent Brain Cognitive Development study (n=5260; 2571 females).ResultsWe demonstrate that functional connectivity profiles predict individual differences in externalizing behaviors in males and females, but only predict internalizing behaviors in females. Furthermore, models trained to predict externalizing behaviors in males generalize to predict internalizing behaviors in females, and models trained to predict internalizing behaviors in females generalize to predict externalizing behaviors in males. Finally, the neurobiological correlates of many behaviors are largely shared within and across sexes: functional connections within and between heteromodal association networks including default, limbic, control, and dorsal attention networks are associated with internalizing and externalizing behaviors as well as attentional deficits.ConclusionsTaken together, these findings suggest that shared neurobiological patterns may manifest as distinct behaviors across the sexes. These results highlight the need to consider factors beyond just neurobiology in the diagnosis and treatment of psychiatric illnesses.

This study aimed (1) to systematically review controlled trials of solid food diets for the treatment of inflammatory bowel disease (IBD); and (2) to grade the overall quality of evidence.Systematic review of prospective controlled trials of solid food diets for the induction or maintenance of remission in IBD. Two authors independently performed study selection, data extraction, and assessment of certainty of evidence. Meta-analyses were performed on studies with quantitative data on response, remission, and relapse.There were 27 studies for meta-analysis. For induction of remission in Crohn's disease (CD), low refined carbohydrate diet and symptoms-guided diet outperformed controls, but studies had serious imprecision and very low certainty of evidence. The Mediterranean diet was similar to the Specific Carbohydrate Diet (SCD) (low certainty of evidence) and partial enteral nutrition (PEN) was similar to exclusive enteral nutrition (very low certainty of evidence). PEN reduced risk of relapse (very low certainty of evidence), while reduction of red meat or refined carbohydrates did not (low certainty of evidence). For ulcerative colitis (UC), diets were similar to controls (very low and low certainty of evidence).Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with partial enteral nutrition for induction and maintenance of remission in CD. Reduction of red meat and refined carbohydrates might not reduce risk of CD relapse. As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients.

Biomolecular phase transitions play an important role in organizing cellular processes in space and time. Methods and tools for studying these transitions, and the intrinsically disordered proteins (IDPs) that often drive them, are typically less developed than tools for studying their folded protein counterparts. In this perspective, we assess the current landscape of chemical tools for studying IDPs, with a specific focus on protein liquid-liquid phase separation (LLPS). We highlight methodologies that enable imaging and spectroscopic studies of these systems, including site-specific labeling with small molecules and the diverse range of capabilities offered by inteins and protein semisynthesis. We discuss strategies for introducing post-translational modifications that are central to IDP and LLPS function and regulation. We also investigate the nascent field of noncovalent small-molecule modulators of LLPS. We hope that this review of the state-of-the-art in chemical tools for interrogating IDPs and LLPS, along with an associated perspective on areas of unmet need, can serve as a valuable and timely resource for these rapidly expanding fields of study.

Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement.

Background The United States has experienced substantial consequences associated with the opioid epidemic. One such consequence has been an increased need for patients who misuse opioids to interface with health care professionals. As such, it is important to understand physician attitudes toward and experiences with this patient population. The goal of this paper is to assess the extent to which physicians hold negative attitudes toward patients who misuse opioids and whether this patient population receives differential treatment. Methods Using a mixed methods design, we surveyed board-certified physicians in Ohio regarding their attitudes toward patients who misuse opioids as well as their observations of bias toward these patients in health care settings. Results Our findings suggest that negative attitudes toward patients who misuse opioids are common among physicians as were personal experiences of bias toward this patient population. We also found that physicians rationalized treating these patients differently and perceived barriers to achieving more equitable treatment. Finally, some physicians expressed a desire for additional training and resources to reduce bias. Conclusions Negative attitudes toward patients who misuse opioids may serve as a critical barrier to patients accessing care in areas heavily affected by the U.S. opioid epidemic.

Benign anorectal disorders of structure and function are common in clinical practice. These guidelines summarize the preferred approach to the evaluation and management of defecation disorders, proctalgia syndromes, hemorrhoids, anal fissures, and fecal incontinence in adults and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations Assessment, Development and Evaluation process. When the evidence was not appropriate for Grading of Recommendations Assessment, Development and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.