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ObjectiveFor large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy.DesignThe modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys.SettingThe work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care.ParticipantsThe panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems.Outcome measuresThe study planned to formulate a research agenda, implications for practice and recommendations for policy.ResultsFor research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals’ needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients.ConclusionsRecommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.

To get properties and characteristics of oil and gas source rocks and for other geological aims, geologists analyzes core samples from wells and outcrop samples. But we should probably somehow correct geochemical source rock properties data we get on outcrop samples, because organic matter could change significantly due to oxidizing and weathering. This problem is very important but poorly developed in modern publications, so it attracted our interest and led to this investigation. Published information on the organic matter weathering which change it’s content and quality in sedimentary rocks is collected and summarized in this article. The changes of the kerogen (isolated from the mineral matrix) elemental composition during its long-term storage are presented. We compared the results we get in laboratory and results of other authors who dealt with natural changes of organic matter in outcrops. An attempt to interpret the results obtained from the point of view of hypergene changes in OM was made. Uncertainties that require further study and development are indicated. This work is the first step to better understanding of weathering effect on organic matter content and properties – question of great importance for making adequate oil and gas prospects estimations. This study continues the work of our foregoers and Teachers – geochemists of the Petroleum Geology Department of Lomonosov Moscow State University: N.B. Vassoevich, Yu.I. Korchagina, O.A. Radchenko, V.A. Uspensky, I.E. Leifman, A.N. Guseva, O.K. Bazhenova, T.A. Kiryukhina.

Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD.This study explored resident physicians' experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident's knowledge and efficacy of treating various SUDs.We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data.Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training.SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.

Background Quality improvement (QI) initiatives often reflect approaches based on anecdotal evidence, but it is unclear how initiatives can best incorporate scientific literature and methods into the QI process. Review of studies of QI initiatives that aim to systematically incorporate evidence review (termed evidence-based quality improvement (EBQI)) may provide a basis for further methodological development. Methods In this scoping review (registration: https://osf.io/hr5bj) of EBQI, we searched the databases PubMed, CINAHL, and SCOPUS. The review addressed three central questions: How is EBQI defined? How is evidence used to inform evidence-informed QI initiatives? What is the effectiveness of EBQI? Results We identified 211 publications meeting inclusion criteria. In total, 170 publications explicitly used the term “EBQI.” Published definitions emphasized relying on evidence throughout the QI process. We reviewed a subset of 67 evaluations of QI initiatives in primary care, including both studies that used the term “EBQI” with those that described an evidence-based initiative without using EBQI terminology. The most frequently reported EBQI components included use of evidence to identify previously tested effective QI interventions; engaging stakeholders; iterative intervention development; partnering with frontline clinicians; and data-driven evaluation of the QI intervention. Effectiveness estimates were positive but varied in size in ten studies that provided data on patient health outcomes. Conclusions EBQI is a promising strategy for integrating relevant prior scientific findings and methods systematically in the QI process, from the initial developmental phase of the IQ initiative through to its evaluation. Future QI researchers and practitioners can use these findings as the basis for further development of QI initiatives.

Objective In pandemics like COVID-19, the need for medical resources quickly outpaces available supply. policymakers need strategies to inform decisions about allocating scarce resources. Study design and setting We updated a systematic review on evidence-based approaches and searched databases through May 2020 for evaluation of strategies for policymakers. Results The 201 identified studies evaluated reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care. Most research exists to reduce demand (n = 149); 39 higher quality studies reported benefits of contact tracing, school closures, travel restrictions, and mass vaccination. Of 28 strategies to augment resources, 6 higher quality studies reported effectiveness of establishing temporary facilities, use of volunteers, and decision support software. Of 23 strategies to optimize existing resources, 12 higher quality studies reported successful scope of work expansions and building on existing interagency agreements. Of 15 COVID-19 studies, 5 higher quality studies reported on combinations of policies and benefits of community-wide mask policies. Conclusion Despite the volume, the evidence base is limited; few strategies were empirically tested in robust study designs. The review provides a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to identify the best available evidence.

BACKGROUND AND OBJECTIVES: While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use. METHODS: A cross-sectional design was used to analyze self-reported participant data. PWID were recruited from community settings in California in 2016/17. Participants reported on food consumption per day for a 30-day period, from which a continuous protein intake variable was created. RESULTS: Modal characteristics of participants (N=937) were: white (42.5%), male (75.3%), healthy BMI (56.6%), and unhoused (82.9%). Less than 1% of participants met or exceeded recommended guidelines for protein intake (0.80 grams per day per 1 kg body weight). The final multiple regression model found protein intake to be significantly positively associated with older age, high school or greater education, frequency of opiate and marijuana use, while Latinx ethnicity was inversely associated with protein intake, adjusting for gender. DISCUSSION AND CONCLUSIONS: Our study shows PWID are generally not underweight, yet they are grossly protein deficient, which can be harder to recognize. Poverty, homelessness, and other structural barriers likely contribute to this issue, which demonstrates the need for communities to provide more access to nutrient-rich food to PWID. SCIENTIFIC SIGNIFICANCE: Our findings demonstrate the novel findings that opiate and marijuana use frequency, but not stimulants (methamphetamine and cocaine) may increase preference for protein-rich foods among PWID.

Lack of sex education in schools has been an ongoing issue in Russia, mainly due to conservative opposition to providing accurate sexual health information openly. Many adolescents may be misinform...

The goal of the present work was to determine the diversity of prokaryotes involved in anaerobic oil degradation in oil fields. The composition of the anaerobic oil-degrading methanogenic enrichment obtained from an oil reservoir was determined by 16S rRNA-based survey, and the facultatively anaerobic chemoorganotrophic bacterial strain HO-Ch2T was isolated and studied using polyphasic taxonomy approach and genome sequencing. The strain HO-Ch2T grew optimally at 28 °C, pH 8.0, and 1–2% (w/v) NaCl. The 16S rRNA gene sequence of the strain HO-Ch2T had 98.8% similarity with the sequence of Actinotalea ferrariae CF5-4T. The genomic DNA G + C content of strain HO-Ch2T was 73.4%. The average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between the genome of strain HO-Ch2T and Actinotalea genomes were 79.8–82.0% and 20.5–22.2%, respectively, i.e., below the thresholds for species delineation. Based on the phylogenomic, phenotypic, and chemotaxonomic characterization, we propose strain HO-Ch2T (= VKM Ac-2850T = KCTC 49656T) as the type strain of a new species within the genus Actinotalea, with the name Actinotalea subterranea sp. nov. Based on the phylogenomic analysis of 187 genomes of Actinobacteria we propose the taxonomic revision of the genera Actinotalea and Pseudactinotalea and of the family Actinotaleaceae. We also propose the reclassification of Cellulomonas carbonis as Actinotalea carbonis comb. nov., Cellulomonas bogoriensis as Actinotalea bogoriensis comb. nov., Actinotalea caeni as Pseudactinotalea caeni comb. nov., and the transfer of the genus Pseudactinotalea to the family Ruaniaceae of the order Ruaniales.

IntroductionThere is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive.Methods and analysisBuilding on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common ‘critical factors for success or failure’ can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma.PROSPERO registration numberCRD42021249348.

There is strong global commitment to eliminate HIV-related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used.Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository.Sixty-nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV-related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV-related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions.This systematic review provides an evidence base of current understandings of HIV-related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV-related stigma on people's health and quality of life.

In the wake of COVID-19, morbidity and mortality due to Opioid Use Disorder (OUD) is beginning to emerge as a second wave of deaths of despair. Medication assisted treatment (MAT) for opioid use disorder MAT delivered by Emergency Medicine (EM) providers can decrease mortality due to OUD; however, there are numerous cited barriers to MAT delivery. We examined the impact of MAT training on these barriers among EM residents in an urban, tertiary care facility with a large EM residency. Training included the scripted and standardized content from the Provider Clinical Support System curriculum. Residents completed pre- and post-training surveys on knowledge, barriers, and biases surrounding OUD. We performed Wilcoxon matched-pairs signed-ranks test to detect statistical differences. Of 74 residents, 49 (66%) completed the pre-training survey, and 34 (69%) of these completed the follow-up survey. Residents reported improved preparedness to treat aspects of OUD across all areas queried, reported decreased perception of barriers to providing MAT, and increased comfort prescribing naloxone, counseling patients, prescribing buprenorphine, and treating opioid withdrawal. A didactic training on MAT was associated with residents reporting improved comfort providing buprenorphine and naloxone. As the wake of morbidity and mortality from both COVID and OUD continue to increase, programs should offer dedicated training on MAT.

Objective To characterize the association between antepartum marijuana exposure and maternal and neonatal outcomes at our institution. Study Design Retrospective chart review identified an obstetric cohort of singleton gestations. Women with self-reported marijuana use were compared with non-users. Demographic characteristics, risk factors, and maternal-fetal outcomes were evaluated. Associations between outcomes and marijuana use were assessed with regression analysis. Results Of 2792 deliveries, 5.4% reported marijuana use. Compared to non-users, marijuana users entered prenatal care later, were younger, non-Hispanic, and used other illicit substances. Marijuana users had a higher rate of cesarean delivery (p = 0.01). After adjusting for confounders, marijuana use remained associated with 4.1-fold risk of delivering a small for gestational age (SGA) infant and 2.89-fold risk of neonatal oxygen use. Conclusion At a safety net hospital, antepartum marijuana use is significantly associated with cesarean delivery, SGA and supplemental oxygen use at birth. Healthcare disparities associated with marijuana use make this a population of critical interest.

Objectives. Survival rates for pediatric cancer have dramatically increased since the 1970s, and the population of childhood cancer survivors (CCS) exceeds 500,000 in the United States. Cancer during childhood and related treatments lead to long-term health problems, many of which are poorly understood. These problems can be amplified by suboptimal survivorship care. This report provides an overview of the existing evidence and forthcoming research relevant to disparities and barriers for pediatric cancer survivorship care, outlines pending questions, and offers guidance for future research. Data sources. This Technical Brief reviews published peer-reviewed literature, grey literature, and Key Informant interviews to answer five Guiding Questions regarding disparities in the care of pediatric survivors, barriers to cancer survivorship care, proposed strategies, evaluated interventions, and future directions. Review methods. We searched research databases, research registries, and published reviews for ongoing and published studies in CCS to October 2020. We used the authors’ definition of CCS; where not specified, CCS included those diagnosed with any cancer prior to age 21. The grey literature search included relevant professional and nonprofit organizational websites and guideline clearinghouses. Key Informants provided content expertise regarding published and ongoing research, and recommended approaches to fill identified gaps. Results. In total, 110 studies met inclusion criteria. We identified 26 studies that assessed disparities in survivorship care for CCS. Key Informants discussed subgroups of CCS by race or ethnicity, sex, socioeconomic status, and insurance coverage that may experience disparities in survivorship care, and these were supported in the published literature. Key Informants indicated that major barriers to care are providers (e.g., insufficient knowledge), the health system (e.g., availability of services), and payers (e.g., network adequacy); we identified 47 studies that assessed a large range of barriers to survivorship care. Sixteen organizations have outlined strategies to address pediatric survivorship care. Our searches identified only 27 published studies that evaluated interventions to alleviate disparities and reduce barriers to care. These predominantly assessed approaches that targeted patients. We found only eight ongoing studies that evaluated strategies to address disparities and barriers. Conclusions. While research has addressed disparities and barriers to survivorship care for childhood cancer survivors, evidence-based interventions to address these disparities and barriers to care are sparse. Additional research is also needed to examine less frequently studied disparities and barriers and to evaluate ameliorative strategies in order to improve the survivorship care for CCS.

The article analyzes the transformation of the institution of higher education and traditional education during the epidemiological crisis, due to which distance learning was introduced in universities on a federal scale. The authors focus not only on the effect of the introduction of online technologies into the higher education system, but emphasize the uniqueness of the situation in the context of the need to use these tools in order to minimize social communications when it comes to the viral threat. The authors’ use of cybermetric analysis, big data mining, and media monitoring using the Medialogia analysis system allowed to analyze the information agenda in the federal media space, to determine how the traditional education changed in the context of the Covid 19 pandemic. The specificity of perception of distance learning by Russian society is noted. It was revealed through analysis of the media space concerning the activities of the Ministry of Science and Higher Education of the Russian Federation from February to June 2020. The article emphasizes that the discussion on digitalization of the educational process will continue. The authors draw attention to the fact that joint efforts of the state and civil society can contribute to the development of an adequate model of higher education, based on the convergence of traditional and digital educational forms, taking into account the interests of all the participants in the higher educational process.

Tobacco smoking is a major cause of death and disease. In Israel, it has been reported that 22.7% of the population aged 18 and over smoke, mostly using cigarettes. Another smoking method is through a water pipe called hookah or nargila. This paper reviews recent studies of tobacco use among Israeli youth and young adults as well as research conducted by the Ben Gurion University, Regional Alcohol and Drug Abuse Research Center. Study findings evidence high rates of smoking linked to being male, secular, non-Israeli origin, and school dropout. Hookah use may be a “gateway” to cigarette smoking. Youth and young adults reported they believe smoking prevention programs are not effective and do not have a noticeable effect on smoking-related attitudes and behavior. Motivation, peer-supported activities in school and the community, and family factors have been found to be important for possible smoking cessation. This article suggests multiple factors be considered, organized, and sustained to promote smoking cessation.

This study investigated the prevalence of common barriers to the use of exposure therapy (ET) in the treatment of youth with anxiety disorders, specifically examining both logistical limitations and negative beliefs about ET. Results from 230 practicing clinicians who treat youth with anxiety disorders found that the top three barriers were session length (56%), lack of training (48%), and concern about parent reaction (47%). Endorsement of barriers to ET was associated with less ET utilization and less optimal implementation of ET. Results suggest that several barriers, especially logistical limitations, must be addressed in order to improve the dissemination of ET.

Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.

The aim of the study was to evaluate the associations between fasting glycemia (FG) at the first prenatal visit and adverse pregnancy outcomes.Medical records of 1,584 pregnant women with a recorded level of FG before 24 weeks of gestation were examined. Subjects with pregestational diabetes or delivery before 24 weeks were excluded. 823 women underwent oral glucose tolerance test (OGTT) at 24-32 weeks of pregnancy. FG values were devided into five groups starting with4.1 mmol/L as the first group, with subsequent increases of 0.5 mmol/L between groups and5.6 mmol/L as the last group. The main outcomes were gestational diabetes mellitus (GDM) development, macrosomia, primary cesarean delivery, shoulder dystocia or birth injury.With increasing FG levels at first prenatal visit, the frequency of GDM (among women who underwent OGTT) increased from 18.3% in the lowest category to 44.4% in the highest (odds ratio (OR) 2.94; 95% confidence interval (CI) 1.39-6.19) and the frequency of hyperbilirubinemia increased from 4.5% to 18% respectively (OR 4.7; 95% CI 1.8-12.5). After adjustment for maternal age and BMI, only the highest glucose category (5.6FG7 mmol/L) was significantly associated with the increased risk of the above mentioned outcomes. The of frequency of shoulder dystocia/birth injury (OR 24.5; 95% CI 2.8-214.8) and preeclampsia (OR 2.7 ; 95% CI 1.2 - 5.9) was increased in the highest glucose category compared to the intermediary categories.Only the highest glucose category (5.6FG7 mmol/L) at the first prenatal visit was strongly associated with some adverse pregnancy outcomes.