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PurposePatient satisfaction surveys are pivotal in evaluating healthcare quality and enhancing patient care. Understanding the factors influencing patient engagement with these surveys in radiation oncology can guide improvements in patient-centered care.MethodsThis retrospective study analyzed data from radiation oncology patients at a large multi-site single-institution center from May 2021 to January 2024. We assessed the influence of demographic, clinical, and socioeconomic factors on the likelihood of survey participation using univariate (UVA) and multivariable (MVA) logistic regression analyses. Factors included age, gender, race, socioeconomic status (SES) via Area Deprivation Index (ADI), language, marital status, smoking, employment, insurance type, mental health disorders (MHD), comorbidity index (CCI), and cancer type.ResultsIn a comprehensive analysis of 11,859 patients, most were female (57.2%), over 65 years old (60.7%), and primarily insured by Medicare (45.9%). MVA showed that higher socioeconomic disadvantage significantly decreased survey participation (ADI third tertile vs. first tertile OR=0.708, p

Background. Coping, within Lazarus transactional theoretical framework, is conceptualized as a dynamic set of cognitive and behavioral processes that adapt continually to manage specific demands, whether internal or external, perceived as exceeding an individual’s available resources. This framework supports understanding healthy coping behaviors, especially regarding adherence to treatment in cardiovascular disease management. Objective. Develop and validate coping scales designed to assess adherence to pharmacological treatment, heart-healthy eating, and cardiovascular physical exercise in mexican patients diagnosed with ischemic heart disease. Design. The research employed both qualitative (focus groups) and quantitative (exploratory and confirmatory factor analysis) methodologies to ensure robustness. The coping scales underwent rigorous testing, including exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), which revealed a two-factor solution for medication adherence coping, a three factors solution for physical exercise adherence coping, and a three factors solution for healthy eating adherence coping. Results. The findings suggest that coping strategies, although universal in nature, are sensitive to cultural nuances among patients with ischemic heart disease. By capturing the complexities of coping behaviors within a specific cultural context, these scales provide valuable insights into the multifaceted nature of adherence to primary prevention measures. Conclusion. This study contributes to the understanding of how coping mechanisms intersect with cultural factors in the management of chronic conditions such as ischemic heart disease, highlighting the importance of tailored interventions that consider patients cultural backgrounds and individual coping styles.

Purpose: Despite the importance of patient satisfaction (PS) on healthcare outcomes, the factors that influence PS in radiation oncology remain unexplored. This study assesses the influence of socioeconomic status (SES) on PS in radiation oncology, using the Area Deprivation Index (ADI) as a measure of SES. Methods: This single-institution cross-sectional study used the National Research Council (NRC) PS survey at four radiation oncology sites from 2021 to 2023. SES was measured using ADI data from the Neighborhood Atlas. Univariate (UVA) and multivariable (MVA) logistic regression analyses were conducted on recommendation scores (0–10 scale, with 9 or higher indicating a likelihood to recommend). Results: In our analysis of 7,501 survey responses, most patients were female (55.3 %), had curative treatment intent (81.5 %), and were diagnosed with breast cancer (30.4 %), with most being follow-up visits (69.0 %). Average scores for state and national ADI were 3.94 and 50.75, respectively. UVA identified factors such as curative intent (OR 1.68, p

ABSTRACT Escherichia coli O157:H7-adulterated food products are associated with disease outbreaks in humans. Although cattle feces are a source for E. coli O157:H7 contamination, it is unclear if human-associated outbreak isolates differentially colonize and shed in the feces of cattle from that of non-outbreak isolates. It is also unclear if phenotypes, such as biofilm formation, cell attachment, or toxin production, differentiate environmental E. coli O157:H7 isolates from those associated with human illness. The objective of this study was to compare the genotypes and phenotypes of a diverse set of E. coli O157:H7 isolates, with the intent of identifying differences that could inform cattle colonization and fecal shedding, along with virulence potential in humans. Isolates differed in attachment phenotypes on human Caco-2 cells and bovine-derived recto-anal junction squamous epithelial cells, with curli having a strong impact on attachment to the human-derived cell line. The prototypical E. coli O157 isolate EDL933 had the greatest expression of the adhesin gene iha, yet it had decreased expression of the virulence genes stx2, eae, and ehxA compared the lineage I/II isolates RM6067W and/or FRIK1989. Strong or weak biofilm production was not associated with significant differences in cattle colonization or shedding, suggesting biofilms may not play a major role in cattle colonization. No significant differences in cattle colonization and fecal shedding were detected, despite genomic and in vitro phenotypic differences. The outbreak isolate associated with the greatest incidence of hemolytic uremic syndrome, RM6067W, induced the greatest Vero cell cytotoxicity and had the greatest stx2 gene expression.IMPORTANCEFoodborne illness has major impacts on global health and imposes financial hardships on food industries. Escherichia coli serotype O157:H7 is associated with foodborne illness. Cattle feces are a source of E. coli O157:H7, and routine surveillance has led to an abundance of E. coli O157:H7 genomic data. The relationship between E. coli O157:H7 genome and phenotype is not clearly discerned for cattle colonization/shedding and improved understanding could lead to additional strategies to limit E. coli O157:H7 in the food chain. The goal of the research was to evaluate genomic and phenotypic attributes of E. coli O157:H7 associated with cattle colonization and shedding, environmental persistence, and human illness. Our results indicate variations in biofilm formation and in vitro cellular adherence was not associated with differences in cattle colonization or shedding. Overall, processes involved in cattle colonization and various phenotypes in relation to genotype are complex and remain not well understood.

El presente trabajo tuvo como objetivo desarrollar y establecer las propiedades psicométricas de la escala de creencias de control hacia la adherencia a la alimentación cardiosaludable en una muestra de pacientes mexicanos con diagnóstico de cardiopatía isquémica, a través de una fase cualitativa (grupos focales) y cuantitativa (análisis factorial exploratorio y confirmatorio). Se realizaron una serie de estudios que contaron con una muestra total de 317 pacientes de ambos sexos, con edades comprendidas entre los 30 y 82 años (M = 52 años, DE = 12.15). La escala fue sometida a un AFE y un AFC, que da cuenta de una solución de dos factores: autodeterminación situacional alimenticia (α= .88) y barreras situacionales (α= .85). con un alfa de Cronbach global de .88 y 45% de la varianza, siendo consistentes con la propuesta teórica y presentando adecuados índices de fiabilidad e índices de bondad de ajuste. Se concluye que las creencias de control a pesar de ser universales son sensibles a la cultura en pacientes con enfermedad isquémica del corazón.

ObjectiveTo describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED-PC, and clinicians' perspectives on the future of ED-PC.MethodThis qualitative study using semi-structured interviews was conducted in June-August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED-PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED-PC currently and in the future.ResultsPC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED-PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED-PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED-PC. Increased primary PC education for ED staff, increased automation, and innovative ED-PC models were seen as areas for future growth.Significance of resultsOur findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED-PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED-PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED-PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.

Anthropogenic disturbance of natural environments has negative impacts on biodiversity. Amphibians are especially sensitive to deforestation, and there is a high rate of this phenomenon in the Democratic Republic of the Congo. We studied the effects of this modification of forest ecosystems on the diversity of amphibians in the Yoko Forest Reserve. During twenty-four field sampling campaigns organized over a period of twelve months, amphibians were collected from nocturnal surveys supported by three techniques: visual spotting using a headlamp, systematic searching of habitats and acoustic hearing of vocalizations. Twelve sampling sites were chosen, and three habitats were explored at each site. Of these three habitats, one is the undisturbed habitat (primary forest), and two are disturbed habitats (fallow and field). Amphibian abundance, species richness, diversity, evenness and density were compared between these two types of habitat. A total of 4443 amphibians in 10 families, 17 genera and 33 species were recorded throughout the study area. Abundance, species richness and relative density were significantly higher in non-disturbed habitats than in disturbed habitats. On the other hand, primary forest is less diverse than fallow, but not significantly. It is, however, significantly more diverse than the field. The undisturbed habitat is also characterized by lower evenness than the disturbed habitats, with which it shares low similarities. The species Amnirana albolabris, Phrynobatrachus auritus, Leptopelis notatus, Leptopelis millsoni, Xenopus pygmaeus, Hyperolius platyceps, Leptopelis calcaratus, Leptopelis christyi, Leptopelis ocellatus, Arthroleptis tuberosus, Ptychadena perreti, Amietia nutti, Arthroleptis variabilis, Cardioglossa leucomystax, Phrynobatrachus perpalmatus and Chiromantis rufescens were recognized, in order of importance, as primary forest indicators according to the results of this study. All these differences between the two habitat statuses (undisturbed and disturbed) confirm the negative effects of natural habitat alteration on forest amphibians.

Fractures are costly to treat and can significantly increase morbidity. Although dual-energy x-ray absorptiometry (DEXA) is used to screen at risk people with low bone mineral density (BMD), not all areas have access to one. We sought to create a readily accessible, inexpensive, high-throughput prediction tool for BMD that may identify people at risk of fracture for further evaluation. Anthropometric and demographic data were collected from 492 volunteers (♂275, ♀217; [44 ​± ​20] years; Body Mass Index (BMI) = [27.6 ​± ​6.0] kg/m2) in addition to total body bone mineral content (BMC, kg) and BMD measurements of the spine, pelvis, arms, legs and total body. Multiple-linear-regression with step-wise removal was used to develop a two-step prediction model for BMC followed by BMC. Model selection was determined by the highest adjusted R2, lowest error of estimate, and lowest level of variance inflation (α ​= ​0.05). Height (HTcm), age (years), sexm=1, f=0, %body fat (%fat), fat free mass (FFMkg), fat mass (FMkg), leg length (LLcm), shoulder width (SHWDTHcm), trunk length (TRNKLcm), and pelvis width (PWDTHcm) were observed to be significant predictors in the following two-step model (p ​

Upon ligand binding, bone morphogenetic protein (BMP) receptors form active tetrameric complexes, comprised of two type I and two type II receptors, which then transmit signals to SMAD proteins. The link between receptor tetramerization and the mechanism of kinase activation, however, has not been elucidated. Here, using hydrogen deuterium exchange mass spectrometry (HDX-MS), small angle X-ray scattering (SAXS) and molecular dynamics (MD) simulations, combined with analysis of SMAD signaling, we show that the kinase domain of the type I receptor ALK2 and type II receptor BMPR2 form a heterodimeric complex via their C-terminal lobes. Formation of this dimer is essential for ligand-induced receptor signaling and is targeted by mutations in BMPR2 in patients with pulmonary arterial hypertension (PAH). We further show that the type I/type II kinase domain heterodimer serves as the scaffold for assembly of the active tetrameric receptor complexes to enable phosphorylation of the GS domain and activation of SMADs.

ContextHealth systems have aspired to integrate palliative care (PC) into the emergency department (ED) to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs.ObjectivesTo describe the new PC-ED delivery innovations that emerged during the COVID-19 pandemic.MethodsFor this qualitative study of PC programs in EDs, semistructured interviews were conducted with ED and PC clinicians between June 30, 2020 and August 18, 2020. Participants were asked about PC-ED integration before, during, and after COVID. We conducted a two-phased rapid analysis using a rapid analysis template and consolidated matrix to identify innovations.ResultsUsing purposive and snowball sampling, we interviewed 31 participants, representing 52 hospitals. Several new innovations in care delivery were identified. These included elements of fully embedded PC, the use of PC extenders, technology both within the electronic medical record and outside it, and innovations in training emergency clinicians in primary PC skills to support care delivery. Most PC efforts focused on increasing goals-of-care conversations. Institutions that implemented these programs reported that they increased PC utilization in the ED, were well received by clinicians, and changed patient's care trajectories.ConclusionSeveral new innovations in PC-ED care delivery emerged during COVID. Many innovations leveraged different types of clinicians to deliver care, an increased physical presence of PC in the ED, and used technology to enhance care delivery. These innovations may serve as a framework for institutions as they plan for evolving needs in the ED during and after COVID. Additional research is needed to evaluate the impact of these programs and understand their applicability beyond the pandemic.

Abstract Background When polygenic risk score (PRS) is derived from summary statistics, independence between discovery and test sets cannot be monitored. We compared two types of PRS studies derived from raw genetic data (denoted as rPRS) and the summary statistics for IGAP (sPRS). Results Two variables with the high heritability in UK Biobank, hypertension, and height, are used to derive an exemplary scale effect of PRS. sPRS without APOE is derived from International Genomics of Alzheimer’s Project (IGAP), which records ΔAUC and ΔR2 of 0.051 ± 0.013 and 0.063 ± 0.015 for Alzheimer’s Disease Sequencing Project (ADSP) and 0.060 and 0.086 for Accelerating Medicine Partnership - Alzheimer’s Disease (AMP-AD). On UK Biobank, rPRS performances for hypertension assuming a similar size of discovery and test sets are 0.0036 ± 0.0027 (ΔAUC) and 0.0032 ± 0.0028 (ΔR2). For height, ΔR2 is 0.029 ± 0.0037. Conclusion Considering the high heritability of hypertension and height of UK Biobank and sample size of UK Biobank, sPRS results from AD databases are inflated. Independence between discovery and test sets is a well-known basic requirement for PRS studies. However, a lot of PRS studies cannot follow such requirements because of impossible direct comparisons when using summary statistics. Thus, for sPRS, potential duplications should be carefully considered within the same ethnic group.

This article provides the first data on amphibian diversity in the Yoko Forest Reserve, located in the Democratic Republic of the Congo. During twenty-four field sampling campaigns organized over a period of twelve months, amphibians were collected from nocturnal surveys supported by three techniques: visual spotting using a headlamp, systematic searching of habitats and acoustic hearing of vocalizations. A total of 5707 amphibians in 10 families, 17 genera and 33 species were recorded throughout the study area. The Hyperoliidae and Arthroleptidae families were the most diverse, with Amnirana albolabris (Ranidae) the most abundant species, followed by Phrynobatrachus auritus (Phrynobatrachidae). By contrast, Afrixalus quadrivittatus, A. equatorialis, Arthroleptis tuberosus, A. variabilis, Cryptothylax greshoffi, Hyperolius langi, H. ocellatus, H. parallelus, Hyperolius sp., Hoplobatrachus occipitalis, Kassina maculosa, Leptopelis calcaratus, Nectophryne batesii, Phrynobatrachus perpalmatus, Sclerophrys gracilipes and S. gutturalis were less frequent. For the first time, Amietia nutti and Kassina maculosa have been reported in Congolese forests. Amphibian species known from the YFRE are widely distributed in Central African forests, and particularly in the Democratic Republic of the Congo, where A. equatorialis, H. langi, H. parallelus and Ptychadena christyi are endemic.

Are feminist coalitions magical enough to survive and endure while questioning and shaking the colonial/racist foundations of Swedish academic knowledge production and the overall Swedish society? Can feminist bridging and collective writing remain a magical process even when grappling with difficult experiences and memories of othering and racialisation? This is a creatively and collectively written article on feminist coalition building, and its importance in thinking, articulating and deconstructing race, racialization and racist structures. More than two years ago, seven interdisciplinary gender studies scholars of mixed ethnic and racial origins, came together to explore our differently situated experiences of disidentifying with Swedish academia and society in a collective we call Loving Coalitions. Against the background of Swedish exceptionalism, historical amnesia of Sweden’s colonial past and present, and the deafening silence on Swedish whiteness and racism, we are sharing our poems, letters, texts and testimonies of racist interactions in Swedish academia and society. While doing so, we discuss how moving away from conventional ways of doing research and experimenting with creative methodological alternatives, such as automatic writing, epistolary formats, poems, fiction, collective memory-work, allow us to acknowledge and embrace our different life backgrounds and academic trajectories as a mode of knowledge production. We hope and believe that our experiences, refl ections and ways to resist racism and Othering in Sweden and Swedish academia through alternative coalition building, based on mutual care and love, can be relevant in a Danish context as well.

We conducted a multicenter pilot investigation of the safety and feasibility of bone marrow transplantation (BMT) in adults with severe sickle cell disease (SCD) (NCT 01565616) using a reduced toxicity preparative regimen of busulfan (13.2 mg/kg), fludarabine (175 mg/m2 ) and thymoglobulin (6 mg/kg) and cyclosporine or tacrolimus and methotrexate for graft-vs-host disease (GVHD) prophylaxis. Twenty-two patients (median age 22 years; range 17-36) were enrolled at eight centers. Seventeen patients received marrow from an HLA-identical sibling donor and five patients received marrow from an 8/8 HLA-allele matched unrelated donor. Before BMT, patients had stroke, acute chest syndrome, recurrent pain events, were receiving regular red blood cell transfusions, or had an elevated tricuspid regurgitant jet (TRJ) velocity, which fulfilled eligibility criteria. Four patients developed grades II-III acute GVHD (18%) and six developed chronic GVHD (27%) that was moderate in two and severe in one patient. One patient died of intracranial hemorrhage and one of GVHD. Nineteen patients had stable donor chimerism, 1-year post-transplant. One patient who developed secondary graft failure survives disease-free after a second BMT. The one-year overall survival and event-free survival (EFS) are 91% (95% CI 68%-98%) and 86% (95% CI, 63%-95%), respectively, and 3-year EFS is 82%. Statistically significant improvements in the pain interference and physical function domains of health-related quality of life were observed. The study satisfied the primary endpoint of 1-year EFS ≥70%. This regimen is being studied in a prospective clinical trial comparing HLA-matched donor BMT with standard of care in adults with severe SCD (NCT02766465).

IntroductionCulture plays a fundamental role in shaping human behavior, with individualism and collectivism being key cultural dimensions. However, existing scales for measuring these constructs, such as the INDCOL scale, have demonstrated issues when applied in diverse cultural contexts. To address this, we present the translation and adaptation of the Mexican Vertical and Horizontal Individualism and Collectivism Scale (MXINDCOL) into English, aiming to identify both universal and culture-specific elements.MethodsData were collected from 1124 participants (371 from the United States, 753 from Mexico) using the MXINDCOL and INDCOL scales. Propensity score matching was applied to balance demographic differences between the samples. Confirmatory Factor Analysis (CFA) assessed model fit, and cross-cultural measurement invariance was examined. Reliability, convergent and discriminant validity were also assessed.ResultsThe English-translated MXINDCOL scale demonstrated good model fit in both US and Mexican samples, outperforming the INDCOL scale. Reliability values were higher for the MXINDCOL scale compared to INDCOL. Cross-cultural measurement invariance was established, allowing for meaningful comparisons between the two cultures. US participants scored higher on vertical collectivism, while Mexican participants scored higher on horizontal collectivism and horizontal individualism.DiscussionThe MXINDCOL scale offers a culturally sensitive measurement of individualism and collectivism, addressing issues found in existing scales. It provides a more accurate assessment of cultural orientations and enriches the understanding of cultural dimensions by incorporating idiosyncratic elements. Further research in diverse cultural contexts is recommended to validate and refine the scale, contributing to a more nuanced understanding of cultural variations in individualism and collectivism.

Abstract Background Genetics studies in the porcine immune system have enhanced selection practices for disease resistance phenotypes and increased the efficacy of porcine models in biomedical research; however limited functional annotation of the porcine immunome has hindered progress on both fronts. Among epigenetic mechanisms that regulate gene expression, DNA methylation is the most ubiquitous modification made to the DNA molecule and influences transcription factor binding as well as gene and phenotype expression. Human and mouse DNA methylation studies have improved mapping of regulatory elements in these species, but comparable studies in the pig have been limited in scope. Results We performed whole-genome bisulfite sequencing to assess DNA methylation patterns in nine pig immune cell populations: CD21+ and CD21− B cells, four T cell fractions (CD4+, CD8+, CD8+CD4+, and SWC6γδ+), natural killer and myeloid cells, and neutrophils. We identified 54,391 cell differentially methylated regions (cDMRs), and clustering by cDMR methylation rate grouped samples by cell lineage. 32,737 cDMRs were classified as cell lowly methylated regions (cLMRs) in at least one cell type, and cLMRs were broadly enriched in genes and regions of intermediate CpG density. We observed strong correlations between differential methylation and expression across immune cell populations, with cell-specific low methylation disproportionately impacting genes exhibiting enriched gene expression in the same cell type. Motif analysis of cLMRs revealed cell type-specific enrichment of transcription factor binding motifs, indicating that cell-specific methylation patterns may influence accessibility by trans-acting factors. Lastly, cDMRs were enriched for immune capacity GWAS SNPs, and many such overlaps occurred within genes known to influence immune cell development and function (CD8B, NDRG1). Conclusion Our DNA methylation data improve functional annotation of the porcine genome through characterization of epigenomic regulatory patterns that contribute to immune cell identity and function, and increase the potential for identifying mechanistic links between genotype and phenotype.

This teaching case focuses on developing a data analytics mindset and students' technology agility through an accounting-oriented, data analytics project. The case covers the sales-to-cash receipts cycle of a fictional tennis equipment company. Students work with seven different raw data files to create two deliverables for their client: a full data analytics report and a synthesized visualization report. A business consulting experience is simulated where the students utilize their accounting knowledge and acumen to craft their own questions of the data instead of relying on instructor-provided questions. Students draw business conclusions from their analysis and must succinctly convey those conclusions through the data analytics report and the presentation, including visualizations. As the case is tool agnostic, instructors can choose from a variety of data analytics and visualization tools (e.g., Alteryx, Excel, Power BI, Tableau, IDEA) to solve the case, thereby potentially increasing the overall technology agility of students. [ABSTRACT FROM AUTHOR]

Purpose: Patient satisfaction surveys are pivotal in evaluating healthcare quality and enhancing patient care. Understanding the factors influencing patient engagement with these surveys in radiation oncology can guide improvements in patient-centered care. Methods: This retrospective study analyzed data from radiation oncology patients at a large multi-site single-institution center from May 2021 to January 2024. We assessed the influence of demographic, clinical, and socioeconomic factors on the likelihood of survey participation using univariate (UVA) and multivariable (MVA) logistic regression analyses. Factors included age, gender, race, socioeconomic status (SES) via Area Deprivation Index (ADI), language, marital status, smoking, employment, insurance type, mental health disorders (MHD), comorbidity index (CCI), and cancer type. Results: In a comprehensive analysis of 11,859 patients, most were female (57.2%), over 65 years old (60.7%), and primarily insured by Medicare (45.9%). MVA showed that higher socioeconomic disadvantage significantly decreased survey participation (ADI third tertile vs. first tertile OR=0.708, p<0.001), with each unit increase in ADI reducing the odds of completion by 1% (p<0.001). Older adults, and patients with head and neck or genitourinary cancers were significantly more likely to participate, while those with higher comorbidities, MHD, or other minority status were less engaged (p<0.001). Telemedicine encounters also significantly increased participation compared to in-person visits (OR=1.149, p=0.006). Conclusions: Multiple factors including age, race, SES, insurance type, cancer type, health conditions, and modality of healthcare delivery influence patient engagement with satisfaction surveys in radiation oncology. Strategies to enhance patient engagement must consider these diverse influences to ensure comprehensive and inclusive feedback mechanisms in healthcare settings. Tailored interventions to mitigate barriers specific to underrepresented groups are crucial for capturing a broad spectrum of patient experiences and improving the overall quality of patient care. [ABSTRACT FROM AUTHOR]