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This paper proposes a point-of-interest (POI) sequence recommendation algorithm based on BERT-ACNN-GRU to address the issues faced by the existing POI recommendation model in social network large data, such as the difficulty in extracting deep feature information and the low recommendation performance. Firstly, the semantic relationship between a word and its context in the text is combined using the bidirectional encoder representation from transformers (BERT) model to effectively eliminate the influence of word distance and obtain the contextualized word vector. Secondly, a convolutional neural network (CNN) utilizing a gated recurrent unit (GRU) is employed to capture the feature information of the text. Lastly, the attention method is utilized to assign weight scores to various terms in order to provide more attention to particular words and boost the precision of recommendations. The experiments demonstrate that the precision, recall rate, F1 score and mean average precision (mAP) of the proposed method are 0.097, 0.26, 0.103, and 0.085 on the Gowalla dataset when the recommendation list has a length of 10, respectively. On the Yelp dataset, the precision is 0.093, the recall rate is 0.26, F1 is 0.099, and MAP is 0.089. Hence, the proposed method can effectively enhance the performance of the POI recommendation system. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. Objective: To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. Design: In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018–2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. Participants: A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. Main Measures: All-cause and ambulatory care sensitive condition hospitalizations in 2018. Key Results: There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88–0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20–1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92–0.99) for all beneficiaries. Conclusions: Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations. [ABSTRACT FROM AUTHOR]

Studies on HIV self-testing (HIV-ST) have been limited to adults (age 18+). The study assessed use of HIV-ST among a diverse group of young men who have sex with men (YMSM) in the United States (US) and assessed differences in uptake by demographic characteristics and requirements for parental consent. This study demonstrated feasibility of HIV-ST for YMSM as young as 14 years of age, which suggests potential for increasing HIV testing in this young age group and promoting health equity. [ABSTRACT FROM AUTHOR]

Vegetable oils can be used as an alternative to traditional mineral-based lubricants because of their biodegradation and good lubrication. Considering that vegetable oils are mixtures composed of different types and proportions of fatty acids, if the structure–activity relationship between their chemical structures and anti-wear properties can be obtained, those unknown vegetable oils' anti-wear performances can be predicted accurately. The quantitative structure–property relationship (QSPR) model of the fatty acid structure and the wear scar diameter (WSD) measured by four-ball friction test was established by selecting meaningful molecular descriptors, including the Balaban index, Estate keys and Molecular shadow index. Based on the model with adjusted R2 more than 0.9, the anti-wear properties of fatty acids and vegetable oils were predicted, showing good prediction ability and low deviation. On the basis of 39 different fatty acid composition reported, cluster analysis (CA) and anti-wear property evaluation of vegetable oils were carried out. It was found that fatty acids with carbon length of 18 and short chain fatty acids had adverse effects on the wear resistance of vegetable oils, which provided reference data for the industrial application of vegetable oils. [ABSTRACT FROM AUTHOR]

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma‐related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact‐based and educational anti‐stigma interventions for nurses in order to reduce stigma towards mental illness. [ABSTRACT FROM AUTHOR]

MIL-101(Cr)@SiO 2 @Fe 3 O 4 magnetic catalytic supports were synthesized by the in-situ growth method, where a MIL-101(Cr) shell was deposited on the surface of the SiO 2 @Fe 3 O 4 core. A series of Au/MIL-101(Cr)@SiO 2 @Fe 3 O 4 magnetic core-shell catalysts with different Au contents were prepared and Au nanoparticles (Au NPs) were decorated on the magnetic supports by the impregnation-reduction method. The structure of the as-synthesized catalysts was characterized by XRD, FTIR, HRTEM, XPS, N 2 adsorption-desorption, NH 3 -TPD, CO 2 -TPD, and VSM, etc. The N-methylation reaction performance and recyclability performance of the catalysts were evaluated in a high-pressure microreactor. The mechanism of the N-methylation reaction had been deeply studied. The results indicated that the thickness of the MIL-101(Cr) shell was about 120 nm, and the Au NPs (~3 nm) were dispersed on the surface and/or in the pores of MIL-101(Cr). The catalytic performance for N-methylation of CO 2 and aniline/H 2 to N-methylaniline and N,N-dimethylaniline was satisfactory. Moreover, the incredible recyclability performance (external magnet) and applicability of different amine substrates were achieved. Under the optimized conditions, the 2%Au/MIL-101(Cr)@SiO 2 @Fe 3 O 4 catalyst demonstrated the best performance, the aniline conversion nearly 44.0%, the selectivity of N-methylaniline and N,N-dimethylaniline were 71.8% and 27.6%, respectively. The reaction mechanism investigation indicated that, firstly, H 2 was adsorbed and activated on the Au NPs, and CO 2 was adsorbed and activated on the O2- Lewis base sites of MIL-101(Cr) cages. Later, the activated H-atoms reacted with the activated CO 2 to generate the formic acid as an intermediate product. Finally, the formic acid reacted with the adsorbed aniline and activated on the Cr3+ Lewis acid sites to produce N-methylaniline and N,N-dimethylaniline. The enhanced selectivity of the reaction might be attributed to the core-shell architecture, high surface area, plentiful active sites, and synergistic interactions between Au NPs and acid-base sites of the MIL-101(Cr) catalyst. [Display omitted] • The magnetic Au/MIL-101(Cr)@SiO 2 @Fe 3 O 4 core-shell catalysts were prepared. • There were adjustable acid-base sites in the MIL-101(Cr) shell. • The catalysts had satisfactory performance for N-methylation of CO 2 and aniline/H 2. • H 2 was adsorbed and activated on the Au NPs sites. • CO 2 was adsorbed and activated on the O2- Lewis base sites. [ABSTRACT FROM AUTHOR]

Transparent conductors (TCs) with high conductivity and optical transparency are important for high-performance downstream applications. However, silver nanowire (Ag NWs) films have several drawbacks, including the high contact resistance (R c) and large insulating voids, which limits the Ag NW film's conductivity. Herein, a simple solution-based method is demonstrated for formation of hybrid film based on MXene/Ag NWs (MA). The two-dimensional (2D) Ti 3 C 2 T x MXene nanosheet can wrap on 1D Ag NWs to weld Ag NWs and provide extra conductive channels between two adjacent Ag NWs, which can greatly improve the conductivity of Ag NWs. The optimized MA hybrid films show largely improved conductivity (sheet resistance: 15 Ω/sq; T %: 89.3 %), high flexibility and environmental stability, greatly facilitating its application as a high-performance flexible transparent heater (cycling stability, 20 cycles of heating/cooling; temperature rising rate, 56.2 °C within 30 s at 5 V). Therefore, the MA hybrid transparent heating film has potential to be used for deicing and wearable heating device. • A feasible method is for the MXene nanosheet to wrap on Ag NWs. • This process readily results in welding Ag NWs and providing extra conductive channels between two adjacent Ag NWs. • The resultant MXene/Ag NW hybrid film shows largely improved carrier transport properties. • It can serve as high-performance electric component in transparent heater. [ABSTRACT FROM AUTHOR]

A series of Cs/CuAl-LDO@Al 2 O 3 @Fe 3 O 4 magnetic catalysts with varied CuAl-LDO contents were prepared by growing CuAl-LDH layers on the surface of Al 2 O 3 @Fe 3 O 4 magnetic cores, impregnated with Cs and followed by calcination. The as-synthesized catalysts were characterized by XRD, N 2 adsorption-desorption, SEM, TEM(EDS), XPS, NH 3 -TPD, CO 2 -TPD, and VSM techniques. The catalytic performance and reusability of the catalysts for the side-chain alkylation of toluene with formaldehyde were evaluated in a micro-high-pressure reactor, and the reaction mechanism was further studied. The results showed that the Al 2 O 3 @Fe 3 O 4 magnetic core of the catalyst was about 110 nm, and the CuAl-LDO formed a staggered lamellar structure with a shell thickness of around 30–45 nm. The magnetic catalyst demonstrated excellent catalytic performance and reusability for the side-chain alkylation of toluene with formaldehyde in one-step to styrene. As-synthesized magnetic Cs/CuAl-LDO@Al 2 O 3 @Fe 3 O 4 catalyst with CuAl-LDO content of 20 wt% delivered toluene conversion of 7.97% under optimized conditions, while the styrene selectivity and the selectivity of side-chain alkylation were 90.17% and 98.36%, respectively. The reaction mechanism showed that the benzene ring of toluene was stably adsorbed on the Al3+ acid sites of the CuAl-LDO layers. The C–H group of the side-chain of toluene formed carboanions and protons under the action of the Cuδ+–Oδ– base sites. Formaldehyde formed a transition state of adsorbed formaldehyde under the action of Cuδ+ acid sites. Finally, these adsorbed states and intermediate species accomplished the side-chain alkylation of toluene with formaldehyde to styrene in one-step under the synergic action of acid-base sites. The synergistic effects of suitable acid-base sites and lamellar spatial structures in the catalyst were the key to styrene formation with high selectivity. [Display omitted] • Synthesis of magnetic catalysts involves growing CuAl-LDH on Al 2 O 3 @Fe 3 O 4 and dipping Cs. • The acid-base properties of the magnetic catalysts were adjusted through calcination. • Satisfactory catalytic activity for side-chain alkylation of toluene in liquid-solid phase. • The rapid is separated by the applied magnetic field and can be reused continuously. • The acid-base sites and layered space-confined effects synergistically interact. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to use the most frequent features to establish a vertebral MRI-based radiomics model that could differentiate multiple myeloma (MM) from metastases and compare the model performance with different features number. Methods: We retrospectively analyzed conventional MRI (T1WI and fat-suppression T2WI) of 103 MM patients and 138 patients with metastases. The feature selection process included four steps. The first three steps defined as conventional feature selection (CFS), carried out 50 times (ten times with 5-fold cross-validation), included variance threshold, SelectKBest, and least absolute shrinkage and selection operator. The most frequent fixed features were selected for modeling during the last step. The number of events per independent variable (EPV) is the number of patients in a smaller subgroup divided by the number of radiomics features considered in developing the prediction model. The EPV values considered were 5, 10, 15, and 20. Therefore, we constructed four models using the top 16, 8, 6, and 4 most frequent features, respectively. The models constructed with features selected by CFS were also compared. Results: The AUCs of 20EPV-Model, 15EPV-Model, and CSF-Model (AUC = 0.71, 0.81, and 0.78) were poor than 10EPV-Model (AUC = 0.84, p < 0.001). The AUC of 10EPV-Model was comparable with 5EPV-Model (AUC = 0.85, p = 0.480). Conclusions: The radiomics model constructed with an appropriate small number of the most frequent features could well distinguish metastases from MM based on conventional vertebral MRI. Based on our results, we recommend following the 10 EPV as the rule of thumb for feature selection. Key Points: • The developed radiomics model could distinguish metastases from multiple myeloma based on conventional vertebral MRI. • An accurate model based on just a handful of the most frequent features could be constructed by utilizing multiple feature reduction techniques. • An event per independent variable value of 10 is recommended as a rule of thumb for modeling feature selection. [ABSTRACT FROM AUTHOR]

Objective: To investigate the values of multimodal imaging approaches in the diagnosis of spinal osteoblastomas with an emphasis on MRI findings. Materials and methods: We retrospectively evaluated the imaging findings of 35 patients with spinal osteoblastomas. The imaging methods included radiography, whole-body bone scintigraphy (WBBS), CT and MRI. Results: Radiography detected 87.1% (27/31) of the lesions; WBBS demonstrated increased radionuclide activity in all the lesions. CT could precisely show and localize all niduses, and calcification was always detected. MRI usually could adequately delineate the niduses of osteoblastomas, especially on T2WI (88.2%; 30/34). 71.9% (23/32) of osteoblastomas were surrounded with moderate or extensive bone marrow edema (BME) with soft tissue edema (STE). STE always extended along the muscle bundle adjacent to the lesion; there was no subcutaneous fat involvement. BME was eccentrically distributed in the vertebral body and spread inward from the sides of the nidus. The extent of BME in the vertebral body tended to be inversely proportional to the distance from the nidus. In addition, rare magnifications of osteoblastoma including multifocal diseases (n = 2), vertebra plana (n = 1) or with aneurysmal bone cysts (n = 6) were also observed in our study. Conclusions: In patients showing moderate or extensive BME together with STE on MRI, both CT and MRI should be used to confirm nidus presence. The above-mentioned characteristics of edema on MRI of patients with spinal osteoblastoma are helpful in not only localizing the nidus, but also enhancing the diagnostic confidence. [ABSTRACT FROM AUTHOR]

• IL-20 and its receptors were increased in arterial wall dissection from AAD patients. • The plasma IL-20 were significantly higher in the AAD patients. • IL-20 may contribute to the inflammatory pathogenesis of AAD. Acute aortic dissection (AAD) is the most devasting cardiovascular disease associated with high mortality. The occurrence and progression of AAD can be regulated by inflammatory processes, and further understanding of this inflammatory pathogenesis may improve the treatment of AAD. Interleukin 20 (IL-20), as an inflammatory mediator, has been demonstrated to be associated with several inflammatory diseases. However, the association between IL and 20 and AAD is still unknown. Five aortic dissection tissue samples and five control aortic tissue samples were evaluated in our study. The expression of IL-20 and its receptor subunits (IL-20Rα and IL-20Rβ) was detected by immunofluorescence staining. From January 2018 to March 2018, 70 consecutive AAD patients and 25 non-AAD (NAD) patients were enrolled in this study. Diagnosis was based on computed tomography angiography (CTA) results. Blood samples were obtained from the patients on the first day of hospitalization. Plasma IL-20, TNF-α and IL-6 concentrations were evaluated with enzyme-linked immunosorbent assay (ELISA) kits. The expression levels of IL-20 and its receptor subunits (IL-20Rα and IL-20Rβ) were increased in the sites of arterial wall dissection in the AAD patients. In a separate group, the plasma IL-20, TNF-α and IL-6 concentrations were significantly higher in the AAD patients than in the non-AAD patients. Spearman's correlation analysis showed that plasma IL-20 was positively correlated with plasma TNF-α and IL-6, D-dimer, C-reaction protein (CRP), creatinine, fasting blood glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Multiple linear regression revealed that IL-20, in addition to IL-6, glucose, CRP and D-dimer, was independently associated with the presence of AAD. IL-20 was closely associated with the presence of AAD. IL-20 may contribute to the inflammatory pathogenesis of AAD. [ABSTRACT FROM AUTHOR]

Actinobacillus pleuropneumoniae (A. pleuropneumoniae/APP) is the pathogen that causes porcine contagious pleuropneumonia. Actinobacillus pleuropneumoniae is divided into 18 serovars, and the cross protection efficacy of epitopes is debatable, which has resulted in the slow development of a vaccine. Consequently, epitope-based vaccines conferring Actinobacillus pleuropneumoniae cross protection have rarely been reported. In this study, B cell epitopes in the head domain of trimeric autotransporter adhesin were predicted, and 6 epitopes were selected. Then, the predicted epitopes (Ba1, Bb5, C1, PH1 and PH2) were connected by linkers to construct a recombinant tandem antigen (rta) gene. The RTA protein encoded by the recombinant rta gene was expressed, and finally the ICR mice were immunized with the RTA protein with or without inactivated Actinobacillus pleuropneumoniae (serovars 1 and 5b) and challenged with Actinobacillus pleuropneumoniae to evaluate the protective effect of the epitope-based vaccine and combined vaccine. The mice in the RTA-immunized group and RTA plus inactivated Actinobacillus pleuropneumoniae vaccine group had a significant improvement in clinical symptoms and a higher level of antibody in the serum than those in the control group. The RTA immune group had a 40% survival rate after Actinobacillus pleuropneumoniae infection, whereas the combination of RTA and inactivated Actinobacillus pleuropneumoniae produced very strong cross immune protection in mice, at least 50% (RTA IB1 + C5) and at most 100% (RTA IB5 + C1), whereas no cross immunoprotection was found in the solo Actinobacillus pleuropneumoniae immune group. Overall, the combination of the RTA protein and inactivated bacteria significantly enhanced the cross protection effects. This implies that RTA protein in combination with a suitable inactivated Actinobacillus pleuropneumoniae strain could be a candidate vaccine for porcine contagious pleuropneumonia. [ABSTRACT FROM AUTHOR]

Background: Patient risk adjustment is critical for hospital benchmarking and allocation of healthcare resources. However, considerable heterogeneity exists among measures. Objectives: The performance of five measures was compared to predict mortality and length of stay (LOS) in hospitalized adults using claims data; these include three comorbidity composite scores (Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, and V W Elixhauser age-comorbidity score), 3 M risk of mortality (3 M ROM), and 3 M severity of illness (3 M SOI) subclasses. Methods: Binary logistic and zero-truncated negative binomial regression models were applied to a 2-year retrospective dataset (2013–2014) with 123,641 adult inpatient admissions from a large hospital system in New York City. Results: All five measures demonstrated good to strong model fit for predicting in-hospital mortality, with C -statistics of 0.74 (95% confidence interval [CI] [0.74, 0.75]), 0.80 (95% CI [0.80, 0.81]), 0.81(95% CI [0.81, 0.82]), 0.94 (95% CI [0.93, 0.94]), and 0.90 (95% CI [0.90, 0.91]) for Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, V W Elixhauser age-comorbidity score, 3 M ROM, and 3 M SOI, respectively. The model fit statistics to predict hospital LOS measured by the likelihood ratio index were 0.3%, 1.2%, 1.1%, 6.2%, and 4.3%, respectively. Discussion: The measures tested in this study can guide nurse managers in the assignment of nursing care and coordination of needed patient services and administrators to effectively and efficiently support optimal nursing care. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Lack of thermal conductivity results in inefficient heat transfer in traditional pothole patching materials. • Thermal asphalt mortar and thermal asphalt concrete were evaluated. • Conductivity of thermal asphalt mix was four times that of the traditional asphalt mix. Abstract Asphalt pavements maintenance is a critical infrastructure issue. This paper reports on a high thermal conductivity asphalt pavement mastic and mixture. Thermal asphalt mortar (ThAM) produced with asphalt, silicon-carbide (SiC) powder in the presence, and absence, of styrene-butadiene styrene (SBS), was evaluated. Optimal SBS and SiC proportions were determined by optimization and the balance of viscosity, ductility, and temperature stability. The results indicated that SBS and SiC optimum contents were 5% and 10%, respectively. The corresponding penetration (25 °C), ductility (5 °C), and softening point were 44 dmm, 380 mm and 78 °C, respectively. Heat absorption rates for both thermal asphalt (ThA) and traditional asphalt (TrA) were tested and compared. It showed that temperature differences up to 30 °C. Two types of thermal asphalt concrete (ThAC), blending with iron powder or not, were prepared. ThAC performance was systematically evaluated. The dynamic stability achieved 5872 times/mm, whereas the low temperature bending stiffness modulus was 5505 MPa, indicating both the rutting resistance and cracking resistance favorable. The most unfavorable load position was analyzed using a node tracking method, Bond strength was five times of the maximum shear stress. ThAC and TrA mix thermal conductivities were compared. ThAC thermal conductivity was 19.642 W/(m·K), which was four times that of the TrA mix. [ABSTRACT FROM AUTHOR]

Abstract α-Neurexins are synaptic organizing molecules implicated in neuropsychiatric disorders. They bind and arrange an array of different partners in the synaptic cleft. The extracellular region of neurexin 1α (n1α) contains six LNS domains (L1–L6) interspersed by three Egf-like repeats. N1α must encode highly evolved structure–function relationships in order to fit into the narrow confines of the synaptic cleft, and also recruit its large, membrane-bound partners. Internal molecular flexibility could provide a solution; however, it is challenging to delineate because currently no structural methods permit high-resolution structure determination of large, flexible, multi-domain protein molecules. To investigate the structural plasticity of n1α, in particular the conformation of domains that carry validated binding sites for different protein partners, we used a panel of structural techniques. Individual particle electron tomography revealed that the N-terminally and C-terminally tethered domains, L1 and L6, have a surprisingly limited range of conformational freedom with respect to the linear central core containing L2 through L5. A 2.8-Å crystal structure revealed an unexpected arrangement of the L2 and L3 domains. Small-angle X-ray scattering and electron tomography indicated that incorporation of the alternative splice insert SS6 relieves the restricted conformational freedom between L5 and L6, suggesting that SS6 may work as a molecular toggle. The architecture of n1α thus encodes a combination of rigid and flexibly tethered domains that are uniquely poised to work together to promote its organizing function in the synaptic cleft, and may permit allosterically regulated and/or concerted protein partner binding. Graphical Abstract Unlabelled Image Highlights • Neurexin 1alpha (n1α) organizes protein networks in the synaptic cleft. • A panel of structural techniques reveals strategic conformational freedom in n1α. • Novel molecular switches are identified between domains. • The architecture of n1α suggests allosteric control and concerted partner binding. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Bifunctional catalysts supported on titanium were prepared. • One step methanol liquid oxidation to formic acid and methyl formate was achieved. • Selectivity of products could be tailored through Au and Pd weight percent. Abstract A series of Au-Pd/TiO 2 bifunctional catalysts with different Au, Pd loading percents have been prepared by sol-immobilization method. The related XRD, HR-TEM and XPS characterizations have been undertaken to uderstand the structure of catalysts. Catalytic activity in methanol liquid phase one-step oxidation to methyl formate have been studied in batch reactor. Results show that the nanoparticles are highly dispersed on TiO 2 with 6.4 nm mean size. Also, bifunctional catalysts could catalyse the conversion of methanol to methyl formate with high efficiency. With 1wt%Au-1wt%Pd/TiO 2 catalysts, when the molar ratio between active components and methanol is 1/2000, the conversion of methanol is 55.7% for 4 h under 100 °C and 25 bar. At the same time, the selectivity of methyl formate is up to 74.2%. The Au-Pd/TiO 2 bifunctional catalysts also shows great stability for the reaction with stable conversion and selectivity after 5 cycles. [ABSTRACT FROM AUTHOR]

Adoption of health information technology (HIT) in nursing homes (NHs) improves quality of care. Although there is a robust body of research on HIT adoption, the closely related process of technology abandonment is not well understood. As NHs grow more reliant on HIT, problems of technology abandonment, defined as failure to scale up, spread, and sustain HIT need to be studied. Our objective is to describe HIT abandonment and its associations with organizational characteristics among a national sample of US NHs. Longitudinal, retrospective analysis of data from 2 sources: HIT Maturity Survey and Staging model and public data from the Care Compare database. Random sample of NHs (n = 299) representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019–August 2020 and year 2 (Y2) was June 2020–August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain. Independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Over the 2-year period, HIT abandonment occurred in 28% (n = 85) of NHs compared with 44% (n = 133) that experienced growth in HIT systems. HIT capabilities in resident care were abandoned most frequently. Using multivariable multinomial logistic regression, we found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. Technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs. This study contributes to the limited understanding of technology abandonment and can serve as a building block for others working to ensure limited resources are used effectively to improve care for NH residents. [ABSTRACT FROM AUTHOR]

Abstract: Starting from two low‐nuclearity linear synthesised Co3 precursors {[Co3L’2(H2O)6]⋅2NO3⋅4H2O} (1) and {[Co3L’2(H2O)6]⋅2NO3} (2) (here, H2L=bis((pyridine‐2‐yl)‐1,2,4‐triazol‐5‐yl)methane, H2L’=bis((pyridine‐2‐yl)‐1,2,4‐triazol −5‐yl)ketone), a series of Co3‐substituted complexes and two higher‐nuclearity Co(II) clusters {[Co8L6(μ3‐O)2]⋅5H2O} (3) and [Co6L4(MeOH)6(OAc)4] (4) have been synthesized and characterized through regulating solvent, anion, and pH conditions. For tracking the formation of higher‐nuclearity clusters, the single‐crystal X‐ray diffraction (SXRD), powder X‐ray diffraction (PXRD) and electrospray ionization mass spectrometry (ESI‐MS) analyses for the solid‐liquid phase at different times, revealed that [Co2L2] and [Co2L] species can combine together to form [Co4L3] species, which bridged each other through two [μ3‐O]2− ions in strong alkaline conditions, to get [Co8(μ3‐O)2L6] units in 3; which or combined [Co2L] species in weak alkaline conditions, to get [Co6L4] species in 4. And the antiferromagnetic coupling in 1–4 has been briefly investigated. [ABSTRACT FROM AUTHOR]

While hospitalizations among people living with human immunodeficiency virus (PLWH) have been elevated in the past compared to their uninfected counterparts, the introduction of antiretroviral therapy (ART) has resulted in great strides in controlling symptomatic infection. However, research largely overlooks important differences among HIV-infected individuals, primarily PLWH who are symptomatic versus those who are asymptomatic. We conducted a retrospective study assessing the length of hospital stay among 717,237 admissions from three hospitals in the New York City area. Using zero-truncated negative binomial regression we documented trends in length of hospital stay among individuals who are HIV positive (with symptoms versus those without symptoms) compared to HIV-negative patients over nine consecutive years, from 2006 to 2014. Approximately 0.85% of the admissions were infected with asymptomatic HIV (n = 6,131), while 1.43% of admissions were infected with symptomatic HIV (n = 10,271). The length of stay (LOS) among symptomatic HIV-infected admissions was 32.0% (95% CI: 29.7%-34.2%) longer than LOS in the general admissions. The mean LOS dropped about 1.5% (95% CI: 1.5%-1.6%) per year in the study sample. The LOS in inpatients with asymptomatic HIV had the same LOS as the general inpatient population. Our findings highlight the need for comprehensive strategies to reduce length of hospitalization among HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Objectives: A number of studies have been conducted to identify the self-care strategies that are used by persons living with chronic illnesses to manage their symptoms, but little work has been done to identify the primary information source for these self-care strategies.Methods: We conducted an anonymous online survey with 1373 persons living with HIV to identify the self-care strategies they use to manage 28 commonly experienced symptoms. Following their report of their symptoms and self-care strategies, we asked an open-ended question to identify where the participant obtained the information. We applied iterative content analysis of the narrative data and multi-nominal regression to identify which demographic factors were significantly related to each information source category.Results: Respondents reported a total of 8539 information sources for their self-care strategies categorized as follows: Common sense/Self-experience, Healthcare professional, Internet, Literature, Multiple Sources, Social Support, and TV ads.Conclusions: We found that respondents with no college education were significantly more likely to report the use of the Internet as the information source for their self-care strategies. On the other hand, males as compared to females were significantly less likely to use the Internet and significantly more likely to use TV ads. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC).Methods: The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis.Results: A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%).Conclusion: Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC.Key Points: • CT is widely used to assess metastatic lymph nodes. • CT has low sensitivity in detecting metastases using conventional criteria. • Diagnostic sensitivity of CT was improved by using lymph node axial ratio. • New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%. • New diagnostic criteria may help clinicians assess patients with oesophageal cancer. [ABSTRACT FROM AUTHOR]

Background Health care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently. Objectives Investigate the NP role in care delivery—primary care providers with the own patient panels or delivering episodic care—within their organizations and understand how work environments affect their role. Design A cross-sectional survey design was used to collect data from primary care NPs. Settings The study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs. Participants 807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%. Methods The survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery. Results About 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio = 2.33; 95% CI: 1.06-5.13); with a one unit increase on this subscale, the incidence of the NPs serving as primary care providers with their own patient panel doubled. Conclusions NPs can help meet the increasing demand for primary care by taking responsibilities as primary care providers, and organizations can assign NPs their own patient panels. Supporting NP independent practice within organizations promotes NP role as primary care providers. Policy and organizational change focused on promoting NP work environments so NPs can practice as primary care providers can be an effective strategy to increase the primary care capacity. [ABSTRACT FROM AUTHOR]

Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives. [ABSTRACT FROM AUTHOR]

Contagious porcine pleuropneumonia (CPP), caused by Actinobacillus pleuropneumoniae (APP), is a highly transmissible and fatal respiratory illness that causes tremendous economic losses for the pig breeding industry worldwide. Propionibacterium acnes (PA) has a strong cross-reaction with anti-APP1 and anti-APP5 serum and can efficiently prevent APP infection, which was fortuitously found in researching the differential gene between the different APP serotypes. There seems to be some natural cross-protection between PA and APP. To identify the common epitope, the phage display library of a PA whole genome was constructed, whose size is 10 5 . The DNA sequence of the positive clone was determined after three rounds of biopanning, and ten common protein types were identified and the epitope was predicted by computer software. Six peptide epitopes were selected and synthesized for further analysis. Among these epitopes, Ba1, Bb5 and C1 could bind to anti-PA serum and anti-APP1 serum and vice versa. Furthermore, the IgG and IL-4 levels and CD4 + / CD8 + T cell ratios in the Ba1, Bb5 and C1 groups were significantly higher than that in the control group, indicating that the epitopes could trigger an immune response, which was mainly humoral immunity. Moreover, Ba1 and Bb5 equally protected 80% of mice from a fatal dose of APP1 infection compared with the control group. Mice could resist APP1 and APP5 challenge after being treated with the combination of Ba1 and Bb5, with survival rates of 80% and 90%, respectively. These findings suggest that the PA epitope confers antigenicity and can heterologously resist to the APP infection. This finding provides a novel strategy for preventing APP infection. [ABSTRACT FROM AUTHOR]

Background: Electronic health and administrative data are increasingly being used for identifying surgical site infections (SSI). We found an unexpectedly high number of patients who could not be classified definitively as having an infection or not. To further explore this, we present an electronic classification algorithm for conservative case finding and identify alterations that would adapt the method for other purposes.Methods: Two computer algorithms were created to identify SSI. One model used a strict National Healthcare Safety Network (NHSN) based SSI algorithm, which was applied to all discharges from 443,284 all discharges from four hospitals in Manhattan, NY, 2009 through 2012. The second model used discharges that only had NHSN-defined SSI procedures during the same period.Results: The strict SSI algorithm was able to classify SSI status for 27.3% of discharges; there was a high number of indeterminate cases. In contrast, the modified, less strict model, classified 97.2% of discharges with NHSN-approved SSI procedures.Conclusion: Electronic records provide several options for aiding with the identification of infections in healthcare settings and can be tailored to suit specific uses. While algorithms for SSI classification should reflect the NHSN definition, our research emphasizes how variations of model building can affect the number of indeterminate cases that may necessitate manual review. [ABSTRACT FROM AUTHOR]

The prevalence of obesity is rising rapidly among Hispanics/Latinas. We evaluated the prevalence of being obese or overweight and associated risk factors among 630 low-income, Latina women from ambulatory care clinics in Upper Manhattan. Overall, 37 % of the sample was overweight and 41 % of the sample was obese, and yet, almost half of women who are overweight considered their weight 'just about right.' After adjusting for socio-demographic, behavioral, and biological risk factors, being obese was strongly associated with having hypertension [relative risk ratio (RRR) 3.93, 1.75-8.82], pre-hypertension (RRR 2.59, 1.43-4.67), diabetes (RRR 2.50, 1.21-5.14) and moderate/moderately severe/severe depression (RRR 2.09, 1.03-4.26). Women who reported that finding time was a barrier to physical activity were also more likely to be obese (RRR 1.78, 1.04-3.02). Chronic financial stress was associated with lower risk of being overweight (RRR 0.47, 0.28-0.79) or obese (RRR 0.51, 0.31-0.86), as well as eating out at restaurants (RRR 0.75, 0.62-0.89). Opportunities for intervention relate to understanding cultural factors around perceptions of weight and helping women find the time for physical activity. [ABSTRACT FROM AUTHOR]

Background The E23K variant of the Kir6.2 subunit of the ATP-sensitive potassium (KATP) channel has been implicated in cardiac remodeling. However, the effects of E23K variant on ventricular electrophysiology and arrhythmogenesis remain unclear. Methods Transgenic rats were generated to express human E23K-variant genomic DNA in the heart under the α-myosin heavy chain promoter. Electrophysiological parameters including electrocardiograph, ventricular action potential duration (APD), effective refractory period (ERP), electrical alternans and ventricle arrhythmia threshold were examined in wild type (WT) and transgenic rats. The KATP current in cardiomyocytes was recorded using whole-cell patch clamp techniques. Results No differences in the electrophysiological parameters between the two groups were found at baseline. However, after acute ischemic stress, shortened QT intervals were further aggravated in the E23K-variant rats. Additionally, the E23K variant exacerbated the decrease of APD 70 , APD 90 and ERP. The ventricular arrhythmia and alternans thresholds were significantly attenuated, and the duration of ventricular arrhythmia induced by electrical stimulation was significantly prolonged in the E23K-variant rats. More importantly, the KATP current in cardiomyocytes was significantly increased in the E23K-variant rats after ischemia. Conclusion The E23K variant of the KATP channel increased the susceptibility to ventricular arrhythmia under acute ischemia stress. [ABSTRACT FROM AUTHOR]

In the United States, HIV has evolved from an acute disease to a chronic illness making health-related quality of life a pre-eminent goal for many persons living with HIV (PLWH). There have been a number of HIV-specific quality-of-life instruments developed, but little attention has been paid to the validation of standardized nondisease-specific quality-of-life instruments tailored to PLWH. The goal of this research was to validate the Patient-Reported Outcomes Measurement Information System (PROMIS)-29, a questionnaire that measures health-related quality of life in PLWH. A sample of 1306 PLWH completed an online anonymous survey assessing their symptom experience and health-related quality of life. A subsample of 209 participants completed another questionnaire 30 days later. The subscales of the PROMIS-29 showed high internal consistency reliability (range = 0.87-0.97). The PROMIS-29 detected differences in health-related quality of life in those persons who reported an AIDS diagnosis compared to those who did not report an AIDS diagnosis. The PROMIS-29 has demonstrated reliability, validity, and reproducibility for use in measuring health-related quality of life in PLWH. [ABSTRACT FROM AUTHOR]

Background: The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians.Objective: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians.Design: Using a cross-sectional survey design, data was collected from 163 primary care practices in Massachusetts.Participants: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %.Main Measures: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale.Key Results: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model.Conclusion: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Asthma is the leading cause of emergency room visits in children, and those with asthma tend to suffer from more severe consequences of respiratory tract infections. The aims of this study were among children who required hospitalization, compare differences between those admitted with or without respiratory infection, describe changes in yearly proportion of asthma among the children admitted with a respiratory infection in New York City from 2006 to 2012 and ascertain how asthma affected the average length of hospital stay for those with respiratory infection.Methods: We conducted an historical prospective study using data obtained from multiple electronic sources of patients discharged from a 200-bed pediatric hospital in a major metropolitan healthcare system between 2006 and 2012. Patient characteristics were obtained from electronic health records and billing codes.Results: Among 83 348 patient discharges, there were 5057 (6.1%) with a respiratory infection. In the multivariable model, children with the following characteristics were significantly more likely to be admitted with a respiratory infection as compared with other diagnoses: asthma [odds ratio (OR) 4.68 (95% confidence limits (CL): 4.31, 5.08], male sex [OR:1.11 (1.05, 1.18)], prior hospitalization [OR: 3.65 (3.43, 3.89)], renal failure [(OR: 2.14 (1.70, 2.70)] and Medicaid coverage [OR: 1.93 (1.81, 2.05)]. Children aged ≥5 years (OR: 0.44 (0.41, 0.47) and those with diabetes (OR: 0.32 (0.21, 0.51) were less likely to be admitted with a respiratory infection. Hospitalized patients with respiratory infection and asthma, identified by ICD-9 codes, had significantly shorter lengths of stay than patients without asthma, 5.3 and 9.0 days, respectively,p < 0.001. Asthma in patients admitted with a respiratory infection increased from 19.2% in 2006 to 28.2% in 2012, peaking at 34.1% in 2010 (p < 0.001).Conclusion: This study suggests that asthma is a significant risk factor for hospitalization of children with respiratory infection, and suggests that the prevalence of asthma is increasing over time among children hospitalized with respiratory infection in this urban setting. [ABSTRACT FROM AUTHOR]

Background: The preoperative prediction of lymph node metastasis (LNM) in pancreatic ductal adenocarcinoma (PDAC) is essential in prognosis and treatment strategy formulation. Purpose: To compare the performance of computed tomography (CT) and magnetic resonance imaging (MRI) radiomics models for the preoperative prediction of LNM in PDAC. Material and Methods: In total, 160 consecutive patients with PDAC were retrospectively included, who were divided into the training and validation sets (ratio of 8:2). Two radiologists evaluated LNM basing on morphological abnormalities. Radiomics features were extracted from T2-weighted imaging, T1-weighted imaging, and multiphase contrast enhanced MRI and multiphase CT, respectively. Overall, 1184 radiomics features were extracted from each volume of interest drawn. Only features with an intraclass correlation coefficient ≥0.75 were included. Three sequential feature selection steps—variance threshold, variance thresholding and least absolute shrinkage selection operator—were repeated 20 times with fivefold cross-validation in the training set. Two radiomics models based on multiphase CT and multiparametric MRI were built with the five most frequent features. Model performance was evaluated using the area under the curve (AUC) values. Results: Multiparametric MRI radiomics model achieved improved AUCs (0.791 and 0.786 in the training and validation sets, respectively) than that of the CT radiomics model (0.672 and 0.655 in the training and validation sets, respectively) and of the radiologists' assessment (0.600–0.613 and 0.560–0.587 in the training and validation sets, respectively). Conclusion: Multiparametric MRI radiomics model may serve as a potential tool for preoperatively evaluating LNM in PDAC and had superior predictive performance to multiphase CT-based model and radiologists' assessment. [ABSTRACT FROM AUTHOR]

We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization. Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted. 26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76–3.46 and AOR = 2.42; 95% CI = 1.87–3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45–4.71). Similar results were obtained with sensitivity analyses. In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents. [ABSTRACT FROM AUTHOR]

Objective: The Health Information Technology Usability Evaluation Scale (Health-ITUES) is a validated and reliable instrument to evaluate usability of information technology (IT) tools. In this study, we aimed to establish the optimal cut-point of the Health-ITUES to identify usability of IT tools.Methods: Adult participants were recruited to a trial evaluating a mobile app for self-managing HIV. Participants completed the Health-ITUES at the 3- and 6-month follow-up. Health-ITUES is a 20-item questionnaire that assesses four subscales: impact, perceived usefulness, perceived ease of use, and user control. The total score ranged from 1 to 5 and a higher score indicates greater usability. App use was defined as the proportion of activities completed by participants in both study arms. The selection of an optimal cut-point involved a series of multiple linear regression models with 500 bootstrap replications to examine the relationship between the Health-ITUES total score and app use, controlling for potential covariates.Results: We included 158 participants; mean age was 49.7 years (SD 10.3), 71% were African American/Black, and 72% were non-Hispanic. Mean Health-ITUES total scores at 3 and 6 months were 4.39 (SD 0.75) and 4.43 (SD 0.75), respectively. App use completedby participants from baseline to the 3-month follow-up visits was 0.61 (SD 0.36, range 0-1.72) and from 3-month to the 6-month follow-up visits was 0.51 (SD 0.37). Participants who reported greater Health-ITUES total score completed more activities [β = 0.18, 95% Confidence Interval (CI) 0.10-0.27]. The optimal cut-point of 4.32 (95% CI: 4.25-4.56) yielded the lowest p-value to identify usability of IT tools.Conclusions: In this study of adults with HIV, we identified an optimal cut-point of 4.32 on the Health-ITUES total score to define usability. Further studies are needed to validate this cut-point. [ABSTRACT FROM AUTHOR]

Liver cancer is the sixth most common tumor in the world and the majority of patients with this disease usually die within 1 year. The effective treatment for end-stage liver disease (also known as liver failure), including liver cancer or cirrhosis, is liver transplantation. However, there is a severe shortage of liver donors worldwide, which is the major handicap for the treatment of patients with liver failure. Scarcity of liver donors underscores the urgent need of using stem cell therapy to the end-stage liver disease. Notably, hepatocytes have recently been generated from hepatic and extra-hepatic stem cells. We have obtained mature and functional hepatocytes from rat hepatic stem cells. Here, we review the advancements on hepatic differentiation from various stem cells, including hepatic stem cells, embryonic stem cells, the induced pluripotent stem cells, hematopoietic stem cells, mesenchymal stem cells, and probably spermatogonial stem cells. The advantages, disadvantages, and concerns on differentiation of these stem cells into hepatic cells are highlighted. We further address the methodologies, phenotypes, and functional characterization on the differentiation of numerous stem cells into hepatic cells. Differentiation of stem cells into mature and functional hepatocytes, especially from an extra-hepatic stem cell source, would circumvent the scarcity of liver donors and human hepatocytes, and most importantly it would offer an ideal and promising source of hepatocytes for cell therapy and tissue engineering in treating liver disease. J. Cell. Physiol. 228: 298-305, 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has forced nursing homes to adapt new models of care in response to the evolving crisis including rapid implementation of telehealth services. The purpose of our study was to investigate implementation of telehealth in nursing homes amidst the COVID‐19 pandemic using a human factors model. Methods: Using a mixed methods design, we conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 204). Using six survey questions, we calculated a total telehealth score (range 0–42). Descriptive statistics and paired sample t‐test were used to explore the change in telehealth in two consecutive years (2019–2021). Next, we conducted semi‐structured interviews with (n = 21) administrators and clinicians to assess differences in implementation according to extent of telehealth use. Results: The mean telehealth score in year 1 was 12.11 (SD = 9.85) and year 2 was 19.25 (SD = 11.25). There was a significant difference in telehealth scores from year 1 to year 2 (t = 6.83, p < 0.000). While 64% of nursing homes reported higher telehealth scores in year 2 compared to year 1, over 32% reported a decline. Qualitative analysis revealed facilitators of telehealth including training, use of integrated equipment, having staff present for the visit, and using telehealth for different types of visits. Barriers included using smart phones to conduct the visit, billing, interoperability and staffing. Conclusion: Training, adaptation of work processes to support communication, and restructuring teams and tasks are the result of interactions between system components that could improve usability and sustainability of telehealth in nursing homes. [ABSTRACT FROM AUTHOR]

Abstract: A rapid and sensitive HPLC/MS/MS method was developed and validated for simultaneous determination of tinidazole, dyclonine and chlorhexidine, the three main components of a film-forming solution, in rat plasma. The plasma samples were pretreated by solid phase extraction (SPE) method. Separation was achieved on a Phenomenex Gemini C18 column (50mm×2.0mm, 5μm) using an isocratic mobile phase system composed of methanol-ammonium formate (10mM)-formic acid (56:44:0.2, v/v/v) (pH 3.5) at a flow rate of 0.2mL/min. Analytes were determined by tandem mass spectrometry with electrospray positive ionization and multiple-reaction monitoring (MRM) mode. The monitoring ions were (m/z) 247.4→(m/z) 81.9 for tinidazole, (m/z) 290.1→(m/z) 97.8 for dyclonine, (m/z) 505.0→(m/z) 335.3 for chlorhexidine and (m/z) 282.1→(m/z) 212.0 for phentolamine (internal standard). The calibration curves were linear in the range of 2–1000ng/mL for the three components. The precision and accuracy of the method were well within the generally accepted criteria for biomedical analysis. It has been successfully applied to the pharmacokinetic research of a film-forming solution in rat. [Copyright &y& Elsevier]

Abstract: This study attempted to optimize the compositions of microemulsion mobile phase to model the drug penetration across blood–brain barrier (BBB) by microemulsion liquid chromatography (MELC). During the study, a continuous increase of the retentions along the operation time was found for all the test drugs. A correction method using methyl paraben and propranolol as the internal standards was proposed, which improved the reliability of the retention time significantly. The corrected retention factors were then used to develop the predictive model. The optimized MELC system with microemulsion consisting of 3.3% sodium dodecyl sulfate (SDS)–6.6% butanol–1.6% heptane–88.5% phosphate buffer (pH 7.0) showed superiorities to other lipophilicity measuring systems for modeling BBB penetration. [Copyright &y& Elsevier]

Abstract: A rapid, sensitive and reproducible HPLC method using C18 monolithic column was developed and validated for the analysis of rifampicin (RIF) and its four related compounds, including rifampicin quinone (RQ), rifamycin SV (SV), rifampicin N-oxide (RNO) and 3-formylrifamycin SV (3-FR). Chromatographic separation was achieved by using the mixture of methanol–acetonitrile–monopotassium phosphate (0.075M)–citric acid (1.0M) (28:30:38:4, v/v) as the mobile phase at a flow rate of 2mL/min and with UV detection at 254nm. Calibration curves were obtained in the concentration ranges of 1–40μg/mL for SV, RNO and 3-FR, 1.5–60μg/mL for RQ and 5–200μg/mL for RIF. Limit of quantitation (LOQ) was determined to be 1μg/mL and the limit of detection (LOD) was 0.2μg/mL for all studied compounds with a 10μL injection. The intra-day R.S.Ds. and inter-day R.S.Ds. for the above five compounds were all less than 2.5%. The recoveries of rifampicin from placebo tablets were from 99.7% to 100.5%. The total run time was less than 11min, as opposed to around 60min by using C18 particle-packed column. In conclusion, by this developed method, RIF and its related compounds can be determined rapidly with good precision and accuracy in pharmceuticals. [Copyright &y& Elsevier]

Abstract: The solvation parameter model has been applied to characterize four microemulsion liquid chromatography (MELC) systems and two micellar liquid chromatography (MLC) systems, and utilized to compare the above systems with other physicochemical and biological processes in this study. The microemulsion mobile phases were composed of sodium dodecyl sulfate (SDS), polyoxyethylene (23) lauryl ether (Brij 35), butanol, heptane and phosphate buffer (pH 7.0) at the designated ratios. The results showed the main difference between the concerned MELC and MLC systems was the decrease of hydrogen-bond basicity of stationary phase with the addition of heptane in microemulsion. Principal component analysis with normalized coefficients can provide consistent results involving the similarities among various systems with that obtained by distance parameter d. Except for some proven similarities of chromatographic systems to octanol–water partition coefficients (log P) and human skin permeation (log K p), a microemulsion HPLC system, the mobile phase being 3.3% SDS–6.6% butanol–1.6% heptane–88.5% buffer, was found very similar to drug penetration across blood–brain barrier and its predictive capability for this biological process was originally evaluated in this study. [Copyright &y& Elsevier]

Abstract: A quantitative method for the determination of total tiopronin (TP) in human plasma was developed by liquid chromatography with electrospray ionisation (ESI) mass spectrometric detection. After reduction with tris (2-carboxy-ethyl) phosphine (TCEP) and derivatization with methyl acrylate (MA) for the thiol group of TP, plasma samples were processed successively by deproteinization and solid phase extraction. N-acetyl-l-cysteine (NAC) was selected as internal standard undergoing the same treatment as TP. The method was validated that it could meet the need of biological analysis. The lower limit of quantitation (LLOQ) of TP in plasma was 0.02μg/mL. Finally, the method was successfully applied to a pharmacokinetic study in 20 healthy Chinese male volunteers after an oral dose of 200mg TP tablets. [Copyright &y& Elsevier]

Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

Thoracic aortic dissection (TAD) is a severe disease, characterized by numerous apoptotic vascular smooth muscle cells (VSMCs). EDIL3/Del-1 is a secreted protein involved in macrophage efferocytosis in acute inflammation. Here, we aimed to investigate whether EDIL3 promoted the internalization and degradation of apoptotic VSMCs during TAD. The levels of EDIL3 were decreased in the serum and aortic tissue from TAD mice. Global edil3 knockout (edil3−/−) mice and edil3−/− bone marrow chimeric mice exhibited a considerable exacerbation in β-aminopropionitrile monofumarate (BAPN)-induced TAD, accompanied with increased apoptotic VSMCs accumulating in the damaged aortic tissue. Two types of phagocytes, RAW264.7 cells and bone marrow-derived macrophages (BMDMs) were used for in vitro efferocytosis assay. edil3-deficient phagocytes exhibited inefficient internalization and degradation of apoptotic VSMCs. Instead, EDIL3 promoted the internalization phase through interacting with phosphatidylserine (PtdSer) on apoptotic VSMCs and binding to the macrophage ITGAV/αv-ITGB3/β3 integrin. In addition, EDIL3 accelerated the degradation phase through activating LC3-associated phagocytosis (LAP). Mechanically, following the engulfment, EDIL3 enhanced the activity of SMPD1/acid sphingomyelinase in the phagosome through blocking ITGAV-ITGB3 integrin, which facilitates phagosomal reactive oxygen species (ROS) production by NAPDH oxidase CYBB/NOX2. Furthermore, exogenous EDIL3 supplementation alleviated BAPN-induced TAD and promoted apoptotic cell clearance. EDIL3 may be a novel factor for the prevention and treatment of TAD.Abbreviations: BAPN: β-aminopropionitrile monofumarate; BMDM: bone marrow-derived macrophage; C12FDG: 5-dodecanoylaminofluorescein-di-β-D-galactopyranoside; CTRL: control; CYBB/NOX2: cytochrome b-245, beta polypeptide; DCFH-DA: 2’,7’-dichlorofluorescin diacetate; EDIL3/Del-1: EGF-like repeats and discoidin I-like domains 3; EdU: 5-ethynyl-2’-deoxyuridine; EVG: elastic van Gieson; H&E: hematoxylin and eosin; IL: interleukin; LAP: LC3-associated phagocytosis; MAP1LC3/LC3: microtubule-associated protein 1 light chain 3; NAC: N-acetylcysteine; PtdSer: phosphatidylserine; rEDIL3: recombinant EDIL3; ROS: reactive oxygen species; SMPD1: sphingomyelin phosphodiesterase 1; TAD: thoracic aortic dissection; TEM: transmission electron microscopy; VSMC: vascular smooth muscle cell; WT: wild-type [ABSTRACT FROM AUTHOR]

Introduction: In the United States, the number of patients with substance use disorders is steadily increasing. Individuals with a substance use disorder may be more likely to experience negative hospital outcomes, including lengthier hospital stays and frequent readmissions, which is extremely costly to patients and to the government. While there are established associations between substance use disorder and hospital readmissions, the impact of substance use disorder on other outcomes such as length of stay remain unclear. We assessed whether hospital admissions diagnosed with substance use disorders experienced longer hospital stays and readmissions compared to patients without a substance use disorder diagnosis.Methods: This is a retrospective study of hospital readmissions rates in three hospitals in the New York City, New York area. Data were examined over a 10-year period (from 2007 to 2016, n = 768,219). We used multilevel multivariable regression models to compare the hospital length of stay, time-to-hospital readmission, and 30-day hospital readmission among admissions with substance use disorder compared to admissions without the disorder.Results: As compared to those who did not have a substance use disorder, admissions with substance use disorder had longer hospital length of stay (Regression coefficient (b) = 1.24; 95% CI: 1.15-1.33), were more likely to experience hospital readmission at any point in time (HR = 1.24; 95 % CI: 1.22-1.25), and were more likely to have a 30-day hospital readmission (RR = 1.16; 95 % CI: 1.13-1.19).Conclusions: Hospital settings could potentially serve as useful venues for substance use-related interventions and could benefit from strong coordination with outpatient providers and more targeted discharge planning. [ABSTRACT FROM AUTHOR]

High quality human tissue is essential for molecular research, but pre-analytical conditions encountered during tissue collection could degrade tissue RNA. We evaluated how prolonged exposure of non-diseased breast tissue to ambient room temperature (22±1°C) impacted RNA quality. Breast tissue received between 70 to 190 minutes after excision was immediately flash frozen (FF) or embedded in Optimal Cutting Temperature (OCT) compound upon receipt (T0). Additional breast tissue pieces were further exposed to increments of 60 (T1 = T0+60 mins), 120 (T2 = T0+120 mins) and 180 (T3 = T0+180 mins) minutes of ambient room temperature before processing into FF and OCT. Total exposure, T3 (T0+180 mins) ranged from 250 minutes to 370 minutes. All samples (FF and OCT) were stored at -80°C before RNA isolation. The RNA quality assessment based on RNA Integrity Number (RIN) showed RINs for both FF and OCT samples were within the generally acceptable range (mean 7.88±0.90 to 8.52±0.66). No significant difference was observed when RIN at T0 was compared to RIN at T1, T2 and T3 (FF samples, p = 0.43, 0.56, 0.44; OCT samples, p = 0.25, 0.82, 1.0), or when RIN was compared between T1, T2 and T3. RNA quality assessed by quantitative real-time PCR (qRT-PCR) analysis of beta-actin (ACTB), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), cyclophilin A (CYPA), and porphobilinogen deaminase (PBGD) transcripts showed threshold values (Ct) that indicate abundant and intact target nucleic acid in all samples (mean ranging from 14.1 to 25.3). The study shows that higher RIN values were obtained for non-diseased breast tissue up to 190 minutes after resection and prior to stabilization. Further experimental exposure up to 180 minutes had no significant effect on RIN values. This study strengthens the rationale for assessing RIN and specific gene transcript levels as an objective method for determining how suitable RNA will be for a specific research purpose ("fit-for purpose"). [ABSTRACT FROM AUTHOR]

Background: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. Purpose: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. Methods: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. Results: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p =.007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p =.04; β = −2.698; 95% CI: −5.268 to −0.127, respectively). Implications for practice: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Objective: Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma.Materials and Methods: CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air.Results: CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees.Conclusion: CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma.Practice Implications: A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved. [ABSTRACT FROM AUTHOR]

Immune response plays a crucial role in post-myocardial infarction (MI) myocardial remodeling. Neogenin (Neo1), a multifunctional transmembrane receptor, plays a critical role in the immune response; however, whether Neo1 participates in pathological myocardial remodeling after MI is unclear. Our study found that Neo1 expression changed significantly after MI in vivo and after LPS + IFN-γ stimulation in bone marrow-derived macrophages (BMDMs) in vitro. Neo1 functional deficiency (using a neutralizing antibody) and macrophage-specific Neo1 deficiency (induced by Neo1flox/flox;Cx3cr1cre mice) increased infarction size, enhanced cardiac fibrosis and cardiomyocyte apoptosis, and exacerbated left ventricular dysfunction post-MI in mice. Mechanistically, Neo1 deficiency promoted macrophage infiltration into the ischemic myocardium and transformation to a proinflammatory phenotype, subsequently exacerbating the inflammatory response and impairing inflammation resolution post-MI. Neo1 deficiency regulated macrophage phenotype and function, possibly through the JAK1-STAT1 pathway, as confirmed in BMDMs in vitro. Blocking the JAK1-STAT1 pathway with fludarabine phosphate abolished the impact of Neo1 on macrophage phenotype and function, inflammatory response, inflammation resolution, cardiomyocyte apoptosis, cardiac fibrosis, infarction size and cardiac function. In conclusion, Neo1 deficiency aggravates inflammation and left ventricular remodeling post-MI by modulating macrophage phenotypes and functions via the JAK1-STAT1 signaling pathway. These findings highlight the anti-inflammatory potential of Neo1, offering new perspectives for therapeutic targets in MI treatment. Neo1 deficiency aggravated inflammation and left ventricular remodeling after MI by modulating macrophage phenotypes and functions via the JAK1-STAT1 signaling pathway. [ABSTRACT FROM AUTHOR]

Background: Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important.Objective: We assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affects their job satisfaction, intent to leave their current job, and quality of care.Design: A cross-sectional survey design was used to collect data from both NPs and physicians in New York State in 2017.Participants: 584 participants (398 NPs and 186 physicians) from 476 primary care practices completed the survey yielding a 27% response rate for NPs and 12% for physicians.Main Measures: The survey tool contained validated measures of teamwork and three outcomes: job satisfaction, intent to leave, and perceived quality of care. Simple and multi-level multivariable regression models were built.Key Results: Most participants (76%) were either moderately satisfied or very satisfied with their job (NP sample: 75%; physician sample: 77%) and about 10% intended to leave their current job (NP sample: 11%; physician sample: 9%). The average perceived quality of care was the same across NP and physician samples with a mean of 8.5 on a 11 point scale. After controlling for confounders, a higher organizational-level teamwork score was associated with higher job satisfaction (cumulative OR: 3.00; 95% CI: 1.85-4.88), lower odds of intent to leave (OR: 0.25; 95% CI: 0.09-0.74), and higher perceived quality of care (b=1.00; 95% CI: 0.77-1.23).Conclusions: This study produced evidence about NP-physician teamwork in primary care practices. We found the vast majority of NPs and physicians reported favorable teamwork, and that teamwork affects clinician job satisfaction and intent to leave as well as perceived quality of care in their practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data. BACKGROUND: Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses. METHODS: Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks. RESULTS: Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later. CONCLUSIONS: Understaffing is associated with increased risk of HAIs. [ABSTRACT FROM AUTHOR]

Background: Some nurse-driven interventions have successfully reduced rates of healthcare-associated infections, though incidence remains unacceptably high. Bacterial contamination in patient rooms may be a source of exposure for patients and thus a target for future interventions; however, few studies have investigated the role of the patient room on organism acquisition. Objectives: The purpose of this study was to determine the incidence of concurrent detection of bacterial pathogens among patients sharing a hospital room. Methods: We performed a retrospective network analysis using electronic administrative and clinical data collected from all patients admitted in 2006 through 2012 to four New York City hospitals, totaling 2,065 beds within 183 inpatient units. A computerized algorithm identified concurrent organism detection among roommates, defined as two patients who shared a room on at least 1 day and had a first positive culture for the same organism within 3 days following cohabitation. Results: In total, 741,271 patient admissions were included. The algorithm identified 373 concurrent detection events: 158 (42%) in which the patients' first positive cultures were drawn after they were no longer sharing a room but within 3 days of cohabitation, 144 (39%) in which the patients' first positive cultures were drawn while they were still sharing a room but on different days, and 71 (19%) in which the patients' first positive cultures were drawn while they were sharing a room on the same day. Discussion: Methods to improve environmental decontamination should be included as part of a comprehensive approach to infection prevention in hospitals. Nurses have an important role to play in the planning and implementation of interventions to reduce bioburden in the patient environment. [ABSTRACT FROM AUTHOR]