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Expertise or Experience: Comparing Discussion of Drought between Audiences and Agencies in Nebraska, Kansas, Iowa, and Missouri
No full textSignificant portions of the states in FEMA region 7 (Kansas, Nebraska, Missouri, and Iowa) were in drought in 2022–23. Culling data gathered from a prominent social media platform and from focus group discussions, this research examines how drought information was communicated between the public officials and the general public. Through the lens of the two-step flow of communication theory, the central research question explored the differences between public conversations about drought among individuals experiencing it and the viewpoints of experts who work on drought-related issues. Results from social media conversations were examined, along with insights from focus group discussions involving local, state, and federal officials, to assess communication patterns about this complex issue. Social media analyses suggested a broad disconnection between public discussion of drought effects, when compared to most officials’ communication, which was limited to responses to acute symptoms of drought. Further, officials during focus groups suggested that barriers to deeper discussions about drought were limited, in part, because of siloed agencies and concerns about audience perceptions. Tying back to the role of positional opinion leaders in communication, the results suggest that larger discussions of drought that involve behavioral change or mitigation strategies were sought by members of the public but not often addressed in most official communication during this event. Significance Statement
The study compared drought discussion from social media conversations and focus groups of key officials. Results indicated that residents often sought help with individualized effects of drought, including damaged crops or financial hardships. Conversely, most Twitter communication from officials focused on monitoring conditions of rainfall or water levels, signaling a disconnection in drought communication between the two groups. Drought officials noted that they often design their communication strategies based on their audiences. These findings suggest that managing drought conditions may not allow for incremental change or solid resource management, unless clearly defined communication strategies are developed
Transportation Barriers to Healthcare Access: A Scoping Review of Measurement Approaches and Associated Health Outcomes
No full textBackground Transportation, along with cost, is a leading healthcare access barrier; however, there is no standardized measure to assess transportation barriers. Objectives To assess how transportation barriers to healthcare access and utilization are measured in U.S. studies, and to describe the types of health outcomes examined in these studies. The review focuses on constructs and operational definitions. Methods Using online databases (PubMed, Embase, CINAHL, EBSCOhost), we searched for articles published in English from 1 January 1991–24 May 2022 with a focus on articles assessing transportation as a means of accessing healthcare services or as a barrier to access/utilization of healthcare for a specified health outcome, screened by title and abstract before doing full text review and data extraction. Results Of 2,527 articles identified, 186 articles met our inclusion criteria and are descriptively summarized. Geographic specificity varied from point location to county. The most common transportation measures were estimated travel distance (n = 94) and time (n = 63), assessed as straight-lines (n = 47). Continuous results were categorized for analysis in 21 studies. Eight studies assessed supply–demand density using a floating catchment area. Health measures could be generally categorized as service access (n = 80; e.g., opioid treatment, cancer screening), healthcare utilization (n = 62; e.g., missed appointments, hospital readmissions), and disease-specific outcomes (n = 74; e.g., diagnosis, organ transplant, mortality). Conclusion We highlight the need for standardized measures and reporting to address transportation barriers across rural and urban settings, aiming to improve healthcare access and health equity. Included studies highlight the complex interactions between healthcare dynamics and transportation barriers
Staphylococcus aureus Encodes Four Differentially Regulated Pyruvate Transporters
No full textThe success of Staphylococcus aureus as a pathogen is attributable, in part, to its ability to exploit the diverse nutrient sources available during infection. Critical to this success are the pathways involving pyruvate that serve as a nexus for energy production, oxidative metabolism, and biosynthetic processes. When available, bacteria acquire pyruvate from the environment to fuel growth. Recently, LrgAB was identified as a pyruvate transporter under microaerobic conditions, leading us to speculate that S. aureus encodes other pyruvate transporters that are active during aerobic growth. In this study, we used the toxic pyruvate analog, 3-fluoropyruvic acid (3-FP), to isolate mutants with impaired pyruvate uptake. Whole-genome sequencing (WGS) of these mutants revealed mutations in two genes, lctP and lldP. Pyruvate uptake was significantly delayed when both lctP and lldP were inactivated. Although LldP and LctP were annotated as L-lactate permeases, 14C-pyruvate uptake assays confirmed that they function as pyruvate transporters. Despite a reduction in pyruvate uptake, the lctP lldP mutant did not have a growth defect in media with pyruvate, indicating that there may be an additional pyruvate importer. Reassessment of 3-FP susceptibility of the lctP lldP mutant revealed a zone of inhibition, confirming there is another transporter. WGS of 3-FP-resistant lldP lctP mutants identified B7H15_13955, an annotated MFS transporter, as the fourth transporter. Importantly, inactivation of all four genes completely eliminated pyruvate uptake, suggesting we have identified all the pyruvate transporters. These findings reveal that S. aureus employs multiple pyruvate transporters to support pyruvate metabolism under aerobic and anaerobic conditions.IMPORTANCEPyruvate is a key metabolite that supports bacterial energy production in many conditions. While the LrgAB system was previously implicated in pyruvate import under microaerobic conditions, the transporters that enable Staphylococcus aureus pyruvate acquisition during aerobic growth have remained undefined. We identified lctP and lldP, two genes annotated as lactate transporters, and B7H15_13955 as additional pyruvate transporters. Through genetic inactivation, pyruvate consumption, growth, and 14C-pyruvate uptake assays, we demonstrate that LctP, LldP, and B7H15_13955 are capable of pyruvate import, and with LrgAB, comprise a regulated network for pyruvate acquisition. This discovery fills a critical gap in our understanding of S. aureus metabolic adaptation and reveals that this pathogen is equipped with multiple systems to import pyruvate under diverse environmental conditions
Posterior Anatomic Limit for Mandibular Molar Distalization in Subjects with Different Growth Patterns, Genders, and Growth Status
No full textThe objective of this study is to identify the anatomical limits for mandibular molar distalization, a technique frequently employed in orthodontics to address various malocclusions. Mandibular molar distalization plays a critical role in the management of crowding, and correction of the molar relationship.
It is imperative to assess the posterior anatomical space (PAS) in the mandibular retromolar area prior to distalization or uprighting the mandibular molars to avoid periodontal issues (dehiscence, orthodontically induced root resorption, and tooth mobility) and achieve successful treatment outcomes.
A clinical question that, however, isn\u27t well understood is whether the amount of mandibular molar distalization is influenced by patient\u27s growth pattern, gender, and growth stage (growing or non- growing)
Microbiome Compositional State and Its Relation to Gut Dysbiosis in the Common Marmoset
No full textThis dissertation aimed to document interactions between the bacterial taxa that comprise the gut microbiome of common marmosets and provide insight into the microbiome’s transition from healthy “eubiosis” to unhealthy “dysbiosis”. This was accomplished by using high-throughput sequencing to obtain a snapshot of microbial composition and comparing multiple snapshots across subjects and time points. Chapter 1 used correlation and network graphical analysis to assess longitudinal bacterial and metabolic interactions in healthy subjects. This analysis revealed bacteria and metabolites that were involved in many significant interactions and used a novel metric to rank bacteria by their perceived influence on the microbiome. The metric ranked Clostridium_sensu_stricto_1, Alloprevotella, and Parabacteroides as the most influential bacteria, and negative correlations suggested competition between high-ranking bacteria and numerically dominant Bifidobacterium. Chapter 2 used differential abundance and pathway enrichment analysis to identify bacteria and bacterial genes that exhibited major shifts in abundance during a period of antibiotic-induced dysbiosis. This analysis found that some bacteria such as Bifidobacterium were severely inhibited by antibiotics while others such as Fusobacterium and Clostridium_sensu_stricto_1 thrived, and that some bacteria possessed antibiotic resistance genes which contributed to their success. Dysregulated pathways for carbohydrate and amino acid metabolism highlighted the importance of microbial organisms in degrading complex molecules and indicated that antibiotics can impair digestion. Together, these findings indicate that Bifidobacterium is a valuable resident of the marmoset gut that can be easily displaced by other bacteria in response to microbiome perturbation. From a broader perspective, this dissertation argues for the importance of holistic microbiome studies that consider the composition of known and unknown bacterial species
Deciphering Mechanisms of Mitoxantrone Action in Homologous Recombination Deficient Ovarian Cancer
No full textMitoxantrone (MX) has broad applications as a chemotherapeutic across cancer types. Its abilities to inhibit topoisomerase 2 and intercalate DNA are well characterized. However, despite years in the clinic, researchers continue to identify non-canonical targets of MX, underlining our limited understanding of MX’s complex cellular interactions. More recently, MX was identified as an inhibitor of the RAD52:RPA protein-protein interaction, which is a critical complex in several DNA repair pathways and in homologous recombination (HR)-deficient cancer cells. Subsequent studies showed heightened sensitivity across several HR-deficient cell lines. However, the mechanisms underlying RAD52:RPA complex disruption and MX-sensitivity in HR-deficient cancer cells were unclear. This information is key to understanding MX’s therapeutic value and interpreting MX-sensitivity in HR-deficient cancer.
The studies presented in Chapter 2 looked to characterize the direct interaction between MX and RAD52. This was done using surface plasmon resonance, limited proteolysis, dynamic light scattering, and nano-differential scanning fluorimetry. Each of these investigations provided evidence of a direct interaction between MX and RAD52. The results suggested that MX interacts near or within the RPA-binding domain of RAD52, and it modulates RAD52 stability and architecture in a dose-dependent manner. These studies provide insight into how RAD52 dynamics are altered upon MX-interaction, which may contribute to disrupting RAD52’s interaction with RPA.
The studies outlined in Chapter 3 examine MX-sensitivity in HR-deficient UWB1.289 ovarian cancer cells and survey the proteome-wide binding profile of MX. First, an MX-biotin probe (MXP) and a negative control (MXP-NC) were used in a proof-of-concept study to demonstrate their utility as molecular probes of MX. These molecular tools were then used to survey the cellular targets of MX in HR-deficient UWB1.289 cells. In parallel, shotgun proteomics was used to assess the molecular consequences of MX-treatment. Proteomic analyses of MX-treated HR-deficient UWB1.289 cells showed unique downregulation of pathways necessary for genomic stability, including single-strand annealing, alongside significant upregulation of proteins related to ribosome biogenesis and RNA processing. Chemoproteomic analysis using MXP corroborated these results. This work helps to characterize the target landscape of MX and provides insight into off-target effects and MX action in HR-deficient cancer
Analysis of the Hospital Medical Surge Preparedness Index in Relation to Hospital Characteristics and Social Determinants of Health
No full textObjective
Substantial investments have been made in hospital emergency preparedness. The Hospital Medical Surge Preparedness Index (HMSPI) has been proposed as a metric to assess health system readiness. This index summarizes hospital system characteristics, space and facilities, staff availability, and supply planning.
Methods
The primary objective was to evaluate the relationship between the HMSPI and characteristics of the respective hospitals, including size, type, location, performance on the Hospital Resilience Index (HRI), and Social Determinants of Health (SDoH).
Results
Higher HMSPI scores were found in suburban compared to rural hospitals, a higher HMSPI in larger hospitals with greater patient volumes and capacity (43.2 [42,44]) versus medium (26 [25,27]) and small (18 [17,19]) hospitals, and teaching status (29 [28,30]) versus non-teaching status (25 [25,26]). Investor-related hospitals and those caring for more patients with Medicare/Medicaid coverage had a lower HMSPI.
Conclusions
In conclusion, hospital medical surge preparedness is unevenly distributed across the U.S. healthcare system, with larger, non-for-profit, and teaching institutions having higher preparedness scores on the HMSPI, while a greater percentage of patients cared for who are covered by Medicare / Medicaid is linked to lower scores
Knowledge, Skills, and Barriers to Palliative Care Referrals by Oncology Providers
Get PDFPalliative Care is an evidence based and integrative aspect of cancer care that has demonstrated improved quality of life and diminished symptomology, however, barriers to referrals exist. With the growing interest in and demand for specialized healthcare services, more research on integration and referral practices surrounding palliative care is necessary. This study aimed to explore the knowledge, attitudes, perceptions, and barriers to referring cancer patients to outpatient palliative care at a teaching and research hospital. In one cancer center, 50 physicians, Advance Practice Providers, and nurse case managers responded to an electronic survey regarding interest and support for palliative care services, including perceptions of the benefits of palliative care for their patients. Results were positive overall, and as expected barriers were identified. These barriers included patient comprehension and perception of palliative care services and providers’ perception of which oncology patients would benefit from palliative care and at what point. This research contributes to the body of knowledge surrounding knowledge, skills, and attitudes, as well as persistent barriers to patients and providers who refer to palliative care services. Further education, training, and research for patients, families, and providers will aid in increased utilization and comprehension