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Using Exit Surveys to Elicit Turnover Reasons among Behavioral Health Employees for Organizational Interventions
No full textObjective: The current study explored turnover reasons via exit surveys for organizational interventions. Methods: The exit surveys were conducted at a community behavioral health organization for over a year, and the open-ended question responses on turnover reasons were analyzed. Results: Thirty-five exit surveys were returned (58% response rate). Five major turnover themes were identified: struggles in current job roles, negative experiences with upper management and senior colleagues, quality of care concerns, no foreseeable future, and personal/family reasons. Conclusions and Implications for Practice: Exit surveys are a useful approach to identify turnover reasons for organizational interventions. The findings provide insights into contextualized strategies for retaining the behavioral health workforce
Modeling Inflammaging of the Bone Marrow Microenvironment Stimulates Multiple Myeloma Associated Stem Cells
No full textBackground:
Multiple Myeloma (MM) is a malignancy of mature plasma cells, primarily affecting those over 65, with a 5-year survival rate of ~62%. Aging alters the bone marrow (BM) microenvironment, including remodeling of the extracellular matrix (ECM), which may promote tumor-supportive functions of mesenchymal stromal cells (MSCs) and hematopoietic stem cells (HSCs). However, determining the impact of aging-related matrix remodeling on MM onset/progression remains challenging due to the absence of microphysiological systems that preserve the tumorigenic phenotype of MM cells in vitro. We hypothesize recapitulating aged BM ECM may overcome these limitations by providing a physiologically relevant framework that sustains MM cell behavior and models the tumor-supportive microenvironment. Additionally, interleukin-6 (IL-6), an inflammatory cytokine elevated in both the inflammaging BM microenvironment and MM, preferentially expands MM-associated MSCs without affecting HSCs.
Methods:
Cryopreserved tumor-associated MSCs and HSCs were cultured on tissue culture plastic (TCP), young ECM (≤25 y/o), or aged ECM (≥60 y/o), in either α-MEM or IMDM media, with some cultures supplemented with IL-6. HSC cluster formation was observed, and cells were analyzed using cytospin with Giemsa-May-Grünwald staining.
Results:
MM-derived HSCs, cultured on aged ECM, exhibited myelopoietic skewing. In contrast, young ECM with IL-6 promoted MSC expansion, suggesting a synergistic effect in developing patient-derived stromal models. Adherent MSCs were harvested and expanded on TCP for ECM generation.
Conclusion:
ECM-based microphysiological systems offer a promising platform for scalable, in vitro systems that recapitulate aging- and MM-associated remodeling of the BM microenvironment. Understanding how aged ECM drives myeloid skewing may reveal therapeutic targets to delay/prevent MM progression. The observed myeloid bias in MM-derived HSCs cultured on aged ECM may reflect physiologically relevant disruptions in immunoregulatory cell populations. Future work will test whether ECM from MM patient-derived MSCs preserves tumor-specific phenotypes to advance translational models for MM drug discovery.This project was funded, in part, with support from the Short-Term Training Program in Biomedical Sciences Grant funded, in part by T35 HL 110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health
Article processing charges and health research output in low-income countries: funding cuts, implications for health policy and system management
No full textArticle processing charges (APCs) pose a material barrier to the dissemination of health research from low income countries where recent funding cuts compound limited domestic financing and fragile health systems. Despite carrying a disproportionate share of global disease, these settings contribute under one percent of global research publications. This Perspective piece explores how APCs and funding cuts intersect to shape research output, summarises mitigation efforts and gaps, and proposes practical options for more equitable access to scholarly publishing. APCs are reported to shape venue choice for researchers in low income countries, while reduced external funding leaves fewer upstream resources to absorb costs. Country examples point to institutional and capacity pressures. Early career researchers often face disproportionate obstacles including slower progression and reduced competitiveness. Waiver policies and regional initiatives such as AJOL, SciELO South Africa and AfricArXiv offer partial relief, yet inconsistencies in eligibility, awareness and implementation persist with ethical implications. A rights and equity oriented response would include tiered APC models, automatic waivers linked to country income classification, ring fenced support for health research in low income settings, greater investment and independent evaluation of diamond open access platforms, and focused research on the effects of funding cuts on APCs and dissemination in low income contexts
Author Correction: GWAS of multiple neuropathology endophenotypes identifies new risk loci and provides insights into the genetic risk of dementia
No full textCorrection to: Nature Genetics 10.1038/s41588-024-01939-9, published online 8 October 2024.
After publication of the article, several collaborators helpfully pointed out issues with genetic variant ID harmonization and effect allele coding errors, each affecting a subset of variants used in our study. The authors regret these errors and have updated the manuscript and summary statistics to correct them. Most results reported in the manuscript were not materially affected by this; however, the lead variant in the reported PIK3R5 locus associated with Braak neurofibrillary tangle (NFT) stage no longer reached genome-wide significance after correction (now P = 1.3 × 10−7). Furthermore, the known Alzheimer’s Disease and related dementias (ADRD) loci CELF1/SPI1 (Braak NFT stage and CERAD score) and TMEM106B (Braak NFT stage) now reach the FDR significance threshold for association with at least one additional neuropathology endophenotype (NPE). Other results, namely P values, effect sizes and colocalization probabilities have minor changes and have been corrected throughout. Several minor typos are now also corrected. We also corrected all tables and figures based on genome-wide association study (GWAS) summary statistics. The Supplementary Information accompanying this amendment shows a detailed list of all updates. All changes discussed are reflected in the HTML and PDF versions of the article.
The authors thank Sven van der Lee and Niccoló Tesi for pointing out the errors in variant harmonization and effect allele coding
Addressing the ethical and legal complexities of hospital visitation restrictions for patients who are incarcerated
No full textDevelopment and Validation of an Electronic Health Record–Based Algorithm for Identifying Patients With Long-Term Opioid Therapy: Cross-Sectional Study
No full textBackground: Health care providers must carefully monitor patients receiving long-term opioid therapy (LTOT) to minimize risks and maximize benefits. Yet, algorithms to support intervention during patient encounters are lacking, with accurate LTOT identification in routine care being the essential first step.
Objective: This study aims to develop and validate an LTOT identification algorithm using electronic health record (EHR) data.
Methods: In this cross-sectional study, we used 2016-2021 OneFlorida+ EHR data linked with Florida Medicaid claims to identify patients aged ≥18 years who received opioid prescriptions. The main outcome was the first LTOT episode in the algorithm development (2016-2018) and validation (2019-2021) periods. A Medicaid claims-based LTOT algorithm served as the reference standard, defined as ≥90 days of continuous opioid use with ≤15-day gaps. Given strong correlations among covariates, an elastic net regression model was applied to identify LTOT episodes in EHR data using patient characteristics, clinically relevant features, and medication use, and to evaluate the model's classification performance. We randomly split the 2016-2018 cohort into development and internal validation datasets (2:1 ratio), stratified by LTOT incidence. External validation was performed using 2019-2021 data.
Results: Among 64,206 eligible patients identified in 2016-2018 (mean age 35.7, SD 12.3 years; 51,421/64,206, 80.1% female), a total of 8899 (13.9%) had LTOT. Among 50,009 eligible patients identified in 2019-2021 (mean age 37.3, SD 12.5 years; 39,866/50,009, 79.7% female), a total of 6000 (12%) had LTOT. The model selected 29 out of 131 candidate features. Among 2967 individuals with LTOT in the 2016-2018 OneFlorida+ internal validation dataset, a total of 2176 (73.3%) individuals were identified in the top 3 deciles of risk scores. The model achieved a C-statistic of 0.83 (95% CI 0.82-0.84), with 73.4% (95% CI 71.8%-75%) sensitivity, 76.8% (95% CI 76.2%-77.4%) specificity, 33.8% (95% CI 33.1%-34.6%) precision, 76.3% (95% CI 75.8%-76.9%) accuracy, and an F1-score of 0.46. In the 2019-2021 OneFlorida+ external validation dataset, a total of 75.5% (4527/6000) individuals were correctly captured in the top 3 risk subgroups. The model achieved a C-statistic of 0.83 (95% CI 0.83-0.84), with 78.8% (95% CI 77.8%-79.9%) sensitivity, 73.3% (95% CI 72.9%-73.7%) specificity, 28.7% (95% CI 28.3%-29.1%) precision, 73.9% (73.6%-74.3%) accuracy, and an F1-score of 0.42.
Conclusions: The EHR-based LTOT algorithm showed comparable accuracy to the claims-based reference and may support risk stratification and inform decision-making during clinical encounters
Inflammasome targeting for periodontitis prevention is sex dependent
No full textInflammasome initiates inflammation via the maturation of interleukin-1 beta (IL-1β). Periodontitis is a prevalent, male-biased disease characterized by inflammation-driven bone loss, yet the mechanism(s) of this sex bias is unknown. This study explored whether enhanced inflammasome represents a causal mechanism for this bias. Analyses of three separate human studies (>6,200 samples) show that males have significantly higher IL-1β in the gingival crevicular fluid than females during health and periodontitis. This pattern is experimentally reproduced with different versions of the ligature-induced periodontitis mouse model where males show greater IL-1β secretion than females. The inflammasome drives bone resorption in males but not females as revealed by analyses of inflammasome gene-deletion mice. Pharmacologic treatment with a caspase-1/4 inhibitor reduces inflammatory cell infiltration, dampens osteoclastogenesis signaling (via the receptor activator of nuclear factor-kappa B pathway), and prevents bone resorption in males but not females during experimental periodontitis. While ovariectomized females show no change in their nonresponsiveness to caspase-1/4 inhibition, orchiectomized males no longer respond to the inhibition, suggesting the importance of an intact male reproductive system in the mediation of this inhibition. Thus, our study identifies inflammasome activation as causal for male-biased experimental periodontitis and supports sex-stratified studies to foster future advancement of inflammasome therapeutics in periodontics
Innovating Nursing Education Through Partnership With Individuals With Intellectual and Developmental Disabilities
No full textBackground Health disparities of individuals with intellectual and developmental disabilities (IDD) have been a longstanding public health concern. Unlike the engagement of service sectors and governmental entities in advocating for human rights and health equity, the nursing profession remains absent from these discussions. Transformational changes are needed to promote systemic changes that will improve health outcomes of individuals with IDD.
Method Strategic planning is needed to effect transformational changes in nursing education. Innovation in nursing education involves an informed understanding of health care barriers that individuals with IDD experience and the necessary processes to effectively engage in partnerships with this population.
Results An approach for change in nursing education is proposed based on IDD concepts in federal legislation and initiatives, social policies, and the self-advocacy movement, and its application in nursing education is described.
Conclusion Integrating IDD concepts into nursing curricula can improve health care equity and health outcomes of individuals with IDD
2023 Indiana Registered Nurse (Certified Registered Nurse Anesthetists Only) Workforce Snapshot
No full textThis report presents a profile of Indiana’s Certified Registered Nurse Anesthetist (CRNA) workforce as of the 2023 renewal period. It includes data on actively practicing CRNAs, highlighting their primary practice settings, specialties, populations served, and educational backgrounds. It also provides geographic distribution insights and service area characteristics, supporting workforce analysis and strategic planning
Precision Generalized Phase I-II Designs
No full textA new family of precision Bayesian dose optimization designs, PGen I-II, based on early efficacy, early toxicity, and long-term time to treatment failure is proposed. A PGen I-II design refines a Gen I-II design by accounting for patient heterogeneity characterized by subgroups that may be defined by prognostic levels, disease subtypes, or biomarker categories. The design makes subgroup-specific decisions, which may be to drop an unacceptably toxic or inefficacious dose, randomize patients among acceptable doses, or identify a best dose in terms of treatment success defined in terms of time to failure over long-term follow-up. A piecewise exponential distribution for failure time is assumed, including subgroup-specific effects of dose, response, and toxicity. Latent variables are used to adaptively cluster subgroups found to have similar dose-outcome distributions, with the model simplified to borrow strength between subgroups in the same cluster. Guidelines and user-friendly computer software for implementing the design are provided. A simulation study is reported that shows the PGen I-II design is superior to similarly structured designs that either assume patient homogeneity or conduct separate trials within subgroups