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Integrating social drivers of health screening and management into prenatal care: protocol for a mixed-methods implementation evaluation
Get PDFBACKGROUND: Social drivers of health (SDOH), such as housing stability, food security and access to transportation, profoundly influence both healthcare access and health outcomes. In pregnancy, screening positively for SDOH domains correlates with poorer perinatal outcomes. While the American college of Obstetricians and Gynaecologists recommends screening for SDOH at every routine prenatal visit, many prenatal practices struggle to systematically screen patients for SDOH. This study evaluates the implementation of a universal SDOH screening and management protocol in prenatal care and aims to bridge the gap between the recommendation for universal SDOH screening in prenatal care and its actual integration by evaluating implementation strategies that can serve as a guide for other prenatal care clinics. METHODS AND ANALYSIS: This multi-site, prospective formative implementation evaluation will assess the integration of standardised SDOH screening and management into prenatal care workflows at four prenatal clinic sites within an academic Obstetrics and Gynaecology department. The study employs a concurrent triangulation mixed-methods approach integrating chart-abstracted patient data, staff surveys, and staff and patient semi-structured interviews, guided by established implementation science frameworks (exploration, preparation, implementation and sustainment, consolidated framework for implementation research and implementation outcomes framework). Key implementation strategies include workflow integration, electronic medical record optimisation, role clarification and comprehensive training. Implementation outcomes to be evaluated include feasibility, acceptability, appropriateness, adoption, fidelity and sustainability. ETHICS AND DISSEMINATION: This study was approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB #24-3104). Verbal informed consent will be obtained from all interview participants, and consent will be embedded in staff surveys. Results will be disseminated through peer-reviewed publications, conference presentations, stakeholder meetings and directly to participating clinical sites
Multilevel challenges and adaptations to patient navigation programs for colorectal cancer screening and follow‐up: Findings from the Accelerating Colorectal Cancer Screening and follow‐up through Implementation Science consortium
Get PDFBACKGROUND: Patient navigation services can substantially boost participation in colorectal cancer screening and follow-up. As part of the Accelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) consortium, this study describes facilitators, barriers, and context-specific adaptations to sustainably deliver navigation in diverse settings. METHODS: Qualitative interviews were conducted with patient navigators and ACCSIS research project team members between February and August 2024; interviews were recorded, transcribed, and analyzed via rapid methods. RESULTS: Seventeen patient navigators and eight research project team members (from six research projects) were interviewed. The navigation programs varied in scope: supporting initial screenings, follow-ups for abnormal stool tests, or both. Common facilitators were training navigators via multiple teaching methods and integrating navigators directly into clinic teams. Common barriers were high staff turnover, lack of sustainable funding for navigator positions, limited clinic resources and inadequate electronic health record tools, difficulty in contacting patients, and problems in accessing endoscopy services. Common adaptations made to improve programs included providing gift bags or drop boxes to make stool testing more appealing to patients, adjusting how often and how navigators were trained, evaluating clinic and specialist capacity before implementation, allowing navigators to schedule colonoscopies directly, and establishing partnerships that reduced colonoscopy costs and shortened wait times. CONCLUSIONS: Identified barriers to patient navigation program implementation might be addressed by providing ongoing navigator training via multiple delivery modes; applying best practices for engaging clinic teams, gastroenterology practices, and community partners; building centralized repositories of navigation training and patient-facing materials; and securing consistent funding via billing and institutional support
The Nourished Mind: A Meta-Analysis of Nutritional-Psychological Synergies in Ultrarunning Performance
Get PDFUltrarunning presents a unique and profound challenge that tests the limits of human endurance, demanding an intricate interplay between physiological capacity and psychological resilience. This meta-analysis, "The Nourished Mind: A Meta-Analysis of Nutritional-Psychological Synergies in Ultrarunning Performance," explores the mechanistic links between an ultrarunner's nutritional state and their psychological capacity to perform. It posits that success in ultra-endurance events is not merely a product of physical fueling or mental toughness in isolation, but rather the outcome of their profound, neurobiologically mediated synergy.
Section 1, "The Psychological Landscape of Ultra-Endurance," delineates the extraordinary mental attributes required for ultrarunning, including extreme fortitude, resilience, and intrinsic motivation, while also acknowledging vulnerabilities such as mood fluctuations, pain management challenges, and the surprisingly high prevalence of psychopathology and cognitive impairment under extreme stress and sleep deprivation. Section 2, "The Fueling Imperative: Nutritional Foundations for Ultra-Endurance," establishes the critical role of meticulously planned nutritional strategies to navigate the immense caloric demands, maintain hydration and electrolyte balance, and overcome gastrointestinal distress through "gut trainability."
The core of this analysis, Section 3, "The Neurobiological Nexus: How Nutrition Governs the Ultrarunner's Brain," delves into the direct neurobiological pathways through which nutritional status impacts brain function. It details how glucose availability directly affects executive function, how the balance of serotonin and dopamine (modulated by nutritional precursors) dictates central fatigue and motivation, and how the nascent field of the microbiome-gut-brain axis influences exercise drive and emotional regulation. Furthermore, it highlights the significant impact of hydration status on cognitive and affective states, culminating in a unified model of neuro-nutritional failure.
Finally, Section 4, "Synthesis and Application: Integrated Nutritional-Psychological Strategies for Optimal Performance," translates these mechanistic insights into an actionable framework. It advocates for a "psych-nutritional" plan that proactively fuels for mental fortitude, strategically mitigates emotional volatility and cognitive decline through real-time adjustments, and proposes future research directions focusing on concurrent in-race measurements, the microbiome frontier, and individual variability. The analysis concludes that nutrition is a powerful, integrated psychological strategy, asserting that a well-nourished brain is the fundamental bedrock for cultivating mental resilience and optimizing ultrarunning performance
Neurologic symptoms following COVID-19 in Lima, Peru: a prospective longitudinal observational study
Get PDFThere is limited research on long-term neurologic symptoms following SARS-CoV-2 infection in Peru. This study aimed to describe the longitudinal experience of survivors of mild to moderate COVID-19 in Lima, Peru. This prospective, longitudinal observational study included neurologic follow-up data between 3- and 12-months following SARS-CoV-2 infection. Recruitment to a parent study: “Natural History of SARS-CoV-2 in Comparison to Influenza Virus: A Multi-site Study Focused on the Southern Hemisphere and Equatorial Regions” (COFLU Peru), occurred between February 2021 and February 2022 in a Callao, Peru public hospital emergency department. In-person visits for this sub-study, “Neuro COFLU,” included neurologic history and symptom questionnaire. Fifty-four patients were seen for at least one visit, two of whom required hospitalization for COVID-19. Forty-one (76%) reported at least one pre-existing neurologic diagnosis (59% headaches; 24% migraines). At follow-up visits, patients reported at least one new neurologic symptom since COVID-19: 24/29 (83%) at 90 days, 31/42 (74%) at 180 days, 41/46 (89%) at 270 days, and 20/21 (95%) at 365 days. The median number of new symptoms was 3 at 90 days, 3 at 180, 4 at 270 and 3 at 365 days. Days 90–180 frequent symptoms included: muscular pain, neck stiffness, headache, loss of appetite, numbness, insomnia, and weakness (24–31%). Days 181–365 frequent symptoms included: fatigue, weakness, memory problems, irritability, changes in hearing, muscular pain, joint pain, and insomnia (28–33%). Pre-existing anxiety was associated with post-COVID-19 hearing changes, muscular pain, numbness and weakness and pre-existing depression with neck stiffness and numbness. No significant association was found with age, sex, vaccination status, or pre-existing headaches. Full recovery was reported for 6/29 (21%) at day 90, 13/42 (31%) at day 180, 17/46 (37%) at day 270, and 9/20 (45%) at day 365. By day 365, patients reported median recovery of 85–90%. Persistent neurological symptoms are common in COVID-19 survivors in Lima. Many new neurologic symptoms persisted and increased in prevalence over 3–12 months. Limitations include lack of control group and small sample size. Longitudinal studies of outcomes are needed to predict and mitigate the long-term physical, social and economic effects of SARS-CoV-2 infection
Retrospective Chart Review of the Acute Care Psychosocial Evaluation Process for Females Diagnosed with Breast Cancer
Get PDFBackground: A breast cancer diagnosis can significantly impact an individual’s quality of life. This retrospective chart review explored the occupational therapy evaluation process with female patients in an inpatient acute care hospital with a breast cancer diagnosis. Methods: This descriptive retrospective chart review analyzed 134 occupational therapy evaluations of female patients with breast cancer admitted to a southeastern US academic medical center. Data were extracted and categorized using the Occupational Therapy Practice Framework. Results: The most frequently administered assessments were non-standardized and the AM-PAC "6-Clicks." Documented short-term goals primarily focused on self-care (56.6%), gross motor skills (24.7%), and instrumental activities of daily living (10.8%). Few goals addressed psychosocial needs, despite documentation of psychosocial factors impacting occupational performance in 37.1% of the charts. Discussion: The findings highlight a potential gap in addressing psychosocial needs within acute care occupational therapy for breast cancer patients. Time constraints, the emphasis on medical stability, and the historical separation of mental and physical health care may contribute to this gap. Conclusion: Occupational therapists must adopt a more holistic approach that integrates psychosocial assessment and intervention to comprehensively support the well-being of individuals with breast cancer. Knowledge Translation Takeaway: This study advocates for incorporating the evaluation of psychosocial functioning into acute care occupational therapy practice to facilitate early identification of psychosocial needs and inform interventions that support patient engagement in meaningful occupations
Correction: Neurologic symptoms following COVID-19 in Lima, Peru: a prospective longitudinal observational study
Get PDFCorrection to: "Neurologic symptoms following COVID-19 in Lima, Peru: a prospective longitudinal observational study
Endothelial-smooth muscle microgauges for modeling pulmonary arterial vasoregulation.
Get PDFPulmonary arterial hypertension (PAH) is a devastating disease for which there is no cure. The pathogenesis of PAH involves endothelial dysfunction and dysregulation of vascular tone, resulting in progressively narrowing pulmonary arteries that increase hemodynamic resistance and blood pressure. The development of effective therapeutics for PAH is hindered by limitations to animal models and a lack of humanized in vitro systems that recapitulate endothelial-dependent regulation of smooth muscle cell contractility. Here, we microfabricated pulmonary artery smooth muscle microgauges (PA-SMUGs) that enable quantification of contractile forces generated by human pulmonary arterial smooth muscle cells (PASMCs) within microtissues that contain a functional monolayer of pulmonary arterial endothelial cells (PAECs). PA-SMUGs demonstrate PAEC-dependent vasorelaxation and respond to treprostinil, a clinically approved PAH therapy. This platform, which establishes a high-throughput method for quantifying EC-dependent vasorelaxation, will facilitate mechanistic studies into the role of PAEC-PASMC crosstalk in PAH pathogenesis and enable screening for novel therapeutics to improve PAH outcomes and hypertensive diseases more broadly
3Mont: A multi-omics integrative tool for breast cancer subtype stratification
Get PDFBreast Cancer (BRCA) is a heterogeneous disease, and it is one of the most prevalent cancer types among women. Developing effective treatment strategies that address diverse types of BRCA is crucial. Notably, among different BRCA molecular sub-types, Hormone Receptor negative (HR-) BRCA cases, especially Basal-like BRCA sub-types, lack estrogen and progesterone hormone receptors and they exhibit a higher tumor growth rate compared to HR+ cases. Improving survival time and predicting prognosis for distinct molecular profiles is substantial. In this study, we propose a novel approach called 3-Multi-Omics Network and Integration Tool (3Mont), which integrates various -omics data by applying a grouping function, detecting pro-groups, and assigning scores to each pro-group using Feature importance scoring (FIS) component. Following that, machine learning (ML) models are constructed based on the prominent pro-groups, which enable the extraction of promising biomarkers for distinguishing BRCA sub-types. Our tool allows users to analyze the collective behavior of features in each pro-group (biological groups) utilizing ML algorithms. In addition, by constructing the pro-groups and equalizing the feature numbers in each pro-group using the FIS component, this process achieves a significant 20% speedup over the 3Mint tool. Contrary to conventional methods, 3Mont generates networks that illustrate the interplay of the prominent biomarkers of different -omics data. Accordingly, exploring the concerted actions of features in pro-groups facilitates understanding the dynamics of the biomarkers within the generated networks and developing effective strategies for better cancer sub-type stratification. The 3Mont tool, along with all supporting materials, can be found at https://github.com/malikyousef/3Mont.git
Global Problems, Local Contexts: Representations of the Global Problem of Antimicrobial Resistance in the UK News
No full textDisease causing pathogens are becoming resistant to the drugs used to treat them. This is a global crisis: In 2019, AMR infections killed 1.14 million people. Human misuse of antimicrobials must be addressed, and microbes’ irreverence for borders demands a global response. To this end, The UN has spearheaded AMR work in global governance, and in September 2024 the General Assembly Produced a Resolution to tackle AMR. But global, high level commitments have not spurred local implementation, which is ultimately necessary for effective global governance; Policymakers cite a lack of civil sector pressure on governments as one cause. While AMR and global governance are highly specialized topics for experts, but the news serves as a link to laypersons: Indeed, news shapes public awareness and opinion of health issues, individual behavior, and pressures policymakers to act. Evaluating news sources allows for an understanding of how the problem of AMR is constructed in a specific country (the UK) and analyzing it’s impact on implementation. Moreover, by analysing the 6 months before and after the UN’s High Level Meeting on AMR (a massive congregation of high level delegates), one can analyze how global governance itself shapes the construction and how in the future narrative shaping practices can help them further their goals of AMR action. In this way, public construction of AMR is linked with policy implementation.
Effect of Paxlovid treatment during acute COVID-19 on Long COVID onset: An EHR-based target trial emulation from the N3C and RECOVER consortia.
Get PDFBACKGROUND: Preventing and treating post-acute sequelae of COVID-19 infection (PASC), commonly known as Long COVID, has become a public health priority. This study tests whether Paxlovid treatment in the acute phase of COVID-19 could help prevent the onset of PASC. METHODS AND FINDINGS: We used electronic health records from the National Clinical Cohort Collaborative to define a cohort of 445,738 patients who had COVID-19 since April 1, 2022, and were eligible for Paxlovid treatment due to risk for progression to severe COVID-19. We used the target trial emulation framework to estimate the effect of Paxlovid treatment on PASC incidence. We emulated a series of six sequential trials: one for each day of a 5-day treatment grace period. For each sequential trial, the treatment group was defined as patients prescribed Paxlovid on the trial start day, and the control group was defined as all patients meeting eligibility criteria who remained untreated on the trial start day. We pooled individual record-level data from the sequential trials for analysis. The follow-up period was 180 days. The primary outcome was overall PASC incidence measured using a computable phenotype. Secondary outcomes were incident cognitive, fatigue, and respiratory symptoms in the post-acute period. We controlled for a wide range of demographic and medical history covariates. Compared to the control group, Paxlovid treatment did not have a significant effect on overall PASC incidence or incident respiratory symptoms. It had a small protective effect against cognitive (relative risk [RR] 0.91; 95% CI [0.84, 0.98]; p = 0.019) and fatigue (RR 0.94; 95% CI [0.90, 0.98]; p = 0.002) symptoms. Finally, we estimated Paxlovid's effect on overall PASC incidence across strata of age, COVID-19 vaccination status, and Charlson Comorbidity Index (CCI) prior to COVID-19. We found small protective effects among patients aged 65 years or more (RR 0.92; 95% CI [0.88, 0.97]; p < 0.001; absolute risk difference [ARD] -0.43%; number needed to treat [NNT] 233) and with a CCI of 3 or 4 (RR 0.83; 95% CI [0.75, 0.92]; p < 0.001; ARD -1.30%; NNT 76). This study's main limitation is that the causal interpretation relies on the assumption that we controlled for all confounding variables. CONCLUSIONS: Although some prior observational studies suggested that Paxlovid held promise as a PASC preventive, this study-with a large, nationally sampled cohort; a contemporary study period; and causal inference methodology-found that Paxlovid treatment during acute COVID-19 had no effect on subsequent PASC incidence. Stratified analyses suggest that Paxlovid may have a small protective effect among higher-risk patients, but the NNT is high. In conclusion, we see Paxlovid as unlikely to become a definitive solution for PASC prevention