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To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.
Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.
2551 participants (aged 18–64 years); sub-sample (n 1949) used to investigate association between FI and overweight.
FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).
FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.
Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.
Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.
The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).
This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.
The flavonoid curcumin is believed to be responsible for the purported health benefits of turmeric. Like other flavonoids, curcumin affects several systemic and central processes involved in neurocognitive aging. We have previously shown that one month administration of a highly bioavailable curcumin extract (Longvida™) improved working memory and reduced fatigue and workload stress in an older, cognitively intact cohort(1). This study focused on the effects of the same extract, focusing on memory tasks subserved by the hippocampus, one of two areas of the adult brain believed to be capable of adult neurogenesis.
Eighty healthy older participants (aged 50–80 years, mean = 68.1, ± SD 6.34) took part in this double-blind, placebo-controlled, parallel-groups trial. Volunteers were randomised to receive administration of 400 mg daily Longvida™ (containing 80 mg curcumin) or a matching placebo. Assessment took place at baseline and 4 and 12 weeks thereafter. Outcomes included two tasks evaluating memory processes relevant to hippocampal function. These were i) a human analogue of the widely used rodent Morris Water Maze - the virtual Morris Water Maze (vMWM) and ii) a Mnemonic Similarity task evaluating pattern separation. Measures of mood, cardiovascular function and other blood biomarkers were collected, and a subset of the cohort underwent neuroimaging using functional magnetic resonance imaging.
Compared with placebo, there were a number of improvements in the curcumin group. The curcumin group had significantly better performance at 12 weeks on the virtual Morris Water Maze (p = .019). Curcumin was also associated with better performance on a pattern separation task (p = .025). Curcumin was also associated with number of significantly benefits to mood, including, from the Profile of Mood States (POMS), including, at 28 days only, total mood disturbance (p = .006), tension-anxiety (p = .028), confusion-bewilderment (p = .019), anger-Hostility (p = .009). There were also significant benefits to the POMS fatigue scores at both assessments (p ≤ .011). There were no group differences in biomarker levels.
These results confirm that Longvida™ curcumin improves aspects of mood and working memory in a healthy older cohort. The pattern of results is consistent with improvements in hippocampal function and may hold promise for alleviating cognitive decline in populations at risk of pathological cognitive decline.
To estimate the prevalence and sociodemographic characteristics of youth and young adults in major Canadian cities with self-reported vegetarian dietary practices and examine efforts to alter their diets.
Data were collected in autumn 2016 via web-based surveys. Respondents reported vegetarian dietary practices (vegan, vegetarian or pescatarian) and efforts in the preceding year to consume more or less of several nutrients, food groups and/or foods with particular attributes. Logistic regression models examined sociodemographic correlates of each vegetarian dietary practice and differences in other eating practices by diet type.
Participants were recruited from five major Canadian cities.
Youth and young adults, aged 16–30 years (n 2566).
Overall, 13·6 % of respondents reported vegetarian dietary practices: 6·6 % vegetarian, 4·5 % pescatarian and 2·5 % vegan. Sex, race/ethnicity, self-reported frequency of using the Nutrition Facts table and health literacy were significantly correlated with self-reported vegetarian dietary practice (P < 0·01 for all). Efforts to consume more fruits and vegetables (66·8 %) and protein (54·8 %), and less sugar (61·3 %) and processed foods (54·7 %), were prevalent overall. Respondents with vegetarian dietary practices were more likely to report efforts to consume fewer carbohydrates and animal products, and more organic, locally produced, ethically sourced/sustainably sourced/fair trade and non-GM foods (P < 0·01 for all), compared with those without these reported dietary practices.
Nearly 14 % of the sampled youth and young adults in major Canadian cities reported vegetarian dietary practices and may be especially likely to value and engage in behaviours related to health-conscious diets and sustainable food production.
A better understood chronological framework for the Middle Pleistocene of Britain has enabled archaeologists to detect a number of temporally-restricted assemblage-types, based not on ‘culture historical’ schemes of typological progression but on independent dating methods and secure stratigraphic frameworks, especially river-terrace sequences. This includes a consistent pattern in the timing of Clactonian and Levalloisian industries, as well as a number of handaxe assemblage types that belong to different interglacial cycles. In other words, Derek Roe’s hunch that the apparent lack of coherent ‘cultural’ patterning was due to an inaccurate and inadequate chronological framework was correct. Some variation in handaxe shape is culturally significant. Here we focus on twisted ovate handaxes, which we have previously argued to belong predominantly to MIS 11. Recent discoveries have enabled us to refine our correlations. Twisted ovate assemblages are found in different regions of Britain in different substages of MIS 11 (East Anglia in MIS 11c and south of the Thames in MIS 11a), the Thames, and the MIS 11b cold interval separating the two occurrences. These patterns have the potential to reveal much about hominin settlement patterns, behaviour, and social networks during the Middle Pleistocene.
This article will consider Adverse Childhood Experiences (ACEs) as a chaotic concept that prioritises risk and obscures the material and social conditions of the lives of its objects. It will show how the various definitions of ACEs offer no cohesive body of definitive evidence and measurement, and lead to a great deal of over-claiming. It discusses how ACEs have found their time and place, locating a variety of social ills within the child’s home, family and parenting behaviours. It argues that because ACEs are confined to intra-familial circumstances, and largely to narrow parent-child relations, issues outside of parental control are not addressed. It concludes that ACEs form a poor body of evidence for family policy and decision-making about child protection and that different and less stigmatising solutions are hiding in plain sight.
Adult schistosomes live in the blood vessels and cannot easily be sampled from humans, so archived miracidia larvae hatched from eggs expelled in feces or urine are commonly used for population genetic studies. Large collections of archived miracidia on FTA cards are now available through the Schistosomiasis Collection at the Natural History Museum (SCAN). Here we describe protocols for whole genome amplification of Schistosoma mansoni and Schistosome haematobium miracidia from these cards, as well as real time PCR quantification of amplified schistosome DNA. We used microgram quantities of DNA obtained for exome capture and sequencing of single miracidia, generating dense polymorphism data across the exome. These methods will facilitate the transition from population genetics, using limited numbers of markers to population genomics using genome-wide marker information, maximising the value of collections such as SCAN.
India has the largest informal, unregistered economy in the world, infrastructurally backward, yet vital for both growth and livelihoods. In the first section of this article, five economic institutions that shape this economy are introduced: small firms, informality, non-metropolitan towns, innovation and innovation systems, and the state's regulative impact on the economy it does not directly regulate. In the second section, we trace the development of the commodity economy of a South Indian town taken for case study over 40 years, before exploring three kinds of innovation in the third section: invention, adaptive, and adoptive innovation. In the fourth section, the formal and informal institutions that nurture informal innovation are analysed: family business, business associations, banks and finance, informal insurance and gold, hybrid state–private institutions, and informal innovation inside the state. The conclusion confirms the innovative dynamism of the informal economy and the complex pathways of institutional change that both shape, and are shaped by, innovation.
OBJECTIVES/SPECIFIC AIMS: To create a searchable public registry of all Quality Improvement (QI) projects. To incentivize the medical professionals at UF Health to initiate quality improvement projects by reducing startup burden and providing a path to publishing results. To reduce the review effort performed by the internal review board on projects that are quality improvement Versus research. To foster publication of completed quality improvement projects. To assist the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety in managing quality improvement across the hospital system. METHODS/STUDY POPULATION: This project used a variant of the spiral software development model and principles from the ADDIE instructional design process for the creation of a registry that is web based. To understand the current registration process and management of quality projects in the UF Health system a needs assessment was performed with the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety to gather project requirements. Biweekly meetings were held between the Quality Improvement office and the Clinical and Translational Science – Informatics and Technology teams during the entire project. Our primary goal was to collect just enough information to answer the basic questions of who is doing which QI project, what department are they from, what are the most basic details about the type of project and who is involved. We also wanted to create incentive in the user group to try to find an existing project to join or to commit the details of their proposed new project to a data registry for others to find to reduce the amount of duplicate QI projects. We created a series of design templates for further customization and feature discovery. We then proceed with the development of the registry using a Python web development framework called Django, which is a technology that powers Pinterest and the Washington Post Web sites. The application is broken down into 2 main components (i) data input, where information is collected from clinical staff, Nurses, Pharmacists, Residents, and Doctors on what quality improvement projects they intend to complete and (ii) project registry, where completed or “registered” projects can be viewed and searched publicly. The registry consists of a quality investigator profile that lists contact information, expertise, and areas of interest. A dashboard allows for the creation and review of quality improvement projects. A search function enables certain quality project details to be publicly accessible to encourage collaboration. We developed the Registry Matching Algorithm which is based on the Jaccard similarity coefficient that uses quality project features to find similar quality projects. The algorithm allows for quality investigators to find existing or previous quality improvement projects to encourage collaboration and to reduce repeat projects. We also developed the QIPR Approver Algorithm that guides the investigator through a series of questions that allows an appropriate quality project to get approved to start without the need for human intervention. RESULTS/ANTICIPATED RESULTS: A product of this project is an open source software package that is freely available on GitHub for distribution to other health systems under the Apache 2.0 open source license. Adoption of the Quality Improvement Project Registry and promotion of it to the intended audience are important factors for the success of this registry. Thanks goes to the UW-Madison and their QI/Program Evaluation Self-Certification Tool (https://uwmadison.co1.qualtrics.com/SE/?SID=SV_3lVeNuKe8FhKc73) used as example and inspiration for this project. DISCUSSION/SIGNIFICANCE OF IMPACT: This registry was created to help understand the impact of improved management of quality projects in a hospital system. The ultimate result will be to reduce time to approve quality improvement projects, increase collaboration across the UF Health Hospital system, reduce redundancy of quality improvement projects and translate more projects into publications.
Analysis of in situ neutron powder diffraction data collected for the porous framework material Zn(hba) during gas adsorption reveals a two-stage response of the host lattice to increasing CO2 guest concentration, suggesting progressive occupation of multiple CO2 adsorption sites with different binding strengths. The response of the lattice to moderate CH4 guest concentrations is virtually indistinguishable from the response to CO2, demonstrating that the influence of host–guest interactions on the Zn(hba) framework is defined more strongly by the concentration than by the identity of the guests.
To evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testing
Retrospective cohort study
University of Pennsylvania Health System, comprised of 3 large tertiary-care hospitals
All adult patients admitted over a 2-year period
Providers were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives.
Compared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; P<.01) and who had their laxatives discontinued and underwent testing (5.4% vs 35.2%; P<.01). We observed a nonsignificant increase in the proportion of patients with C. difficile related complications (5.0% vs 8.9%; P=.11).
A C. difficile order set was successful in decreasing inappropriate C. difficile testing and improving the timely discontinuation of laxatives.
Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.
We tested the benefits of adding telephone support to cCBT.
We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.
Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.
Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
To evaluate invasiveness index as a potential predictor of spine surgical site infection (SSI) after spinal fusion, revision fusion, or laminectomy.
Retrospective cohort study.
Single, large, academic medical center.
Adults undergoing spinal fusion, revision fusion, or laminectomy.
Data were obtained from electronic hospital databases; cases of SSI were extracted from the infection control database using National Healthcare Safety Network (NHSN) definitions. For each case, an invasiveness index, determined by surgical approach, procedure, and number of spine levels treated, was calculated using current procedural terminology (CPT) billing codes. Statistical analyses were performed using univariate and multivariate logistic regression models.
In total, 3,143 patients met inclusion criteria, and 43 of these developed SSI. Multivariate regression showed that advanced age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.005–1.05, for each year of life) and invasiveness index (medium invasiveness index OR, 5.36; 95% CI, 1.92–14.96; high invasiveness index OR, 14.1; 95% CI, 4.38–45.43) were significant predictors of infection. In subgroup analyses of spinal fusion patients, morbid obesity (OR, 2.542; 95% CI, 1.08–5.99), trauma (OR, 2.41; 95% CI, 1.05–5.55), and invasiveness index (medium invasiveness index OR, 5.39; 95% CI, 1.56–18.61; high invasiveness index OR, 13.44; 95% CI, 3.28–55.01) were significant predictors of SSI. Models containing invasiveness index were compared to NHSN models and demonstrated similar performance.
Invasiveness index is a predictor of SSI after spinal fusion and performs similarly to NHSN models. Invasiveness index shows promise as a potential risk stratification tool that is easily calculated and is available preoperatively.