Explore the vast range of titles available.

This books presents the proceedings of four conferences. The conferences are part of the larger 2020 World Congress in computer science, computer engineering and applied computing. Includes the tracks on security & management, wireless networks, internet computing and IoT, and embedded systems as well as cyber-physical systems. It features papers from SAM'20, ICWN'20, ICOMP'20 and ESCS'20.

Providers currently rely on universal screening to identify health-related social needs (HRSNs). Predicting HRSNs using EHR and community-level data could be more efficient and less resource intensive. Using machine learning models, we evaluated the predictive performance of HRSN status from EHR and community-level social determinants of health (SDOH) data for Medicare and Medicaid beneficiaries participating in the Accountable Health Communities Model. We hypothesized that Medicaid insurance coverage would predict HRSN status. All models significantly outperformed the baseline Medicaid hypothesis. AUCs ranged from 0.59 to 0.68. The top performance (AUC = 0.68 CI 0.66–0.70) was achieved by the “any HRSNs” outcome, which is the most useful for screening prioritization. Community-level SDOH features had lower predictive performance than EHR features. Machine learning models can be used to prioritize patients for screening. However, screening only patients identified by our current model(s) would miss many patients. Future studies are warranted to optimize prediction of HRSNs.

Over the past two decades, enormous progress has been made in designing fluorescent sensors or probes for divalent metal ions. In contrast, the development of fluorescent sensors for monovalent metal ions, such as sodium (Na ⁺), has remained underdeveloped, even though Na ⁺ is one the most abundant metal ions in biological systems and plays a critical role in many biological processes. Here, we report the in vitro selection of the first (to our knowledge) Na ⁺-specific, RNA-cleaving deoxyribozyme (DNAzyme) with a fast catalytic rate [observed rate constant ( k ₒbₛ) ∼0.1 min ⁻¹], and the transformation of this DNAzyme into a fluorescent sensor for Na ⁺ by labeling the enzyme strand with a quencher at the 3′ end, and the DNA substrate strand with a fluorophore and a quencher at the 5′ and 3′ ends, respectively. The presence of Na ⁺ catalyzed cleavage of the substrate strand at an internal ribonucleotide adenosine (rA) site, resulting in release of the fluorophore from its quenchers and thus a significant increase in fluorescence signal. The sensor displays a remarkable selectivity (>10,000-fold) for Na ⁺ over competing metal ions and has a detection limit of 135 µM (3.1 ppm). Furthermore, we demonstrate that this DNAzyme-based sensor can readily enter cells with the aid of α-helical cationic polypeptides. Finally, by protecting the cleavage site of the Na ⁺-specific DNAzyme with a photolabile o -nitrobenzyl group, we achieved controlled activation of the sensor after DNAzyme delivery into cells. Together, these results demonstrate that such a DNAzyme-based sensor provides a promising platform for detection and quantification of Na ⁺ in living cells. Significance Monovalent ions, such as Na ⁺, play important roles in biology, yet few sensors that image intracellular Na ⁺ have been reported. Although deoxyribozymes (DNAzymes) have been shown to be a promising platform for detection of metal ions, most reported DNAzymes require multivalent metal ions for catalytic activity. Existing monovalent ion-responsive DNAzymes have poor selectivity for Na ⁺, low catalytic rate, and require high ion concentrations for function. Here, we report in vitro selection of the first (to our knowledge) highly selective, sensitive, and efficient Na ⁺-specific, RNA-cleaving DNAzyme and its conversion into a catalytic beacon sensor for imaging Na ⁺ in living cells, using an efficient cationic polypeptide delivery method, together with a photocaging strategy, to allow controllable activation of the DNAzyme probe inside cells.

Total knee arthroplasty (TKA) is one of the most commonly performed, major elective surgeries in the USA. African American TKA patients on average experience worse clinical outcomes than whites, including lower improvements in patient-reported outcomes and higher rates of complications, hospital readmissions, and reoperations. The mechanisms leading to these racial health disparities are unclear, but likely involve patient, provider, healthcare system, and societal factors. Lower physical and mental health at baseline, lower social support, provider bias, lower rates of health insurance coverage, higher utilization of lower quality hospitals, and systemic racism may contribute to the inferior outcomes that African Americans experience. Limited evidence suggests that improving the quality of surgical care can offset these factors and lead to a reduction in outcome disparities.

Background: Guidelines recommend that physicians screen all adults for obesity and offer an intensive counseling and behavioral interventions for weight loss for obese adults. Current trends of weight-related counseling are unknown in the setting of the US obesity epidemic. Objectives: To describe primary care physician (PCP) weight-related counseling, comparing counseling rates in 1995-1996 and 2007-2008. Research Design: Data analysis of outpatient PCP visits in 1995-1996 and 2007-2008, as reported in the National Ambulatory Medical Care Survey. Subjects: A total of 32,519 adult primary care visits with PCPs. Measures: Rates of counseling for weight, diet, exercise, and a composite variable, weight-related counseling (defined as counseling for weight, diet, or exercise) between survey years. Adjusted analyses controlled for patient and visit characteristics. Results: Weight counseling declined from 7.8% of visits in 1995-1996 to 6.2% of visits in 2007-2008 [adjusted odds ratios, 0.64; 95% confidence intervals, 0.53, 0.79]. Rates of receipt of diet, exercise, and weight-related counseling similarly declined. Greater declines in odds of weight-counseling receipt were observed among those with hypertension (47%), diabetes (59%), and obesity (41%), patients who stand the most to gain from losing weight. Conclusions: Rates of weight counseling in primary care have significantly declined despite increased rates of overweight and obesity in the United States. Further, these declines are even more marked in patients with obesity and weight-related comorbidities, despite expectations to provide such care by both patients and policymakers. These findings have implications for determining deliverable, novel ways to engage PCPs in addressing the obesity epidemic.

Alveolar ridge preservation by guided bone regeneration (GBR) is a surgical procedure that can be performed prior to implant placement to increase the likelihood of survival. Autogenic, allogenic, or xenogeneic derived bone (particulate graft) are frequently placed in conjunction with a barrier membrane for GBR; however, advancements in tissue engineering have led to the development of promising synthetic alternatives. Fiber-based scaffolds exhibit high surface-to-volume ratio and thereby improve cellular adhesion, reduce the likelihood of dehiscence and poor bone regeneration often associated with poorly immobilized particulate graft. This study aimed to evaluate the performance of a novel electrospun composite scaffold coated in a recombinant variant of human bone morphogenetic protein-2 (OsteoAdapt) relative to a porcine-derived xenograft. Further, it sought to determine if OsteoAdapt would remain within the defect without a membrane in place, as this is not feasible with the particulate xenograft currently used in clinical practice. Four-walled mandibular defects were created in each adult beagle dog (n = 4 defects per dog; n = 4 dogs for a total of 16 defects). Each defect received one of three experimental (test) groups: (i) OsteoAdapt without membrane (OA), (ii) OsteoAdapt with porcine membrane (OA/ZM), (iii) OsteoAdapt mixed with porcine particulate xenograft (Zcore™) with porcine membrane (OA/P/ZM) and compared to a positive control - Zcore™ with porcine membrane (CTRL). After 4-weeks , bone regeneration was assessed through qualitative volumetric reconstruction, qualitative and quantitative histological analyses. Histomorphometric measurement of bone regeneration (% bone) within the region of interest revealed no significant differences between OA, OA/ZM, or OA/P/ZM in comparison to the CTRL at 4-weeks ( = 0.086, = 0.218, and = 0.806, respectively). Similarly, evaluation of soft tissue presence (% soft tissue) indicated no significant differences between experimental groups OA, OA/ZM, or OA/P/ZM relative to the CTRL ( = 0.341, = 0.679, = 0.982, respectively). However, qualitative analysis of the histological micrographs demonstrated advanced bone healing characterized by an abundance of nucleation sites for regeneration to occur in defects treated with OA relative to the CTRL. Bone overgrowth beyond the limits of defect borders was observed in groups treated OA/ZM and OA/P/ZM. In contrast to the treatment groups, minimal woven bone was visualized in the CTRL group. Compared to defects treated with porcine-derived particulate and barrier membrane (CTRL), defects filled with OA exhibited bone regeneration throughout the defect, with bone overgrowth when covered by a barrier membrane at 4-weeks . This suggests that the novel combination of AMP-2 and a bioceramic/synthetic polymer-based electrospun scaffold is a suitable candidate for GBR procedures, without a barrier membrane to secure its place within a defect.

Online weight loss programs are increasingly popular. However, little is known about outcomes and associations with website usage among members of free online weight loss programs. This retrospective cohort study examined the association between website usage and weight loss among members of a free commercial online weight loss program (SparkPeople). We conducted a retrospective analysis of a systematic random sample of members who joined the program during February 1 to April 30, 2008, and included follow-up data through May 10, 2010. The main outcome was net weight change based on self-reported weight. Measures of website usage included log-ins, self-monitoring entries (weight, food, exercise), and use of social support tools (discussion forums, friendships). The main sample included 1258 members with at least 2 weight entries. They were 90.7% female, with mean (SD) age 33.6 (11.0) and mean (SD) BMI 31.6 (7.7). Members with at least one forum post lost an additional 1.55 kg (95% CI 0.55 kg to 2.55 kg) relative to those with no forum posts. Having at least 4 log-in days, weight entry days, or food entry days per 30 days was significantly associated with weight loss. In the multiple regression analysis, members with at least 4 weight entry days per 30 days reported 5.09 kg (95% CI 3.29 kg to 6.88 kg) more weight loss per 30 days than those with fewer weight entry days. After controlling for weight entry days, the other website usage variables were not associated with weight change. Weekly or more frequent self-monitoring of weight is associated with greater weight loss among members of this free online weight loss program.

Background: Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate BP measurements in routine practice. We investigated barriers affecting measurement of BP for adult patients in primary care. Methods: We conducted a qualitative evaluation in 6 adult primary care clinics. BP measurement was observed during 54 routine patient encounters. Six managers completed semistructured interviews and 18 clinical staff members participated in focus group discussions. We used an inductive, data-driven approach to identify and organize findings into cohesive, overarching themes describing factors affecting BP measurement. Results: Observed errors in BP measurement spanned the entire spectrum of steps required to obtain BP properly. Barriers to proper BP measurement were related to staff knowledge and behavior (inadequate knowledge, training, and feedback); workflow constraints (need to multitask, inadequate time); and equipment issues (BP monitors, seating). Patient characteristics and behavior also affected BP measurement. Conclusions: Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care. These findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.

IntroductionDiagnostic errors in primary care are common, particularly in the interpretation and follow-up of abnormal haemoglobin (Hgb) and estimated glomerular filtration rate (eGFR) results. These errors frequently result in missed or delayed diagnoses of serious conditions such as anaemia and chronic kidney disease. This protocol describes a stepped-wedge cluster randomised controlled trial designed to evaluate a novel, evidence-based, team-based intervention aimed at improving diagnostic safety and efficiency.Methods and analysisThe study will be conducted across 12 University of Texas Physicians (UTPs) primary care clinics in Houston, Texas, USA. Adult patients (≥18 years) with newly identified abnormal Hgb or eGFR results will be eligible for inclusion. The intervention integrates automated tracking of abnormal laboratory results, nurse navigators to support patient follow-up and engagement, and clinical pathologists to provide diagnostic guidance to primary care providers. The primary outcome is diagnostic safety, defined as the proportion of patients who receive a correct diagnosis within 6 months. Secondary outcomes include diagnostic efficiency, appropriate test utilisation, cost-effectiveness, patient activation and implementation metrics such as acceptability, fidelity and sustainability. The study will also explore barriers and facilitators to successful implementation using mixed-methods evaluation.Ethics and disseminationThis trial has been approved by the Institutional Review Board at The University of Texas Health Science Center at Houston. Study results will be disseminated through peer-reviewed publications and conference presentations, and findings will be reported to UTP leadership to inform potential system-wide implementation.Trial registration numberNCT05735314.

BackgroundH&E-based histopathology is a cost-effective and reliable method that is widely utilized in clinical practice to examine human tissue specimens for routine diagnosis. However, molecular diagnostic techniques such as multiplexed immunofluorescence (mIF) offer promise for a better understanding of the tissue microenvironment beyond tissue and cell morphology. Developing a method to combine the two techniques on the same FFPE slide could empower researchers and pathologists with significantly better-informed prognosis. We developed a simple strategy for rapid and efficient H&E removal for subsequent biomarker detection with mIF, bridging traditional histopathology and the phenotypic and functional features identified using digital pathology tools.MethodsMultiple new and archived human tonsil and non-small cell lung cancer (NSCLC) FFPE tissue slides previously stained with H&E were evaluated in this study. After the initial brightfield scan to detect H&E, slides were processed with Ultivue’s proprietary H&E de-staining workflow. After confirming the H&E stain removal, the slides were stained using Ultivue PD-L1 FixVUE® kit including anti-CK, PD-L1, CD68, and CD8 on a Leica Bond RX autostainer. The resultant mIF-stained slides were then scanned on Zeiss Axioscan.Z1. The brightfield and mIF images from the same slide were co-registered using UltiStacker® software, and the signal evaluated for concordance with appropriate controls.ResultsWe found that hematoxylin and eosin strongly absorbed fluorescence from most fluorophores in mIF assays. Our chemical de-staining process removed both hematoxylin and eosin, abating their quenching activity in less than ten minutes, permitting subsequent staining with quantitative mIF. The fluorescence signal distribution and the signal-to-noise ratio were comparable to those of freshly stained tissue sections. We observed that the mIF staining intensity was reduced in some tissues, likely requiring further optimization.ConclusionsDe-staining H&E tissue slides for multiplexed tissue analysis such as mIF could enable the investigation of rare, pre-screened, or archival FFPE tissue sections. This is particularly useful when the number of tissue sections is limited, or if H&E and biomarkers need to be visualized on the same tissue. Follow-up studies are currently ongoing to evaluate the de-staining workflow on multiple tissue types, specimen conditions, and assays.