Assessment of the Usability and Impact of the Idaho Health Data Exchange (IHDE)

Eighty four health care professionals participated in an online survey assessing the usability, and clinical and administrative impact of the Idaho Health Data Exchange’s (IHDE) Virtual Health Record (VHR). The IHDE VHR allows authorized users to use a secure web interface to view lab, radiology and transcribed reports from multiple facilities and view medical histories on patients in the data exchange. Results indicate the usability of the IHDE VHR was almost universally positively rated with the Software Usability Measurement Inventory (SUMI) utilized as the assessment method. Medical providers however had the lowest rating of the exchange, raising concerns about the need for additional training and support. The addition of other Idaho health care organizations to the health data exchange was most widely desired, with the most frequently cited benefit being more comprehensive access to patients’ records. In contrast to other published evaluations of health data exchanges in the U.S., few of the concerns emerged about cost of implementation of the data exchange or trust in the quality of information contained therein

Methylglyoxal, A Metabolite Increased in Diabetes is Associated with Insulin Resistance, Vascular Dysfunction and Neuropathies

The published manuscript is available at EurekaSelect via http://www.eurekaselect.com/openurl/content.php?genre=article&doi=10.2174/1389200217666151222155216 © 2018 Bentham Science PublishersBackground: Diabetes mellitus (DM) is a pandemic metabolic disease characterized by a chronically elevated blood glucose concentration (hyperglycemia) due to insulin dysfunction. Approximately 50% of diabetics show diabetes complications by the time they are diagnosed. Vascular dysfunction, nephropathy and neuropathic pain are common diabetes complications. Chronic hyperglycemia contributes to reactive oxygen species (ROS) generation such as methylglyoxal (MGO). Methods: Peer reviewed research papers were studied through bibliographic databases searching focused on review questions and inclusion/exclusion criteria. The reviewed papers were appraised according to the searching focus. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to the included studies using a conceptual framework to yield this comprehensive systematic review. Results: Sixty-six papers were included in this review. Eleven papers related methylglyoxal generation to carbohydrates metabolism, ten papers related lipid metabolism to methylglyoxal and 5 papers showed the proteolytic pathways that contribute to methylglyoxal generation. Methylglyoxal metabolism was derived from 7 papers. Descriptive figure 1 was drawn to explain methylglyoxal sources and how diabetes increases methylglyoxal generation. Furthermore, twenty-six papers related methylglyoxal to diabetes complications from which 9 papers showed methylglyoxal ability to induce insulin dysfunction, an effect which was described in schematic figure 2. Additionally, fifteen papers revealed methylglyoxal contribution to vascular dysfunction and 3 papers showed methylglyoxal to cause neuropathic pain. Methylglyoxal-induced vascular dysfunction was drawn in a comprehensive figure 3. This review correlated methylglyoxal with diabetes and diabetes complications which were summarised in table 1. Conclusion: The findings of this review suggesting methylglyoxal as an essential therapeutic target for managing diabetes in the future.Peer reviewedFinal Accepted Versio

The non-genomic effects of the PPARβγ agonist GW0742 on streptozotocin treated rat aorta

Copyright© Bentham Science Publishers; For any queries, please email at [email protected]: The ubiquitous nuclear receptor PPARβ/δ is increasingly being studied in regards to numerous diseases including diabetes following on the finding that PPARβ/δ agonist GW0742 controls Type 1 Diabetes in rats. Studies have shown that GW0742 has off target, non- PPARβ/δ effects in the cell although there are some key questions that remain to be addressed in respect to the significance of this control on vascular tone. Methods: Using isometric organ baths, rat aorta rings were exposed to ROCK inhibitors and the changes in contraction and dilation measured. Results: Our data shows that the PPARβ/δ agonist GW0742 (10 -7M) inhibits contractile responses to U46619 and phenylephrine, and that these responses are similar in normal and Streptozotocin (STZ) diabetic rat aorta. ROCK inhibitors Fasudil and Y27632 significantly reduced GW0742 mediated dilation of naïve rat aorta, but Fasudil had no effect on GW0742 dilation in STZ diabetic rat aorta. In contrast, STZ diabetic rat aorta pre-contracted with high [K +] Krebs lacked a dilatory response to GW0742, which taken together indicates that the mechanism of action of GW0742 mediated dilation changes in the diabetic state compared to non-diabetic state. Conclusion: This is the first direct evidence demonstrating the non- PPARβ/δ effect of GW0742 on contraction is irrespective to the diabetic state, and that GW0742 has the potential to induce vasodilation via multiple off-target mechanisms.Peer reviewedFinal Accepted Versio

The pan-genome of Lactobacillus reuteri strains originating from the pig gastrointestinal tract

Background Lactobacillus reuteri is a gut symbiont of a wide variety of vertebrate species that has diversified into distinct phylogenetic clades which are to a large degree host-specific. Previous work demonstrated host specificity in mice and begun to determine the mechanisms by which gut colonisation and host restriction is achieved. However, how L. reuteri strains colonise the gastrointestinal (GI) tract of pigs is unknown. Results To gain insight into the ecology of L. reuteri in the pig gut, the genome sequence of the porcine small intestinal isolate L. reuteri ATCC 53608 was completed and consisted of a chromosome of 1.94 Mbp and two plasmids of 138.5 kbp and 9.09 kbp, respectively. Furthermore, we generated draft genomes of four additional L. reuteri strains isolated from pig faeces or lower GI tract, lp167-67, pg-3b, 20-2 and 3c6, and subjected all five genomes to a comparative genomic analysis together with the previously completed genome of strain I5007. A phylogenetic analysis based on whole genomes showed that porcine L. reuteri strains fall into two distinct clades, as previously suggested by multi-locus sequence analysis. These six pig L. reuteri genomes contained a core set of 1364 orthologous gene clusters, as determined by OrthoMCL analysis, that contributed to a pan-genome totalling 3373 gene clusters. Genome comparisons of the six pig L. reuteri strains with 14 L. reuteri strains from other host origins gave a total pan-genome of 5225 gene clusters that included a core genome of 851 gene clusters but revealed that there were no pig-specific genes per se. However, genes specific for and conserved among strains of the two pig phylogenetic lineages were detected, some of which encoded cell surface proteins that could contribute to the diversification of the two lineages and their observed host specificity. Conclusions This study extends the phylogenetic analysis of L. reuteri strains at a genome-wide level, pointing to distinct evolutionary trajectories of porcine L. reuteri lineages, and providing new insights into the genomic events in L. reuteri that occurred during specialisation to their hosts. The occurrence of two distinct pig-derived clades may reflect differences in host genotype, environmental factors such as dietary components or to evolution from ancestral strains of human and rodent origin following contact with pig populations

Assessing Idaho Rural Family Physician Scope of Practice Over Time

Context: An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community. Purpose: The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study. Methods: The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000. Identical surveys and methods were utilized in both 2007 and 2012. Results: The physician survey was mailed to 252 rural physicians and was returned by 89 for a response rate of 35.3%. Parametric and non-parametric statistical analyses were conducted to analyze the 2012 results and to assess changes in scope of practice across the time periods. Discussion: The percentage of rural family physicians in Idaho in 2012 who provided prenatal care, vaginal deliveries and nursing home care was significantly lower than the results from the 2007 survey. Female physicians were more likely to provide prenatal care and vaginal deliveries than males in 2012. Male physicians were more likely to provide emergency room coverage and esophagogastroduodenoscopy or colonoscopy services than females in 2012. Younger physicians were found to be more likely to provide inpatient admissions and mental health services in 2012 than older physicians. Employed physicians were more likely to provide Cesarean sections, other operating room services and emergency room coverage in 2012 than non-employed physicians. Further research is needed to assess the root causes of these changes

The significance of time in the design of a public landscape Exploring accepted, experimental and relational dimensions of drawing time

This paper revisits a built project to reveal a hidden and experimental ambition for a public space through drawing in time. Behind the project’s initial inception lay the designer’s motivation to challenge, open and expand the consideration of time in the way in which public landscapes are invented, configured and received. As such, the project sought to attend both to the way in which time manifests as a design consideration through drawing and to the way in which time could be conceptually and experientially sustained in the afterlife of the completed work. In the inevitable ebbs and flows of productivity and decision taking that ran through the project, the designer came to realize that the ambitions outlined above stretched beyond their client’s comprehension of what the project could and should be. Instead, an aspiration to design “in time” became subservient to the client and stakeholders’ focus on the material manifestation of the work as a visual object and to the project’s public reception when it was deemed “complete”. For the designer this meant that opportunities to expand design thinking into practices tied to the continuing and relational opportunities of the space remained disappointingly determinate and closed. By revisiting the existing representations and by making new drawings that were more explorative and unburdened by the conditions of project delivery, new liberty was found, revealing a unique bond between drawing in time and the relational opportunities of the work

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

BACKGROUND: Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. METHODS: RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. RESULTS: The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. CONCLUSION: There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis

Losing sight of women's rights (again):A response to Cowan et al.

This article responds to Cowan et al.’s critique of our article ‘Losing sight of women’s rights: the unregulated introduction of gender self-identification as a case study of policy capture in Scotland’, published by Scottish Affairs 28(3) in August 2019. Cowan et al. make a series of strong criticisms, including of our accuracy, diligence and adherence to scholarly norms. We reject these as unreasonable. In our view, they misunderstand and misrepresent the fundamental purpose of our article, fail to engage with our core thesis of policy capture, and implausibly seek to place our view of the law beyond academic respectability. Their own strongly-asserted view of the law appears at least open to question. We argue that the problem is not with our scholarship falling below any normal acceptable standard, but rather that Cowan et al. appear to be uncomfortable with others holding and expressing any different view to theirs on this topic. They have therefore reached too quickly for assertions of incompetence or worse. We discuss the climate in which our original article was produced and in which we are now defending it. Describing our own experiences as well of those of other academics, we question how the scholarship needed to help shape policy and law in this area can take place under such conditions