Microfluidic droplet arrays potentially allow to carry out assays involving complex workflows at the single-cell level. In recent developments e.g. (Jeong et al. in Lab Chip 16:1698, 2016), each ...droplet of the array can be addressed individually thanks to on-chip pneumatic valves. In this experimental and theoretical work, we investigate the multiple interaction regimes between one or several droplets and a pneumatic valve. In particular, two main trapping modes are characterized, with very distinct flow features. We quantify the potentially huge increase of hydrodynamic resistance induced by the droplet/valve interaction. Finally, we rationalize the main transitions between trapped and non-trapped regimes through a generic theoretical model of the balance between capillary, hydrodynamic and elastic forces.
Osteoarthritis (OA) is a degenerative disorder of the cartilage and is one of the leading causes of disability, particularly amongst the elderly, wherein patients with advanced-stage OA experience ...chronic pain and functional impairment of the limbs, thus resulting in a significantly reduced quality of life. The currently available treatments primarily revolve around symptom management, and is thus palliative rather than curative. The aim of the present review is to briefly discuss the limitations of some of the currently available treatments for patients with OA, and highlight the value of the potential use of stem cells in cellular therapy, which is widely regarded as the breakthrough that can address the present unmet medical needs for treatment of degenerative diseases, such as OA. The advantages of stem cell therapy, particularly mesenchymal stem cells, and the challenges involved are also discussed in this review.
Background Transgender and gender diverse (TGD) people experience significant barriers to accessing affirming health services. There is a paucity of literature examining how both community members ...and health care professionals (HCPs) understand potential causes and solutions for these barriers, particularly in non-urban settings. Objective We present the first systematic examination of perspectives from community members and HCPs regarding barriers to and solutions for promoting access to gender-affirming health care. Design Study activities were conducted through the Plan and Act for Transgender Health (PATH) Project, a health needs assessment of TGD people. Community members in the catchment area were recruited to participate in focus group discussions about access to gender-affirming health care and optimal health service delivery models in March-October 2019. HCPs were recruited to participate in focus group discussions or in-depth interviews about experiences working with TGD clients. Data were analyzed using an inductive grounded theory approach. Setting 25 rural counties in Massachusetts, New York, Connecticut, Vermont, and New Hampshire. Participants Study participants included 61 adult TGD community members and 23 HCPs working in the catchment area. Results Both community members and HCPs spoke of the need for connectedness and linkages among disparate health system components for gender-affirming health care. Participants expressed this priority through calls for systems-level improvements within existing services (e.g., expanded data collection, expanded mental health services, inclusive and affirming health care environments, and TGD staff). They also expressed the need for expanded TGD community outreach and engagement (e.g., incorporation of a patient feedback process, TGD health navigators, and resource mapping). Limitations Findings specifically reflect the perspectives of community members and HCPs in the rural New England area. Furthermore, the study sample was predominantly White non-Hispanic. Conclusion Interventions to achieve accessible gender-affirming health care must address the diverse perspectives and needs of both community members and HCPs.
In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. ...This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation.
We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR.
Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority).
Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators' patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload.
Clinical Trial Registration Number NCT03514433 , 5/2/2018.
The tradeoff between knowing when to seek greater rewards (exploration), and knowing when to settle (exploitation), is critical to success. One dispositional factor that may modulate this tradeoff is ..."grit." Gritty individuals tend to persist in the face of difficulty and consequently experience greater life success. It is possible that they may also experience a greater tendency to explore in a reward task. However, although most exploration/exploitation tasks manipulate beliefs about the presence/magnitude of rewards in the environment, the belief of one's ability to actually achieve a reward is also critical. As such, we investigated whether individuals higher in grit were more likely to explore, and how beliefs about the magnitude/presence of rewards, and the perceived ability to achieve a reward, modulated their exploration tendencies. Over two experiments, participants completed 4 different exploration/persistence tasks: two that tapped into participant beliefs about the presence/magnitude of rewards, and two that tapped into participant beliefs about their ability to achieve a reward. Participants also completed measures of dispositional grit (Experiment 1a and 1b), conscientiousness (Experiment 1b), and working memory (Experiment 1a and 1b). In both experiments, we found a relationship between the two "belief of rewards" tasks, as well as between the two "belief of ability" tasks, but performance was unrelated across the two types of task. We also found that dispositional grit was strongly associated with greater exploration, but only on the "belief of ability" tasks. Finally, in Experiment 1b we showed that conscientiousness better predicted exploration on the "belief of ability" tasks than grit, suggesting that it is not grittiness per se that is associated with exploration. Overall, our findings showed that individuals high in grit/conscientiousness are more likely to explore, but only when there is a known reward available that they believe they have the ability to achieve.
The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease ...(SCD).
Six focus groups were held at four urban pediatric hematology clinics in the Northeastern region of the United States from November to December 2019. Discussion questions were developed to align with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation science framework, focusing on the domains of context and recipient and how clinics address adverse social determinants of health (SDoH) in their patient populations. A summative content analytical approach was taken to identify major themes in the data.
We discerned the following themes: (1) families of children with SCD experience numerous unmet basic needs; (2) clinic staff believed they had a role to play in addressing these unmet basic needs; (3) staff felt their ability to address families' unmet basic needs depended upon caregivers' capacity to act on staff's recommendations; and (4) clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control.
These findings have important implications for how best to address adverse SDoH for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.
Introduction
The 2018 National Comprehensive Cancer Network guidelines for prostate cancer genetic testing expanded access to genetic services. Few studies have examined how this change has affected ...provider practice outside of large cancer centers.
Methods
We conducted a qualitative study of multi-disciplinary health care providers treating patients with prostate cancer at a safety-net hospital. Participants completed an interview that addressed knowledge, practices, and contextual factors related to providing genetic services to patients with prostate cancer. A thematic analysis using both inductive and deductive coding was undertaken.
Results
Seventeen providers completed interviews. Challenges in identifying eligible patients for genetic testing stemmed from a lack of a) systems that facilitate routine patient identification, and b) readily available family history data for eligibility determination. Providers identified non-medical patient characteristics that influenced their referral process, including health literacy, language, cultural beliefs, patient distress, and cost. Providers who see patients at different times along the cancer care continuum viewed benefits of testing differently.
Conclusion
The use of digital technologies that systematically identify those eligible for genetic testing referrals may mitigate some but not all challenges identified in this study. Further research should determine how individual provider perceptions influence referral practices and patient access to genetics both within and across cancer specialties.
IntroductionThere are substantial inequities in oral health access and outcomes in the USA, including by income and racial and ethnic identity. People with adverse social determinants of health ...(aSDoH), such as housing or food insecurity, are also more likely to have unmet dental needs. Many patients with dental problems present to the emergency department (ED), where minimal dental care or referral is usually available. Nonetheless, the ED represents an important point of contact to facilitate screening and referral for unmet oral health needs and aSDoH, particularly for patients who may not otherwise have access to care.Methods and analysisMapping Oral health and Local Area Resources is a randomised controlled trial enrolling 2049 adult and paediatric ED patients with unmet oral health needs into one of three trial arms: (a) a standard handout of nearby dental and aSDoH resources; (b) a geographically matched listing of aSDoH resources and a search link for identification of geographically matched dental resources; or (c) geographically matched resources along with personalised care navigation. Follow-up at 3, 6, 9 and 12 months will evaluate oral health-related quality of life, linkage to resources and dental treatment, ED visits for dental problems and the association between linkage and neighbourhood resource density.Ethics and disseminationAll sites share a single human subjects review board protocol which has been fully approved by the Mass General Brigham Human Subjects Review Board. Informed consent will be obtained from all adults and adult caregivers, and assent will be obtained from age-appropriate child participants. Results will demonstrate the impact of addressing aSDoH on oral health access and the efficacy of various forms of resource navigation compared with enhanced standard care. Our findings will facilitate sustainable, scalable interventions to identify and address aSDoH in the ED to improve oral health and reduce oral health inequities.Trial registration numberNCT05688982.
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