We report the results of a study designed to assess and evaluate how the law shapes the public health system's preparedness activities. Based on 144 qualitative interviews conducted in nine states, ...we used a model that compared the objective legal environment with how practitioners perceived the laws. Most local public health and emergency management professionals relied on what they perceived the legal environment to be rather than on an adequate understanding of the objective legal requirements. Major reasons for the gap include the lack of legal training for local practitioners and the difficulty of obtaining clarification and consistent legal advice regarding public health preparedness. Narrowing the gap would most likely improve preparedness outcomes. We conclude that there are serious deficiencies in legal preparedness that can undermine effective responses to public health emergencies. Correcting the lack of legal knowledge, coupled with eliminating delays in resolving legal issues and questions during public health emergencies, could have measurable consequences on reducing morbidity and mortality.
Stoma patients are vulnerable to poor psychosocial health outcomes owing to the loss of an important bodily function and the distortion of their self-image. We used a cross-sectional, descriptive, ...and correlational design to investigate the relationship between self-efficacy and quality of life of stoma patients in Hong Kong and to examine the association between self-efficacy and stoma patients' sociodemographic characteristics. Using a convenience sampling method, 96 patients (mean age, 64 years) were recruited from 2 acute hospitals. Significant correlations were found between the Chinese Stoma Self-efficacy Scale and the Chinese Short-Form Health Survey 36 subscale scores (from r = 0.21, P = .039, to r = 0.59, P < .001). Significant positive correlations were also found between the 2 Chinese Stoma Self-efficacy subscales and all 8 of the Chinese Short-Form Health Survey 36 subscales. The results indicated that the self-efficacy and quality of life of stoma patients were correlated. Based on this study's results, self-efficacy is an important factor to consider in the provision of care to stoma patients. Specific interventions to enhance self-efficacy also need to be evaluated for their impact on the quality of life of stoma patients.
A three-dimensional computational fluid dynamic (CFD) model is developed for simulating a cylindrical Oscillating Water Column (OWC) device for harvesting wave energy. The single-phase CFD model ...solves the Reynolds-Averaged Navier-Stokes (RANS) equations using the finite element method for simulating the wave motion and uses an aerodynamic model to simulate the flow through the air turbine. The model is implemented to simulate wave energy harvesting of a cylindrical OWC device. Through harmonic decomposition, it is found that the first harmonic wave surface elevation oscillates like a piston in the OWC chamber. However, both the amplitude and phase of the second harmonic wave surface elevation vary significantly along the wave direction in the OWC chamber, demonstrating a sloshing mode of the second harmonic. This study further proved the reduction of the capture width ratio caused by the transverse sloshing mode when the wavelength is the same as the wave flume width. The effect of the width of the wave flume on the peak CWR is found to be negligibly small when the wave flume width is three times the OWC diameter.
Abstract Introduction Patients with Obstructive Sleep Apnea (OSA) have higher levels of inflammatory cytokines, like tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6). Similar higher systemic ...inflammatory cytokines have been linked to insulin resistance, thus emphasizing possible metabolic complications of OSA. Yet, the effect of positive airway pressure (PAP) therapy on glycemic control in those with concomitant OSA and pre-diabetes i unknown. Methods We performed a retrospective cohort study analyzing data from our tertiary care sleep center in adults with OSA and concomitant prediabetes who were initiated on CPAP therapy between April 2018 to April 2021. OSA was identified using ICD-9-CM (327.23) and ICD-10code (G47.39). Prediabetes was defined as hemoglobin A1c (HbA1c) between 5.7–6.4%. Demographic data were collected including age, gender, BMI, and number of comorbidities. The data was stratified among those on medications for pre-diabetes versus those that were not on any medications for it. Our outcome of interest was the change of mean A1c after CPAP initiation. Descriptive statistics were performed, while t-test was used to assess the changes of mean A1c values before and after CPAP treatment with a statistically significant level p< 0.05 Results A total of 71 patients were included in the current analysis. The average age was 61.53 years, and 65% were female, while 44% non-Hispanic whites, 28% non-Hispanic blacks, 21% Hispanics and 6% Asians. Among those with concomitant OSA-prediabetes on medications, the mean HbA1c before CPAP initiation was 6.03% which changed to 6.63% after CPAP initiation over a mean follow up duration of 485 days (p=0.04 from one-tail t-test). Among those with concomitant OSA-prediabetes not on medications, the mean A1c before CPAP initiation was 6% which marginally had changed to 6.42% after CPAP therapy over mean follow up duration of 447 days (p=0.05 from one-tail t-test), again remaining within pre-diabetes range. Conclusion Our results show that HbA1c remain stable within pre-diabetes range in patients with concomitant OSA and pre-diabetes using CPAP therapy. Some limitations could be retrospective nature of the study, small sample size, lack of CPAP compliance data. Larger prospective studies are suggested to further investigate the effect of CPAP on progression to diabetes among these patients. Support (if any)
Tamsulosin is the most widely used alpha-1 blocker medication for managing benign prostatic hyperplasia (BPH) as indicated in the current practice guideline. The aim of this study was to compare ...all-cause medical costs and BPH-specific medical costs in older male adults with BPH treated with tamsulosin vs other alpha-1 blockers (i.e., doxazosin, terazosin, and alfuzosin).
This was a retrospective propensity-score matched cohort study based on 2006–2012 Medicare claims data. All-cause medical costs and BPH-specific medical costs were compared between tamsulosin and other alpha-1 blockers treatment groups using baseline-adjusted quantile regression analyses. The comparisons were performed at different percentiles of the cost distributions.
176,793 older male adults with BPH who used alpha-1 blockers were included in the analysis. All-cause medical costs in 75th and 95th percentiles of the cost distribution are substantially higher in tamsulosin treatment group when compared to other alpha-1 blocker medications (p < 0.05 for all). Tamsulosin treatment group had substantially higher BPH-specific medical costs in 99th percentile of the cost distribution when compared to doxazosin and terazosin (p < 0.001 for all). Overall, the top 5% of the patients with the highest all-cause medical costs accounted for approximately 45% of the overall all-cause medical costs, and the top 1% of the patients with the highest BPH-specific medical costs accounted for 39–51% of those costs.
Older adults with BPH who encountered higher medical expenses had substantially higher medical costs when treated with tamsulosin than other common alpha blockers. Cost-related quality of measures should be assessed to improve health outcomes in older adults with BPH.
Oscillating water column (OWC) devices utilise wave-induced oscillation of water column in partially submerged chambers to extract energy of waves in ocean. The principal aim of this paper is to ...investigate scaling effects of two-dimensional OWC through numerical simulations. The fluid motion under waves is simulated by solving the two-dimensional incompressible Reynolds-Averaged Navier-Stokes equations using finite element method under Arbitrary Lagrangian-Eulerian scheme. To investigate scaling effects, the waves and the OWC are scaled up or down according to Froude number similarity. The turbine is scaled up or down using three different scaling methods: (1) Turbine coefficient remains unchanged, i.e. not scaling the turbine at all; (2) Equivalent pneumatic damping coefficient of the turbine is constant and (3) the two-dimensional turbine coefficient is constant. The numerical results show that method (2) has the smallest effects on the best hydraulic efficiency and method (3) has the smallest effects on the best performance wave number, i.e. the wave number where the OWC receives the largest percentage of the wave energy. The worst scaling method is not scaling the turbine. Because the best performance wave number varies with the model scale in method (1) and (2), it is very likely the scaling effects of the model scale on the hydrodynamic performance at different wave numbers are different from each other. In addition, the effects of the wave height and the chamber volume are studied. Increasing chamber volume causes a reduction of the best performance, however it may improve general performance of OWC because it increases the frequency band of waves with high hydraulic efficiency. Increasing wave height causes a reduction of the hydraulic efficiency.
Endogenous retroviruses (ERVs) are remnants of ancient retroviral infections that have invaded the germ line of both humans and non-human primates. Most ERVs are functionally crippled by deletions, ...mutations, and hypermethylation, leading to the view that they are inert genomic fossils. However, some ERVs can produce mRNA transcripts, functional viral proteins, and even non-infectious virus particles during certain developmental and pathological processes. While there have been reports of ERV-specific immunity associated with ERV activity in humans, adaptive immune responses to ERV-encoded gene products remain poorly defined and have not been investigated in the physiologically relevant non-human primate model of human disease.
Here, we identified the rhesus macaque equivalent of the biologically active human ERV-K (HML-2), simian ERV-K (SERV-K1), which retains intact open reading frames for both Gag and Env on chromosome 12 in the macaque genome. From macaque cells we isolated a spliced mRNA product encoding SERV-K1 Env, which possesses all the structural features of a canonical, functional retroviral Envelope protein. Furthermore, we identified rare, but robust T cell responses as well as frequent antibody responses targeting SERV-K1 Env in rhesus macaques.
These data demonstrate that SERV-K1 retains biological activity sufficient to induce cellular and humoral immune responses in rhesus macaques. As ERV-K is the youngest and most active ERV family in the human genome, the identification and characterization of the simian orthologue in rhesus macaques provides a highly relevant animal model in which to study the role of ERV-K in developmental and disease states.
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