Efficacy and safety of sofosbuvir/velpatasvir in a real-world chronic hepatitis C genotype 3 cohort.
Real-world data on sofosbuvir/velpatasvir with and without ribavirin (SOF/VEL ± RBV), particularly among patients with genotype 3 (GT3) decompensated cirrhosis, prior treatment, coinfection, and hepatocellular carcinoma (HCC), are scarce. We aimed to assess the efficacy and safety of SOF/VEL ± RBV in a real-world setting that included both community and incarcerated GT3 hepatitis C virus (HCV) patients. We included all GT3 HCV patients treated with SOF/VEL ± RBV in our institution. The primary outcome measure was the overall sustained virological response 12 weeks after treatment (SVR12), reported in both intention-to-treat (ITT) and per-protocol analyses. The secondary outcome measures were SVR12 stratified by the presence of decompensated cirrhosis, prior treatment, HCC, and HIV/hepatitis C virus coinfection and the occurrence rate of serious adverse events requiring treatment cessation or hospitalization. A total of 779 HCV patients were treated with 12 weeks of SOF/VEL ± RBV, of which 85% were treated during incarceration. Among the 530 GT3 HCV patients, 31% had liver cirrhosis, and 6% were treatment-experienced. The overall SVR12 for GT3 was 98.7% (95% confidence interval: 97.3%, 99.5%) and 99.2% (95% confidence interval: 98.1%, 99.8%) in ITT and per-protocol analyses, respectively. High SVR12 was also seen in ITT analysis among GT3 HCV patients with decompensated cirrhosis (88%), prior treatment (100%), HCC (100%), and HIV/hepatitis B virus coinfection (100%). Apart from one patient who developed myositis, no other serious adverse events were observed. The SOF/VEL ± RBV is a safe and efficacious treatment option for GT3 HCV patients in a real-world setting. SOF/VEL with RBV may be considered for decompensated GT3 HCV patients.


The digital factory in both the modern dental lab and clinic.
Significant technological advances are occurring in the dental industry that are complementary to the introduction of monolithic restorative materials. Glidewell Laboratories has been at the forefront of innovation of these developments and these internal developments may be instructive of future trends in dentistry. This paper examines internal Glidewell data from 2010 to 2019 about zirconia-related technology and provides context for some technological advancements at Glidewell Laboratories. The trend towards increased use of monolithic zirconia in both, posterior and anterior regions continues to grow. With the advent of intraoral scanners and chairside CAD/CAM technologies, more and more dentists are able to provide same day dentistry. Despite the many clinicians that have made the leap to digital dentistry the low rate of growth in ownership and utilization means PVS impression will be common place long into the future. Glidewell Laboratories has an advanced, automated impression scanning, AI crown design, automated milling and glazing system extending the advantages of digital dentistry to all dentists and pushing the bounds of the technology further. This paper describes the first use of AI GAN to design dental crowns and also shows the strong path monolithic zirconia restorations are paving into the future. Supporting technologies will continue to evolve around zirconia and this paper provides a snapshot of those that exist and a few that are in development.


Hybrid micro/nano-topography of a TiO2 nanotube-coated commercial zirconia femoral knee implant promotes bone cell adhesion in vitro.
Various approaches have been studied to engineer the implant surface to enhance bone in-growth properties, particularly using micro- and nano-topography. In this study, the behavior of osteoblast (bone) cells was analyzed in response to a titanium oxide (TiO2) nanotube-coated commercial zirconia femoral knee implant consisting of a combined surface structure of a micro-roughened surface with the nanotube coating. The osteoblast cells demonstrated high degrees of adhesion and integration into the surface of the nanotube-coated implant material, indicating preferential cell behavior on this surface when compared to the bare implant. The results of this brief study provide sufficient evidence to encourage future studies. The development of such hierarchical micro- and nano-topographical features, as demonstrated in this work, can provide insightful designs for advanced bone-inducing material coatings on ceramic orthopedic implant surfaces.


Asymmetric Auto-Tandem Palladium Catalysis for 2,4-Dienyl Carbonates: Ligand-Controlled Divergent Synthesis.
Developing new asymmetric auto-tandem catalysis processes, especially in a divergent manner, is highly attractive but extremely challenging. Presented herein is a palladium-catalyzed auto-tandem reaction between 2,4-dienyl carbonates and o-TsNH arylimines or trifluoroacetophenones that proceeds through a consecutive N-allylation, vinylogous addition, π-σ-π isomerization, and another N-allylation sequence. Importantly, switchable diastereodivergent synthesis could be achieved by tuning the chiral bisphosphine ligands, which led to the construction of a broad spectrum of fused tetrahydroquinoline architectures with moderate to excellent enantioselectivity. Ligand control even enabled effective access to regiodivergent azetidine or chemodivergent β-H elimination with fair enantioselectivity, further showing the versatility of the current auto-tandem catalysis.


The influence of aging on the spatial and temporal variables of gait during usual and fast speeds in older adults aged 60 to 102 years.
With increases in life expectancy, it is important to understand the influence of aging on gait, given that this activity is related to the independence of older adults and may help in the development of health strategies that encourage successful aging in all phases of this process. To compare gait parameters with usual and fast speeds for independent and autonomous older adults throughout the aging process (60 to 102 years old), and also to identify which of the gait variables are best for identifying differences across the different age groups. Two hundred older adults aged between 60 and 102 years were evaluated. The sample was divided into 3 age groups: 60 to 79 years, 80 to 89 years and 90 years and over. The analyzed gait variables were: speed (meters/s), cadence (steps/min), stride time (seconds), step length (centimeters), double support (percentage of the gait cycle), swing (percentage of the gait cycle), step length variability (CoV%) and stride time variability (CoV%). Group comparison regarding usual gait and fast gait revealed a significant difference in all gait variables. In addition, it can be seen that variables such as gait speed and step length showed greater effect sizes in intergroup comparison (usual gait: 0.48 and 0.47; fast gait: 0.36 and 0.40; respectively), possibly showing that these variables can better detect the changes observed with increasing age. There are differences in the gait performance of older adults from different age groups for usual and fast gait speeds, which is more evident regarding gait speed and step length variables. We recommend the use of usual gait for the identification of the effects of aging because, besides showing a higher effect size values it is more comfortable and requires less effort from older subjects.


Low temperature tolerance of three Aedes albopictus strains (Diptera: Culicidae) under constant and fluctuating temperature scenarios.
Aedes albopictus, a vector of numerous viruses and filarial worms, has already established in 20 countries in Europe, mainly colonising subtropical regions. Continuing adaptation to climatic conditions in temperate areas would probably result in a spread to more northern European countries, producing an increasing risk of mosquito-borne pathogen transmission over a much greater area. Based on previous studies showing that Ae. albopictus is able to overwinter in Germany, this study aims to determine more exactly its ecological limits of enduring low temperatures. Non-diapausing and experimentally induced diapausing eggs of three different Ae. albopictus strains (tropical, subtropical and temperate origins) were exposed to four different regimes with constant temperatures and three different regimes with fluctuating temperatures in a course of a day for a minimum of 2 and a maximum of 30 days. The hatching rate of larvae after cold exposure of the eggs was taken as a measure of cold tolerance. The experiments showed that the tropical Ae. albopictus strain had a lower cold tolerance than the subtropical and the temperate strains. The eggs of all used strains were able to survive constant temperatures as low as -5 °C for an exposure period of 30 days, while constant temperatures as low as -10 °C were endured for 2 days by the tropical strain and for 10 and 20 days by the subtropical and temperate strains, respectively. At fluctuating temperatures, both the subtropical and the temperate strains exhibited hatching under all temperature regimes, even with a minimum temperature of -10 °C, whereas the tropical strain ceased hatching after an exposure period of 30 days under the temperature regime with a minimum temperature of -10 °C. The analyses showed that the temperature played the major role in interpreting the hatching rates of the eggs. The condition, whether the eggs were diapausing or not, had no significant influence, although results indicated a slightly higher cold tolerance of diapausing eggs at -10 °C. It must be expected that subtropical and temperate strains of Ae. albopictus are able to withstand common central European winters and are able to establish in considerable parts of the continent.


[A finite element investigation of bilateral atlantoaxial trans-articular screws and atlas laminar hooks instrumentation].
To investigate the mechanical properties of bilateral atlantoaxial trans-articular screws and atlas laminar hooks instrumentation with finite element method. There was a volunteer with age of 28 years old, body height 172 cm, body weight of 60 kg and without cervical deformity by X rays. The ligamentous, nonlinear, three-dimensional finite element models of normal upper cervical spine (C0-3) was developed and validated. The destabilized model with bilateral atlantoaxial trans-articular screws and atlas laminar hooks was evaluated for quasistatic loading. The finite element model of upper cervical spine consists of 229,047 nodes and 152,475 elements, and correlated well with experimental data for all load cases and could be used for experiment. The finite model with bilateral atlantoaxial trans-articular screws and atlas-laminar hooks predicted that the maximum Von Mises Stress was in the region in which screws penetrated the atlantoaxial articular facet. The novel instrumentation resulted in sufficient stability. The bilateral atlantoaxial trans-articular screws and atlas laminar hooks instrumentation is useful and effective for atlantoaxial arthrodesis.


Evidence for the promotion of aboveground grassland production by native large herbivores in Yellowstone National Park.
We examined the effect of native large herbivores on aboveground primary production of nonforested habitat in Yellowstone National Park, Wyoming. Productivity of vegetation grazed by elk (Cervus elaphus) and bison (Bison bison) was compared with that of ungrazed (permanently fenced) vegetation at four sites. Two methods were used that, we believed, would provide the most accurate measurements under the different grazing regimes encountered in the study. Production of ungrazed vegetation in permanent exclosures (10×10 m or 15×15 m, 3 per site) and that of vegetation that was grazed only in the winter was taken as peak standing crop. Production of vegetation grazed during the growing season was the sum of significant increments (P<0.05) in standing crop inside temporary exclosures (1.5×1.5 m, 6 per site) moved every four weeks to account for herbivory.Aboveground productivity of grazed vegetation was .47% higher than that of ungrazed vegetation across sites (P<0.0003). This result could be explained by either a methodological or grazer effect. We believe it was the latter. Results from a computer simulation showed that sequential sampling with temporary exclosures resulted in a slight underestimation of production, suggesting that the reported differences between treatments were conservative. We suggest that stimulation of aboveground production by ungulates may be, in part, due to the migratory behavior of native ungulates that track young, high quality forage as it shifts spatially across the Yellowstone ecosystem.


The Evolution of Worldwide Nurse-Led Cancer Research in the Last 2 Decades (2004-2022): A Bibliometric Mapping and Visual Analysis.
Research led by nurses has evolved rapidly over the last 2 decades globally. Assessing the work that has been conducted so far can help the specialty to strategically shape future directions of nurse-led cancer research. The aim of this study was to provide a comprehensive, up-to-date synthesis of all nurse-led cancer research published articles over 20 years. A bibliometric analysis was used. Three databases were used to retrieve nurse-led cancer research publications for the period from January 1, 2004, to March 11, 2022. A total of 7043 original articles were retrieved. A significant increase in nurse-led cancer research over the past 2 decades was evident. The United States and United Kingdom were the most productive countries in terms of the number of published articles. Minimal international collaboration was observed among low- or middle-income countries versus high-income countries. Breast cancer, palliative care, and quality of life received the most attention in nurse-led cancer research, followed by education, pain, and communication. Very few publications addressed cancer prevention, breaking bad news, and cancer rehabilitation. Areas to consider in the future include more international collaborations on commonly agreed research agendas, capacity building to allow more research beyond the few countries that dominate the publications, and more focus on low- or middle-income countries. The findings of this study provide direction for future research led by cancer nurses and the areas that warrant further investigation.


Research on indoor positioning method based on LoRa-improved fingerprint localization algorithm.
Traditional fingerprint localization algorithms need help with low localization accuracy, large data volumes, and device dependence. This paper proposes a LoRa-based improved fingerprint localization algorithm-particle swarm optimization-random forest-fingerprint localization for indoor localization. The first improvement step involves creating a new exceptional fingerprint value (referred to as RSSI-RANGE) by adding the Time of Flight ranging value (referred to as RANGE) to the Received Signal Strength Indication (RSSI) value and weighting them together. The second improvement step involves preprocessing the fingerprint data to eliminate gross errors using Gaussian and median filtering. After noise reduction, the particle swarm optimization algorithm is used to optimize the hyper parameters of the random forest algorithm, and the best RSSI-RANGE value is obtained using the random forest algorithm. The Kriging method is then used for interpolation to establish an offline fingerprint database, and the final online recognition and localization are performed. Experimental results demonstrate that the first improvement step improves localization accuracy by 53-57% in different experimental scenarios, while the second improves localization accuracy by 25-31%. When both steps are combined, the localization accuracy is improved by 58-63%. The effectiveness of this method is demonstrated through experiments.


Use of virtual and augmented reality-based interventions in health education to improve dementia knowledge and attitudes: an integrative review.
Immersive technologies such as virtual (VR) and augmented reality (AR) can potentially help health professionals and trainees understand psychological symptoms and responsive behaviours associated with dementia within a safe and supportive learning environment. This integrative review sought to ascertain the types of VR and AR-based interventions used in dementia education and training and its efficacy to improve knowledge and attitudes of health professionals or trainees. The protocol was submitted to PROSPERO and literature published from 2000 onwards was searched in eight databases: CINAHL, MEDLINE, Web of Science, Cochrane, Embase, PsycINFO, ERIC and Scopus. A total of 19 articles were included and assessed with the Mixed Methods Appraisal Tool. Methodological quality varied across studies. VR rather than AR-based intervention are used in dementia education and training for health professional and trainees. Immersive virtual learning potentially enhance knowledge, attitudes, empathy and sensitivity of health professionals and trainees. While promising, there remains a lack of conclusive and robust evidence to fully recommend the introduction and inclusion of immersive virtual learning in dementia education and training. Additional rigorously designed research studies with larger sample sizes are needed to confirm the benefits on attitudes, empathy, sensitivity and knowledge. CRD42020182083.


Assessment of vernier acuity development using the "equivalent intrinsic blur" paradigm.
Vernier acuity in human infants is more than two orders of magnitude poorer than in adults and does not appear to reach adult levels until well beyond the first postnatal year. One source of these developmental differences in vernier acuity may be the presence of levels of intrinsic blur that are higher in infants than in adults. We investigated this hypothesis by measuring vernier acuity in 3-month-olds, 5-month-olds, and adults using stimuli blurred by two-dimensional Gaussian filters. Experiment 1 showed that more stimulus blur is required to degrade vernier acuity in infants than in adults. From these data we estimated that the level of equivalent intrinsic blur for this vernier acuity task decreased by approx. 1.5 log units between 3 months of age and adulthood. These results also suggested that this reduction of equivalent intrinsic blur can account entirely for the improvement in vernier acuity between 3 and 5 months postnatal. However, the large further improvement which occurs between 5 months of age and adulthood cannot be explained solely by equivalent intrinsic blur. In Expt 2, we measured vernier acuity in 3-month-olds and adults using a non-blurred stimulus with the same luminance contrast as the most-blurred stimulus used in Expt 1. Infants' and adults' thresholds were degraded slightly, relative to the non-blurred stimulus from Expt 1, but still were significantly better than the most blurred condition of Expt 1. This suggests that the results from the first experiment were not due simply to the reduction in overall luminance contrast which occurs when stimuli are blurred.


Medical specialty choice: replications and extensions.
A large longitudinal data base is used to provide information about 1) stability of specific specialty choice, 2) stability between specialty choice groupings, and 3) distributions and patterns of specialty choice.


Subthreshold electrical stimulation reduces motor unit discharge variability and decreases the force fluctuations of plantar flexion.
The purpose of this study was to examine the influence of subthreshold electrical stimulation on the force fluctuations and motor-unit discharge variability during low-level, steady contraction of the plantar flexor muscles. Seven subjects performed a force-matching task of isometric plantar flexion at 5% of maximal voluntary contraction with and without random electrical stimulation applied to the tibial nerve. During the task, the motor unit action potential was continuously recorded with fine-wire electrodes, and the inter-spike intervals of a single motor unit were calculated. The coefficient of variation (CV) of the force fluctuations and the inter-spike intervals of the motor unit discharge were significantly decreased by the intervention of subthreshold electrical stimulation, although there were no changes in the mean values. These results suggest that subthreshold stimulation reduced the motor-unit discharge variability, which in turn, increased the steadiness of the force.


Acceptability and Efficacy of the SMARxT Media Literacy Education Program to Counter Pharmaceutical Marketing Influences among Medical Trainees.
Evidence-based prescribing (EBP) results in decreased morbidity and reduces medical costs. However, pharmaceutical marketing influences medication requests and prescribing habits, which can detract from EBP. Media literacy, which teaches critical thinking, is a promising approach for buffering marketing influences and encouraging EBP. The authors developed the "SMARxT" media literacy education program around marketing influences on EBP decision-making. The program consisted of six videos and knowledge assessments that were delivered as an online educational intervention through the Qualtrics platform. In 2017, we assessed program feasibility, acceptability, and efficacy of enhancing knowledge among resident physicians at the University of Pittsburgh. Resident physicians (n=73) responded to pre-test items assessing prior knowledge, viewed six SMARxT videos, and responded to post-test items. A 6-month follow-up test was completed to quantitatively assess sustained changes in knowledge and to qualitatively assess summative feedback about the program (n=54). Test scores were assessed from pre- to post-test and from pre-test to follow-up using paired-sample t-tests. Qualitative results were synthesized through content analysis. Proportion of correct knowledge responses increased from pre-test to immediate post-test (31% to 64%, P<0.001) at baseline. Correct responses also increased from pre-test to 6-month follow-up (31% to 43%, P<0.001). Feasibility was demonstrated by 95% of enrolled participants completing all baseline procedures and 70% completing 6-month follow-up. Quantitative measures of acceptability yielded positive scores and qualitative responses indicated participants' increased confidence in understanding and countering marketing influences due to the intervention. However, participants stated they would prefer shorter videos, feedback about test scores, and additional resources to reinforce learning objectives. The SMARxT media literacy program was efficacious and acceptable to resident physicians. Participant suggestions could be incorporated into a subsequent version of SMARxT and inform similar clinical education programs. Future research should assess program impact on real-world prescribing practices.


Mutations of an active site threonyl residue promote beta elimination and other side reactions of the enediol intermediate of the ribulosebisphosphate carboxylase reaction.
The side chain of residue threonine 65 within the active site of ribulosebisphosphate carboxylase participates in a network of hydrogen bonds and ionic interactions involving the phosphate moiety attached to C-1 of the substrate. This residue was replaced with serine, alanine, and valine in the enzyme from Synechococcus PCC 6301. The mutant enzymes were stable, expressed abundantly by Escherichia coli, and retained the ability to form gel-filterable complexes with the reaction-intermediate analog, 2'-carboxyarabinitol-1,5-bisphosphate. The substitutions reduced the kcat/Km(CO2) (where kcat is the substrate-saturated turnover rate) of the enzyme from 17- to 340-fold with the more radical substitutions causing more severe reductions. The CO2/O2 specificity also deteriorated progressively, the valine replacement causing a 2.3-fold reduction. In concert with these changes, a compound tentatively identified as 1-deoxy-D-glycero-2,3-pentodiulose-5-phosphate, the product of beta elimination of the 2,3-enediol(ate) intermediate of the catalytic reaction, appeared among the reaction products in progressively increasing amounts. In the case of the valine substitution, it comprised 13% of the ribulose bisphosphate consumed. The mutant enzymes also partitioned more of their reaction flux to pentulose bisphosphate isomers of ribulose bisphosphate. By contrast, the diversion of carboxylated product to pyruvate, as a result of beta elimination of the three-carbon aci-carbanion intermediate of the carboxylation reaction, was ameliorated by the replacements, the valine mutant showing a 5-fold improvement in this parameter. These observations focus attention on a geometric conflict which exists between the requirements for stabilization of the 5-carbon enediol(ate) and 3-carbon aci-carbanion intermediates. This conflict must be resolved by a change in the angle of the C-1/bridge oxygen bond during each catalytic cycle. The network of hydrogen bonds involving the side chain of threonine 65 must play a crucial role in facilitating reaction of the enediol(ate) with the gaseous substrate and in shepherding this subsequent movement.


Dichloridobis{2-[(1H-1,2,4-triazol-1-yl)meth-yl]-1H-benzimidazole-κN (3)}-zinc(II).
In the title complex, [ZnCl2(C10H9N5)2], the Zn(II) ion is coordinated by two N atoms from two 2-[(1H-1,2,4-triazol-1-yl)meth-yl]-1H-benzimidazole (tmb) ligands and by two chloride ligands in a slightly distorted tetra-hedral geometry. In the tmb ligands, the benzimidazole rings systems are essentially planar, with maximum deviations from the mean plane of 0.021 (3) and 0.030 (3) Å, and form dihedral angles of 73.2 (2) and 83.5 (2)° with the triazole rings. In the crystal, N-H⋯N hydrogen bonds link complex mol-ecules into chains along [010]. In addition, weak C-H⋯Cl and C-H⋯N hydrogen bonds complete a three-dimensional network. Two weak intra-molecular C-H⋯Cl hydrogen bonds are also observed.


Preoperative Acute Normovolaemic Hemodilution (ANH) in combination with Hypotensive Epidural Anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684].
BACKGROUND: Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45-50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR). METHODS: Twenty-eight patients scheduled for TKR are randomised to ANH or no hemodilution (non-ANH). Both groups are anaesthetized with HEA. ANH is established with predonation of 20 % of the total blood volume, and replacement with equal volume of HAES 6 %. Blood re-transfusion is completed within 6 h. RESULTS: A mean of 877 ml blood was predonated (19.7 % of the total blood volume). Blood loss was, except from the intraoperative loss, significantly higher in ANH group. The total loss was 1306 mL (ANH) vs. 1026 mL (non-ANH), p < 0.05. Except from the first hour postoperatively, hematocrit was identical in between groups postoperatively. The amount of blood transfusion was identical 386 ml (ANH) vs. 343 ml (non-ANH) (ns). 50 % went through surgery without receiving blood (ANH) vs. 58 % (non-ANH). No renal, neurological or cardiopulmonary complications were registered. CONCLUSIONS: These data suggest no benefits in combining HEA and ANH in TKR surgery. Probably because of the reduced viscosity of the blood after ANH, there is an increased postoperative blood loss. The need for homologous blood transfusion was identical.


Preliminary identification of key miRNAs, signaling pathways, and genes associated with Hirschsprung's disease by analysis of tissue microRNA expression profiles.
Hirschsprung's disease (HSCR) is a congenital gut motility disorder of infants, and if left untreated, it is fatal to the affected infants. This study aimed to identify key microRNAs (miRNAs), signaling pathways and genes involved in the pathogenesis of HSCR. The miRNA microarray dataset GSE77296 was downloaded. Nine colon tissue samples were available: six from HSCR patients and three matched control samples. Differentially expressed miRNAs (DEMs) were identified after data preprocessing. Target genes of the selected upregulated and downregulated DEMs were predicted. In addition, functional enrichment analyses for the selected DEMs and target genes were conducted. Finally, interaction networks between the DEMs and target genes were constructed. A total of 162 DEMs (73 upregulated and 89 downregulated) were obtained. A total of 2511 DEM-target gene pairs for the 40 selected DEMs were identified, including 1645 pairs for the upregulated DEMs and 866 pairs for the downregulated DEMs. The upregulated DEM miR-141-3p and down-regulated DEM miR-30a-3p were identified as key miRNAs by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and network analyses. Besides, KEGG pathway enrichment analysis revealed that pathways in cancer and the mitogen-activated protein kinase (MAPK) signaling pathway were key pathways. The key genes frizzled class receptor 3 (FZD3) and docking protein 6 (DOK6) were obtained through the DEM-target gene interaction networks. Two key miRNAs (miR-141-3p and miR-30a-3p), the MAPK signaling pathway and two key genes (FZD3 and DOK6) were implicated in the pathogenesis of HSCR.


National nutrition policy in high-income countries: is health equity on the agenda?
Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined. We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations. Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi's "What's the Problem Represented to be?' analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle "problems" and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition. To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.


Understanding How Providers and Staff Make Decisions About Where to Refer Their Patients: A Qualitative Study.
Value-based payment incentivizes primary care providers (PCPs) to refer patients to specialists inside their own organization. "Outmigration" of patients to specialists in other organizations is common, yet why it occurs is not clear. We conducted qualitative interviews of PCPs, nurses, and administrative staff at primary care practices in a physician organization (PO) to determine reasons for outmigration. While participants reported that they preferred making within-PO referrals, they identified 18 barriers to within-PO referrals, which often led to patients receiving care elsewhere. Many of these barriers are potentially modifiable and could inform the design of future interventions to decrease unnecessary outmigration.


Induction of endometriosis and adenomyosis by transvaginal pituitary transplantation in mice with and without natural killer cell activity.
The aims of this study were to establish a mouse model of endometriosis and adenomyosis and to elucidate the necessity of reduced natural killer (NK)-cell and T-cell activities in the establishment of endometriosis and adenomyosis. Pituitary glands, submandibular glands, a hypothalami were transvaginally inoculated into the uteri of syngeneic female mice. Twenty weeks later, the recipient mice were sacrificed and examined. Cysts, adhesion of the uteri to surrounding tissues, and adenomyosis had formed in the uteri of 7 (29.2%), 14 (58.3%), and 22 (91.7%) mice, respectively, out of 24 BALB/c mice after the transplantation of pituitary glands. Similar findings were obtained by experiments with C3H/He and C57BL/6 mice. In NK-cell-deficient C57BL/6-bgJ and T-cell-deficient BALB/c nu/nu mice, an increase in the formation of cysts, adhesion, and adenomyosis was not observed. These findings indicate that transvaginal pituitary transplantation specifically induces cysts, adhesion, and adenomyosis. Reduced NK-cell activities may not be necessary in the primary development of endometriosis and adenomyosis.