The transmission dynamics of Tuberculosis (TB) involve complex epidemiological and socio-economical interactions between individuals living in highly distinct regional conditions. The level of exogenous reinfection and first time infection rates within high-incidence settings may influence the impact of control programs on TB prevalence. The impact that effective population size and the distribution of individuals’ residence times in different patches have on TB transmission and control are studied using selected scenarios where risk is defined by the estimated or perceive first time infection and/or exogenous re-infection rates.
Methods
This study aims at enhancing the understanding of TB dynamics, within simplified, two patch, risk-defined environments, in the presence of short term mobility and variations in reinfection and infection rates via a mathematical model. The modeling framework captures the role of individuals’ ‘daily’ dynamics within and between places of residency, work or business via the average proportion of time spent in residence and as visitors to TB-risk environments (patches). As a result, the effective population size of Patch i (home of i-residents) at time t must account for visitors and residents of Patch i, at time t.
Results
The study identifies critical social behaviors mechanisms that can facilitate or eliminate TB infection in vulnerable populations. The results suggest that short-term mobility between heterogeneous patches contributes to significant overall increases in TB prevalence when risk is considered only in terms of direct new infection transmission, compared to the effect of exogenous reinfection. Although, the role of exogenous reinfection increases the risk that come from large movement of individuals, due to catastrophes or conflict, to TB-free areas.
Conclusions
The study highlights that allowing infected individuals to move from high to low TB prevalence areas (for example via the sharing of treatment and isolation facilities) may lead to a reduction in the total TB prevalence in the overall population. The higher the population size heterogeneity between distinct risk patches, the larger the benefit (low overall prevalence) under the same “traveling” patterns. Policies need to account for population specific factors (such as risks that are inherent with high levels of migration, local and regional mobility patterns, and first time infection rates) in order to be long lasting, effective and results in low number of drug resistant cases.
The maintenance of chromosomal integrity is an essential task of every living organism and cellular repair mechanisms exist to guard against insults to DNA. Given the importance of this process, it is expected that DNA repair proteins would be evolutionarily conserved, exhibiting very minimal sequence change over time. However, BRCA1, an essential gene involved in DNA repair, has been reported to be evolving rapidly despite the fact that many protein-altering mutations within this gene convey a significantly elevated risk for breast and ovarian cancers.
Results
To obtain a deeper understanding of the evolutionary trajectory of BRCA1, we analyzed complete BRCA1 gene sequences from 23 primate species. We show that specific amino acid sites have experienced repeated selection for amino acid replacement over primate evolution. This selection has been focused specifically on humans and our closest living relatives, chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). After examining BRCA1 polymorphisms in 7 bonobo, 44 chimpanzee, and 44 rhesus macaque (Macaca mulatta) individuals, we find considerable variation within each of these species and evidence for recent selection in chimpanzee populations. Finally, we also sequenced and analyzed BRCA2 from 24 primate species and find that this gene has also evolved under positive selection.
Conclusions
While mutations leading to truncated forms of BRCA1 are clearly linked to cancer phenotypes in humans, there is also an underlying selective pressure in favor of amino acid-altering substitutions in this gene. A hypothesis where viruses are the drivers of this natural selection is discussed.
The social determinants of health (SDOH) represent factors that impact the health and effectiveness/compliance of a treatment plan for a patient. The SDOH include such factors as economic stability, education, home and community context, access to healthcare, neighborhood and built environment, and personal behavior. The purpose of this study is to determine the extent of collection and integration of SDOH into clinical practice, and the usefulness of this information in medical decision making. Following a thorough literature review, an online survey was deployed to physicians and administrators around the country, with the aim of answering the following questions: 1) Do provider practices collect information on a patient's social determinants of health? 2) If yes, how is that information being used, if at all? 3) If not, what is preventing them from doing so? 4) Do the answers to questions 1-3 differ based on the type of payment model (Fee-for-Service or Capitation) to which the practice is subject? The results of the study suggest that fee-for-service payment environments present less incentive to use a patient's SDOH in medical decision making.
What is being done to promote cultural sensitivity in healthcare settings? To find answers and solutions to the widespread deficit of cultural competence in the health care industry, this case study interviews a varied sample of five physicians consisting of three men and two women in clinical, academic, and administrative positions. The hypothesis was physicians do not receive cultural sensitivity training in medical school and as a result, they have to find other ways to learn about the cultures of their patients. None of the participants had received formal cultural competency training in medical school and all of them found methods to improve their cultural literacy. The study uncovered the cultural training physicians do receive is sporadic and inconsistent, which can cause some disconnect between education and real-life clinical practice. Many solutions to improve cultural competency in health care delivery are presented. The results of this exploratory research should be used to inspire future conversations about cultural competency in health care as well as the creation of support and educational services and materials to medical students and health care workers on improving cultural sensitivity in clinical practice.
As 2020 unfolded, a new headline began taking over front pages: “COVID-19”. In the months that followed, waves of fear, sorrow, isolation, and grief gripped the population in the viruses’ wake. We have all heard it, we have all felt it, indeed because we were all there. Trailing a few months behind those initial headlines, more followed that only served to breed misinformation and ludicrous theories. Even with study after study, quality, scientific data about this new virus could not come fast enough. There was somehow both too much information and also not enough. We were scrambling to process the abundance of raw numbers into some semblance of an explanation. After those first few months of the pandemic, patterns in the research are beginning to emerge. These horrific patterns tell much more than just the pathology of COVID-19. As the number of sick, surviving, and deceased patients began to accumulate, it became clear that some populations were left devastated, while others seemed unscathed. The reasons for these patterns were present long before the COVID-19 Pandemic. Disparities in health care were highlighted by the pandemic – not caused by it. The roots of these disparities lie in the five Social Determinants of Health (SDOH): (1) economic stability, (2) neighborhood and built environment, (3) education, (4) social and community context, and (5) health and health care. Minority populations, namely Black Americans, Hispanic Americans, Native Americans, and Pacific Islanders consistently have higher diagnosis rates and poorer patient outcomes compared to their White American and Asian American counterparts. This is partly because minority populations tend to have jobs that pay lower, increase exposure risk, and provide little healthcare. When unemployment increased in the wake of the pandemic, minorities were the first to lose their jobs and their health insurance. In addition, these populations tend to live in densely populated neighborhoods, where social isolation is harder. Higher poverty rates encourage work DISPROPORTIONATE EFFECTS OF COVID-19 ON MINORITY POPULATIONS 3 rather than education, often perpetuating the cycle. The recent racial history and current aggressions towards minority people might produce a social attitude against healthcare Health care itself can be expensive, hard to find, and/or tied to employment, leading to poorly controlled comorbidities, which exacerbate poor patient outcomes in the case of COVID-19 infection. The healthcare delivery system plays little part in the SDOH, instead, public policy must be called to reform in order to fix these issues.
In January of 2020, the first cases of COVID-19 were recorded in the United States with one of them being an Arizona State University student. Since these initial cases, over 2.4 million more cases have been recorded in Arizona alone. As of March of 2020, Arizona State University Ambulatory Health Services moved to adjust their healthcare delivery methods in response to the COVID-19 pandemic. We aim to identify areas of ASU Ambulatory Health Services as of March of 2020 that need improvement based on an anonymous survey carried out among ASU students, faculty, and staff. The survey was created through Survey Monkey and consisted of 20 questions about the participant’s experience with ASU’s Ambulatory Health Services; while the survey was being created, a literature review was being conducted concerning ASU’s health care delivery in the past and the health care delivery in the greater Maricopa County region. The overall consensus of the 54 participants who took the survey was that approximately 55% of participants had an overall very satisfactory experience through ASU Ambulatory Health Services with a net promoter score of 87% satisfaction and approximately 47% of participants were very likely to recommend ASU Ambulatory Health Services with a net promoter score of about 79%. Most participants reported overall satisfactory experiences but when asked for further commentary they provided more specific criticisms of their experience that could be improved. The specific frustrations that were mentioned were issues with insurance, lack of awareness with available services, instructions on updated regulations and scheduling, and issues with patients’ visits being logged into their medical records. We recommend that ASU Ambulatory Health Services improve in these areas highlighted by the survey answers; as most of these issues are results from communication issues between ASU Ambulatory Health Services and the public, we suggest better means of communication between the public and the health services.
In January of 2020, the first cases of COVID-19 were recorded in the United States with one of them being an Arizona State University student. Since these initial cases, over 2.4 million more cases have been recorded in Arizona alone. As of March of 2020, Arizona State University Ambulatory Health Services moved to adjust their healthcare delivery methods in response to the COVID-19 pandemic. We aim to identify areas of ASU Ambulatory Health Services as of March of 2020 that need improvement based on an anonymous survey carried out among ASU students, faculty, and staff. The survey was created through Survey Monkey and consisted of 20 questions about the participant’s experience with ASU’s Ambulatory Health Services; while the survey was being created, a literature review was being conducted concerning ASU’s health care delivery in the past and the health care delivery in the greater Maricopa County region. The overall consensus of the 54 participants who took the survey was that approximately 55% of participants had an overall very satisfactory experience through ASU Ambulatory Health Services with a net promoter score of 87% satisfaction and approximately 47% of participants were very likely to recommend ASU Ambulatory Health Services with a net promoter score of about 79%. Most participants reported overall satisfactory experiences but when asked for further commentary they provided more specific criticisms of their experience that could be improved. The specific frustrations that were mentioned were issues with insurance, lack of awareness with available services, instructions on updated regulations and scheduling, and issues with patients’ visits being logged into their medical records. We recommend that ASU Ambulatory Health Services improve in these areas highlighted by the survey answers; as most of these issues are results from communication issues between ASU Ambulatory Health Services and the public, we suggest better means of communication between the public and the health services.