Characterizing dynamic atmosphere generation system performance for analytical method development.

A significant portion of the work of developing and validating methods for volatile organic compound (VOC) sampling in workplace atmospheres involves the use of laboratory-generated atmospheres. The sample variability was evaluated from the dynamic atmosphere generation system used for VOC atmosphere generation and sampling. Characterization of the bias and variability of samples was done for a variety of atmospheres containing neat n-heptane and mixtures of VOCs sampled on activated coconut shell charcoal.

Evaluation of propylene glycol methyl ether as a potential challenge agent for leak detection of liquid and headspace from closed system drug transfer devices using Fourier transform infrared spectroscopy.

Choosing an appropriate surrogate of hazardous drugs for use in testing Closed System Drug-Transfer Devices (CSTDs) is a challenging endeavor with many factors that must be considered. It was suggested that the compound propylene glycol methyl ether (PGME) may meet many of the criteria we considered important in a suitable surrogate. Criteria included sufficient volatility to evaporate from aqueous liquid leaks efficiently, a Henry's constant which produced sufficient vapor phase concentrations to make headspace leaks detectable, and suitability for detection using a low-cost detection system.

Method development for on-site monitoring of volatile organic compounds via portable TD-GC-MS: evaluation of the analytical performances of HAPSITE ER instrumentation and thermal desorption sampling media.

Determining worker exposure to hazardous volatile organic compounds (VOCs) in air at levels exceeding the Permissible Exposure Limits and Recommended Exposure Limits established by the U.S. federal agencies of Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), respectively, will continue to be an important part of environmental and occupational health risk assessments.

Pragmatic Randomized Study of Targeted Text Message Reminders to Reduce Missed Clinic Visits.

Introduction: Missed clinic appointments ("no-shows") waste health system resources, decrease physician availability, and may worsen patient outcomes. Appointment reminders reduce no-shows, though evidence on the optimal number of reminders is limited and sending multiple reminders for every visit is costly. Risk prediction models can be used to target reminders for visits that are likely to be missed.

A roadmap to operationalize and evaluate impact in a learning health system.

Background: Many health systems invest in initiatives to accelerate translation of knowledge into practice. However, organizations lack guidance on how to develop and operationalize such Learning Health System (LHS) programs and evaluate their impact. Kaiser Permanente Washington (KPWA) launched our LHS program in June 2017 and developed a logic model as a foundation to evaluate the program's impact.

Nanoparticle assisted nuclear relaxation-based oligonucleotide detection.

We present a proof-of-concept "on-off" detection scheme, which uses gadolinium phthalocyanine (GdTcPc)-grafted silica nanoparticles as paramagnetic centers, capable of modifying the transverse relaxation time (T) of water protons in solution. A DNA strand (as probe) was conjugated to the GdTcPc to act as a recognition element. In the presence of the target DNA, which was complementary to the probe, an increase in the T value was detected, with magnitude proportional to the target DNA concentration.

Plasmon-enhanced triplet-triplet annihilation upconversion of post-modified polymeric acceptors.

We report the localized surface plasmon resonance (LSPR)-enhanced triplet-triplet annihilation upconversion (TTA-UC) of polymeric acceptors containing high percentages of acceptor units. A poly[(methyl methacrylate)-co-(glycidyl methacrylate)] copolymer series with increasing glycidyl methacrylate ratio was prepared using reversible addition-fragmentation chain transfer (RAFT) polymerization. After post-modification of the glycidyl group with anthracene, the acceptor unit, a series of poly[(methyl methacrylate)-co-(2-hydroxypropyl-9-anthroate methacrylate)] (polyACA) was produced with different numbers of acceptor units.

Acidotoxicity via ASIC1a Mediates Cell Death during Oxygen Glucose Deprivation and Abolishes Excitotoxicity.

Ischemic reperfusion (I/R) injury is associated with a complex and multifactorial cascade of events involving excitotoxicity, acidotoxicity, and ionic imbalance. While it is known that acidosis occurs concomitantly with glutamate-mediated excitotoxicity during brain ischemia, it remains elusive how acidosis-mediated acidotoxicity interacts with glutamate-mediated excitotoxicity. Here, we investigated the effect of acidosis on glutamate-mediated excitotoxicity in acute hippocampal slices.

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties.

Background: A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation.

Improvements in glycemic control after gastric bypass occur despite persistent adipose tissue inflammation.

Objective: Type 2 diabetes commonly goes into remission following Roux-en-Y gastric bypass (RYGB). As the mechanisms remain incompletely understood, a reduction in adipose tissue inflammation may contribute to these metabolic improvements. Therefore, whether RYGB reduces adipose tissue inflammation compared with equivalent weight loss from an intensive lifestyle intervention was investigated.

Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial.

Aims/hypothesis: Mounting evidence indicates that Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes, but randomised trials comparing surgical vs nonsurgical care are needed. With a parallel-group randomised controlled trial (RCT), we compared RYGB vs an intensive lifestyle and medical intervention (ILMI) for type 2 diabetes, including among patients with a BMI <35 kg/m(2).

Methods: By use of a shared decision-making recruitment strategy targeting the entire at-risk population within an integrated community healthcare system, we screened 1,808 adults meeting inclusion criteria (age 25-64, with type 2 diabetes and a BMI 30-45 kg/m(2)).

Learning About Missing Data Mechanisms in Electronic Health Records-based Research: A Survey-based Approach.

Background: Bias due to missing data is a major concern in electronic health record (EHR)-based research. As part of an ongoing EHR-based study of weight change among patients treated for depression, we conducted a survey to investigate determinants of missingness in the available weight information and to evaluate the missing-at-random assumption.

Methods: We identified 8,345 individuals enrolled in a large EHR-based health care system who had monotherapy treatment for depression from April 2008 to March 2010.

Antipsychotic medications and extreme weight gain in two health systems.

Objective: We conducted this study to investigate the rate of clinically important, extreme weight gain (EWG; ≥7% body weight gain) among all second generation antipsychotic (SGA) users in two large health care systems in the United States.

Study Design: Retrospective observational cohort study.

Methods: We used electronic medical record databases of two health systems to identify adults aged 18-79 years who from 1 January 2004 to 31 December 2011 had initiated a SGA medication.

Decision aids for benign prostatic hyperplasia and prostate cancer.

Objectives: To examine the relationships among implementing decision aids (DAs) for benign prostatic hyperplasia (BPH) and prostate cancer (PRCA), and treatment rates and costs.

Study Design: A pre-post observational evaluation of a quality improvement initiative in a healthcare system in Washington state.

Methods: Men with BPH seen in urology clinics and all men diagnosed with localized PRCA were identified for an intervention period, in which urologists were instructed to order a DA for every patient with those conditions, and a historical control period.

A population-based, shared decision-making approach to recruit for a randomized trial of bariatric surgery versus lifestyle for type 2 diabetes.

Background: Randomized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients, which may limit the interpretation and generalizability of study findings. The objective of this study was to assess the feasibility of a population-based shared decision-making (SDM) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes.

Methods: Adult members with a body mass index (BMI) between 30 and 45 kg/m(2) taking diabetes medications were identified in electronic databases and underwent a multiphase screening process.

Weight control practices of severely obese patients who are not seeking bariatric surgery.

Objective: We sought to better understand why so few severely obese patients undergo bariatric surgery in the United States.

Design And Methods: We conducted a telephone survey to assess the weight control practices of severely obese patients who were not actively seeking bariatric surgery in Group Health, a health system in Washington State.

Results: Among 295 severely obese participants surveyed (63% response rate), most reported actively working on weight loss (58%), although current use of commercial weight loss programs (10%) and obesity pharmacotherapy (0.

Influence of body mass index on the choice of therapy for depression and follow-up care.

Objective: Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow-up visits.

Design And Methods: Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible.

Incorporating patient decision aids into standard clinical practice in an integrated delivery system.

Background: Randomized controlled trials show that patient decision aids (DAs) can promote shared decision making and improve decision quality. Despite this evidence, integration of DAs into routine clinical practice has proceeded slowly.

Objective: To identify factors that promote or impede integrating DAs into clinical practice in a large health care delivery system.

Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs.

Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State.

Relationship between Obesity, Depression, and Disability in Middle-Aged Women.

BACKGROUND: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions. DESIGN AND METHODS: In this study, 4 641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II).

Relationship between obesity, depression, and disability in middle-aged women.

Background: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions.

Design And Methods: In this study, 4641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II).

Randomized trial of a video-based patient decision aid for bariatric surgery.

The decision to have bariatric surgery should be based on accurate information on possible risks and benefits of all treatment options. The goal of this study was to determine whether a video-based bariatric decision aid intervention results in superior decision quality compared to an educational booklet. We conducted a prospective, randomized controlled trial among adult patients in a single health plan who met standard criteria for bariatric surgery.

Insurance coverage and incentives for weight loss among adults with metabolic syndrome.

Objective: To describe how insured adults with metabolic syndrome respond to various options for insurance coverage and financial incentives for weight management.

Methods And Procedures: Insured adults meeting the criteria for the metabolic syndrome were randomly identified through automated medical records and invited to participate in a telephone-based survey of the acceptability of various weight management programs-with different financial incentives and insurance coverage options-in a health maintenance organization. Multivariable logistic regression models were used to test the relationship between participant characteristics and the odds of being motivated by incentives.