Research Triangle Institute Research Articles

996-P: Cost-Effectiveness of Sugar-Sweetened Beverage Tax Policies in California—A Microsimulation Study

Sugar-sweetened beverage (SSB) consumption is associated with increased risk of diabetes and cardiovascular diseases. In California, state-wide SSB taxes were proposed to reduce its consumption. We projected the health and economic consequence of imposing a state-wide SSB excise tax of $0.01/ounce over 10 years in California, using the Microsimulation of Nutrition, Diabetes and Cardiovascular Disease (MONDAC) developed by Centers for Disease Control and Prevention and RTI International. The MONDAC model is a validated microsimulation model to track user-defined dietary changes on downstream outcomes: body-mass index, diabetes incidence, cardiovascular disease (CVD) incidence, all-cause mortality, quality-adjusted life-years (QALYs), direct medical costs, and cost-effectiveness. We generated a California representative sample aged ≥ 18 years based on data from the 2011-2014 National Health and Nutrition Examination Survey and 2018 census. Data on reduction of the SSB consumption (by 20%) and program’s costs resulting from the $0.01/ounce SSB taxes were from published literature. We found that imposing a $0.01-per-ounce excise SSB tax in California would reduce diabetes, CVD, deaths and healthcare costs but increase QALYs, thus this policy would be cost-saving (Table). Disclosure Y.Chen: None. G.Imperatore: None. D.B.Rolka: None. B.T.Allaire: None. S.J.Onufrak: None. C.S.Holliday: None. P.Zhang: None.

Building Evidence for Principles to Guide the Development of Products for Adults with Intellectual and Developmental Disabilities and Extreme Low Literacy-A Product Development Tool.

This article presented a new product development tool for adults with intellectual and developmental disabilities (IDD) developed by the Centers for Disease Control and Prevention (CDC). People with IDD who also have extreme low literacy (ELL) have unique communication needs; public health communicators often face challenges developing effective communication materials for this audience. To support CDC communication specialists with the development of communication products for adults with IDD/ELL, CDC, with its partners RTI International and CommunicateHealth, created a product development tool for this audience through literature review, expert input, and interviews with adults with IDD/ELL and caregivers of adults with IDD/ELL. To build evidence around the principles described in the tool, RTI conducted interviewer-administered surveys with 100 caregivers who support people with IDD/ELL. During the interviews, we presented caregivers with stimuli (portions of a communication product) that either did or did not apply a single principle and asked which would be easier for the person they support to understand. Across all 14 principles tested, the caregiver respondents indicated that the principle-based version would be easier for the person they support to understand compared with the non-principle-based version(s). These findings provide additional evidence to support the principles included in CDC's Tool for Developing Products for People with IDD/ELL.

Patient-provider communication factors associated with mt-sDNA screening for colorectal cancer.

e22514 Background: Several colorectal cancer (CRC) screening tests, shown to reduce CRC incidence and mortality, are recommended for average-risk adults aged 45-75 years. CRC screening is underutilized in the US with access to facility-based options, such as colonoscopy, representing a barrier to screening. Stool-based tests are guideline-endorsed and offer patients a convenient and more accessible CRC screening option that can be completed at home. Provider recommendation is consistently identified as the primary factor driving patient adherence. Understanding how aspects of patient-provider communication influence CRC screening can inform interventions to improve adherence. We developed a survey, informed by behavioral theory, to identify communication factors associated with completion of mt-sDNA screening. Methods: Adults aged 45-75 years, with a US postal address, who received a valid order for mt-sDNA and whose kit was shipped between 5/21-9/21 were eligible for sampling. The survey was administered by RTI International between 3/22-6/22. Participants could complete electronic or paper surveys. We fit a multivariable logistic regression to identify patient-provider communication factors associated with mt-sDNA test completion. Results: 2,973 respondents completed the survey (response rate = 21.7%). The majority (77.3%) completed the mt-sDNA test and said they would be ‘very likely’ (76.8%) to complete Cologuard in the future. The proportion of respondents who had conversations with their healthcare provider about Cologuard, and the specific content of those conversations, was significantly different between completers and non-completers and between respondents who said they were ‘very likely’ to complete Cologuard in the future compared to respondents who were not. Results from a binary logistic regression suggested that discussions with a healthcare provider related to step-by-step instructions for completing Cologuard (OR = 1.62) and needing to have a colonoscopy follow-up (OR = 1.93), as well as feeling included ‘a great deal’ in the decision-process with respondents’ healthcare provider (compared to ‘somewhat’ or ‘not at all’) increase the odds of kit completion. Additionally, healthcare provider discussions relating to test cost (OR = 1.47) and performance (OR = 1.72), as well as feeling included ‘a great deal’ in the decision-process was positively associated with respondents indicating they were ‘very likely’ to use Cologuard in the future. Provider discussions about the cost of a follow-up colonoscopy was negatively associated with a ‘very likely’ future user (OR = 0.52). Conclusions: Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

Straddling the Fields of Disaster Preparedness and Disaster Epidemiology: Lessons Learned from Planning a Study for Implementation Within Weeks of an Unpredictable Natural Disaster

Introduction:Studies on the impact of disasters on communities often occur months to years after the event. Pre- and peri-event details collected from participants may be imprecise or even unobtainable as memory is affected by time. More so, delays in data collection can introduce recall bias when participants with adverse outcomes provide differential responses about exposure. In 2019, the US Centers for Disease Control (CDC) and RTI International designed a study to mitigate these issues by surveying within weeks of a natural disaster to examine associations of preparedness to peri-event exposures, emergency services, and health.Method:Given the unpredictability of natural disasters, a significant challenge for the team was to plan a rigorous study design applicable to several types of severe weather events. This presentation will review our forethought, planning, and resulting strategy, including important considerations related to IRB and OMB applications with unspecified disaster/location details. We will share decision-making on sampling, instrumentation, communication materials, and multi-mode data collection procedures. The impact of delays due to COVID-19 and waiting to select a disaster that met a prior disaster inclusion/exclusion criteria will also be presented.Results:Results are forthcoming. We will present details on RTI’s 2022 survey implementation in the Fort Myers area of Florida within weeks of Hurricane Ian landfall including information on our final sampling strategy, field period, and outcome rates among key community groups and exposures.Conclusion:Conclusions will be presented. Pragmatic lessons learned related to timeline, labor, and other resources will be used to compare our strategy to rapid needs assessment methodology as well as more typical self-report surveys with later post-disaster data collection periods. Researchers working in emergency preparedness/response and disaster epidemiology will have gained a solid understanding of the advantages and disadvantages to planning studies for the immediate aftermath of undefined disasters.

Exploring the Experience of Neck Pain in Individuals With Episodic Migraine (P3-12.004)

Exploring the Experience of Neck Pain in Individuals With Episodic Migraine (P3-12.004)

Abstract 770: Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control

Abstract Background: Multiple guideline-recommended colorectal cancer (CRC) screening options have been shown to reduce CRC incidence and mortality among average-risk patients. Yet, CRC screening continues to be underutilized in the US. Provider recommendation has consistently shown to improve screening completion. Our study aimed to delineate the pathways through which provider communication influences CRC screening completion. We tested how provider communication about the "Why” and “How” of mt-sDNA screening contributes to mt-sDNA screening intention through influencing patients’ screening outcome expectancies and perceived behavioral control. Methods: Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. The survey was administered between 3/22-6/22 by RTI International, with a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/21-9/21. Participants completed an electronic or paper survey. We measured patients’ reports of providers’ “Why” communication with items on mt-sDNA screening performance, advantages/disadvantages, and cost. Providers’ “How” communication was measured with items on instructions and need for follow-up testing. We tested the proposed relationships using structural equation modeling and tested indirect effects using bootstrapping. Results: A total of 2973 participants completed the survey (response rate: 21.7%). “Why” communication was positively associated with perceived effectiveness of mt-sDNA screening (b = 0.349, p < .001) and negatively associated with CRC worry (b = -0.078, p = .002). “How” communication was positively associated with perceived ease of use (b = 0.392, p < .001) and perceived comfort of mt-sDNA screening (b = 0.138, p < .001). Perceived effectiveness and perceived ease of use were positively associated with intention to complete mt-sDNA screening (b = 0.404, p < .001; b = 0.339, p < .001). “Why” communication contributed to screening intention through influencing perceived effectiveness (b-indirect effect = 0.141, 95% CI: 0.115, 0.177). “How” communication contributed to screening intention through influencing perceived ease of use (b-indirect effect = 0.133, 95% CI: 0.104, 0.172). Conclusions: Improving patients’ beliefs about the effectiveness and ease of use of screening may be one pathway through which provider communication contributes to CRC screening completion. Efforts are needed to develop and implement provider-patient communication strategies and toolkits that are efficacious at fostering patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients’ self-efficacy in completing their preferred screening option. Citation Format: Xuan Zhu, Paul Limburg, Linda Squiers, Leah Helmueller, Gabriel Madson, Brian Southwell, Carlye Gates, Shama Alam, Jennifer Laffin, Lila Finney Rutten. Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 770.

Hospice Quality, Race, and Disenrollment in Hospice Enrollees With Dementia.

Background: Racial and ethnic minoritized people with dementia (PWD) are at high risk of disenrollment from hospice, yet little is known about the relationship between hospice quality and racial disparities in disenrollment among PWD. Objective: To assess the association between race and disenrollment between and within hospice quality categories in PWD. Design/Setting/Subjects: Retrospective cohort study of 100% Medicare beneficiaries 65+ enrolled in hospice with a principal diagnosis of dementia, July 2012-December 2017. Race and ethnicity (White/Black/Hispanic/Asian and Pacific Islander [AAPI]) was assessed with the Research Triangle Institute (RTI) algorithm. Hospice quality was assessed with the publicly-available Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey item on overall hospice rating, including a category for hospices exempt from public reporting (unrated). Results: The sample included 673,102 PWD (mean age 86, 66% female, 85% White, 7.3% Black, 6.3% Hispanic, 1.6% AAPI) enrolled in 4371 hospices nationwide. Likelihood of disenrollment was higher in hospices in the lowest quartile of quality ratings (vs. highest quartile) for both White (adjusted odds ratio [AOR] 1.12 [95% confidence interval 1.06-1.19]) and minoritized PWD (AOR range 1.2-1.3) and was substantially higher in unrated hospices (AOR range 1.8-2.0). Within both low- and high-quality hospices, minoritized PWD were more likely to be disenrolled compared with White PWD (AOR range 1.18-1.45). Conclusions: Hospice quality predicts disenrollment, but does not fully explain disparities in disenrollment for minoritized PWD. Efforts to improve racial equity in hospice should focus both on increasing equity in access to high-quality hospices and improving care for racial minoritized PWD in all hospices.

The Idaho Student Homicides and the Future of Forensic Genetic Genealogy

The Idaho Student Homicides and the Future of Forensic Genetic Genealogy

Multi-Laboratory Evaluation of Prototype Dried Blood Spot Quality Control Materials for Creatine Kinase-MM Newborn Screening Assays

Pilot studies to detect newborns with Duchenne Muscular Dystrophy (DMD) by newborn bloodspot screening (NBS) have been conducted under the New York State Newborn Screening Program (NYS) and are currently in progress as part of the Early Check Program at Research Triangle Institute (RTI) International. The Newborn Screening Quality Assurance Program (NSQAP) at the U.S. Centers for Disease Control and Prevention (CDC) produced a set of seven prototype dried blood spot (DBS) reference materials spiked with varying levels of creatine kinase MM isoform (CK-MM). These DBS were evaluated over a 3-week period by CDC, NYS, and RTI, all using the same CK-MM isoform-specific fluoroimmunoassay. Results from each laboratory were highly correlated with the relative proportion of CK-MM added to each of the six spiked pools. Based on reference ranges established by NYS and RTI for their pilot studies, these contrived DBS collectively spanned the CK-MM ranges found in typical newborns and the elevated ranges associated with DMD. This set allows quality assessment over the wide range of fluctuating CK-MM levels in typical and DMD-affected newborns.

Business Roundup

BUSINESS Business Roundup ShareShare onFacebookTwitterWechatLinked InRedditEmail C&EN, 2023, 101 (5), p 13February 6, 2023Cite this:C&EN 101, 5, 13AbstractQuaker Houghton , which makes industrial process fluids, has signed a contract with Constellation Energy to purchase renewable energy certificates. The certificates will match half of Quaker Houghton’s electricity needs. Ube will almost double capacity for polyimide hollow fibers at its facility in Ube, Japan. The company says demand for the fibers is growing for use in membranes that separate CO 2 from biogas. Syzygy Plasmonics will work with the nonprofit research institute RTI International to demonstrate the production of low-carbon fuel from carbon dioxide and methane. The pilot facility will combine Syzygy’s photocatalytic reactor with RTI’s Fischer-Tropsch synthesis system. Albemarle has launched a stand-alone subsidiary, Ketjen, to supply its catalysts for the petrochemical, refining, and specialty chemical industries. Albemarle says Ketjen aims to support manufacturers transitioning from fluidized catalytic cracking to clean fuels and hydroprocessing.  Valero Energy and Darling Ingredients have approved plans to build a $315 millionView: PDF | Full Text HTML

Enhanced Identification of Hispanic Ethnicity Using Clinical Data: A Study in the Largest Integrated United States Health Care System.

Collection of accurate Hispanic ethnicity data is critical to evaluate disparities in health and health care. However, this information is often inconsistently recorded in electronic health record (EHR) data. To enhance capture of Hispanic ethnicity in the Veterans Affairs EHR and compare relative disparities in health and health care. We first developed an algorithm based on surname and country of birth. We then determined sensitivity and specificity using self-reported ethnicity from the 2012 Veterans Aging Cohort Study survey as the reference standard and compared this to the research triangle institute race variable from the Medicare administrative data. Finally, we compared demographic characteristics and age-adjusted and sex-adjusted prevalence of conditions in Hispanic patients among different identification methods in the Veterans Affairs EHR 2018-2019. Our algorithm yielded higher sensitivity than either EHR-recorded ethnicity or the research triangle institute race variable. In 2018-2019, Hispanic patients identified by the algorithm were more likely to be older, had a race other than White, and foreign born. The prevalence of conditions was similar between EHR and algorithm ethnicity. Hispanic patients had higher prevalence of diabetes, gastric cancer, chronic liver disease, hepatocellular carcinoma, and human immunodeficiency virus than non-Hispanic White patients. Our approach evidenced significant differences in burden of disease among Hispanic subgroups by nativity status and country of birth. We developed and validated an algorithm to supplement Hispanic ethnicity information using clinical data in the largest integrated US health care system. Our approach enabled clearer understanding of demographic characteristics and burden of disease in the Hispanic Veteran population.

Commentary: Improving the Effectiveness and Utility of the Helping to End Addiction Long-Term (HEAL) Prevention Cooperative: A Full Translational Framework.

The Helping to End Addiction Long-term (HEAL) Prevention Collaborative (HPC) is designed to expedite the development of programs aimed at preventing opioid misuse and opioid use disorder (OUD) in older adolescents and young adults (ages 16-30). Funded by the National Institutes of Health Office of the Director (ODP-NIH), the HPC includes ten outcome studies that focus on distinct interventions to determine their effectiveness and real-world applicability. Also included is a coordinating center at RTI International that supports the individual projects. This commentary highlights the scientific and practical significance of this cooperative and its promise for facilitating the production and implementation of successful interventions. Attributes such as novel program designs, advanced methodologies, addressing unique characteristics of diverse populations, and real-time analysis of data and costs make this cooperative highly innovative. We note, however, that papers in this Supplemental Issue did not specifically address the persistent need to obtain stronger effect sizes than those achieved to date. Existing data captured earlier in development (< 16years of age) are uncovering interactive neurocognitive and social-contextual mechanisms underlying the phenomena we wish to prevent. HPC projects could be guided by this information to incorporate developmentally appropriate measures of mechanisms shown previously to be influential in targeted outcomes and determine how they are impacted by specific components of their interventions. This mechanistic information can provide a roadmap for constructing interventions that are more precision-based and, thus, more likely to yield greater benefits for a larger number of recipients. Furthermore, an understanding of underlying mechanism(s) promises to shed light on the sources of heterogeneity in outcomes for further intervention refinement. It is quite possible, if not probable, that meaningful measures of underlying processes will reveal subtypes-some with very high effect sizes and others that are much lower-directly enabling program refinements to more directly target mechanisms that portend and explain less favorable outcomes. Described herein is a full-spectrum translational approach which promises to significantly boost effect sizes, a key objective that should be reached prior to scaling.

PHYSICAL FUNCTION AMONG OLDER ADULTS AND CAREGIVERSARTHRITIS AMONG CAREGIVERS—BRFSS 2017, 2019

Abstract Unpaid caregivers are people who provide support to a family member or friend with a health condition or disability. While there are benefits to caregiving, it can negatively affect caregivers’ physical and mental health. Arthritis and caregiving affect 58.5 million and 53 million U.S. adults, respectively, and these numbers are expected to increase with increasing numbers of older adults. Little is known about the experience of caregivers with arthritis.Data from the 2017 and 2019 BRFSS were combined for all states that administered the optional Caregiving and the core Arthritis modules (17 states; n=91,224). Analyses accounted for the complex sampling design using SUDAAN (version 11.0; RTI International). Statistical significance was determined at α=0.05.Overall, 20.6% of respondents were caregivers, among whom 35.1% had arthritis compared with 24.5% of non-caregivers (p &amp;lt; 0.001). Arthritis among caregivers was higher in all 17 states compared to non-caregivers. Among adults with arthritis, caregivers were more likely to be younger, female, White, and more physically active than non-caregivers. Caregivers were also more likely to experience arthritis-related activity and work limitations than non-caregivers. Arthritis-related limitation outcomes varied at the individual state levels.Among caregivers, those with arthritis provided more care in weekly hours and duration (years) and were more likely to report difficulty walking or climbing stairs, dressing or bathing, and doing errands alone than caregivers without arthritis. Given the disparities between caregivers with and without arthritis, it is crucial for public health to collect data on the experience of caregivers with arthritis.

NURSING FACILITY QUALITY, CLOSURES, AND STAFFING

Abstract The quality of care provided in nursing facilities has long been a societal concern and an important focus of policy at the federal and state level. The COVID-19 pandemic has drawn increased attention to nursing facilities due to high infection and mortality rates as well as increased media attention on staffing shortages that have occurred in the wake of the pandemic. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) and RTI International have recently completed a series of studies focused on nursing facility quality and staffing. This symposium will present the results of four of those studies. First, we will report the results of a study exploring states’ use of value-based payment (VBP) programs as part of their nursing facility Medicaid payment systems. Second, we will present the results of a study examining inappropriate discharges from nursing facilities. Third, we will report findings from a study that examined the factors associated with nursing facility closures. Finally, we will present findings from a study that explored the effect of the pandemic on nursing facility staffing. Together these studies provide important information about the state of nursing facilities in the wake of the COVID-19 pandemic and suggest key areas of focus for policymakers.

POLICY ATTENTION NEEDED TO IMPROVE DIRECT CARE WORKER WAGES AND OTHER CHALLENGES

Abstract Direct care workers (DCWs), including nursing assistants, home health aides, and personal care assistants, play an essential role in the health and well-being of over 20 million Americans who receive long-term services and supports (LTSS) at home, in nursing facilities, and other settings. In 2020, nearly 4 million DCWs supported older adults and people with disabilities in completing self-care and other daily tasks. Their efforts require considerable technical and interpersonal skills, but these essential workers receive low pay and rarely receive benefits. The COVID-19 pandemic has increased the attention paid to DCWs in the media and among policymakers. This symposium presents the results of three studies conducted by RTI International and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) focused on DCWs. First, we present the results of a study examining how the wages of DCWs compare to the wages of other entry-level workers across all 50 states and report the effect of state policies aimed at improving DCW wages. Second, we report findings from a study exploring the experiences of home care aides during the pandemic as well as the federal and state policies implemented to assist these DCWs during the pandemic. Finally, we present the results of a study that assessed the effect of the COVID-19 pandemic on DCW staffing in nursing facilities. Together these studies suggest that more policy attention is needed to improve direct care work and attract the millions of additional DCWs that are expected to be needed in coming years.

1659. Association of Rurality and Identifying as Black with Receipt of Specialty Care among Patients Hospitalized with Diabetic Foot Ulcers: a Medicare cohort study

Abstract Background Among those with diabetic foot ulcers, rural patients identifying as Black face at least 10% greater risk of major amputation or death compared to the US as a whole. As specialty care is associated with lower risk of major amputation, this difference could be driven by specialty care access. We hypothesize that rural patients and, particularly, rural patients identifying as Black, receive less inpatient specialty care compared to the overall cohort. Methods We built a cohort of all Medicare patients hospitalized with diabetic foot ulcers (2013–2014). Rurality was measured using Rural Urban Commuting Area codes. Race was categorized using the Research Triangle Institute algorithm. Specialty care was defined as receiving inpatient care from at least 1 of 6 relevant specialties to address diabetes, infection, biomechanics or vascular disease, per National Provider Taxonomy codes: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. We reported observed differences in specialty care, overall and stratified by rurality, identifying as Black, and ulcer severity. Pearson X2 tests were performed on observed frequencies. Results Overall, 32.2% of the cohort received inpatient specialty care. This proportion decreased to 29.6% for rural patients (X2 = 36.2, p ≤ 0.001) and 26.2% for rural patients identifying as Black (X2 = 19.5, p ≤ 0.001). Among those with osteomyelitis, 54.3% of the cohort received specialty care, while only 49.5% of rural patients, 50.8% of patients identifying as Black, and 37.6% of rural patients identifying as Black received specialty care; the disparity for rural patients identifying as Black was greater than the sum of rural and racial disparities (4.8% for rural + 3.5% for Blacks = 8.3% versus a 16.7% observed difference for rural Blacks; Figure 1). Notably, only 2.7% of patients presenting with osteomyelitis were seen by an infectious disease specialist. This proportion decreased to 2.5% for rural patients. Observed Proportions of Patients Receiving Specialty Care Stratified by Rurality, Identifying as Black, and Ulcer Severity Conclusion A smaller proportion of rural patients received specialty care, and rural patients identifying as Black were half as likely to receive specialty care than the overall cohort. Improving specialty access for these high-risk patients may reduce disparities in major amputations. Disclosures All Authors: No reported disclosures.

Exposure to Household Air Pollution (HAP) and measures of central hemodynamic parameters among Bangladeshi population- A cross-sectional study.

Household Air Population (HAP) has been linked to an array of adverse health hazards, including cardiovascular mortality and morbidity. We have assessed whether household air pollution (HAP) is associated with hemodynamic parameters as part of the Bangladesh Global Environmental and Occupational Health (GEO Health) project. We assessed central hemodynamic parameters-Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Heart rate (HR) using a standard cuff sphygmomanometer (Omron) and Mean Arterial Pressure (MAP) and Pulse Pressure (PP) using the standard formula. The exposures to particulate matter &amp;#x3c; 2.5µm (PM2.5) and Black Carbon (BC) from biomass fuel were measured for 24 hours using a personal monitor, RTI MicroPEM (RTI International, NC), among healthy, non-smoking women (n=400) and men (n=200). A multiple linear regression model adjusted for potential confounders was used to examine the association between HAP exposures and hemodynamic outcomes. The average 24-hour PM2.5 concentration was 167.7 &amp;#x3bc;gm-3 for females and 98.0&amp;#x3bc;gm-3 for males. The average 24-hour concentration of BC was 14.1&amp;#x3bc;gm-3 for females and 10.3&amp;#x3bc;gm-3 for males. In the adjusted multivariable regression model, an 1% increase in BC resulted in a 1.6 mm of Hg reduction in MAP (95% CI: -3.24, -.03 mm of Hg, P=0.04), 2.8 mm of Hg increase in PP (95% CI: 1.55, 4.22 mm of Hg, P=0.00) and 2.6 mm of Hg reduction in DBP (95% CI: -4.09, -1.10 mm of Hg, P=0.00). No association was observed between BC and SBP as well as BC and HR. PM2.5 was not associated with any of the hemodynamic parameters even after adjusting for age, cooking duration, household income, and Body mass index (BMI). This population-based study provides evidence that exposure to HAP (BC) is linked with central hemodynamic parameters, especially MAP and PP, which have negative implications for cardiovascular health when they become high and low. HAP, Hemodynamics, Bangladesh

Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015-2019.

The 2014–2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners—International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization—worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.

Evaluation of the Fast Prior Authorization Technology Highway

BackgroundPrior authorization (PA) is a utilization management tool used by health plans and pharmacy benefit managers where the payer requires additional documentation from health care providers before authorization of payment for a medication or procedure. PA processes are hypothesized to be more efficient if electronic transmission is utilized instead of manual submission. ObjectiveTo evaluate the impact of electronic PA (ePA) on approval rate and time to decision and to assess health care provider perception of using ePA. MethodsAmerica’s Health Insurance Plans selected 2 technology companies, Availity and Surescripts, and used an independent research organization (Research Triangle Institute [RTI]) to conduct a provider survey and analyze over 40,000 PA transactions from participating health plans. RTI examined processing time, provider experience, and other measures for PAs both before and after provider implementation of ePA. ResultsProviders used these tools for roughly 62% of PAs in the 6 months after implementation. The median time from PA request to decision fell from 18.7 hours to 5.7 hours. Providers using ePA reported observing some benefits relative to the number of phone calls and faxes required after ePA implementation. ConclusionThe primary benefit of ePA implementation was reduced time to decision. Additional benefits may occur with greater adoption since 38% of PAs were still manual after implementation of ePA.

Results of the 2019 Survey of Engineered Nanomaterial Occupational Health and Safety Practices.

In collaboration with RTI International, the U.S. National Institute for Occupational Safety and Health (NIOSH) administered a survey to North American companies working with nanomaterials to assess health and safety practices. The results would contribute to understanding the impact of the efforts made by the NIOSH Nanotechnology Research Center (NTRC) in communicating occupational health and safety (OHS) considerations for workers when handling these materials. The survey, developed by RAND Corporation, was conducted online from September 2019–December 2019. Forty-five companies or organizations in the U.S. and Canada that fabricate, manufacture, handle, dispose, or otherwise use nanomaterials completed the survey. The survey was designed to answer research questions regarding the nanomaterials in use, which resources the companies have consulted for OHS guidance, and the overall OHS culture at the companies. Other questions specifically addressed whether the companies interacted with NIOSH or NIOSH resources to inform OHS policies and practices. Among participating companies, 57.8% had a maximum of 50 employees. Gold nanoparticles and polymers were most common (n = 20; 45.5% each), followed by graphene (36.4%), carbon nanotubes and nanofibers (34.1%), and zinc oxide nanoparticles (31.8%). Environmental monitoring was performed by 31.8% of the companies. While 88.9% of the companies had laminar flow cabinets, only 67.5% required it to be used with ENMs. Information and training programs were indicated by 90% of the sample, and only 29.6% performed specific health surveillance for ENM workers. Personal protective equipment primarily included gloves (100%) and eye/face protection (97.7%). More than a third (37.8%) of the respondents reported using at least one NIOSH resource to acquire information about safe handling of ENMs. The small number of companies that responded to and completed the survey is a considerable limitation to this study. However, the survey data are valuable for gauging the reach and influence of the NIOSH NTRC on nano OHS and for informing future outreach, particularly to small businesses.