Identifying responders to elamipretide in Barth syndrome: Hierarchical clustering for time series data.

BACKGROUND: Barth syndrome (BTHS) is a rare genetic disease that is characterized by cardiomyopathy, skeletal myopathy, neutropenia, and growth abnormalities and often leads to death in childhood. Recently, elamipretide has been tested as a potential first disease-modifying drug. This study aimed to identify patients with BTHS who may respond to elamipretide, based on continuous physiological measurements acquired through wearable devices. RESULTS: Data from a randomized, double-blind, placebo-controlled crossover trial of 12 patients with BTHS were used, including physiological time series data measured using a wearable device (heart rate, respiratory rate, activity, and posture) and functional scores. The latter included the 6-minute walk test (6MWT), Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue score, SWAY Balance Mobile Application score (SWAY balance score), BTHS Symptom Assessment (BTHS-SA) Total Fatigue score, muscle strength by handheld dynamometry, 5 times sit-and-stand test (5XSST), and monolysocardiolipin to cardiolipin ratio (MLCL:CL). Groups were created through median split of the functional scores into "highest score" and "lowest score", and "best response to elamipretide" and "worst response to elamipretide". Agglomerative hierarchical clustering (AHC) models were implemented to assess whether physiological data could classify patients according to functional status and distinguish non-responders from responders to elamipretide. AHC models clustered patients according to their functional status with accuracies of 60-93%, with the greatest accuracies for 6MWT (93%), PROMIS (87%), and SWAY balance score (80%). Another set of AHC models clustered patients with respect to their response to treatment with elamipretide with perfect accuracy (all 100%). CONCLUSIONS: In this proof-of-concept study, we demonstrated that continuously acquired physiological measurements from wearable devices can be used to predict functional status and response to treatment among patients with BTHS.

Assessing Changes in Blood Pressure Capture in Primary Care Emr Systems during the Covid-19 Pandemic

Background Primary care electronic medical records (EMRs) data can be used to inform health services, disease surveillance, and interventions. However, its utility is reliant on how well variables are captured. The COVID-19 pandemic shifted primary care delivery to virtual care resulting in fewer patients having their blood pressure (BP) checked in office. As such, BP may not be well documented in the structured fields of the EMR. In the EMR, BP's are used to identify patients who have hypertension, assess rates of hypertension screening, and evaluate hypertension management. The purpose of this study was to determine the change in BP documentation during the COVID-19 pandemic. Methods Data for this study were from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a EMR database which contains clinical records from family medicine clinics in Ontario, Canada. Hypertension visits (ICD-9 billing code 401) were assessed pre-pandemic (Jan 2017-Dec 2019) and during the pandemic (Jan 2020-Dec 2021) for structured BP. A sample of 12% of hypertension visits during the pandemic without structured BP measures were reviewed to determine if BP was recorded in an unstructured format. Two abstractors reviewed progress notes of patient charts to identify if BP was recorded. Results were analyzed using descriptive statistics. Results Pre-pandemic, 67% of hypertension visits had a BP recorded in structured fields (OR=4.14, 95% CI: 4.04-4.23), however this significantly decreased during the pandemic with only 33% of cases having a recorded BP (OR=0.24, 95% CI: 0.23-0.24). In the pandemic, 55% of hypertension visits were virtual. In the pandemic, 10% of virtual visits (OR=0.01, 95% CI: 0.01-0.01), versus 59% of in-person visits did have a structured BP (OR=2.48, CI: 2.37-2.60). Abstractors reviewed 3200 hypertension visits without structured BP. 55% of hypertension visits had a BP recorded in the unstructured progress notes. Conclusion There are clear gaps in pandemic BP recordings most likely due to high rates of virtual visits. Given that virtual visits will continue, future research should develop strategies for capturing BP from progress notes in EMR databases.Copyright © 2023 American College of Cardiology Foundation

COVID-19 and policy impacts on the Bangladesh rice market and food security

This research employs a partial equilibrium model to estimate the short- and long-run effects of COVID-19 and rice policies on Bangladesh's rice market and food security. We also analyze the impact of relevant policies in terms of their effectiveness in mitigating stresses stemming from a hypothetical pandemic with a COVID-19-like impact. The results indicate that the effect of COVID-19 on Bangladeshi food security during FY 2019/20 was mixed, as the indicators of food availability improved by 5%, and decreased by 17% for food stability, relative to what they would have been otherwise. Policy simulation results indicate that a higher import tariff improves self-sufficiency status, but undermines rice availability and accessibility by bending the market toward a restrictive trade regime. Results also indicate that unlike stock enhancement policy, closing the existing yield gap improves rice availability, accessibility, and moderates the depressing effect of a future event with repercussions similar to COVID-19, although the yield policy appears more speculative and could be too costly. The insights generated contribute to the understanding of policies that aim to achieve sustainable development goals related to aggregate food security, and build resilience against future shocks akin to COVID-19.

Too Real or Just Real Enough? Service Adaptation and Authenticity Perception in Cross-Cultural Service Encounters: An Abstract

With limited travel in a post COVID-19 world, consumers seek cultural experiences closer to home. Services like ethnic dining provide consumers the opportunity to immerse in a culturally authentic experience not a part of their daily lives (Southworth 2018;Yu et al. 2020). However, to date, research has not determined how authentic is authentic enough or if customer need some adaptation of the service encounter to their own culture for full satisfaction. On the one hand, prior research suggest that cross-cultural service encounter adaptation is associated with positive customer outcomes such as rapport, satisfaction, and WOM (Azab and Clark 2017). On the other hand, cultural authenticity is suggested to be a driver of successful service encounters (Wang and Mattila 2015), increasing customers’ satisfaction and loyalty (Park et al. 2019). Thus, adaptation and authenticity present conflicting forces in optimizing the cross-cultural service experience and satisfying customers’ demand to immerse in a foreign culture. Further complicating the situation, there is a lack of generalization across different customer groups. In this study, the authors explore the following research questions;(1) Could higher service adaptation lead to lower satisfaction if it is perceived to take away from cultural authenticity? Does too much authenticity lead to discomfort, reducing positive customer outcomes? Is there an optimum level of authenticity-adaptation? (2) Do the same assumptions hold across different generations? Is seeking authentic or more adapted cultural service experiences a generational phenomenon? (3) What role do cultural competences play - can customer cultural competences bridge the perceived authenticity – customer experience gap? The authors explore these research questions using scenario-based experiments set in the context of an Indian restaurant. Results show that too much authenticity may hinder the optimum service experience (Study 1). While younger customers prefer moderate adaptation/ authenticity (rather than low adaptation), older generation seems more adventurous and perceives a better experience (satisfaction, WoM, repatronage) when there is low to no adaptation (full authenticity) (Study 1 and 2). We find that positive outcomes are significantly higher for older generations when adaptation is low (Study 2). The effect of cultural competences is yet to be determined (Study 3). This study contributes to the literature by revealing that high levels of perceived authenticity do not always ensure positive outcomes, and that outcomes associated with perceived authenticity vary across generations. Managerially, the study helps organizations tailor the optimal level of authenticity by adjusting the level of adaptation of the offering to suit particular clientele. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Selected impacts of the COVID-19 pandemic and responses on U.S. agriculture and agricultural product markets: FAPRI-MU Report #06-21

The following text examines some impacts of the COVID-19 pandemic on U.S. agricultural and agricultural product markets, producers, consumers, and related indicators. We outline reasons why reviewing events in isolation in 2020 might not give reliable estimates of the impacts of the COVID-19 pandemic and might result in misleading expectations about a future pandemic. Next, we explore the effects of three key aspects of the shock in the United States: (1) lockdown impacts that reduced liquid fuel use dramatically, (2) disruptions in the livestock-meat sector supply chain, and (3) changes in overall economic activity, household income, and total expenditures. For these experiments, we use the FAPRI-MU stochastic model to simulate the impacts of a hypothetical future pandemic. This is not a study of the entire COVID-19 pandemic. The full impacts of the COVID-19 pandemic are large and complex. Factors include effects on health and mortality, a broader economic shock with its employment and income effects, lockdowns and reduced socializing, supply chain disruptions, policy responses, and similar shocks to other countries. The negative effects were experienced differently by each country. We focus only on the U.S. experience. We draw some conclusions from this and related work. * Market outcomes in 2020 were driven by factors other than the pandemic, such as a surge in crop exports and weather disruptions, so year-over-year changes alone are probably not good indicators of how the pandemic affected the sector. * Three of the largest direct impacts of COVID-19 on the agriculture sector were on fuel markets, meat supply chains, and consumer demand patterns. Demands for fuels fell by 5-10% after taking into account price and income effects. Margins between meat retail prices and livestock prices widened after considering other factors. * The loss of economic activity as measured by the falling U.S. GDP could have been expected to cause weaker demand for agricultural goods, lower prices, and sharply lower farm income than what was observed in 2020. * U.S. policy responses included payments that increased disposable income, boosted consumer demand, and mitigated the impacts on farm income from the drop in the size of the national economy. Greater payments directly to farmers also help explain why farm income rose in 2020 relative to 2019. * The impact of COVID-19 is partly a story of policy responses, including sector-specific actions targeting agriculture, fiscal policy, monetary policy, and lockdowns. A future pandemic might be set in a context that limits or disallows some of these options, or a setting that has - perhaps by design - new options. * A future pandemic's impacts would differ from recent experiences because of disease characteristics and also new individual, firm, and policy responses. If one assumes that a future pandemic is an exact repeat of the 2020 pandemic, then that implicitly requires that the disease is equally contagious and harmful, individuals and firms respond to a new pandemic the same as they did in 2020, and policy responses repeat the responses to COVID-19.

Baseline update for international dairy, livestock and biofuel markets: FAPRI-MU report #08-21

In 2021 the markets for the commodities in this update have continued to be disrupted by COVID-19. All levels of the markets in many countries have been impacted from the supply of inputs, to processing capability and logistics. African Swine Fever (ASF), particularly in China, has disrupted meat markets. Volatility in these markets in the near term is to be expected and it is important to note that the path these markets take will be more volatile than what is projected here. Furthermore, the numbers presented in this report should not be interpreted as forecasts but as projections. They are estimates of the average values that would prevail under normal weather, current policy and macroeconomic parameters assumed herein. This update was prepared the weeks of August 23 and August 30, 2021 using data available at that time. Current policies are assumed to remain in place. The update uses data for international dairy and livestock from USDA's Production, Supply and Distribution database, with updates from the latest USDA's GAIN reports and other sources. Biofuels data comes primarily from F.O. Licht supplemented by GAIN reports and some country sources. The macroeconomy is assumed to evolve as forecast by IHS Markit in July 2021. Additionally no further assumptions have been made with regards to any other markets impacts associated with COVID-19.

Low-income household food consumption consequences of rice policy and pandemic impacts on income and price in Thailand

Using Thai household data, we estimated a demand system and analyzed the impacts of changes in rice prices and household income on food consumption, then used these results in four experiments. We found that a trade policy that attempts to reduce domestic prices benefits households in the higher income brackets while negatively affecting low-income, rice-producing households’ food security. Results suggest that an agricultural policy with a view to support food security might have different, if not opposite, distributional impacts on targeted groups. © 2021, Food Distribution Research Society. All rights reserved.

Early estimates of the impacts of COVID-19 on U.S. agricultural commodity markets, farm income and government outlays

COVID-19 represents an unprecedented situation both for the economy and the agricultural sector, and thus there is a limit to which prior experience can guide the current analysis. This analysis is both preliminary and highly uncertain given the constantly evolving market conditions. The analysis considers only some of the ways in which COVID-19 may affect markets and is based on a series of assumptions, many of which may be overtaken by events. The objective is not to provide definitive estimates of impacts, but to identify some key issues and help readers develop some notion of the rough magnitudes of possible effects.

Interventions to Influence the Use of Antibiotics for Acute Upper Respiratory Tract Infections

Acute upper respiratory tract infections (URTIs) result from viral or bacterial pathogens that infect the upper airways.1 URTIs comprise a range of conditions and symptoms such as cough, sore throat, acute otitis media (AOM), pharyngitis, tonsillitis, rhinitis, common cold, influenza, and sinusitis.1 While serious complications are rare, patients can develop pneumonia and associated adverse sequelae.1 A substantial proportion of health care visits to primary care and other family medicine settings are due to suspected URTIs.2 Most URTIs are viral in origin, meaning they are unlikely to benefit from antibiotics and can often be effectively managed remotely with supportive treatments. Despite this knowledge, antibiotics are often inappropriately prescribed.3 , 4 A descriptive analysis in Ontario estimated unnecessary antibiotic prescribing in primary care at rates of 48.4% for acute sinusitis and 52.6% for acute bronchitis.5 Further, more than 80% of unnecessary antibiotic prescriptions were attributed to respiratory tract conditions and infections.5 Overprescribing contributes to excessive use, unwanted side effects (e.g., allergic reactions, gastrointestinal symptoms, emergency department visits),6 and antibiotic resistance.7 Antibiotic resistance is a global public health threat and its reduction is a priority.8 Initiatives such as Choosing Wisely aim to reduce antibiotic overuse and advise against using antibiotics for URTIs that are viral in origin.7 However, while the risks of inappropriate and overuse are established, antibiotic prescribing is challenging and providers must balance the pressure of diagnostic uncertainty, time constraints, and patient expectations and preferences against the undesirable consequences of overprescribing.8 Thus, there is interest in management approaches that aid decision-making and reduce excessive prescribing and use. Various interventions are available that address inappropriate antibiotic prescribing and the pressures of providing in-person care for patients with URTIs. These include delayed (post-dated) antibiotic prescriptions9 and different interventions to guide the use of antibiotics (e.g., clinical decision support tools, rapid point-of-care testing [POCT], viral prescription pads). 10 The desired outcome is to reduce the overprescribing of antibiotics and antibiotic resistance, and potentially to improve clinical outcomes (e.g., reduce harms from antibiotics) and reduce health care utilization such as hospital and emergency department visits. Changes to health care service delivery and organization due to the COVID-19 pandemic mean providers in primary care face difficulty in caring for patients with URTIs.7 Practical guidance and interventions continue to be required to assist clinicians in making care decisions for patients with upper respiratory tract symptoms. Resources such as the Using Antibiotics Wisely campaign's updated The Cold Standard toolkit provide resources for clinicians to support virtual and in-person management.11 However, there continues to be an interest and need for evaluating contemporary evidence to identify which interventions might be most effective for supporting shared decision-making and optimizing the care of people with URTIs. This report aims to summarize the evidence regarding the clinical effectiveness of delayed antibiotic prescription-filling interventions and other family medicine interventions to influence the use of antibiotics for suspected acute URTIs.

Patient experiences with telehealth in sleep medicine: A qualitative evaluation

Rationale: The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. While numerous randomized trials support the efficacy of telehealth to treat conditions such as obstructive sleep apnea (OSA) and insomnia, relatively little is known about patients' experiences and perceptions of telehealth in typical practice. Methods: We recruited a purposive sample of patients who had sleep provider encounters via one of three telehealth modalities: in-clinic video, home-based video, and telephone. We conducted semi-structured interviews to assess general telehealth experiences, elicit perceptions around most and least helpful aspects, and contrast their experiences with in-person care. Two analysts coded transcripts using content analysis. After review of coding and categorization, the analysts identified emergent themes that cut across participants and categories. Results: We conducted interviews with 35 patients (in-clinic video n=12, home-based video n=11, telephone n=12) at two VA medical centers from June 2019 to May 2020. Five themes emerged including access to care, security and privacy, personalization of care, patient empowerment, and unmet needs. 1) Access to care: Patients perceived that telehealth provided access to sleep care in a timely and convenient manner, especially during the COVID-19 pandemic. Patients also saw telehealth as a way to improve continuity of care with their preferred providers. 2) Security and Privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security within appointments due to avoidance of anxiety provoking triggers (e.g. crowds). However, patients also noted a potential loss of privacy when telehealth was delivered at home. 3) Personalization of care: Patients outlined ways in which telehealth both improved and hindered their ability to communicate their individual needs to providers. In turn, this communication translated into the delivery of personalized care and positive health impacts. 4) Patient Empowerment: Patients described how telehealth empowered them to engage in self-management for their sleep disorders. 5) Unmet Needs: Patients recognized that there were specific areas where telehealth was not meeting their needs, including lack of follow-through with PAP therapy. Patients also expressed concerns around the lack of a physical examination. Conclusion: Patients described both positive and negative experiences with telehealth, highlighting areas where care can be further adapted to better suit their needs. As we continue to refine telehealth practices, we encourage providers and hospital systems to consider these aspects of the patient experience.