If you build it, will they come? Is test site availability a root cause of geographic disparities in COVID-19 testing?

OBJECTIVES: The purpose of this study was to examine the relationship between test site availability and testing rate within the context of social determinants of health. STUDY DESIGN: A retrospective ecological investigation was conducted using statewide COVID-19 testing data between March 2020 and December 2021. METHODS: Ordinary least squares and geographically weighted regression were used to estimate state and ZIP code level associations between testing rate and testing sites per capita, adjusting for neighbourhood-level confounders. RESULTS: The findings indicate that site availability is positively associated with the ZIP code level testing rate and that this association is amplified in communities of greater economic deprivation. In addition, economic deprivation is a key factor for consideration when examining ethnic differences in testing in medically underserved states. CONCLUSION: The study findings could be used to guide the delivery of testing facilities in resource-constrained states.

Amino acids of Epstein-Barr virus nuclear antigen 3A essential for repression of Jkappa-mediated transcription and their evolutionary conservation.

Epstein-Barr virus (EBV) nuclear antigen 3A (EBNA-3A) is essential for virus-mediated immortalization of B lymphocytes in vitro and is believed to regulate transcription of cellular and/or viral genes. One known mechanism of regulation is through its interaction with the cellular transcription factor Jkappa. This interaction downregulates transcription mediated by EBNA-2 and Jkappa. To identify the amino acids that play a role in this interaction, we have generated mutant EBNA-3A proteins. A mutant EBNA-3A protein in which alanine residues were substituted for amino acids 199, 200, and 202 no longer downregulated transcription. Surprisingly, this mutant protein remained able to coimmunoprecipitate with Jkappa. Using a reporter gene assay based on the recruitment of Jkappa by various regions spanning EBNA-3A, we have shown that this mutation abolished binding of Jkappa to the N-proximal region (amino acids 125 to 222) and that no other region of EBNA-3A alone was sufficient to mediate an association with Jkappa. To determine the biological significance of the interaction of EBNA-3A with Jkappa, we have studied its conservation in the simian lymphocryptovirus herpesvirus papio (HVP) by cloning HVP-3A, the homolog of EBNA-3A encoded by this virus. This 903-amino-acid protein exhibited 37% identity with its EBV counterpart, mainly within the amino-terminal half. HVP-3A also interacted with Jkappa through a region located between amino acids 127 and 223 and also repressed transcription mediated through EBNA-2 and Jkappa. The evolutionary conservation of this function, in proteins that have otherwise significantly diverged, argues strongly for an important biological role in virus-mediated immortalization of B lymphocytes.

An interdisciplinary clinical advancement program within a patient-centered care model.

Restructuring in health care does not have to compromise the pursuit of clinical excellence and quality patient care. The clinical advancement program (CAP) at the Hospital for Special Care is a newly developed multidisciplinary reward and recognition program for clinical staff. The program is integrated into the hospital's structure of service line management and, unlike traditional advancement programs, is open to all levels of care providers: professional personnel, technical staff, and aides. This article describes the basic features of the CAP model and how its was developed by a multidisciplinary task force.

Tissue and serum enzyme activities in the yellow rat snake (Elaphe obsoleta quadrivitatta).

Activities of diagnostically important enzymes were measured in serum and lysates of liver, kidney, skeletal muscle, heart, intestine, lung, and pancreatic tissues from wild-caught yellow rat snakes, Elaphe obsoleta quadrivitatta. All samples were analyzed for alkaline phosphatase, lactate dehydrogenase (LD), aspartate transaminase (AST), alanine transaminase, gamma-glutamyltransferase, and creatine kinase (CK) activities. The major enzyme activities found in the liver were LD and AST. The kidney had moderate activities of LD, AST, alanine transaminase, and CK. Skeletal muscle and heart contained high CK activity. Intestine, lung, and pancreas had low activities for most enzymes analyzed. Little to no gamma-glutamyltransferase activity was found in serum or tissues analyzed. Serum enzyme activities in yellow rat snakes were similar to those described for other reptile species, except for serum CK activity, which was increased in rat snakes.

Implementing a mainframe packaged pharmacy computer system in a 190-bed hospital.

The implementation of a pharmacy computer system in a 190-bed institution is described. A computer system was instituted in the pharmacy department as part of a hospitalwide conversion to an online information system. Planning for implementation began nine months before the actual live date (date of full computerization). Problems in the existing distribution and record-keeping systems that might be eliminated by computerization were identified, and changes in the layout of the pharmacy and department procedures were initiated to prepare for computerization. The events leading to computerization are presented in chronological order, and the advantages and shortcomings of the system are discussed. Because of careful planning, the cooperation of all pharmacy staff members, and frequent assistance from the computer vender, the nine-month conversion to a computerized system proceeded smoothly.

A microcomputer in the small-hospital pharmacy: practical uses.

The use of a microcomputer in a small-hospital pharmacy is discussed. In a 50-bed hospital, computerization of repetitive functions was achieved with a modest expense. This was done with standard and inexpensive programs and self-written software that ran on a microcomputer purchased for the pharmacy. Time savings were immediately produced, and other uses followed to allow better use of personnel. Brief descriptions of major types of software are also given. An inexpensive computer can be used to great advantage, even in very small hospitals and without expensive pharmacy-specific software.