1600 10 20655 https://www.socictopen.socict.org/files/original/51917a5a372fff4d655553f0a91ad5a1.pdf d2864e0efb663f16db20fd69101c2777 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pulmonary Tuberculosis and SARS, China Creator An entity primarily responsible for making the resource Wei Liu, Arnaud Fontanet, Pan-He Zhang, Lin Zhan, Zhong-Tao Xin, Fang Tang, Laurence Baril, Wu-Chun Cao Date A point or period of time associated with an event in the lifecycle of the resource 2006 Subject The topic of the resource SARS, People’s Republic of China, pulmonary tuberculosis, Letter, China Identifier An unambiguous reference to the resource within a given context DOI: 10.3201/eid1204.050264 Source A related resource from which the described resource is derived Emerging Infectious Diseases Publisher An entity responsible for making the resource available Centers for Disease Control and Prevention Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Infectious and parasitic diseases, Medicine Language A language of the resource EN https://www.socictopen.socict.org/files/original/a66335eacffb50a9c16513f4976a912b.pdf 34a22255e1680c9ddb3d91902d34a0e4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pulmonary, cardiac and renal distribution of ACE2, furin, TMPRSS2 and ADAM17 in rats with heart failure: Potential implication for COVID-19 disease. Creator An entity primarily responsible for making the resource Yara Knaney, Samuel N. Heyman, Safa Kinaneh, Emad E Khoury, Ahmad Fokra, Zaher Azzam, Zaid Abassi Description An account of the resource Congestive heart failure (CHF) is often associated with kidney and pulmonary dysfunction. Activation of the renin-angiotensin-aldosterone system (RAAS) contributes to avid sodium retention, cardiac hypertrophy and oedema formation, including lung congestion. While the status of the classic components of RAAS such as renin, angiotensin converting enzyme (ACE), angiotensin II (Ang II) and angiotensin II receptor AT-1 is well studied in CHF, the expression of angiotensin converting enzyme-2 (ACE2), a key enzyme of angiotensin 1-7 (Ang 1-7) generation in the pulmonary, cardiac and renal systems has not been studied thoroughly in this clinical setting. This issue is of a special interest as Ang 1-7 counterbalance the vasoconstrictory, pro-inflammatory and pro-proliferative actions of Ang II. Furthermore, CHF predisposes to COVID-19 disease severity, while ACE2 also serves as the binding domain of SARS-CoV-2 in human host-cells, and acts in concert with furin, an important enzyme in the synthesis of BNP in CHF, in permeating viral functionality along TMPRSST2. ADAM17 governs ACE2 shedding from cell membranes. Therefore, the present study was designed to investigate the expression of ACE2, furin, TMPRSS2 and ADAM17 in the lung, heart and kidneys of rats with CHF to understand the exaggerated susceptibility of clinical CHF to COVID-19 disease. Heart failure was induced in male Sprague Dawley rats by the creation of a surgical aorto-caval fistula. Sham-operated rats served as controls. One week after surgery, the animals were subdivided into compensated and decompensated CHF according to urinary sodium excretion. Both groups and their controls were sacrificed, and their hearts, lungs and kidneys were harvested for assessment of tissue remodelling and ACE2, furin, TMPRSS2 and ADAM17 immunoreactivity, expression and immunohistochemical staining. ACE2 immunoreactivity and mRNA levels increased in pulmonary, cardiac and renal tissues of compensated, but not in decompensated CHF. Furin immunoreactivity was increased in both compensated and decompensated CHF in the pulmonary, cardiac tissues and renal cortex but not in the medulla. Interestingly, both the expression and abundance of pulmonary, cardiac and renal TMPRSS2 decreased in CHF in correlation with the severity of the disease. Pulmonary, cardiac and renal ADAM17 mRNA levels were also downregulated in decompensated CHF. Circulating furin levels increased in proportion to CHF severity, whereas plasma ACE2 remained unchanged. In summary, ACE2 and furin are overexpressed in the pulmonary, cardiac and renal tissues of compensated and to a lesser extent of decompensated CHF as compared with their sham controls. The increased expression of the ACE2 in heart failure may serve as a compensatory mechanism, counterbalancing the over-activity of the deleterious isoform, ACE. Downregulated ADAM17 might enhance membranal ACE2 in COVID-19 disease, whereas the suppression of TMPRSS2 in CHF argues against its involvement in the exaggerated susceptibility of CHF patients to SARS-CoV2. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource TMPRSS2, Kidney, lung, Heart failure, angiotensin-converting enzyme 2, ADAM17, heart, furin Identifier An unambiguous reference to the resource within a given context 10.1111/jcmm.16310 Source A related resource from which the described resource is derived Journal of cellular and molecular medicine https://www.socictopen.socict.org/files/original/d7ed0e7aa437178c9eb14f87e366d55c.pdf 4c801da5a6aad08b5f572379543a4621 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Agricultura sostenible Description An account of the resource Dominio científico: Agricultura sostenible Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Puntos críticos de la cadena productiva de la mora (Rubus glaucus Benth), en el municipio de Pamplona, Colombia Creator An entity primarily responsible for making the resource Yolanda Gonzalez Castro, Omaira Manzano Durán, Obdulio García-Hoya Description An account of the resource Se realizó un diagnóstico a la cadena productiva de la mora (Rubus glaucus Benth), en el municipio de Pamplona, Colombia, mediante un enfoque mixto. En lo cuantitativo, se estudiaron las variables: investigación, buenas prácticas agrícolas y manejo de pos cosecha. En lo cualitativo, se estudiaron las debilidades de la cadena productiva y mejoras que se requieren, a partir de entrevistas a expertos. Como resultado se obtuvo que la cadena productiva de la mora presenta fortalezas, como: suficiencia de espacios para la siembra, adaptación y rendimiento del fruto a los suelos, consideraciones del valor medicinal y nutricional del producto, entre otras. Sin embargo, se encuentran puntos críticos en cuanto a: la mejora genética de los cultivos, faltan rutinas para el análisis de agua y desinfección adecuada, junto con malas prácticas en el manejo técnico del cultivo. Igualmente, se evidencia que los productores no utilizan herramientas administrativas ni llevan registros contables que orienten la toma de decisiones. Date A point or period of time associated with an event in the lifecycle of the resource 2019 Subject The topic of the resource Agricultura, Mora, cadena productiva, cultivo, investigación agrícola Identifier An unambiguous reference to the resource within a given context 10.19053/20278306.v10.n1.2019.10008 Source A related resource from which the described resource is derived Revista de Investigación, Desarrollo e Innovación Publisher An entity responsible for making the resource available Universidad Pedagógica y Tecnológica de Colombia Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Social Sciences, Management. Industrial management, Industries. Land use. Labor, Technological innovations. Automation Relation A related resource <a href="https://revistas.uptc.edu.co/index.php/investigacion_duitama/article/view/10008" target="_blank" rel="noreferrer noopener">https://revistas.uptc.edu.co/index.php/investigacion_duitama/article/view/10008</a> https://www.socictopen.socict.org/files/original/1489ea806d94affbb1627fff0c024580.pdf 517640d4ad3f9df964f7ad31dc39ecd8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Agricultura sostenible Description An account of the resource Dominio científico: Agricultura sostenible Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Puntos de corte provisionales para el diagnóstico de sarcopenia en ancianos de Caldas, Colombia Creator An entity primarily responsible for making the resource Johan Sebastián Villada-Gómez, Clara Helena González-Correa, Felipe Marulanda-Mejía Description An account of the resource Introducción. La sarcopenia es la disminución de masa muscular y la consecuente reducción del rendimiento y de la función física. Su aparición puede ser indicativa de riesgo de otras condiciones en los ancianos, y su diagnóstico requiere la comparación con los datos sobre la composición corporal de la población joven sana para establecer valores de referencia de la disminución de la masa muscular. Objetivo. Establecer puntos provisionales de corte recolectados mediante bioimpedancia eléctrica para el diagnóstico de sarcopenia en ancianos caldenses a partir de los datos de la composición muscular esquelética de jóvenes. Materiales y métodos. Se utilizaron las mediciones de la composición corporal de jóvenes sanos entre los 18 y los 35 años de edad tomadas mediante bioimpedancia eléctrica con base en las cuales se estableció el índice de masa muscular esquelética. Se aplicó la prueba de Kolmogorov-Smirnov para evaluar la normalidad de los datos y se estableció el promedio de dicho índice con sus desviaciones estándar tanto para hombres como para mujeres. Resultados. A partir de estos datos, se estableció como bajo un índice de masa muscular esquelética con un valor de dos desviaciones estándar por debajo de la media del índice en jóvenes. En las mujeres el valor fue de 6,42 kg/m2 y, en hombres, de 8,39 kg/m2. Conclusión. Estos valores son similares a los determinados por algunos autores en población asiática, lo que evidencia que esta tiene características de composición corporal similares a la población de estudio. Hasta donde se sabe, este es el primer estudio que ofrece una descripción de la composición corporal muscular esquelética en jóvenes colombianos y establece puntos de corte para el diagnóstico de sarcopenia en ancianos de esta región centro-andina del país. Date A point or period of time associated with an event in the lifecycle of the resource 2018 Subject The topic of the resource Colombia, Envejecimiento, composición corporal, impedancia eléctrica, músculo esquelético, sarcopenia Identifier An unambiguous reference to the resource within a given context 10.7705/biomedica.v38i4.4302 Source A related resource from which the described resource is derived Biomédica: revista del Instituto Nacional de Salud Publisher An entity responsible for making the resource available Instituto Nacional de Salud Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine, Arctic medicine. Tropical medicine Relation A related resource <a href="https://www.revistabiomedica.org/index.php/biomedica/article/view/4302" target="_blank" rel="noreferrer noopener">https://www.revistabiomedica.org/index.php/biomedica/article/view/4302</a> https://www.socictopen.socict.org/files/original/b3771abf3e8ec82d7522ce4d8f0ee840.pdf 5ab2d6e1eaa13b1946e3ff63beb113bb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Agricultura sostenible Description An account of the resource Dominio científico: Agricultura sostenible Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Purchases of Family Farming to PNAE in the rural territory médio Rio das Contas - BA (2015-2017 Creator An entity primarily responsible for making the resource Jéssica Souza Ribeiro, William Santos Silva Description An account of the resource The acquisition of food from family farming and rural family entrepreneurs for National School Feeding Program is an important strategy for regional development and Food and Nutrition Security, promoting healthy eating and valuing food culture. For its effectiveness, several limitations must be overcome, requiring commitment and engagement of the actors involved. The present study had the objective of making a diagnosis of the purchases of family farming for school feeding in the Territory of Medium Identity Rio das Contas, Bahia. The survey of the transfers of the National Fund was carried out for the Development of Education for school feeding, Public Calls for Family Agriculture, and the number of students attended in the triennium 2015-2017. We observed that most municipalities had made Public Calls, applying resources above the minimum required by the legislation. We concluded that this practice should be maintained and promoted in other municipalities, but some adjustments are necessary, such as meeting clear criteria for the quotation of products and determination of selling prices and adoption of classification criteria determined by legislation. Training for those involved in institutional procurement and an effective follow-up of technical assistance agencies in the territory are possible strategies to use. Date A point or period of time associated with an event in the lifecycle of the resource 2018 Subject The topic of the resource Agricultura Familiar, Compra Institucional, Programa Nacional de Alimentação Escolar, Territórios de Identidade Source A related resource from which the described resource is derived Revista Eletrônica Competências Digitais para Agricultura Familiar Publisher An entity responsible for making the resource available Universidade Estadual Paulista Júlio de Mesquita Filho Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Agriculture (General) Relation A related resource <a href="http://codaf.tupa.unesp.br:8082/index.php/recodaf/article/view/80" target="_blank" rel="noreferrer noopener">http://codaf.tupa.unesp.br:8082/index.php/recodaf/article/view/80</a> https://www.socictopen.socict.org/files/original/f217716b27c094843d335d6107639ba3.pdf 941c47def81f520013550f56329580f1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Purview of 3D printing in medical applications during COVID-19. Creator An entity primarily responsible for making the resource Sumit Kumar, Vikram Khanna, Balendra Pratap Singh, Ranjitkumar Patil, Divya Mehrotra Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource infectious diseases, covid-19, additive manufacturing, 3D printing (3DP) Identifier An unambiguous reference to the resource within a given context 10.1016/j.hlpt.2020.11.007 Source A related resource from which the described resource is derived Health policy and technology https://www.socictopen.socict.org/files/original/92d66b7e3675309ba4f1eae3b368eeb3.pdf b9504f08d9a98dd375f85e0ded5bdb19 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pustulan Activates Chicken Bone Marrow-Derived Dendritic Cells In Vitro and Promotes Ex Vivo CD4⁺ T Cell Recall Response to Infectious Bronchitis Virus Creator An entity primarily responsible for making the resource Dennis Christensen, Bernt Guldbrandtsen, Jacob Pitcovski, Tina S. Dalgaard, Frederik T. Larsen, Rikke B. Kjærup Description An account of the resource Infectious bronchitis virus (IBV) is a highly contagious avian coronavirus. IBV causes substantial worldwide economic losses in the poultry industry. Vaccination with live-attenuated viral vaccines, therefore, are of critical importance. Live-attenuated viral vaccines, however, exhibit the potential for reversion to virulence and recombination with virulent field strains. Therefore, alternatives such as subunit vaccines are needed together with the identification of suitable adjuvants, as subunit vaccines are less immunogenic than live-attenuated vaccines. Several glycan-based adjuvants directly targeting mammalian C-type lectin receptors were assessed in vitro using chicken bone marrow-derived dendritic cells (BM-DCs). The β-1-6-glucan, pustulan, induced an up-regulation of MHC class II (MHCII) cell surface expression, potentiated a strong proinflammatory cytokine response, and increased endocytosis in a cation-dependent manner. Ex vivo co-culture of peripheral blood monocytes from IBV-immunised chickens, and BM-DCs pulsed with pustulan-adjuvanted recombinant IBV N protein (rN), induced a strong recall response. Pustulan-adjuvanted rN induced a significantly higher CD4+ blast percentage compared to either rN, pustulan or media. However, the CD8+ and TCRγδ+ blast percentage were significantly lower with pustulan-adjuvanted rN compared to pustulan or media. Thus, pustulan enhanced the efficacy of MHCII antigen presentation, but apparently not the cross-presentation on MHCI. In conclusion, we found an immunopotentiating effect of pustulan in vitro using chicken BM-DCs. Thus, future in vivo studies might show pustulan as a promising glycan-based adjuvant for use in the poultry industry to contain the spread of coronaviridiae as well as of other avian viral pathogens. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource adjuvant, chicken, IBV, BMDC, pustulan, subunit vaccination Identifier An unambiguous reference to the resource within a given context DOI: 10.3390/vaccines8020226 Source A related resource from which the described resource is derived Vaccines Publisher An entity responsible for making the resource available MDPI AG Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine https://www.socictopen.socict.org/files/original/2e62f76eeabb6d62cecb2f94f3821315.pdf 09bb715f48b8048c1fe67fca19c72deb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Putative Inhibitors of SARS-CoV-2 Main Protease from A Library of Marine Natural Products: A Virtual Screening and Molecular Modeling Study Creator An entity primarily responsible for making the resource Davide Gentile, Vincenzo Patamia, Angela Scala, Maria Teresa Sciortino, Anna Piperno, Antonio Rescifina Description An account of the resource The current emergency due to the worldwide spread of the COVID-19 caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a great concern for global public health. Already in the past, the outbreak of severe acute respiratory syndrome (SARS) in 2003 and Middle Eastern respiratory syndrome (MERS) in 2012 demonstrates the potential of coronaviruses to cross-species borders and further underlines the importance of identifying new-targeted drugs. An ideal antiviral agent should target essential proteins involved in the lifecycle of SARS-CoV. Currently, some HIV protease inhibitors (i.e., Lopinavir) are proposed for the treatment of COVID-19, although their effectiveness has not yet been assessed. The main protease (Mpr) provides a highly validated pharmacological target for the discovery and design of inhibitors. We identified potent Mpr inhibitors employing computational techniques that entail the screening of a Marine Natural Product (MNP) library. MNP library was screened by a hyphenated pharmacophore model, and molecular docking approaches. Molecular dynamics and re-docking further confirmed the results obtained by structure-based techniques and allowed this study to highlight some crucial aspects. Seventeen potential SARS-CoV-2 Mpr inhibitors have been identified among the natural substances of marine origin. As these compounds were extensively validated by a consensus approach and by molecular dynamics, the likelihood that at least one of these compounds could be bioactive is excellent. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource COVID-19, SARS-CoV-2, marine natural product, virtual screening, docking Identifier An unambiguous reference to the resource within a given context DOI: 10.3390/md18040225 Source A related resource from which the described resource is derived Marine Drugs Publisher An entity responsible for making the resource available MDPI AG Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Biology (General) Language A language of the resource EN https://www.socictopen.socict.org/files/original/c7003874b2a3a728812845ec96752692.pdf 8b2eafa11a1d46de46c31c4cef2a938c Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Putative SARS-CoV-2 M^pro Inhibitors from an In-House Library of Natural and Nature-Inspired Products: A Virtual Screening and Molecular Docking Study Creator An entity primarily responsible for making the resource Stefania Mazzini, Loana Musso, Sabrina Dallavalle, Roberto Artali Description An account of the resource A novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has been the cause of a recent global pandemic. The highly contagious nature of this life-threatening virus makes it imperative to find therapies to counteract its diffusion. The main protease (Mpro) of SARS-CoV-2 is a promising drug target due to its indispensable role in viral replication inside the host. Using a combined two-steps approach of virtual screening and molecular docking techniques, we have screened an in-house collection of small molecules, mainly composed of natural and nature-inspired compounds. The molecules were selected with high structural diversity to cover a wide range of chemical space into the enzyme pockets. Virtual screening experiments were performed using the blind docking mode of the AutoDock Vina software. Virtual screening allowed the selection of structurally heterogeneous compounds capable of interacting effectively with the enzymatic site of SARS-CoV-2 Mpro. The compounds showing the best interaction with the protein were re-scored by molecular docking as implemented in AutoDock, while the stability of the complexes was tested by molecular dynamics. The most promising candidates revealed a good ability to fit into the protein binding pocket and to reach the catalytic dyad. There is a high probability that at least one of the selected scaffolds could be promising for further research Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource coronavirus, infectious diseases, molecular docking, covid-19, molecular modeling, natural products library Identifier An unambiguous reference to the resource within a given context 10.3390/molecules25163745 Source A related resource from which the described resource is derived Biotemas Publisher An entity responsible for making the resource available Universidade Federal de Santa Catarina Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Organic chemistry https://www.socictopen.socict.org/files/original/a248491908be270a6b75334f80b718b8.pdf 59c3ea6da39c82907cc1005cf9857f6f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Putting Patient Concerns on the Policy Agenda Creator An entity primarily responsible for making the resource Gyan Moorthy Description An account of the resource Photo by Possessed Photography on Unsplash INTRODUCTION  Currently, the interests of patients at most levels of policymaking are represented by a disconnected patchwork of groups focusing on disease, age, ethnicity, or gender, like Susan G. Komen, the AARP, and the NAACP. These groups compete with one another for funding and are ill-equipped to compete with groups representing the interests of healthcare professionals, pharmaceutical and medical device companies, hospitals, and insurance providers. The result is an imbalance – big health has more financing and power, resulting in healthcare policy that does not adequately reflect patient concerns, especially the concerns of poor or otherwise vulnerable patients. These big health groups also misrepresent patient concerns to further their own interests, and patients are seldom in a position to push back. While some suggest the creation of a unified, independent patient lobby to interface directly with policymakers and the public, it is not altogether clear how such a lobby could be formed or how to focus its efforts to have the intended impact. ANALYSIS Nearly all Americans will be patients at some point in their life, so patients are a diverse group. They have a range of unique interests informed by their disease, age, location, socioeconomic situation and, to some extent, political views. The differences that exist between individual patients are much greater than the differences between different pharmaceutical companies or even different physicians. But this does not mean that patients have nothing in common. Most patients have similar expectations about the confidentiality of their records or protections that should be afforded to them if their treating physician asks them to participate in a research trial. They want to be able to receive care at the nearest emergency department and to choose their doctors. They all hate surprise medical billing, and most are troubled by the high price of prescription drugs. A strong patient lobby might be able to successfully pressure Congress into taking action on these issues, or at least help advance the conversation by serving as a counterweight to the influence of other lobbies. The 2001 Bipartisan Patient Bill of Rights, sponsored by Senators John McCain (R, AZ) and Edward Kennedy (D, MA), would have expanded HMO coverage requirements and enabled employees to sue their employers if their claims were denied.[1] It failed after a sustained lobbying and public information campaign by insurance companies and employers, linked through the deceptively-named Health Benefits Coalition.[2] Several efforts to end surprise medical billing and promote price transparency have similarly failed or been stalled, in part because the American Hospital Association (AHA) complained that the changes would be too difficult to implement during the COVID-19 pandemic.[3] The Affordable Care Act (ACA) enacted some popular changes, including an elimination of coverage exclusions for people with pre-existing conditions, closure of the Medicare Part D “donut hole,” and expansion of coverage to age 26.[4] A patient lobby might have been able to secure more benefits, e.g., coverage requirements for dental, vision, and mental health services. But the need to protect the ACA may be a better impetus for the formation of a strong patient lobby. The ACA has already been gutted by the Trump Administration’s actions to end certain insurance subsidies and Congress’s decision to repeal the penalty associated with the individual mandate, resulting in premium increases.[5] Cuts to funds that facilitate sign-ups on the exchanges also resulted in premium increases. The individual mandate is the subject of yet another Supreme Court challenge. If the legislation is struck down, already weakened protections for pre-existing conditions will be in jeopardy.[6] The changes to the ACA may galvanize patients to organize. Already, the general public’s interest in health policy has increased and appears to remain strong, unlike the waning enthusiasm following the failure of the Clinton healthcare plan. Nevertheless, there are significant practical and cultural obstacles to the formation of a unified, independent patient lobby in the United States, and limits to what such a lobby could reasonably accomplish. Patients are a diverse group, and on a variety of issues, they can hardly be considered a group at all. The healthcare system consists of many interlocking parts. A provision to significantly benefit one group of patients, e.g., those on Medicaid, may not only come at the expense of insurance companies, but at the expense of other groups of patients. It is doubtful that most better-off patients would be willing to make sacrifices for the more disadvantaged among them. Research funding is limited, and if it is allocated to curing childhood leukemia, it may not be allocated to curing joint disease in the elderly. Then there is the problem of what is actually necessary to promote patient welfare. Patients often do not know exactly what will benefit them, whether their town really needs a Level IV neonatal intensive care unit or whether pharmaceutical companies should be able to advertise off-label drug uses. Even if they agree on general problems, they may not agree on solutions. Patient groups are also susceptible to industry influence. The prestige of larger, well-established patient advocacy groups makes them attractive investments. According to a 2017 study in the New England Journal of Medicine, more than 80 percent of the largest 104 patient advocacy groups accepted money from drug, medical device, and biotechnology companies. Several groups did not disclose sources of funding or did not disclose what proportion of their budget came from each donor. Many also have company executives on their governing boards.[7] When diverse patient advocacy groups have banded together to increase their clout, industry has always been a part of the conversation. The results have been predictable. For example, the American Cancer Society, the American Heart Association, and the American Diabetes Association, as well as various pharmaceutical and biotechnology companies are all members of the National Health Council, an organization founded to advocate for those living with chronic diseases and disabilities. These companies provide the majority of the Council’s funding and have strong representation on its board. In 2016, the Council came out strongly in favor of a deal between the FDA and pharmaceutical companies to speed the approval of new drugs as part of the reauthorization of the Prescription Drug User Fee Act. It also campaigned energetically for the 21st Century Cures Act, which was criticized by watchdogs as another attempt at weakening the FDA’s protection of consumers from dangerous drugs and medical devices.[8]It is possible that patients really believed they would benefit from these changes, and perhaps some will, but the changes will chiefly benefit the pharmaceutical industry, the legitimacy of which is boosted by its partnerships with patient groups. Since the 1960s, medical culture has undergone dramatic changes. Patients are seen more as partners in health and well-being than passive slabs of clay. Their individual value systems and social context are incorporated into care plans. The result has been more satisfied patients, more cost-effective care delivery, and better health outcomes.[9] These productive partnerships could extend into policymaking by expanding the physician-patient dyad, or physician-patient-hospital triad, to include more actors. Keeping interest high and ensuring that the voices of some patients do not drown out the voices of others will be a challenge. To begin to broaden patient groups at the local level, hospitals and clinics can host community meetings, where patients, healthcare providers, and administrators talk about the issues affecting them and brainstorm solutions. Trust grows over time. Perhaps patients can secure more forgiving medical debt repayment programs, reforms to arbitration procedures, more permissive visitation policies, or transparency in ethics and quality improvement committee deliberations and recommendations. Local patient groups can help steer conversations and exert gentle pressure, where necessary. They can ensure that hospitals and physicians do not blindly follow national guidelines but tailor them to meet the specific needs of the local population. They can publish lists of institutions or physicians who engage productively with them, potentially costing others goodwill and business. State and national institutions involved in health policy creation can also attempt to incorporate patient voices into their deliberations. Unlike in Germany, where all Health Committee hearings feature testimony from the same several Spitzenverbände (national associations of various interests) and all meetings and briefs are made accessible online, US legislation is deliberated in a haphazard, back-and-forth process that involves a lot of back-room dealing.[10] That is, there is no single table at which American patient groups can sit to have far-reaching impact; they must establish themselves at multiple levels and learn to play a lobbying game that other interests have been playing a lot longer. But state public health departments in addition to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) could establish public/patient advisory boards or include patient advocates as agenda setters in various sub-departments. Some short-term results could be more generous Medicaid eligibility and coverage requirements or accelerated Certificate-of-Need hearings for the creation of new medical infrastructure. In the long-term, the institutionalized representation of patient voices at various places in the bureaucracy could provide the basis for the development of a unified patient lobby. These boards could vie for increased influence through membership in a formalized, state, regional, or national organization. Local patient advocacy groups could be incorporated as well.[11] After consolidation, the lobby might expand its purview and meaningfully pressure legislatures on issues like surprise medical billing, high prescription drug prices, and privacy protections. The lobby’s success may depend on its commitment to issues on which there is little disagreement between patients. To ensure the continued independence of the patient lobby, sunshine laws mandating funding transparency could be expanded.[12] Importantly, this unified patient lobby could include existing patient advocacy groups that could continue to pursue their own goals independently, much as various pharmaceutical companies, hospitals, and physicians do outside of the Pharmaceutical Research and Manufacturers of America (PhRMA), the AHA, or the American Medical Association (AMA). The whole is greater than the sum of its parts: a unified patient lobby can (1) push for action on issues where patients generally agree, like surprise medical billing, (2) indirectly further the goals of each constituent organization, e.g., through a push for global increases in disease and disability research, and (3) slowly raise the level of public debate, encouraging and sustaining broader and more informed public attention to the health policy development process. Ideally, a unified patient lobby would also elevate previously-unheard voices. As patients with various backgrounds and interests work with one another to achieve their common goals, they may find that they have other things in common as well. They may also see that improving the health of some parts of the population has important spillover effects for others. For example, healthy workers are more productive, and healthy parents can be more engaged in their children’s lives, setting them up for success. In the same way that the AARP has special divisions to promote the particular interests of its black and Hispanic members, an umbrella patient lobbying group could allocate some resources to promoting the interests of disadvantaged patients. Most importantly, however, it could create a tighter sense of community among patients, pushing society to become more compassionate and understanding. James Morone would warn that creating mechanisms for increasing the representation of disaffected or marginalized groups is not a panacea. This “democratic wish” could begin a social and political process that ends in circumstances similar to those that initially brought it about: political stalemate.[13] But I argue that the stalemate is avoidable, and that group representation can further democracy. Disease, age, ethnicity, and gender groups like the American Association of Pediatrics (AAP), which campaigns for policies that benefit children’s health, should continue to represent patient interests as well. Within the unified patient lobby, experts on cost and quality, including those who suggest unpopular solutions like certain changes to Medicare, should be heard and, in many cases, heeded. A unified, independent patient lobby could help to restore balance to a policymaking process dominated by other well-funded, well-organized interests. CONCLUSION Patients in the United States are a diverse group, with complicated and often contradictory interests. However, they do share some common interests including expectations of confidentiality, freedom to choose their providers, and a hatred of surprise medical billing. Though there are structural obstacles to the development of a unified, independent patient lobby, such a lobby could successfully pressure the appropriate officials or lawmakers to address the issues that affect most patients. Today’s culture values patient input, and with key ACA provisions at risk, patients should begin organizing so they can influence policymaking – potentially with a little help from bureaucrats. To get off the ground, a patient lobbying group analogous to PhRMA, the AHA, or the AMA would have to commit to a big tent philosophy, and it would have to fight hard to maintain its independence. With time, it might become more ambitious and catalyze substantive changes in the arena of patient access and care. [1] US Congress. Senate. 2001. Bipartisan Patient Protection Act. S1052. 107th Congress. Introduced in Senate June 14, 2001. https://www.congress.gov/107/bills/s1052/BILLS-107s1052es.pdf. [2] Brubaker, Bill. 2001. “Patients’ Bill’s Foes Back Away From Ad.” Washington Post, April 12, 2001. https://www.washingtonpost.com/archive/business/2001/04/12/patients-bills-foes-back-away-from-ad/53377e06-e173-4bd0-8e5b-797c172c34fc/. [3] LaPointe, Jacqueline. 2020. “Surprise Billing Action Needed, But Hospitals Urge Congress to Wait.” RevCycleIntelligence, August 6, 2020. https://revcycleintelligence.com/news/surprise-billing-action-needed-but-hospitals-urge-congress-to-wait. [4] Engel, Jonathan. 2018. Unaffordable. Madison and London: The University of Wisconsin Press. [5] Kamal, Rabah, Rachel Fehr, Marco Ramirez, and Katherine Horstman. 2018. “How Repeal of the Individual Mandate and Expansion of Loosely Regulated Plans Are Affecting 2019 Premiums.” KFF. October 26, 2018. https://www.kff.org/health-costs/issue-brief/how-repeal-of-the-individual-mandate-and-expansion-of-loosely-regulated-plans-are-affecting-2019-premiums/. [6] Simmons-Duffin, Selena. 2019. “Trump Is Trying Hard To Thwart Obamacare. How’s That Going?” NPR, October 14, 2019. https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going. [7] McCoy, Matthew S., Michael Carniol, Katherine Chockley, John W. Urwin, Ezekiel J. Emanuel, and Harald Schmidt. 2017. “Conflicts of Interest for Patient-Advocacy Organizations.” New England Journal of Medicine 376 (9): 880–85. https://doi.org/10.1056/NEJMsr1610625. [8] Hilzenrath, David S. 2016. “In FDA Meetings, ‘Voice’ of the Patient Often Funded by Drug Companies.” Project On Government Oversight (POGO). https://www.pogo.org/investigation/2016/12/in-fda-meetings-voice-of-patient-often-funded-by-drug-companies/. [9] Vahdat, Shaghayegh, Leila Hamzehgardeshi, Somayeh Hessam, and Zeinab Hamzehgardeshi. 2014. “Patient Involvement in Health Care Decision Making: A Review.” Iranian Red Crescent Medical Journal 16 (1). https://doi.org/10.5812/ircmj.12454. [10] Redman, Eric. 2000. The Dance of Legislation: An Insider’s Account of the Workings of the United States Senate. 1st edition. Seattle: University of Washington Press. [11] This is just one possible means by which a unified patient lobby could be formed. Others include slowly, in a grass-roots fashion, by wealthy benefactors or through consolidation of existing disease-specific groups in a more substantive way than has been done to date. I do not claim to know which is most feasible, or if any of them are. But even if they are not, it is important to think about, as future leaders, interested parties, etc. can shape culture and institutions such that they become feasible. [12] Karas, Laura, Robin Feldman, Ge Bai, So Yeon Kang, and Gerard F Anderson. 2019. “Pharmaceutical Industry Funding to Patient-Advocacy Organizations: A Cross-National Comparison of Disclosure Codes and Regulation” 42 (2): 33. [13] Morone, James. 1998. The Democratic Wish: Popular Participation and the Limits of American Government. New Haven and London: Yale University Press. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource Patient, gender, Age, disease, Philosophy, policy-making, AMA, big health Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Ethics, Medical philosophy. Medical ethics