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M Ellen Kuenzig,1,2 Therese A Stukel,3,4 Matthew W Carroll,5 Gilaad G Kaplan,6 Anthony R Otley,7 Harminder Singh,8– 10 Alain Bitton,11 Stephen G Fung,12,13 Sarah Spruin,3,14 Stephanie Coward,6 Yunsong Cui,15 Zoann Nugent,8 Anne M Griffiths,1,2,16 David R Mack,12,13,17 Kevan Jacobson,18 Geoffrey C Nguyen,3,4,19 Laura E Targownik,19 Wael El-Matary,20 Charles N Bernstein,8,9 Trevor J B Dummer,21 Jennifer L Jones,15 Lisa M Lix,22 Sanjay K Murthy,14,23– 25 Juan Nicolás Peña-Sánchez,26 Soheila Nasiri,12,13 Eric I Benchimol1– 4,16 On behalf of the Canadian Gastro-Intestinal Epidemiology Consortium1SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada; 2Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; 3ICES, Toronto, Ontario, Canada; 4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 5Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; 6Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 7Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; 8Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; 9Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; 10Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada; 11McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada; 12CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada; 13CHEO Research Institute, Ottawa, Ontario, Canada; 14Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 15Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 16Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; 17Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; 18Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; 19Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 20Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; 21School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; 22Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 23Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 24Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada; 25School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; 26Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCorrespondence: Eric I Benchimol, The Hospital for Sick Children Division of Gastroenterology, Hepatology and Nutrition 555 University Avenue, Toronto, ON, M5G 1X8, Canada, Fax +1-416-813-4972, Email eric.benchimol@sickkids.caPurpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes.Patients and Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD < 16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes.Results: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥ 1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥ 1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn’s disease but not colectomy in ulcerative colitis.Conclusion: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn’s disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.Plain Language Summary: Inflammatory bowel disease (IBD) is a chronic health condition of the gastrointestinal system, which is becoming more common in children. They require lifelong treatment and receiving high quality care is important for preventing complications. We determined if outcomes of children with IBD was different across Canada. We also tested if differences in care at diagnosis was related to outcomes. More than three-quarters of children with IBD were treated at pediatric hospitals. Children treated at some hospitals were more likely to be hospitalized and visit the emergency room when compared to children treated at other hospitals. Children with Crohn’s disease (one type of IBD) were more likely to have surgery at some hospitals when compared to children treated at other hospitals. We should improve care to make sure children living with IBD have timely access to high quality specialist care.Keywords: Crohn’s disease, ulcerative colitis, health administrative data, variation in care, health services utilization, surgery

Introduction: Previous studies have demonstrated that common breast cancer susceptibility alleles are differentially associated with breast cancer risk for BRCA1 and/or BRCA2 mutation carriers. It is currently unknown how these alleles are associated with different breast cancer subtypes in BRCA1 and BRCA2 mutation carriers defined by estrogen (ER) or progesterone receptor (PR) status of the tumour.Methods: We used genotype data on up to 11,421 BRCA1 and 7,080 BRCA2 carriers, of whom 4,310 had been affected with breast cancer and had information on either ER or PR status of the tumour, to assess the associations of 12 loci with breast cancer tumour characteristics. Associations were evaluated using a retrospective cohort approach.Results: The results suggested stronger associations with ER-positive breast cancer than ER-negative for 11 loci in both BRCA1 and BRCA2 carriers. Among BRCA1 carriers, single nucleotide polymorphism (SNP) rs2981582 (FGFR2) exhibited the biggest difference based on ER status (per-allele hazard ratio (HR) for ER-positive = 1.35, 95% CI: 1.17 to 1.56 vs HR = 0.91, 95% CI: 0.85 to 0.98 for ER-negative, P-heterogeneity = 6.5 × 10-6). In contrast, SNP rs2046210 at 6q25.1 near ESR1 was primarily associated with ER-negative breast cancer risk for both BRCA1 and BRCA2 carriers. In BRCA2 carriers, SNPs in FGFR2, TOX3, LSP1, SLC4A7/NEK10, 5p12, 2q35, and 1p11.2 were significantly associated with ER-positive but not ER-negative disease. Similar results were observed when differentiating breast cancer cases by PR status.Conclusions: The associations of the 12 SNPs with risk for BRCA1 and BRCA2 carriers differ by ER-positive or ER-negative breast cancer status. The apparent differences in SNP associations between BRCA1 and BRCA2 carriers, and non-carriers, may be explicable by differences in the prevalence of tumour subtypes. As more risk modifying variants are identified, incorporating these associations into breast cancer subtype-specific risk models may improve clinical management for mutation carriers. © 2011 Mulligan et al.; licensee BioMed Central Ltd.

Eric I Benchimol,1–5 M Ellen Kuenzig,1,2,5 Charles N Bernstein,6,7 Geoffrey C Nguyen,5,8 Astrid Guttmann,5,9 Jennifer L Jones,10 Beth K Potter,4 Laura E Targownik,6,7 Christina A Catley,5 Zoann J Nugent,6,11 Divine Tanyingoh,12,13 Nassim Mojaverian,5 Fox E Underwood,12,13 Shabnaz Siddiq,1,2 Anthony R Otley,14 Alain Bitton,15 Matthew W Carroll,16 Jennifer C deBruyn,17 Trevor JB Dummer,18 Wael El-Matary,19 Anne M Griffiths,9 Kevan Jacobson,20,21 Desmond Leddin,10 Lisa M Lix,22 David R Mack,1–3 Sanjay K Murthy,4,23 Juan Nicolás Peña-Sánchez,24 Harminder Singh,6,7 Gilaad G Kaplan12,13 On behalf of the Canadian Gastro-Intestinal Epidemiology Consortium 1Children’s Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Canada; 2Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada; 3Department of Pediatrics, University of Ottawa, Ottawa, Canada; 4School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; 5ICES, Toronto, Canada; 6University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Canada; 7Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; 8Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Canada; 9Department of Paediatrics, University of Toronto, Toronto, Canada; 10Department of Medicine, Dalhousie University, Halifax, Canada; 11CancerCare Manitoba, Winnipeg, Canada; 12Department of Medicine, University of Calgary, Calgary, Alberta, Canada; 13Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 14Department of Pediatrics, Dalhousie University, Halifax, Canada; 15Division of Gastroenterology, McGill University Health Centre, Montreal, Canada; 16Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Canada; 17Division of Gastroenterology, Department of Pediatrics, University of Calgary, Calgary, Canada; 18School of Population and Public Health, University of British Columbia, British Columbia, Canada; 19Department of Pediatrics, University of Manitoba, Winnipeg, Canada; 20Department of Pediatrics, The University of British Columbia, British Columbia, Canada; 21Child and Family Research Institute, The University of British Columbia, British Columbia, Canada; 22Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; 23The Ottawa Hospital IBD Centre, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 24Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada Background and aims: Canada’s large geographic area and low population density pose challenges in access to specialized health care for remote and rural residents. We compared health services use, surgical rate, and specialist gastroenterologist care in rural and urban inflammatory bowel disease (IBD) patients in Canada.Methods: We used validated algorithms that were applied to population-based health administrative data to identify all people living with the following three Canadian provinces: Alberta, Manitoba, and Ontario (ON). We compared rural residents with urban residents for time to diagnosis, hospitalizations, outpatient visits, emergency department (ED) use, surgical rate, and gastroenterologist care. Multivariable regression compared the outcomes in rural/urban patients, controlling for confounders. Provincial results were meta-analyzed using random-effects models to produce overall estimates.Results: A total of 36,656 urban and 5,223 rural residents with incident IBD were included. Outpatient physician visit rate was similar in rural and urban patients. IBD-specific and IBD-related hospitalization rates were higher in rural patients (incidence rate ratio [IRR] 1.17, 95% CI 1.02–1.34, and IRR 1.27, 95% CI 1.04–1.56, respectively). The rate of ED visits in ON were similarly elevated for rural patients (IRR 1.53, 95% CI 1.42–1.65, and IRR 1.33, 95% CI 1.25–1.40). There were no differences in surgical rates or prediagnosis lag time between rural and urban patients. Rural patients had fewer IBD-specific gastroenterologist visits (IRR 0.79, 95% CI 0.73–0.84) and a smaller proportion of their IBD-specific care was provided by gastroenterologists (28.3% vs 55.2%, P65 years (33.0% vs 59.2%, P

Audrey Cund,1–4 Jayne L Birch-Jones,1,3,4 Martin Kay,1 Patricia Connolly4 1School of Health, Nursing and Midwifery, University of The West of Scotland, Paisley, Scotland, UK; 2Nottinghamshire Health and Social Care Assistive Technology Programme, Mansfield and Ashfield Clinical Commissioning Group, National Health Service, Rainworth, Mansfield, Nottinghamshire, UK; 3Kay Consultancy Ltd, Newark, UK; 4Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK Background: Living with and managing a long-term condition are complex processes that are further compounded by a range of medical and psychosocial factors. The size and scale of long-term conditions in the UK is vast, with strategic drivers seeking to find innovative ways to managing this problem. Methods: This project introduced Simple Telehealth “Florence,” a software-based short message service texting system to monitor a variety of conditions, such as diabetes, hypertension, and wounds, initially in one region of the East Midlands, England, UK. This article discusses the findings from our patient and staff evaluations of using the system. In total, 37 patients across four conditions, diabetes, chronic obstructive pulmonary disease, hypertension, and Asperger's syndrome, evaluated the study and this exercise involved 33 nurses in teams across three locations over a 6-month period. Evaluation was made using a simple, self-completed questionnaire and analysis of qualitative comments. Results: The majority of patients find the service easy to use, reassuring, and reducing the number of contacts they had with their doctor. The results also show that staff did notice a reduction in consultation time, highlighting the potential of the system to save time; the majority viewed it as a support to existing approaches aimed at the management of long-term conditions. Discussion: This study adds to the growing body of evidence that supports community nurses through the use of innovative ways to assess, support, and monitor long-term conditions. It also offers insight into the experience of patients and staff working together in one region of England, UK. Recommendations: Embedding Simple Telehealth “Florence” as an option within primary care services in the UK is hereby proposed. This would add to the range of options and therapeutic approaches available through modern Telehealth. Keywords: self-management, simple telehealth, Flo, patient experience, community nurse

SUMMARY Toxoplasmosis caused by the protozoan parasite, Toxoplasma gondii, is a worldwide zoonosis. In this paper published information on toxoplasmosis in humans and other animals in Ethiopia is reviewed. Limited data indicate that the prevalence of T. gondii in humans in Ethiopia is very high, up to 41% of children aged 1-5 years were reported to be seropositive. There is little information on seroprevalence data in pregnant women and no data on congenital toxoplasmosis in children. About 1 million adults in Ethiopia are considered to be infected with HIV with less than one-third likely receive highly active antiviral therapy. Based on a conservative T. gondii seroprevalence of 50%, thousands might die of concurrent opportunistic infections, including toxoplasmosis. However, exact figures are not available, and most serological surveys are not current. Serological surveys indicate up to 79% of goats and sheep have T. gondii antibodies. However, there is no information on losses due to toxoplasmosis in livestock or the presence of viable T. gondii in any host in Ethiopia. [ABSTRACT FROM AUTHOR]

Ductal carcinoma in situ (DCIS) now represents up to 20% of breast cancer cases, yet its behaviour is still poorly understood. Morphological classifications go some way to predicting prognosis, but more sophisticated approaches are required to better tailor therapy to the individual. A number of biological molecules have been identified that appear to relate to prognosis and, in model systems, promote progression to invasive disease. Some of these, such as COX-2, provide real therapeutic opportunities, whilst other marker combinations are showing promise in categorising women according to risk. Gene expression studies have led to an emerging molecular classification of invasive breast cancer, and it is now evident that at least some of these molecular subtypes can be identified at the pre-invasive stage. The difference in frequency of these subtypes between DCIS and invasive cancer may hold clues as to the biological mechanisms underpinning disease transition. It is increasingly clear that the host microenvironment can have a major impact on disease behaviour, and as well as acting as potential predictive factors, the altered microenvironment phenotype also offers novel therapeutic opportunities. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Scope of the Problem: Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Acute infections in pregnant women can be transmitted to the fetus and cause severe illness (e.g., mental retardation, blindness, and epilepsy). An estimated 400-4,000 cases of congenital toxoplasmosis occur each year in the United States. Of the 750 deaths attributed to toxoplasmosis each year, 375 (50%) are believed to be caused by eating contaminated meat, making toxoplasmosis the third leading cause of foodborne deaths in this country. Etiologic Factors: Toxoplasma can be transmitted to humans by three principal routes: a) ingestion of raw or inadequately cooked infected meat; b) ingestion of oocysts, an environmentally resistant form of the organism that cats pass in their feces, with exposure of humans occurring through exposure to cat litter or soil (e.g., from gardening or unwashed fruits or vegetables); and c) a newly infected pregnant woman passing the infection to her unborn fetus. Recommendations for Prevention: Toxoplasma infection can be prevented in large part by a) cooking meat to a safe temperature (i.e., one sufficient to kill Toxoplasma); b) peeling or thoroughly washing fruits and vegetables before eating; c) cleaning cooking surfaces and utensils after they have contacted raw meat, poultry, seafood, or unwashed fruits or vegetables; d) pregnant women avoiding changing cat litter or, if no one else is available to change the cat litter, using gloves, then washing hands thoroughly; and e) not feeding raw or undercooked meat to cats and keeping cats inside to prevent acquisition of Toxoplasma by eating infected prey. Research Agenda: Priorities for research were discussed at a national workshop sponsored by CDC in September 1998 and include a) improving estimates of the burden of toxoplasmosis, b) improving diagnostic tests to determine when a person becomes infected with Toxoplasma, and c) determining the applicability of national screening programs. Conclusion: Many cases of congenital toxoplasmosis can be prevented. Specific measures can be taken by women and their health-care providers to decrease the risk for infection during pregnancy and prevent severe illness in newborn infants. [ABSTRACT FROM AUTHOR]

Problem/Condition: Acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (OIs) are the major cause of morbidity and mortality among persons infected with human immunodeficiency virus (HIV). As a result of new treatments that reduce mortality for persons with AIDS, the number of persons living with AIDS is increasing, and the incidence of AIDS is decreasing. In 1997, an estimated 271,245 persons were living with AIDS in the United States and thus were at high risk for OIs. In 1997, an estimated 21,909 HIV-infected persons died with AIDS, nearly all as a result of OIs. Reporting Period Covered: Aggregate data and trends for 1992-1997 were examined to determine a) the frequencies at which OIs occurred first; b) the incidence of OIs; c) the percentage of persons among those who have died who had had a given OI during their course of AIDS, and d) the frequency of prescriptions for antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia (PCP) and for Mycobac-terium avium complex disease (MAC). Description of System: Data were analyzed from the Adult/Adolescent Spectrum of HIV Disease (ASD) sentinel surveillance project, a prospective medical record review of HIV-infected persons aged >/=13 years conducted in 11 U.S. cities. ASD data were standardized to national AIDS surveillance data for 1992-1997 by age; race; sex; country of birth; year of AIDS diagnosis; HIV exposure mode; and for incidence calculations, by CD4+ T-lymphocyte distribution. Results: The incidence declined significantly for each of 15 of the 26 specific AIDS-defining OIs (p<0.05). PCP was the most common AIDS-defining OI to occur first (PCP was the first OI to occur for 36% of HIV-infected persons), the most common incident AIDS-defining OI (274 cases per 1000 person-years), and the most common AIDS-defining OI to have occurred during the course of AIDS (53% of persons who died with AIDS had PCP diagnosed at some time during their course of AIDS). Of persons with CD4+ T-lymphocyte counts <500 cells/muL, the number with prescriptions for triple combination therapy increased from zero in 1992 to 40% in 1997, and 80% of persons had a prescription for any antiretroviral therapy in 1997. Of persons with CD4+ T-lymphocyte counts <200 cells/muL, the percentage with prescriptions for PCP prophylaxis remained stable from 1992 through 1997 (range: 75% to 80%). Of persons with CD4+ T-lymphocyte counts <50 cells/muL, the percentage with prescriptions for MAC prophylaxis increased from 9% in 1992 to 44% in 1997. Interpretations: The incidences of many OIs are decreasing primarily because of advances in HIV-related therapy. However, OIs are still occurring, especially when patients access care late during the course of disease. Even after accessing care, persons may develop OIs because of lack of prescription for prophylaxis, antiretroviral drug resistance, or poor adherence to therapy. During 1992-1997, most patients in need of PCP prophylaxis received a prescription for it; however, even in 1997, most patients in need of MAC prophylaxis did not receive a prescription for it. Actions Taken: These surveillance data are used by persons involved with developing guidelines for preventing OIs to determine the importance of and trends in OIs and preventive therapy. CDC is developing population-based approaches for surveillance of HIV disease progression, OIs, and therapies with the goal of making these data available in more geographic areas to help assess public health and health-care programs. [ABSTRACT FROM AUTHOR]

Introduction: Throughout the COVID-19 pandemic, there was an urgent need for the rapid and equitable translation of knowledge and effective treatments to reach vulnerable populations in response to the ever-shifting pandemic environment. The approval of neutralizing monoclonal antibodies (mAbs) for treatment of outpatient COVID-19 resulted in a need to rapidly design dissemination strategies to increase awareness and equitable access for community members and healthcare providers., Materials and Methods: We used the Fit to Context (F2C) Framework for Designing for Dissemination and Sustainability to (a) design products such as messages and materials, and (b) disseminate the products. We leveraged existing partnerships (e.g., community members, health system leaders, Regional Health Connectors, public health agencies, policymakers, and others) for activities including (a) advising on contextual implementation challenges and opportunities; (b) convening a stakeholder advisory panel; (c) rapid feedback on product reach and impact; and (d) serving as potential product adopters and distributors. We used concurrent data collection and co-design with rapid, iterative prototyping. We used real-world data to evaluate impact of D&I strategies on mAb use in Colorado., Results: Moving through the F2C Framework phases, we assessed mAb implementation and access barriers and facilitators, identified partner priorities, co-designed messages and materials for multiple audiences, and disseminated through audience-specific communication channels. An emphasis on equity led to tailoring materials to communities with lower health literacy, under- and uninsured groups, Spanish-speaking communities, Native American communities, and rural areas. Dissemination messages, materials, and distribution strategies were updated frequently based on emerging data on COVID-19 treatment effectiveness and availability. Real-world data revealed more than 400% increase in both referrals and number of unique referring providers, with the greatest impact on underserved communities. This was accomplished in under 9 months., Conclusion: The Fit to Context Framework for Designing for Dissemination and Sustainability is a novel process framework that can inform a rapid, iterative dissemination strategy. The COVID-19 pandemic presented an opportunity to learn better ways to speed translation of evidence to practice and enhance equitable access to evidence-based care. The mAb Colorado project demonstrated the importance of having strong community-academic-public health partnerships and leveraging existing capacity to enhance adoption and reach., Competing Interests: AG reports grants from the National Institutes of Health (NIH) for the conduct of this study and other grants related to COVID-19 from the NIH, Centers for Disease Control and Prevention, Department of Defense, AbbVie, and Faron Pharmaceuticals, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kwan, Sobczak, Fish, Ginde, Grant, Hamer, Leggott, Owen, Reno, Shrader, Whittington, Jones, Koren, Begay, Vinaithirthan and Lum.)

Introduction: A drowning definition is available for use with National Syndromic Surveillance Program (NSSP) data. However, its accuracy in capturing drowning emergency department and urgent care visits at the regional level is unknown. We tested the ability of the syndromic surveillance (SS) definition in capturing unintentional and undetermined intent drowning (UUID) and describe UUID SS visit trends in a large metropolitan area., Methods: We applied the drowning definition to NSSP data from 2016 to 2022 for the 8-county metropolitan Houston region. We queried the dataset for UUID ICD-10-CM codes and manually reviewed the chief complaint (CC) and discharge diagnosis (DD) for SS visits. True-positives were calculated by dividing the number of UUID cases identified by UUID ICD-10-CM codes and CC/DD review by the total visits captured by the SS definition. Demographics and trends of UUID visits were calculated from 2018 to 2022 due to limited data from 2016 to 2017 in NSSP., Results: 2,759 visits were captured by the SS definition. After case review, 2,019 (73.2%) had ICD-10-CM drowning codes of any intent; and 2,015 of those (99.8%) were classified as UUID. Of the remaining 740 cases with no ICD-10-CM codes that were pulled by the SS definition, 690 (93.2%) had a CC/DD diagnosis of drowning/submersion/underwater related to aquatic exposure. Taken together, 2,705 (98.0%) were true-positive UUID visits based on the SS drowning definition.. Children (aged < 18 years) constituted 79% of UUID visits. Black, White and Asian/Pacific Islander persons comprised 17%, 60% and 4% of UUID visits respectively. Rates of UUID visits were lowest in 2020., Conclusion: Syndromic surveillance is a novel and accurate method to conduct real-time drowning surveillance in a large metropolitan region., (© 2024. The Author(s).)

Background: Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care., Methods: We conducted an observational study of patients undergoing mpox testing between 1 June 2022 and 15 December 2022. We assessed concomitant sexually transmitted infection (STI) testing, sexual history, and anogenital examination and a composite outcome of all 3, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic)., Results: Of 276 patients included, more than half (62.7%) were evaluated in the ED. Sexual history, anogenital examination, and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox; syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in an ID clinic had higher odds ratio of completing all 3 measures (adjusted odds ratio, 3.6 [95% confidence interval, 1.4-9.3]) compared to PCP setting adjusted for age, gender, and men who have sex with men status. Cisgender men who have sex with men, transgender males, and transgender females had higher odds ratio of completing all 3 measures compared to cisgender females (adjusted odds ratio, 4.0 [95% confidence interval, 1.9-8.4]) adjusted for age and venue of care., Conclusions: Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients., Competing Interests: Potential conflicts of interest. K.A.G. receives royalties from UpToDate, non-paid position at Pfizer, and personal consulting from Spark HealthCare, Premier HealthCare, Harrison Consulting and MedEd Learning. W.M.G. reports receiving honorarium from DKBmed; serving as a scientific advisor to Gilead Sciences, Inc; and owning stock in Abbott Laboratories, Danaher, Eli Lilly and Company, Iqvia, Johnson & Johnson, Stryker, UnitedHealth Group, and AstraZeneca Pharmaceuticals. M.M.H. receives royalties from UpToDate and BMJ publishing and has received consultant fees from Chembio, Cepheid, and Roche diagnostics. He has also received donations of test kits for research studies from Chembio, Cepheid, Roche diagnostics, and Hologic. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Cultural eutrophication from excessive human-related nutrient (phosphorus, P, and nitrogen, N) inputs is a major concern for water quality. Because P historically was regarded as the critical nutrient in controlling noxious algal/plant growth, P became the focus of "capturing" techniques, with emphasis on removal performance rather than environmental impacts. Here, we synthesize a literature review of known environmental effects linked to use of metal-cation-based P-capturing materials under eutrophic conditions in freshwaters. P-capturing materials with functional cations based on aluminum (Al), calcium (Ca), iron (Fe), lanthanum (La), and magnesium (Mg) were reviewed in terms of their ecotoxicity, persistence, and bioaccumulation-standard criteria used to evaluate environmental risks of chemical substances. We found very few published studies on environmental impacts of metal-cation-based P-capturing materials under eutrophic conditions. Available reports indicated that environmental effects vary depending on the selected material, dose, target organism(s), and experimental conditions. The Al-based materials had the potential to negatively impact various biota; several Fe-based materials caused various levels of toxicity in a limited group of aquatic organisms; La-based materials can bioaccumulate and some were linked to various harmful effects on biota; and Mg-based materials also adversely affected various organisms. The limited number of published studies underscores the need for further research to characterize the environmental impacts of these materials. Results can be used to guide future work and can assist resource managers in sustainable management strategies. Among various research needs, future assessments should assess the impacts of chronic exposures on sensitive species under realistic field conditions in eutrophic waters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The engagement of community partners in equitable partnerships with academic teams is necessary to achieve health equity. However, there is no standardized approach to support bidirectional engagement among research stakeholders in the context of partnership equity at each phase of the research process., Objective: We describe the development of a systematic framework along with competencies and tools promoting bidirectional engagement and equity within community-academic partnerships at each phase of the research process., Design: We conducted a four-step research process between November 2020 and December 2023 for framework development: (1) a narrative literature review; (2) expansion of existing bidirectional, equitable framework; (3) a scientific review with two groups of cognitive interviews (five community engagement researchers and five community leaders and members); and (4) three community-based organization leader focus groups. Thematic analysis was used to analyse focus group data., Results: Using results of each step, the framework was iteratively developed, yielding four phases of the bidirectional engagement and equity (BEE) research framework: Relationship building and assessment of goals and resources (Phase I); form a community-academic partnership based on shared research interests (may include multilevel stakeholders) (Phase II); develop a research team comprising members from each partnering organization (Phase III); and implement the six-step equitable research process (Phase IV). Bidirectional learning and partnership principles are at the core of the partnership, particularly in Phases II-IV. Competencies and tools for conducting an equitable, engaged research process were provided., Discussion: This conceptual framework offers a novel, stepwise approach and competencies for community-academic partners to successfully partner and conduct the research process equitably., Conclusion: The BEE research framework can be implemented to standardize the conduct of an equitable, engaged research process within a community-academic partnership, while improving knowledge and trust across partners and, ultimately, an increased return on investment and sustainability to benefit both partners in the area of health outcomes and ultimately health equity., Patient or Public Contribution: The development of this framework was co-led with a community organization in which two leaders in the organization were equitably involved in each phase of the research process, including grant development, study design, participant recruitment, protocol development for focus groups and community and researcher review, framework design and content and dissemination of this manuscript as a co-author. For grant development, the community leader completed the give-get grid components for them as a partner. They also wrote up their lived experience in the research process for the progress report. For the focus groups, one community leader co-led the focus group with the academic partner. For the narrative review, the community leaders did not actively conduct the narrative review but observed the process through the academic partners. One community leader wrote the section 'relationship building' and 'bidirectional learning' sections with the assistance of the academic partner, while they both equally provided input on other sections of the manuscript alongside academic partners. The community leaders have extensive experience in leading programmes, along with partnering with researchers to address health equity issues and improve health outcomes., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

As the dimensionality, throughput and complexity of cytometry data increases, so does the demand for user-friendly, interactive analysis tools that leverage high-performance machine learning frameworks. Here we introduce FlowAtlas: an interactive web application that enables dimensionality reduction of cytometry data without down-sampling and that is compatible with datasets stained with non-identical panels. FlowAtlas bridges the user-friendly environment of FlowJo and computational tools in Julia developed by the scientific machine learning community, eliminating the need for coding and bioinformatics expertise. New population discovery and detection of rare populations in FlowAtlas is intuitive and rapid. We demonstrate the capabilities of FlowAtlas using a human multi-tissue, multi-donor immune cell dataset, highlighting key immunological findings. FlowAtlas is available at https://github.com/gszep/FlowAtlas.jl.git., Competing Interests: JJ reports receiving consulting fees and grant support from Sanofi Genzyme and Enhanc3DGenomics, and consulting fees from Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funders did not play a part in study design, data collection, decision to publish, or preparation of the manuscript. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Coppard, Szep, Georgieva, Howlett, Jarvis, Rainbow, Suchanek, Needham, Mousa, Menon, Feyertag, Mahbubani, Saeb-Parsy and Jones.)