Search

Geographic information systems (GIS) can be used to map mosquito larval and adult habitats and human populations at risk for mosquito exposure and possible arbovirus transmission. Along with traditional methods of surveillance-based targeted mosquito control, GIS can help simplify and target efforts during routine surveillance and post-disaster (e.g., hurricane-related flooding) to protect emergency workers and public health. A practical method for prioritizing areas for emergency mosquito control has been developed and is described here. North Carolina (NC) One Map was used to identify state-level data layers of interest based on human population distribution and mosquito habitat in Brunswick, Columbus, Onslow, and Robeson Counties in eastern NC. Relevant data layers were included to create mosquito control treatment areas for targeted control and an 18-step protocol for map development is discussed. This protocol is expected to help state, territorial, tribal, and/or local public health officials and associated mosquito control programs efficiently create treatment area maps to improve strategic planning in advance of a disaster. This protocol may be applied to any NC county and beyond, thereby increasing local disaster preparedness.

Abstract Sickle cell trait (SCT), a commonly asymptomatic condition, has many associated clinical complications that upon presentation, can be very difficult to attribute to SCT. The effects of SCT on the spleen, for example, are not completely understood, though there have been a number of case reports detailing related complications in diverse populations. Our objective was to perform the first comprehensive case report review of splenic infarction in SCT patients to highlight the relevance of this seemingly rare condition. We conducted an extensive literature search reviewing case reports and case series of acute splenic infarctions from 1970 to 2020. This comprehensive search resulted in 54 articles with a total of 85 individuals. The ages ranged from 7 to 65, 12% were female. Individuals were of African‐American (26%), European (16%), South Asian (13%), Middle Eastern (7%), Latin American (7%), North or East African (4%), Mediterranean (4%), West African (1%), and unknown (22%) origins. Although splenic infarct in SCT patients has been associated with high altitudes, 39% of cases reporting altitude occurred below 3000 m. Among cases where HbS values were recorded, 88% occurred in individuals with HbS levels higher than 35%, suggesting that high HbS values may be a risk factor for splenic infarction. Our findings indicate that splenic infarct occurs across a wide range of demographic populations and environmental settings. While our understanding of SCT evolves, the findings here suggest that future advances in research and healthcare could benefit more from real‐time surveillance and registry initiation for various SCT outcomes such as splenic infarct.

Abstract Objective To describe the development of the Pediatric Epilepsy Outcome‐Informatics Project (PEOIP) at Alberta Children's Hospital (ACH), which was created to provide standardized, point‐of‐care data entry; near‐time data analysis; and availability of outcome dashboards as a baseline on which to pursue quality improvement. Methods Stakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes‐ seizure type and frequency, adverse effects, emergency department visits, hospitalization, and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient‐ and population‐level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note. Results In the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point‐of‐care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered “valuable” or “really valuable” by 86% of respondents and facilitated communication with family members, school, and advocacy organizations. Significance The PEOIP serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable process/outcome dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based.

Abstract Background The pharmacological treatment for autism spectrum disorders is often poorly tolerated and has traditionally targeted associated conditions, with limited benefit for the core social deficits. We describe the novel use of a cannabidiol-based extract that incidentally improved core social deficits and overall functioning in a patient with autism spectrum disorder, at a lower dose than has been previously reported in autism spectrum disorder. Case presentation The parents of a 15-year-old boy, of South African descent, with autism spectrum disorder, selective mutism, anxiety, and controlled epilepsy, consulted a medical cannabis physician to trial cannabis extract to replace seizure medications. Incidentally, at a very low cannabidiol-based extract dose, he experienced unanticipated positive effects on behavioral symptoms and core social deficits. Conclusion This case report provides evidence that a lower than previously reported dose of a phytocannabinoid in the form of a cannabidiol-based extract may be capable of aiding in autism spectrum disorder-related behavioral symptoms, core social communication abilities, and comorbid anxiety, sleep difficulties, and weight control. Further research is needed to elucidate the clinical role and underlying biological mechanisms of action of cannabidiol-based extract in patients with autism spectrum disorder.

Approximately 25% of individuals report poor mental health during their pregnancy or postpartum period, which may impact fetal neurodevelopment, birth outcomes, and maternal behaviors. In the present study, maternal serum samples were collected from pregnancies at 28–32 weeks gestation from the All Our Families (Alberta, Canada) cohort and assessed using nuclear magnetic resonance spectroscopy (1H-NMR) and inductively coupled plasma-mass spectrometry (ICP-MS). Individuals with poor mental health at 34–36 weeks gestation were age-matched with mentally healthy pregnant controls. Metabolites were examined against validated self-reported mental health questionnaires for associations with depressive symptoms (Edinburgh Perinatal Depression Scale) and anxiety symptoms (Spielberger State-Trait Anxiety Inventory). 1H-NMR metabolites were identified for depression (alanine, leucine, valine, methionine, phenylalanine, glucose, lactate, 3-hydroxybutyrate, and pyruvate) and anxiety (3-hydroxybutyrate). For ICP-MS, antimony and zinc were significant for depression and anxiety, respectively. Upon false discovery rate (FDR) correction at 10%, five 1H-NMR metabolites (alanine, leucine, lactate, glucose, and phenylalanine) for depression remained significantly increased. Although results warrant further validation, the identified metabolites may serve as a predictive tool for assessing mental health during pregnancy as earlier identification has the potential to aid intervention and management of poor mental health symptomology, thus avoiding harmful consequences to both mother and offspring.

Abstract Background Hydroxyurea (HU) is recommended as standard practice for youth with sickle cell disease (SCD). Yet, despite its efficacy, HU adherence in adolescents and young adults is often poor. Poor medication adherence increases disease burden, healthcare cost and widens health disparities. Adolescence is a critical time to improve adherence through improved chronic disease self-management. This study aims to test the efficacy of an intervention delivered to youth/parent dyads by community health workers (CHWs), augmented by tailored text messages on HU adherence (primary outcome). Secondary outcomes are intervention sustainability, youth health-related quality of life, self-management responsibility concordance, acute hospital use and self-reported disease symptoms. Methods Hydroxyurea Adherence for Personal Best in Sickle Cell Disease, “HABIT,” is a 12 month multi-center randomized controlled trial. One hundred four youth, 10 to 18 years of age prescribed HU who meet eligibility criteria, enrolled with their parent as dyads, will be randomized 1:1 to either the HABIT intervention or to usual clinical care plus education handouts. All subjects will complete clinic visits at months 0, 2, 4, 6 (efficacy component), 9 and 12 (sustainability component) for assessment of HbF biomarker, other hematologic parameters, and to complete questionnaires. In addition, dyads assigned to the HABIT intervention will work with CHWs to identify a daily habit (e.g., brushing teeth) on which to build a HU adherence habit. Tailored daily text message reminders to support the habit will be developed by the dyad in collaboration with the CHWs and sent to parent and youth. At the 6 month visit, the intervention will end and the sustainability portion of the trial will begin. All data analyses will be based on intention to treat with all randomized subjects included in the analyses. Discussion Prior retrospective studies demonstrate that a majority of adolescents are poorly adherent to HU. If efficacious, the HABIT intervention has the potential to improve the lives of youth with SCD. Trial registration Clinicaltrials.gov NCT03462511. Registered March 6, 2018, last updated July 26, 2019.

Coordination of a power system with the phasor measurement devices (PMUs) in real time on the load and generation sides is carried out within the context of smart grid studies. Power systems equipped with information systems in a smart grid pace with external security threats. Developing a smart grid which can resist against cyber threats is considered indispensable for the uninterrupted operation. In this study, a two-way secure communication methodology underpinned by a chaos-based encryption algorithm for PMU devices is proposed. The proposed system uses the IEEE-14 busbar system on which the optimum PMU placement has been installed. The proposed hyperchaotic system-based encryption method is applied as a new security methodology among PMU devices. The success of results is evaluated by the completeness of data exchange, durations, the complexity of encryption-decryption processes, and strength of cryptography using a microcomputer-based implementation. The results show that the proposed microcomputer-based encryption algorithms can be directly embedded as encryption hardware units into PMU and PDC devices which have very fast signal processing capabilities taking into considerations the acceptable delay time for power system protection and measuring applications and quality metering applications which is 2 ms and 10 ms, respectively. While proposed algorithms can be used in TCP or UDP over IP-based IEEE C37.118, IEC 61850, and IEC 61850-90-5 communication frameworks, they can also be embedded into electronic cards, smartcards, or smart tokens which are utilized for authentication among smart grid components.

β-thalassemia is a disorder caused by altered hemoglobin protein synthesis and affects individuals worldwide. Severe forms of the disease, left untreated, can result in death before the age of 3 years (1). The standard of care consists of chronic and costly palliative treatment by blood transfusion combined with iron chelation. This dual approach suppresses anemia and reduces iron-related toxicities in patients. Allogeneic bone marrow transplant is an option, but limited by the availability of a highly compatible HSC donor. While gene therapy is been explored in several trials, its use is highly limited to developed regions with centers of excellence and well-established healthcare systems (2). Hence, there remains a tremendous unmet medical need to develop alternative treatment strategies for β-thalassemia (3). Occurrence of aberrant splicing is one of the processes that affects β-globin synthesis in β-thalassemia. The (C>G) IVS-2-745 is a splicing mutation within intron 2 of the β-globin gene. It leads to an aberrantly spliced mRNA that incorporates an intron fragment. This results in an in-frame premature termination codon that inhibits β-globin production. Here, we propose the use of uniform 2'-O-methoxyethyl (2'-MOE) splice switching oligos (SSOs) to reverse this aberrant splicing in the pre-mRNA. With these lead SSOs we show aberrant to wild type splice switching. This switching leads to an increase of adult hemoglobin (HbA) up to 80% in erythroid cells from patients with the IVS-2-745 mutation. Furthermore, we demonstrate a restoration of the balance between β-like- and α-globin chains, and up to an 87% reduction in toxic α-heme aggregates. While examining the potential benefit of 2'-MOE-SSOs in a mixed sickle-thalassemic phenotypic setting, we found reduced HbS synthesis and sickle cell formation due to HbA induction. In summary, 2'-MOE-SSOs are a promising therapy for forms of β-thalassemia caused by mutations leading to aberrant splicing.

Background: Some patients who have undergone a laparoscopic adjustable gastric band operation express dissatisfaction with visible scars or protrusion of the access port after sufficient weight loss. We hypothesized that subfascial port implantation could minimize those problems as well as port-related complications. Subjects and Methods: We retrospectively reviewed the medical records of patients who underwent "transumbilical" subfascial port (SP) implantation between March 2009 and July 2011. We compared these results with those of conventional placement of laparoscopic adjustable gastric band ports (CP) on the anterior rectus fascia by the four-point suture technique. The SP technique rendered the access port essentially nonpalpable, and therefore it could only be accessed under fluoroscopy. Results: In total, 66 consecutive patients were enrolled into our study. Thirty-three patients underwent the SP procedure, and 33 patients underwent the CP procedure. Both groups were matched for age (31.4 ± 6.5 years versus 34.0 ± 8.7 years, P=.168), gender (female:male 30:3 versus 27:6, P=.282), and preoperative body mass index (36.6 ± 5.4 kg/m(2) versus 36.9 ± 4.1 kg/m(2), P=.786). The mean follow-up period was 9.6 ± 3.9 months for the SP group and 18.9 ± 5.3 months for the CP group. During that period, the SP group tended to have a lower incidence of port infection (SP group, 0/33; CP group, 3/33, P=.076), and no patients in the SP group complained of hypertrophic scarring at the port site (SP group, 0/33; CP group, 4/33; P=.04). Two patients in the CP group had port inversion/migration. Two patients in the CP group had port protrusion. Two patients in the CP group underwent port revision surgery (subfascial port) 6 months after port removal. One patient in the CP group underwent port exchange surgery under local anesthesia for port leakage. None of the patients in the SP group had any of the above port-related complications. Conclusions: Our preliminary results show that subfascial implantation of the laparoscopic adjustable gastric band port could minimize port-related complications during the weight loss phase. [ABSTRACT FROM AUTHOR]

Objective: The role of adenosine (ADO) in the regulation of glucose homeostasis is not clear. In the current study, we used A1-ADO receptor (A1AR)-deficient mice to investigate the role of ADO/A1AR signaling for glucose homeostasis.Research Design and Methods: After weaning, A1AR(-/-) and wild-type mice received either a standard diet (12 kcal% fat) or high-fat diet (HFD; 45 kcal% fat). Body weight, fasting plasma glucose, plasma insulin, and intraperitoneal glucose tolerance tests were performed in 8-week-old mice and again after 12-20 weeks of subsequent observation. Body composition was quantified by magnetic resonance imaging and epididymal fat-pad weights. Glucose metabolism was investigated by hyperinsulinemic-euglycemic clamp studies. To describe pathophysiological mechanisms, adipokines and Akt phosphorylation were measured.Results: A1AR(-/-) mice were significantly heavier than wild-type mice because of an increased fat mass. Fasting plasma glucose and insulin were significantly higher in A1AR(-/-) mice after weaning and remained higher in adulthood. An intraperitoneal glucose challenge disclosed a significantly slower glucose clearance in A1AR(-/-) mice. An HFD enhanced this phenotype in A1AR(-/-) mice and unmasked a dysfunctional insulin secretory mechanism. Insulin sensitivity was significantly impaired in A1AR(-/-) mice on the standard diet shortly after weaning. Clamp studies detected a significant decrease of net glucose uptake in A1AR(-/-) mice and a reduced glucose uptake in muscle and white adipose tissue. Effects were not triggered by leptin deficiency but involved a decreased Akt phosphorylation.Conclusions: ADO/A1AR signaling contributes importantly to insulin-controlled glucose homeostasis and insulin sensitivity in C57BL/6 mice and is involved in the metabolic regulation of adipose tissue. [ABSTRACT FROM AUTHOR]

The aerial parts of Saururus chinensis (SC) have been used for the treatment of edema, fever, jaundice, and inflammatory diseases in Korean folk medicine for centuries. However, the mechanism by which SC exerts these anti-tumorigenic activities in human prostate and breast cancer cells has not yet been fully understood. In this study, we report on the methylene chloride fraction from SC exerting cytotoxicity against prostate and breast cancer cells in a dose-dependent manner. Specifically, SC exerted the most potent cytotoxicity in LNCaP and MCF-7 cells. SC was shown to down-regulate various angiogenetic (VEGF), proliferative (Cyclin D(1)), anti-apoptotic (Bcl-2) gene products in these cells. SC also increased the number of annexin V-positive apoptotic bodies and the sub-G1 DNA contents of the cell cycle undergoing apoptosis through caspase-3 activation in both LNCaP and MCF-7 cells. We further confirmed that caspase-3 plays an important role in SC-induced apoptosis in LNCaP and MCF-7 cells through the use of the caspase-3 inhibitor. Moreover, we observed that SC potentiated paclitaxel-induced apoptosis in MCF-7 cells and sauchinone is a major active constituent of SC, which could induce apoptosis in the cells. Taken together, our data provide the evidence that SC induces apoptosis depending on caspase-3 activation and overcomes the natural biological resistance to chemotherapy found in human prostate and breast cancer cells. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT for detecting open-globe injury.Methods: We enrolled 28 patients with unilateral open-globe injury confirmed by surgery and 28 controls with other types of orbital trauma. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis. The diagnostic performance of the following CT findings suggesting open-globe injury was also determined from independent analysis by two readers, i.e. change in the ACD and the globe contour, obvious volume loss of the globe, dislocated/deformed lens, intraocular foreign body/air and intraocular haemorrhage.Results: The ACD measurements were possible only in 15 patients with open-globe injuries. A difference in the ACDs > or =0.4 mm resulted in 0.85 of the area under the ROC curve with a sensitivity of 73% and specificity of 100% (p = 0.0001). The presence of one or more of the CT findings had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 89%.Conclusions: Change in the ACD is a helpful CT finding for detecting open-globe injury. A difference in the ACDs > or =0.4 mm is a helpful diagnostic criterion with excellent specificity. [ABSTRACT FROM AUTHOR]

Background: The performance of the computer-aided detection (CAD) system can be determined by the sensitivity and false-positive marks rate, therefore these factors should be improved by upgrading the software version of the CAD system. Purpose: To compare retrospectively the performances of two software versions of a commercially available CAD system when applied to full-field digital mammograms for the detection of breast cancers in a screening group. Material and Methods: Versions 3.1 and 8.3 of a CAD software system (ImageChecker, R2 Technology) were applied to the full-field digital mammograms of 130 women (age range 36-80, mean age 53 years) with 130 breast cancers detected by screening. Results: The overall sensitivities of the version 3.1 and 8.3 CAD systems were 92.3% (120 of 130) and 96.2% (125 of 130) (P=0.025), respectively, and sensitivities for masses were 78.3% (36 of 46) and 89.1% (41 of 46) (P=0.024) and for microcalcifications 100% (84 of 84) and 100% (84 of 84), respectively. Version 8.3 correctly marked five lesions of invasive ductal carcinoma that were missed by version 3.1. Average numbers of false-positive marks per image were 0.38 (0.15 for calcifications, 0.23 for masses) for version 3.1 and 0.46 (0.13 for calcifications, 0.33 for masses) for version 8.3 (P=0.1420). Conclusion: The newer version 8.3 of the CAD system showed better overall sensitivity for the detection of breast cancer than version 3.1 due to its improved sensitivity for masses when applied to full-field digital mammograms. [ABSTRACT FROM AUTHOR]