Perceptions of the Changing Healthcare Environment: A Florida Perspective

This study reviewed public perceptions of healthcare, including the public’s opinions of healthcare reform. The study’s objective was to examine how opinions are affected by individual differences such as age, income, race, and current insurance. It used telephone survey responses from the citizens of Florida to provide a more empirical look at the views of the population. Overall, the study findings provided important insight into the perceptions of Floridians of important components of the Patient Protection and Affordable Care Act (ACA) including cost, affordability, Medicaid expansion, and universal access to care. The results of this study indicate that whereas income, type of insurance held, race, education, and age have some impact on response to the statements posed, party affiliation is the best indicator of individuals\u27 perceptions of the policies. In addition, results suggest that policymakers should consider more effective and targeted ACA educational campaigns for those populations that are older, more educated, and with higher incomes. They also should consider identifying and implementing opportunities to expand the Medicaid program because there is such broad support for its expansion

Therapists’ Perceptions of School-based Mental Health Services: A Qualitative Evaluation of two Behavioral Health Models

Therapists’ perceptions of school-based mental health programs are considered to be an important factor in determining the effectiveness of a school based behavioral health model. This qualitative evaluation summarizes the perceptions of participant therapists on two different behavioral health models called Full Service Schools (FSS) and Full-Service Schools (FSS) Plus model that are currently being implemented in a large school district in Florida. FSS therapists provide therapy at a hub location whereas FSS Plus therapists work at one particular school. The study utilizes therapists’ views of their respective programs to compare and contrast the effectiveness of each of the behavioral health models. Five focus groups involving 24 therapists from both models were held at five separate locations. Nvivo version 10 was used to conduct a thematic analysis of collected data. Study findings revealed better results for the FSS Plus model as compared to the FSS model in terms of successful elimination of barriers such as transportation and lack of physical space to provide therapy. This study suggests that improved and effective behavioral health services can be provided to students by assigning a designated therapist at each school

Chronology with a pinch of salt:Integrated stratigraphy of Messinian evaporites in the deep Eastern Mediterranean reveals long-lasting halite deposition during Atlantic connectivity

The Messinian Salinity Crisis (MSC; 5.97–5.33 Ma) is considered an extreme environmental event driven by changes in climate and tectonics, which affected global ocean salinity and shaped the biogeochemical composition of the Mediterranean Sea. Yet, after more than 50 years of research, MSC stratigraphy remains controversial. Recent studies agree that the transition from the underlying pre-evaporite sediments to thick halite deposits is conformal in the deep Eastern Mediterranean Basin. However, the age of the base and the duration of halite deposition are still unclear. Also disputed is the nature of the intermediate and upper MSC units, which are characterized as periods of increased clastic deposition into the Eastern Mediterranean based on marginal outcrops and seismic data. We provide a multidisciplinary study of sedimentary, geochemical, and geophysical data from industrial offshore wells in the Levant Basin, which recovered a sedimentary record of deep-basin Mediterranean evaporites deposited during the MSC. In combination with previous observations of the MSC throughout the Mediterranean Basin, our results promote the need for a new chronological model. Remarkably, the one-kilometer-thick lower part of the evaporitic unit is composed of essentially pure halite, except for a thin transitional anhydrite layer at its base. The halite is undisturbed and homogeneous, lacking diverse features apparent in more proximal sections, indicating a deep-sea depositional environment. We find that distinct, meters-thick non-evaporitic intervals interbedded with the halite, previously thought to be clastic layers, are diatomites. While XRD analysis confirms an increase in clastic components in these sediments, they are composed primarily of well-preserved marine and freshwater planktonic diatoms. The occurrence of marine planktonic diatoms in these intervals indicates the input of Atlantic waters into the Mediterranean Basin during the deposition of the massive halite unit. Seismic stratigraphy and well-log cyclostratigraphy further support deep basin halite deposition, which started about 300 kyr earlier than widely assumed (~5.97 Ma). We propose that halite deposition in the deep Mediterranean took place during stage 1 of the MSC, rather than being limited to the short 50 kyr MSC acme when sea level was presumably at its lowest. Thus, brine formation, salt precipitation, and faunal extinction occurred at least in part in a deep, non-desiccated basin, with a restricted yet open Mediterranean-Atlantic connection that allowed inflow of oceanic water. We observe an increase in heavy minerals and reworked fauna within the clastic-evaporitic, Interbedded Evaporites of the basinal MSC section, and argue that these settings correspond in the deep basins with a significant sea-level drawdown during stage 2 of the MSC, as observed in the marginal sections. This correlation is corroborated by astrochronology and chemostratigraphic markers, such as the distribution of n-alkanes and biomarker-based thermal maturity indices. The Levant deposits indicate that high sea level and partial connectivity with global oceans promoted the deposition of deep-basin deep-water halite, while sea-level drawdown promoted deposition of reworked and transported material from the margins into deep Mediterranean basins. This study modifies the current understanding of the mechanisms governing salt deposition throughout the MSC with implications for other evaporitic events in the geologic record

AhrC and Eep are biofilm infection-associated virulence factors in enterococcus faecalis

Enterococcus faecalis is part of the human intestinal microbiome and is a prominent cause of health care-associated infections. The pathogenesis of many E. faecalis infections, including endocarditis and catheter-associated urinary tract infection (CAUTI), is related to the ability of clinical isolates to form biofilms. To identify chromosomal genetic determinants responsible for E. faecalis biofilm-mediated infection, we used a rabbit model of endocarditis to test strains with transposon insertions or in-frame deletions in biofilm-associated loci: ahrC, argR, atlA, opuBC, pyrC, recN, and sepF. Only the ahrC mutant was significantly attenuated in endocarditis. We demonstrate that the transcriptional regulator AhrC and the protease Eep, which we showed previously to be an endocarditis virulence factor, are also required for full virulence in murine CAUTI. Therefore, AhrC and Eep can be classified as enterococcal biofilm-associated virulence factors. Loss of ahrC caused defects in early attachment and accumulation of biofilm biomass. Characterization of ahrC transcription revealed that the temporal expression of this locus observed in wild-type cells promotes initiation of early biofilm formation and the establishment of endocarditis. This is the first report of AhrC serving as a virulence factor in any bacterial species

Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features

Dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA.R-EPOCH) is used for upfront treatment of high-risk diffuse large B cell lymphoma (DLBCL). In this study, we compared the outcomes in patients with high-risk DLBCL who received frontline rituximab, cycophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or DA.R-EPOCH immunochemotherapy. Outcomes and treatment-related cost were analyzed. DLBCL with one of the following features were included in the study: MYC ± BCL2 or BCL6 rearrangement by FISH or MYC overexpression by immunohistochemistry, Ki67 index ≥ 80% or nongerminal center immunophenotype, tumor measuring ≥5 cm and NCCN- IPI score ≥4. A total of 80 patients were treated with R-CHOP (n = 52, 65%) or DA.R-EPOCH (n = 28, 35%), with a median follow-up of 11.2 months (range: 0.7–151.3 months). The hazard ratios (HRs) for progression-free survival and overall survival were 0.79 [95% confidence interval (CI) 0.28%–2.29%, p = 0.67] and 0.86 (95% CI 0.26%–2.78%, p = 0.80), respectively for DA.R-EPOCH compared to R-CHOP. The total mean cost was USD106,940 ± USD39,351 and USD58,509 ± 24,588 for DA.R-EPOCH and R-CHOP respectively (p < 0.001). In our analysis, DA.R-EPOCH resulted comparable clinical outcomes and increased treatment-related expenses compared to R-CHOP in high-risk DLBCL

Quantitative Abdominal Arterial Calcification Correlates with Kidney Transplant Waitlist Mortality

Introduction: The scarcity of available organs for kidney transplantation has resulted in a substantial waiting time for patients with end-stage kidney disease. This prolonged wait contributes to an increased risk of cardiovascular mortality. Calcification of large arteries is a high-risk factor in the development of cardiovascular diseases, and it is common among candidates for kidney transplant. The aim of this study was to correlate abdominal arterial calcification (AAC) score value with mortality on the waitlist. Methods: We modified the coronary calcium score and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were listed for kidney transplant, between 2005 and 2015, and had abdominal computed tomography scan. Patients were divided into two groups: those who died on the waiting list group and those who survived on the waiting list group. Results: Each 1,000 increase in the AAC score value of the sum score of the abdominal aorta, bilateral common iliac, bilateral external iliac, and bilateral internal iliac was associated with increased risk of death (HR 1.034, 95% CI: 1.013, 1.055) (p = 0.001). This association remained significant even after adjusting for various patient characteristics, including age, tobacco use, diabetes, coronary artery disease, and dialysis status. Conclusion: The study highlights the potential value of the AAC score as a noninvasive imaging biomarker for kidney transplant waitlist patients. Incorporating the AAC scoring system into routine imaging reports could facilitate improved risk assessment and personalized care for kidney transplant candidates

Physiological and Communicative Emotional Disconcordance in Children on the Autism Spectrum

BACKGROUND: Individuals on the autism spectrum commonly have differences from non-autistic people in expressing their emotions using communicative behaviors, such as facial expressions. However, it is not yet clear if this reduced expressivity stems from reduced physiological reactivity in emotional contexts or if individuals react internally, but do not show these reactions externally to others. We hypothesized that autism is characterized by a discordance between in-the-moment internal psychophysiological arousal and external communicative expressions of emotion. METHODS: Forty-one children on the autism spectrum and 39 non-autistic, typically developing (TD) children of two age groups (2-4 and 8-12 years) participated in a low-level stress task whilst wearing a wireless electrocardiogram. Children\u27s negative emotional expressions (facial, vocal, bodily) were coded following standardized protocols. Alexithymia traits were assessed using the Children\u27s Alexithymia Measure with school-aged children only. Data analyses involved ANOVAs, correlations, and sensitivity analyses. RESULTS: There were no group differences in physiological arousal (heart rate) or in communicative expressions of stress to the stress task. For TD preschoolers, physiological arousal during the stress task was associated with vocal expressions and for TD school-aged children, they were associated with facial and bodily expressions. By contrast, for children on the autism spectrum, physiological arousal during the stress tasks was not associated with communicative expressions across age groups. CONCLUSIONS: Our findings suggest that children on the autism spectrum might experience emotional disconcordance, in that their physiological arousal does not align with their communicative expressions. Therefore, the internally experienced stress of children on the autism spectrum may be inadvertently missed by teachers and caregivers and, consequently, learning opportunities for teaching emotional communication and regulation may be also missed. Our results support the use of wearable biosensors to facilitate such interventions in children on the autism spectrum

Expanding the diversity of mycobacteriophages: insights into genome architecture and evolution.

Mycobacteriophages are viruses that infect mycobacterial hosts such as Mycobacterium smegmatis and Mycobacterium tuberculosis. All mycobacteriophages characterized to date are dsDNA tailed phages, and have either siphoviral or myoviral morphotypes. However, their genetic diversity is considerable, and although sixty-two genomes have been sequenced and comparatively analyzed, these likely represent only a small portion of the diversity of the mycobacteriophage population at large. Here we report the isolation, sequencing and comparative genomic analysis of 18 new mycobacteriophages isolated from geographically distinct locations within the United States. Although no clear correlation between location and genome type can be discerned, these genomes expand our knowledge of mycobacteriophage diversity and enhance our understanding of the roles of mobile elements in viral evolution. Expansion of the number of mycobacteriophages grouped within Cluster A provides insights into the basis of immune specificity in these temperate phages, and we also describe a novel example of apparent immunity theft. The isolation and genomic analysis of bacteriophages by freshman college students provides an example of an authentic research experience for novice scientists

Nebraska’s groundwater legacy: Nitrate contamination beneath irrigated cropland

A 31 year record of ~44,000 nitrate analyses in ~11,500 irrigation wells was utilized to depict the decadal expansion of groundwater nitrate contamination (N\u3e10 mg/L) in the irrigated corn-growing areas of eastern and central Nebraska and analyze long-term nitrate concentration trends in 17 management areas (MAs) subject to N fertilizer and budgeting requirements. The 1.3 M contaminated hectares were characterized by irrigation method, soil drainage, and vadose zone thickness and lithology. The areal extent and growth of contaminated groundwater in two predominately sprinkler-irrigated areas was only ~20% smaller beneath well-drained silt loams with thick clayey-silt unsaturated layers and unsaturated thicknesses \u3e15 m (400,000 ha and 15,000 ha/yr) than beneath well and excessively well-drained soils with very sandy vadose zones (511,000 ha and 18,600 ha/yr). Much slower expansion (3700 ha/yr) occurred in the 220,000 contaminated hectares in the central Platte valley characterized by predominately gravity irrigation on thick, well-drained silt loams above a thin (~5.3 m), sandy unsaturated zone. The only reversals in long-term concentration trends occurred in two MAs (120,500 ha) within this contaminated area. Concentrations declined 0.14 and 0.20 mg N/L/yr (p\u3c0.02) to ~18.3 and 18.8 mg N/L, respectively, during \u3e20 years of management. Average annual concentrations in 10 MAs are increasing (p\u3c0.05) and indicate that average nitrate concentrations in leachates below the root zone and groundwater concentrations have not yet reached steady state. While management practices likely have slowed increases in groundwater nitrate concentrations, irrigation and nutrient applications must be more effectively controlled to retain nitrate in the root zone