A Case Report of Angioedema and Anaphylactic Shock Induced by Ingestion of Polyethylene Glycol

Introduction: We report one of few documented cases of a severe anaphylactic reaction with angioedema to polyethylene glycol (PEG).Case Report: The patient presented 30 minutes after onset of his symptoms and quickly developed hypoxia and hypotension refractory to intramuscular epinephrine, intravenous fluids, methylprednisolone, and supplemental oxygen via non-rebreather mask. He ultimately required intubation, an epinephrine infusion, and admission to the medical intensive care unit.Discussion: This case depicts a clinical reaction to PEG, a medication rarely implicated in severe anaphylaxis or angioedema.Conclusion: The allergenic potential of PEG-containing products should be raised, and providers should have a heightened awareness of these potential side effects

New Services for Families in the DC Superior Court

Until recently, because of concerns about safety and parties’ abilities to make good decisions in cases with a history of high intimate partner violence or abuse (IPV/A), in the District of Columbia’s Superior Court such cases were screened out of mediation and sent back to the family court. But two big program additions — videoconferencing and shuttle mediation — have allowed parties in these cases to consider mediation. The Multi-Door Dispute Resolution Division of the DC Superior Court (Multi-Door) implemented this change after several years of preparation: its administrators added safety measures, provided in-depth training for staff and mediators, and consulted with experts to design a research study to compare videoconference, shuttle mediation, and the prior practice of returning these cases to court

Evaluation of Behavioral Theory and Integrated Internet/Telephone Technologies to Support Military Obesity and Weight Management Programs

The primary objective of the study was to evaluate the interaction of two different weight management interventions and two methods of follow up counseling on weight loss in overweight active duty military service members after 3 months. Participants (n=172) were randomized to one of four groups using a 2 x 2 factorial treatment structure: (1) Standard 'Class' + 'In-person' follow up counseling every 3 months, (2) 'Class' + weekly 'Internet' weight management follow up, (3) 'Tailored' behaviorally based counseling session + 'In-person' follow up every 3 months, or 4) 'Tailored' + 'Internet'. The secondary objective was to determine the relationship between stages of change for five different weight control behaviors (dietary fat, fruits and vegetables, portion control, beverage choices, exercise) and weight loss after 3 months. Measurements were taken at 0 (baseline) and 3 months and included body weight, body composition, waist circumference, blood pressure, fasting blood glucose, lipid levels, stages of change and dietary assessment. Analysis of covariance with repeated measures was used to compare outcome differences among groups over time. There was no significant difference in weight loss or other outcomes among treatment groups at 3 months. However, the 'Tailored + Internet' (-1.33 +/- 0.66 kg, p<0.05) and 'Class + In-person' (-1.4 +/- 0.63 kg, p<0.05) groups lost significant weight compared to baseline after 3 months. The 'Tailored + Internet' group also lost significant total fat, trunk fat and percent body fat and had reduced waist circumference after 3 months while the 'Class + In-person' group significantly lost lean body mass but not fat when compared to baseline. Furthermore, being in the action stage for each weight control behavior did not result in significantly more weight loss than being in the pre-action stages. These results suggest that although the 'Tailored + Internet' group lost significant weight and body fat after 3 months when compared to baseline, no treatment was superior. Future research should explore other approaches, such as those found in an ecological model of health behavior, because of the influence of other environmental factors on weight management in the military

Multilayer and multiplex networks: an introduction to their use in veterinary epidemiology

This is the final version. Available from Frontiers Media via the DOI in this record.Contact network analysis has become a vital tool for conceptualizing the spread of pathogens in animal populations and is particularly useful for understanding the implications of heterogeneity in contact patterns for transmission. However, the transmission of most pathogens cannot be simplified to a single mode of transmission and, thus, a single definition of contact. In addition, host-pathogen interactions occur in a community context, with many pathogens infecting multiple host species and most hosts being infected by multiple pathogens. Multilayer networks provide a formal framework for researching host-pathogen systems in which multiple types of transmission-relevant interactions, defined as network layers, can be analyzed jointly. Here, we provide an overview of multilayer network analysis and review applications of this novel method to epidemiological research questions. We then demonstrate the use of this technique to analyze heterogeneity in direct and indirect contact patterns amongst swine farms in the United States. When contact among nodes can be defined in multiple ways, a multilayer approach can advance our ability to use networks in epidemiological research by providing an improved approach for defining epidemiologically relevant groups of interacting nodes and changing the way we identify epidemiologically important individuals such as superspreaders.Biotechnology and Biological Sciences Research Council (BBSRC)NIFA-NSF-NIH Ecology and Evolution of Infectious Disease awardAgriculture and Food Research InitiativeSwine Health Information Center (SHIC)University of MinnesotaUniversity of Exete

Equine Rhinitis A Virus Infection at a Standardbred Training Facility: Incidence, Clinical Signs, and Risk Factors for Clinical Disease

Respiratory disease is a common morbidity of young racehorses. Infections can lead to compromised welfare, and economic loss. Identification of risk factors for infection through clinical signs monitoring and collection of demographic, serologic, and contact network data can aid in the development of prevention and control strategies. The study objectives were to: (1) describe the transmission and clinical course of infectious respiratory disease in standardbred racehorses in a multi-barn training facility and, (2) identify demographic, serological, and contact network risk factors associated with Equine Rhinitis A virus (ERAV) respiratory disease. The study population included standardbred racehorses (age 1–5 years: n = 96) housed at a multi-barn training facility in southern Ontario. Clinical signs were monitored daily over a 41-day period in fall 2017. Descriptive statistics, including incidence rate, prevalence and incidence risk were calculated for the observed period. Associations between demographic, serologic, and contact pattern variables, and clinical disease status were investigated using multivariable logistic regression. Respiratory disease cases were characterized by mucopurulent discharge (100%), intermittent cough (37.7%), and ocular discharge (62.3%). Fever (>38.5°C) and inappetence were rarely reported (15.2 and 3.8%). Seroconversion to ERAV among cases was 75%. Total, and yearling-specific incidence risks were 52.5 and 87.9%. The cumulative incidence was 0.027 new cases/horse day. A negative association (OR = 0.011) between increasing age and respiratory disease was significant (p = < 0.001) in the final regression model. Yearling horses were at increased risk of infectious respiratory disease as demonstrated by the high yearling-specific incidence risk, and the negative association between age and infection. Disease control strategies, such as vaccination programs and isolation of new horses arriving from auction, should be targeted at young animals entering training facilities

Role of a Lateral Orbital Frontal Cortex-Basolateral Amygdala Circuit in Cue-Induced Cocaine-Seeking Behavior

Cocaine addiction is a disease characterized by chronic relapse despite long periods of abstinence. The lateral orbitofrontal cortex (lOFC) and basolateral amygdala (BLA) promote cocaine-seeking behavior in response to drug-associated conditioned stimuli (CS) and share dense reciprocal connections. Hence, we hypothesized that monosynaptic projections between these brain regions mediate CS-induced cocaine-seeking behavior. Male Sprague-Dawley rats received bilateral infusions of a Cre-dependent adeno-associated viral (AAV) vector expressing enhanced halorhodopsin 3.0 fused with a reporter protein (NpHR-mCherry) or a control AAV (mCherry) plus optic fiber implants into the lOFC (Experiment 1) or BLA (Experiment 2). The same rats also received bilateral infusions of a retrogradely transported AAV vector expressing Cre recombinase (Retro-Cre-GFP) into the BLA (Experiment 1) or lOFC (Experiment 2). Thus, NpHR-mCherry or mCherry expression was targeted to lOFC neurons that project to the BLA or to BLA neurons that project to the lOFC in different groups. Rats were trained to lever press for cocaine infusions paired with 5-s CS presentations. Responding was then extinguished. At test, response-contingent CS presentation was discretely coupled with optogenetic inhibition (5-s laser activation) or no optogenetic inhibition while lever responding was assessed without cocaine/food reinforcement. Optogenetic inhibition of lOFC to BLA, but not BLA to lOFC, projections in the NpHR-mCherry groups disrupted CS-induced reinstatement of cocaine-seeking behavior relative to (i) no optogenetic inhibition or (ii) manipulations in mCherry control or (iii) NpHR-mCherry food control groups. These findings suggest that the lOFC sends requisite input to the BLA, via monosynaptic connections, to promote CS-induced cocaine-seeking behavior

The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea

Background: While evidence supports using sustained release morphine for chronic refractory breathlessness, little is known about the longitudinal pattern of breathlessness intensity as people achieve symptomatic benefit. The aim of this study is to describe this pattern. Methods: This secondary analysis used breathlessness intensity scores (100mm visual analogue scale (VAS)) from a prospective, dose increment study of once daily (morning) sustained release morphine for chronic refractory breathlessness. Participants who achieved < 10% improvement over their own baseline at one week (10 mg) were titrated to 20mg and if no response, another week later to 30mg for one week. Time was standardized at the first day of the week in which participants responded generating twice daily data one week either side of symptomatic benefit. Analysis used random effect mixed modeling. Results: Of the 83 participants, 17/52 responders required > 10 mg: 13 participants (20 mg) and 4 (30 mg), contributing 634 VAS observations. In the week leading to a response, average VAS scores worsened by 0.3mm/ day ( p = 0.16); the average improvement in the first 24 hours of response was 10.9mm (7.0 to 14.7; p < 0.0001), with continued improvement of 2.2 mm/day ( p < 0.001) for six more days. Conclusion: When treating chronic refractory breathlessness with once daily sustained release morphine, titrate to effect, since inadequate dose may generate no response; and following an initial response, further dose increases should not occur for at least one week. Whether further benefit would be derived beyond day six on the dose to which people respond, and what net effect a further dose increase would have are questions yet to be answered

Characterization of Biofilm Formation by Borrelia burgdorferi In Vitro

Borrelia burgdorferi, the causative agent of Lyme disease, has long been known to be capable of forming aggregates and colonies. It was recently demonstrated that Borrelia burgdorferi aggregate formation dramatically changes the in vitro response to hostile environments by this pathogen. In this study, we investigated the hypothesis that these aggregates are indeed biofilms, structures whose resistance to unfavorable conditions are well documented. We studied Borrelia burgdorferi for several known hallmark features of biofilm, including structural rearrangements in the aggregates, variations in development on various substrate matrices and secretion of a protective extracellular polymeric substance (EPS) matrix using several modes of microscopic, cell and molecular biology techniques. The atomic force microscopic results provided evidence that multilevel rearrangements take place at different stages of aggregate development, producing a complex, continuously rearranging structure. Our results also demonstrated that Borrelia burgdorferi is capable of developing aggregates on different abiotic and biotic substrates, and is also capable of forming floating aggregates. Analyzing the extracellular substance of the aggregates for potential exopolysaccharides revealed the existence of both sulfated and non-sulfated/carboxylated substrates, predominately composed of an alginate with calcium and extracellular DNA present. In summary, we have found substantial evidence that Borrelia burgdorferi is capable of forming biofilm in vitro. Biofilm formation by Borrelia species might play an important role in their survival in diverse environmental conditions by providing refuge to individual cells

Internationalisation in learning and teaching : Thematic Peer Group report

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