Compiling Diverse Affordable Housing Resources for Distribution in Primary Care

During primary care office visits, patients often mention concerns regarding social determinants of health that are unable to be fully addressed in the limited time of the appointment. Often, these concerns center around housing concerns and related financial strain. Several such instances were documented during this rotation.https://scholarworks.uvm.edu/fmclerk/1892/thumbnail.jp

Extrarenale Manifestationen der autosomal dominanten polyzystischen Nierenerkrankung (ADPKD)

Die autosomal dominante polyzystische Nierenerkrankung (ADPKD) ist eine chronisch fortschreitende Systemerkrankung, die bei mehr als 75 % der Betroffenen zu einem Nierenversagen als zentraler Manifestation führt. Bei nahezu allen ADPKD-Patienten/Patientinnen sind jedoch auch extrarenale Organe betroffen, insbesondere werden im Verlauf der Erkrankung hepatische und kardiale Manifestationen relevant. Während sich die hepatischen Manifestationen bildmorphologisch nachweisen lassen und in ihrer Ausprägung variieren, zählen zu den vielfältigen kardialen klinischen Erscheinungen der ADPKD die linksventrikuläre Hypertrophie, Herzklappenerkrankungen, Dissektionen der Aorta und der inneren Karotis, sowie Koronaraneurysmata. Darüber hinaus treten auch Kardiomyopathien und Perikardergüsse auf. Bisher gibt es noch keine größere Kohortenstudie oder aussagekräftige Daten über die Prävalenz von hepatischen und kardialen Manifestationen bei ADPKD. In der vorliegenden Arbeit wurden die beiden häufigsten extrarenalen Manifestationen der ADPKD, namentlich die hepatischen und kardialen Manifestationen, anhand von ADPKD-Patienten/Patientinnen des deutschen AD(H)PKD-Studie deskriptiv untersucht und detailliert charakterisiert. Für die weitere Untersuchung der hepatischen Zysten erfolgte eine Bildgebung mittels Magnetresonanztomographie (MRT), während die kardialen Manifestationen mittels transthorakaler Echokardiographie (TTE) untersucht wurden. Die Ergebnisse zeigten, dass die Mehrzahl der Patienten/Patientinnen pathologische Echokardiographiebefunde aufwiesen. Diese Befunde korrelierten signifikant mit Parametern, die auf ein Fortschreiten der Erkrankung bei ADPKD hinweisen, wie z.B. die intraventrikuläre Septumwanddicke (IVSd) und der Durchmesser der Aortenwurzel. Auch wurden bei einigen Patienten/Patientinnen Anzeichen von Leberzysten gefunden, die mit einer erhöhten Leberfunktionsmarker in Zusammenhang standen. Allerdings konnte keine signifikante Korrelation zwischen genetischen Mutationen und kardialen oder hepatischen Manifestationen festgestellt werden. In der hier vorgelegten Arbeit zeigte sich in der untersuchten Kohorte eine hohe Prävalenz sowohl für Leberzysten als auch für kardiale Manifestationen. Die hier vorgelegten Ergebnisse unterstreichen die Wichtigkeit der regelmäßigen Bildgebung sowohl der Herz- als auch der Leberfunktion bei Patienten/Patientinnen mit ADPKD, um frühzeitig pathologische Befunde zu identifizieren und zu behandeln. In Anbetracht des Zusammenhangs zwischen ADPKD und linksventrikulärer Hypertrophie sowie des höheren kardiovaskulären Risikos, welches dazu führt, dass kardiovaskuläre Komplikationen die häufigste Todesursache bei Patienten/Patientinnen mit ADPKD sind, sind eine frühzeitige Behandlung und möglicherweise eine Vorbeugung wichtige Ziele eines zielführenden Therapieschemas. Eine Aussage über die Prävalenz einzelner kardialer Manifestationen ist daher von einer hohen klinischen Relevanz

Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study

BACKGROUND: The relationship between COVID-19 and epilepsy is uncertain. We studied the potential association between COVID-19 and seizures or epilepsy in the six months after infection. METHODS: We applied validated methods to an electronic health records network (TriNetX Analytics) of 81 million people. We closely matched people with COVID-19 infections to those with influenza. In each cohort, we measured the incidence and hazard ratios (HRs) of seizures and of epilepsy. We stratified data by age and by whether the person was hospitalized during the acute infection. We then explored time-varying HRs to assess temporal patterns of seizure or epilepsy diagnoses. RESULTS: We analyzed 860,934 electronic health records. After matching, this yielded two cohorts each of 152,754 patients. COVID-19 was associated with an increased risk of seizures and epilepsy compared to influenza. The incidence of seizures within 6 months of COVID-19 was 0.81% (95% CI, 0.75-0.88; HR compared to influenza 1.55 (1.39-1.74)). The incidence of epilepsy was 0.30% (0.26-0.34; HR compared to influenza 1.87 (1.54-2.28)). The HR of epilepsy after COVID-19 compared to influenza was greater in people who had not been hospitalized and in individuals aged under 16 years. The time of peak HR after infection differed by age and hospitalization status. CONCLUSIONS: The incidence of new seizures or epilepsy diagnoses in the six months following COVID-19 was low overall, but higher than in matched patients with influenza. This difference was more marked in people who were not hospitalized, highlighting the risk of epilepsy and seizures even in those with less severe infection. Children appear at particular risk of seizures and epilepsy after COVID-19 providing another motivation to prevent COVID-19 infection in pediatric populations. That the varying time of peak risk related to hospitalization and age may provide clues as to the underlying mechanisms of COVID-associated seizures and epilepsy

Soil Loss Estimation Using the Revised Universal Soil Loss Equation (RUSLE): A Coarse Resolution Dataset in the Indian Himalayan Region

Soil erosion is considered a very critical environmental issue that has repercussions for almost every aspect of the world. In developing countries, such as India, soil erosion continues to be a major limitation. A prediction and assessment of erosion prone areas is of utmost importance for soil fertility and water management. Recent technological advancements have provided useful models through which remotely-sensed data for a large scale area can be analyzed and interpreted. This study aims to adopt an erosion model that is unique to the physiography, biological and climatic conditions of the Indian Himalayan Region. The Revised Universal Soil Loss Equation (RUSLE) model estimates the average annual soil loss A in tonnes ha-1 year-1. Recognizing the conditions of the region, the RUSLE developed by Renard et al., (1997) was applied in conjunction with Geographic Information System (GIS) for estimating soil loss. All parameters of the model were thoroughly studied, starting from reviews and research papers on soil erosion assessment at national and catchment levels. The study follows the RUSLE soil model in estimating the rate of soil erosion at state and district level. The model was developed around coarse resolution data requirements, with practicality in providing annual soil loss rate for a large study area. It provides a means to describe specific districts that are vulnerable to soil erosion, rendering immediate action for soil conservation practices. To determine the spatial distribution of average annual soil erosion within the study area, cell-based parameters of the RUSLE were multiplied in the specified 500m x 500m spatial resolution using the raster calculator function in ArcGIS 10.0 software. The spatial pattern of soil erosion indicates that maximum erosion takes place in the north, north-western and eastern regions of the study area while the areas with low erosion rates are located in the eastern-most part of the study area.Keywords: Soil erosion, Remote sensing, Geographic information system, Soil erodibilit

Active cortical networks promote shunting fast synaptic inhibition in vivo

Fast synaptic inhibition determines neuronal response properties in the mammalian brain and is mediated by chloride-permeable ionotropic GABA-A receptors (GABAARs). Despite their fundamental role, it is still not known how GABAARs signal in the intact brain. Here, we use in vivo gramicidin recordings to investigate synaptic GABAAR signaling in mouse cortical pyramidal neurons under conditions that preserve native transmembrane chloride gradients. In anesthetized cortex, synaptic GABAARs exert classic hyperpolarizing effects. In contrast, GABAAR-mediated synaptic signaling in awake cortex is found to be predominantly shunting. This is due to more depolarized GABAAR equilibrium potentials (EGABAAR), which are shown to result from the high levels of synaptic activity that characterize awake cortical networks. Synaptic EGABAAR observed in awake cortex facilitates the desynchronizing effects of inhibitory inputs upon local networks, which increases the flexibility of spiking responses to external inputs. Our findings therefore suggest that GABAAR signaling adapts to optimize cortical functions

No Fall Too Small: Assessing Barriers to Fall Prevention Programs

In Vermont, 1/3 of adults 45 years or older fell in the year 2018, statistically above the national average, which has not changed since 2012. Of those who fell, 34% experienced an injury after their fall. Evidence-based interventions and fall prevention programs effectively reduce falls, and these programs aimed at reducing falls appear to reduce fractures. In fact, it has been shown that exercise intervention reduces fall risk by 30%. Our review of the literature highlighted that there are numerous barriers to accessing fall prevention programs, including loss of independence, transportation, cost, and lack of interest. With this in mind, we investigated the potential barriers to accessing and attending fall prevention programs in Vermont.https://scholarworks.uvm.edu/comphp_gallery/1311/thumbnail.jp