How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project.

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions' strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods

The response of the coastal ocean to strong offshore winds: With application to circulations in the Gulfs of Tehuantepec and Papagayo

Two ocean models are used to investigate the response of the coastal ocean to strong offshore winds: a linear 1½-layer model, and a nonlinear 1½-layer model that allows entrainment of cool water into the surface layer. The models are forced by wind stress fields similar in structure to the intense winter-time, mountain-pass jets (∼20 dyne/cm2) that appear in the Gulfs of Tehuantepec and Papagayo for periods of 3–10 days. Solutions are arranged in a hierarchy of increasing dynamical complexity, in order to illustrate the important physical processes. They compare favorably with observations in several ways. Some properties of solutions are the following. While the wind strengthens there is an ageostrophic current (not Ekman drift) that is directed offshore. This offshore drift forces coastal upwelling, thereby lowering the local sea level and sea surface temperature (SST). Although the drop in sea level at the coast can be large and rapid (of the order of 20 cm at the peak of a wind event), none of this signal propagates poleward as a coastally trapped wave. While the wind weakens the ageostrophic current is directed onshore, and consequently the coastal ocean readjusts toward its initial state. Throughout the wind event, cyclonic and anticyclonic gyres spin up offshore on either side of the jet axis due to Ekman pumping. Entrainment cools SST offshore, on and to the right (looking onshore) of the jet axis, and virtually eliminates the cyclonic gyre. The advection terms intensify the anticyclonic gyre and give it a more circular shape. After a wind event, the anticyclonic gyre propagates westward due to β. Its propagation speed is enhanced over that of a linear Rossby wave due to the nonlinear terms associated with the increased layer thickness at the center of the gyre and with the divergence of momentum flux

EEG spectral coherence data distinguish chronic fatigue syndrome patients from healthy controls and depressed patients-A case control study

<p>Abstract</p> <p>Background</p> <p>Previous studies suggest central nervous system involvement in chronic fatigue syndrome (CFS), yet there are no established diagnostic criteria. CFS may be difficult to differentiate from clinical depression. The study's objective was to determine if spectral coherence, a computational derivative of spectral analysis of the electroencephalogram (EEG), could distinguish patients with CFS from healthy control subjects and not erroneously classify depressed patients as having CFS.</p> <p>Methods</p> <p>This is a study, conducted in an academic medical center electroencephalography laboratory, of 632 subjects: 390 healthy normal controls, 70 patients with carefully defined CFS, 24 with major depression, and 148 with general fatigue. Aside from fatigue, all patients were medically healthy by history and examination. EEGs were obtained and spectral coherences calculated after extensive artifact removal. Principal Components Analysis identified coherence factors and corresponding factor loading patterns. Discriminant analysis determined whether spectral coherence factors could reliably discriminate CFS patients from healthy control subjects without misclassifying depression as CFS.</p> <p>Results</p> <p>Analysis of EEG coherence data from a large sample (n = 632) of patients and healthy controls identified 40 factors explaining 55.6% total variance. Factors showed highly significant group differentiation (p < .0004) identifying 89.5% of unmedicated female CFS patients and 92.4% of healthy female controls. Recursive jackknifing showed predictions were stable. A conservative 10-factor discriminant function model was subsequently applied, and also showed highly significant group discrimination (p < .001), accurately classifying 88.9% unmedicated males with CFS, and 82.4% unmedicated male healthy controls. No patient with depression was classified as having CFS. The model was less accurate (73.9%) in identifying CFS patients taking psychoactive medications. Factors involving the temporal lobes were of primary importance.</p> <p>Conclusions</p> <p>EEG spectral coherence analysis identified unmedicated patients with CFS and healthy control subjects without misclassifying depressed patients as CFS, providing evidence that CFS patients demonstrate brain physiology that is not observed in healthy normals or patients with major depression. Studies of new CFS patients and comparison groups are required to determine the possible clinical utility of this test. The results concur with other studies finding neurological abnormalities in CFS, and implicate temporal lobe involvement in CFS pathophysiology.</p

Longitudinal decrease in blood oxygenation level dependent response in cerebral amyloid angiopathy

AbstractLower blood oxygenation level dependent (BOLD) signal changes in response to a visual stimulus in functional magnetic resonance imaging (fMRI) have been observed in cross-sectional studies of cerebral amyloid angiopathy (CAA), and are presumed to reflect impaired vascular reactivity. We used fMRI to detect a longitudinal change in BOLD responses to a visual stimulus in CAA, and to determine any correlations between these changes and other established biomarkers of CAA progression. Data were acquired from 22 patients diagnosed with probable CAA (using the Boston Criteria) and 16 healthy controls at baseline and one year. BOLD data were generated from the 200 most active voxels of the primary visual cortex during the fMRI visual stimulus (passively viewing an alternating checkerboard pattern). In general, BOLD amplitudes were lower at one year compared to baseline in patients with CAA (p=0.01) but were unchanged in controls (p=0.18). The longitudinal difference in BOLD amplitudes was significantly lower in CAA compared to controls (p<0.001). White matter hyperintensity (WMH) volumes and number of cerebral microbleeds, both presumed to reflect CAA-mediated vascular injury, increased over time in CAA (p=0.007 and p=0.001, respectively). Longitudinal increases in WMH (rs=0.04, p=0.86) or cerebral microbleeds (rs=−0.18, p=0.45) were not associated with the longitudinal decrease in BOLD amplitudes

A rapid turnaround gene panel for severe autoinflammation: Genetic results within 48 hours

There is an important unmet clinical need for fast turnaround next generation sequencing (NGS) to aid genetic diagnosis of patients with acute and sometimes catastrophic inflammatory presentations. This is imperative for patients who require precise and targeted treatment to prevent irreparable organ damage or even death. Acute and severe hyper- inflammation may be caused by primary immunodeficiency (PID) with immune dysregulation, or more typical autoinflammatory diseases in the absence of obvious immunodeficiency. Infectious triggers may be present in either immunodeficiency or autoinflammation. We compiled a list of 25 genes causing monogenetic immunological diseases that are notorious for their acute first presentation with fulminant inflammation and which may be amenable to specific treatment, including hemophagocytic lymphohistiocytosis (HLH); and autoinflammatory diseases that can present with early-onset stroke or other irreversible neurological inflammatory complications. We designed and validated a pipeline that enabled return of clinically actionable results in hours rather than weeks: the Rapid Autoinflammation Panel (RAP). We demonstrated accuracy of this new pipeline, with 100% sensitivity and 100% specificity. Return of results to clinicians was achieved within 48-hours from receiving the patient's blood or saliva sample. This approach demonstrates the potential significant diagnostic impact of NGS in acute medicine to facilitate precision medicine and save "life or limb" in these critical situations

Impacts of regional mixing on the temperature structure of the equatorial Pacific Ocean. Part 1: Vertically uniform vertical diffusion

AbstractWe investigate the sensitivity of numerical-model solutions to regional changes in vertical diffusion. Specifically, we vary the background diffusion coefficient, κb, within spatially distinct subregions of the tropical Pacific, assess the impacts of those changes, and diagnose the processes that account for them.Solutions respond to a diffusion anomaly, δκb, in three ways. Initially, there is a fast response (several months), due to the interaction of rapidly-propagating, barotropic and gravity waves with eddies and other mesoscale features. It is followed by a local response (roughly one year), the initial growth and spatial pattern of which can be explained by one-dimensional (vertical) diffusion. At this stage, temperature and salinity anomalies are generated that are either associated with a change in density (“dynamical” anomalies) or without one (“spiciness” anomalies). In a final adjustment stage, the dynamical and spiciness anomalies spread to remote regions by radiation of Rossby and Kelvin waves and by advection, respectively.In near-equilibrium solutions, dynamical anomalies are generally much larger in the latitude band of the forcing, but the impact of off-equatorial forcing by δκb on the equatorial temperature structure is still significant. Spiciness anomalies spread equatorward within the pycnocline, where they are carried to the equator as part of the subsurface branch of the Pacific Subtropical Cells, and spiciness also extends to the equator via western-boundary currents. Forcing near and at the equator generates strong dynamical anomalies, and sometimes additional spiciness anomalies, at pycnocline depths. The total response of the equatorial temperature structure to δκb in various regions depends on the strength and spatial pattern of the generation of each signal within the forcing region as well as on the processes of its spreading to the equator