A Citizen's Guide to Redistricting

Provides a detailed overview of states' rules and processes for redrawing federal, state, and local legislative districts. Illustrates possible motives behind redistricting, effects on elections, implications for legislation, and reform recommendations

A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children

<p>Abstract</p> <p>Background</p> <p>Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV) maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV fluids for maintenance needs.</p> <p>Methods</p> <p>This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional fluids were left to their discretion.</p> <p>Results</p> <p>Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours) and rate of study fluid infusion, and the volume of additional isotonic fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02) and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07). The rate of change and absolute change in serum [Na] did not differ significantly between groups.</p> <p>Conclusions</p> <p>When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended.</p> <p>Clinical Trial Registration Number</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00457873">NCT00457873</a> (<url>http://www.clinicaltrials.gov/</url>)</p

Cachexia and protein-energy wasting in children with chronic kidney disease

Children with chronic kidney disease (CKD) are at risk for “cachexia” or “protein-energy wasting” (PEW). These terms describe a pathophysiologic process resulting in the loss of muscle, with or without loss of fat, and involving maladaptive responses, including anorexia and elevated metabolic rate. PEW has been defined specifically in relation to CKD. We review the diagnostic criteria for cachexia and PEW in CKD and consider the limitations and applicability of these criteria to children with CKD. In addition, we present an overview of the manifestations and mechanisms of cachexia and PEW. A host of pathogenetic factors are considered, including systemic inflammation, endocrine perturbations, and abnormal neuropeptide signaling, as well as poor nutritional intake. Mortality risk, which is 100- to 200-fold higher in patients with end-stage renal disease than in the general population, is strongly correlated with the components of cachexia/PEW. Further research into the causes and consequences of wasting and growth retardation is needed in order to improve the survival and quality of life for children with CKD

Treatment with Glucocorticoids or Calcineurin Inhibitors in Primary FSGS

In primary FSGS, calcineurin inhibitors have primarily been studied in patients deemed resistant to glucocorticoid therapy. Few data are available about their use early in the treatment of FSGS. We sought to estimate the association between choice of therapy and ESRD in primary FSGS

From pandemic response to portable population health: A formative evaluation of the Detroit mobile health unit program

This article describes our experience developing a novel mobile health unit (MHU) program in the Detroit, Michigan, metropolitan area. Our main objectives were to improve healthcare accessibility, quality and equity in our community during the novel coronavirus pandemic. While initially focused on SARS-CoV-2 testing, our program quickly evolved to include preventive health services. The MHU program began as a location-based SARS-CoV-2 testing strategy coordinated with local and state public health agencies. Community needs motivated further program expansion to include additional preventive healthcare and social services. MHU deployment was targeted to disease “hotspots” based on publicly available SARS-CoV-2 testing data and community-level information about social vulnerability. This formative evaluation explores whether our MHU deployment strategy enabled us to reach patients from communities with heightened social vulnerability as intended. From 3/20/20-3/24/21, the Detroit MHU program reached a total of 32,523 people. The proportion of patients who resided in communities with top quartile Centers for Disease Control and Prevention Social Vulnerability Index rankings increased from 25% during location-based “drive-through” SARS-CoV-2 testing (3/20/20-4/13/20) to 27% after pivoting to a mobile platform (4/13/20-to-8/31/20; p = 0.01). The adoption of a data-driven deployment strategy resulted in further improvement; 41% of the patients who sought MHU services from 9/1/20-to-3/24/21 lived in vulnerable communities (Cochrane Armitage test for trend, p\u3c0.001). Since 10/1/21, 1,837 people received social service referrals and, as of 3/15/21, 4,603 were administered at least one dose of COVID-19 vaccine. Our MHU program demonstrates the capacity to provide needed healthcare and social services to difficult-to-reach populations from areas with heightened social vulnerability. This model can be expanded to meet emerging pandemic needs, but it is also uniquely capable of improving health equity by addressing longstanding gaps in primary care and social services in vulnerable communities

Methodology: Systematic Review and Meta-analysis of the AAC Literature for People with Autism Spectrum Disorder or Intellectual Disabilities who have Complex Communication Needs through 2020

A comprehensive meta-analysis examining the impacts of augmentative and alternative communication for individuals with complex communication needs was conducted, examining the relationship between social-communicative and educational outcomes and use of augmentative and alternative communication devices and across potential moderating variables. This document reports the methodology of the project as a whole, describing overarching procedures. Given the comprehensiveness of the review and meta-analysis, results of this review are reported in digestible groupings of types of research designs, types of research questions, and moderator groupings. Each of the resulting papers cite this primary document, as do additional reviews derived from the assembled data set. The documents herewith report the overarching methodology of the project, including the following. The document searches occurred in 2018 and 2020, resulting in 7,327 documents reviewed for title/abstract indication of meeting inclusion criteria. Full text document review was conducted for 1,758 documents for the next inclusion/exclusion gate. Documents were divided into group design (n = 132) and single-case experimental design (SCED) documents (n = 547) and reviewed for basic design criteria, resulting in 59 group design documents and 257 SCED documents. Lead project authors conducted screening remaining documents for false positives, resulting in 20 group and 176 SCED documents remaining for further analysis. Data extraction and potential moderator variable coding procedures are described in detail, with relevant coding manuals and other materials attached. Effect size metrics used for meta-analytic procedures are detailed.The research described here is supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A180110 to Texas A&M University. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Educatio

Overview of the Canadian pediatric end-stage renal disease database

<p>Abstract</p> <p>Background</p> <p>Performing clinical research among pediatric end-stage renal disease patients is challenging. Barriers to successful initiation and completion of clinical research projects include small sample sizes and resultant limited statistical power and lack of longitudinal follow-up for hard clinical end-points in most single center studies.</p> <p>Description</p> <p>Existing longitudinal organ failure disease registry and administrative health datasets available within a universal access health care system can be used to study outcomes of end-stage renal disease among pediatric patients in Canada. To construct the Canadian Pediatric End-Stage Renal Disease database, registry data were linked to administrative health data through deterministic linkage techniques creating a research database which consists of socio-demographic variables, clinical variables, all-cause hospitalizations, and relevant outcomes (death and renal allograft loss) for this patient population. The research database also allows study of major cardiovascular events using previously validated administrative data definitions.</p> <p>Conclusion</p> <p>Organ failure registry linked to health administrative data can be a powerful tool to perform longitudinal studies in pediatric end-stage renal disease patients. The rich clinical and demographic information found in this database will facilitate study of important medical and non-medical risk factors for death, graft loss and cardiovascular disease among pediatric end-stage renal disease patients.</p

In-roads to the spread of antibiotic resistance: regional patterns of microbial transmission in northern coastal Ecuador

The evolution of antibiotic resistance (AR) increases treatment cost and probability of failure, threatening human health worldwide. The relative importance of individual antibiotic use, environmental transmission and rates of introduction of resistant bacteria in explaining community AR patterns is poorly understood. Evaluating their relative importance requires studying a region where they vary. The construction of a new road in a previously roadless area of northern coastal Ecuador provides a valuable natural experiment to study how changes in the social and natural environment affect the epidemiology of resistant Escherichia coli. We conducted seven bi-annual 15 day surveys of AR between 2003 and 2008 in 21 villages. Resistance to both ampicillin and sulphamethoxazole was the most frequently observed profile, based on antibiogram tests of seven antibiotics from 2210 samples. The prevalence of enteric bacteria with this resistance pair in the less remote communities was 80 per cent higher than in more remote communities (OR = 1.8 [1.3, 2.3]). This pattern could not be explained with data on individual antibiotic use. We used a transmission model to help explain this observed discrepancy. The model analysis suggests that both transmission and the rate of introduction of resistant bacteria into communities may contribute to the observed regional scale AR patterns, and that village-level antibiotic use rate determines which of these two factors predominate. While usually conceived as a main effect on individual risk, antibiotic use rate is revealed in this analysis as an effect modifier with regard to community-level risk of resistance

Complete Bacteriophage Transfer in a Bacterial Endosymbiont (Wolbachia) Determined by Targeted Genome Capture

Bacteriophage flux can cause the majority of genetic diversity in free-living bacteria. This tenet of bacterial genome evolution generally does not extend to obligate intracellular bacteria owing to their reduced contact with other microbes and a predominance of gene deletion over gene transfer. However, recent studies suggest intracellular coinfections in the same host can facilitate exchange of mobile elements between obligate intracellular bacteria—a means by which these bacteria can partially mitigate the reductive forces of the intracellular lifestyle. To test whether bacteriophages transfer as single genes or larger regions between coinfections, we sequenced the genome of the obligate intracellular Wolbachia strain wVitB from the parasitic wasp Nasonia vitripennis and compared it against the prophage sequences of the divergent wVitA coinfection. We applied, for the first time, a targeted sequence capture array to specifically trap the symbiont's DNA from a heterogeneous mixture of eukaryotic, bacterial, and viral DNA. The tiled array successfully captured the genome with 98.3% efficiency. Examination of the genome sequence revealed the largest transfer of bacteriophage and flanking genes (52.2 kb) to date between two obligate intracellular coinfections. The mobile element transfer occurred in the recent evolutionary past based on the 99.9% average nucleotide identity of the phage sequences between the two strains. In addition to discovering an evolutionary recent and large-scale horizontal phage transfer between coinfecting obligate intracellular bacteria, we demonstrate that “targeted genome capture” can enrich target DNA to alleviate the problem of isolating symbiotic microbes that are difficult to culture or purify from the conglomerate of organisms inside eukaryotes