Genetic Tracking of the Raccoon Variant of Rabies Virus in Eastern North America

AbstractTo gain insight into the incursion of the raccoon variant of rabies into the raccoon population in three Canadian provinces, a collection of 192 isolates of the raccoon rabies virus (RRV) strain was acquired from across its North American range and was genetically characterized. A 516-nucleotide segment of the non-coding region between the G and L protein open reading frames, corresponding to the most variable region of the rabies virus genome, was sequenced. This analysis identified 119 different sequences, and phylogenetic analysis of the dataset supports the documented history of RRV spread. Three distinct geographically restricted RRV lineages were identified. Lineage 1 was found in Florida, Alabama and Georgia and appears to form the ancestral lineage of the raccoon variant of rabies. Lineage 2, represented by just two isolates, was found only in Florida, while the third lineage appears broadly distributed throughout the rest of the eastern United States and eastern Canada. In New York State, two distinct spatially segregated variants were identified; the one occupying the western and northern portions of the state was responsible for an incursion of raccoon rabies into the Canadian province of Ontario. Isolates from New Brunswick and Quebec form distinct, separate clusters, consistent with their independent origins from neighboring areas of the United States. The data are consistent with localized northward incursion into these three separate areas with no evidence of east–west viral movement between the three Canadian provinces

Efficiency Strategies for Facilitating Computerized Clinical Documentation in Ambulatory Care

Most providers have experienced increased documentation demands with the use of electronic health records (EHRs). We sought to identify efficiency strategies that providers use to complete clinical documentation tasks in ambulatory care. Two observers performed ethnographic observations and interviews with 22 ambulatory care providers in a U.S. Veterans Affairs Medical Center. Observation notes and interview transcripts were coded for recurrent strategies relating to completion of the EHR progress notes. Findings included: the use of paper artifacts for handwritten notations; electronic templates for automation of certain parts of the note; use of shorthand and phrases rather than narrative writing; copying and pasting from previous EHR notes; directly entering information into the EHR note during the patient encounter; reliance on memory; and pre-populating an EHR note prior to seeing the patient. We discuss the findings in the context of distributed cognition to understand how clinical information is propagated and represented toward completion of a progress note. The study findings have important implications for improving and streamlining clinical documentation related to human factors workload management strategies

Arrival of the Fukushima Radioactivity Plume in North American Continental Waters

The large discharge of radioactivity into the northwest Pacific Ocean from the 2011 Fukushima Dai-ichi nuclear reactor accident has generated considerable concern about the spread of this material across the ocean to North America. We report here the first systematic study to our knowledge of the transport of the Fukushima marine radioactivity signal to the eastern North Pacific. Time series measurements of 134Cs and 137Cs in seawater revealed the initial arrival of the Fukushima signal by ocean current transport at a location 1,500 km west of British Columbia, Canada, in June 2012, about 1.3 y after the accident. By June 2013, the Fukushima signal had spread onto the Canadian continental shelf, and by February 2014, it had increased to a value of 2 Bq/m3 throughout the upper 150 m of the water column, resulting in an overall doubling of the fallout background from atmospheric nuclear weapons tests. Ocean circulation model estimates that are in reasonable agreement with our measured values indicate that future total levels of 137Cs (Fukushima-derived plus fallout 137Cs) off the North American coast will likely attain maximum values in the 3–5 Bq/m3 range by 2015–2016 before declining to levels closer to the fallout background of about 1 Bq/m3 by 2021. The increase in 137Cs levels in the eastern North Pacific from Fukushima inputs will probably return eastern North Pacific concentrations to the fallout levels that prevailed during the 1980s but does not represent a threat to human health or the environment

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III

The Black Hole Mass of NGC 4151: Comparison of Reverberation Mapping and Stellar Dynamical Measurements

We present a stellar dynamical estimate of the black hole (BH) mass in the Seyfert 1 galaxy, NGC 4151. We analyze ground-based spectroscopy as well as imaging data from the ground and space, and we construct 3-integral axisymmetric models in order to constrain the BH mass and mass-to-light ratio. The dynamical models depend on the assumed inclination of the kinematic symmetry axis of the stellar bulge. In the case where the bulge is assumed to be viewed edge-on, the kinematical data give only an upper limit to the mass of the BH of ~4e7 M_sun (1 sigma). If the bulge kinematic axis is assumed to have the same inclination as the symmetry axis of the large-scale galaxy disk (i.e., 23 degrees relative to the line of sight), a best-fit dynamical mass between 4-5e7 M_sun is obtained. However, because of the poor quality of the fit when the bulge is assumed to be inclined (as determined by the noisiness of the chi^2 surface and its minimum value), and because we lack spectroscopic data that clearly resolves the BH sphere of influence, we consider our measurements to be tentative estimates of the dynamical BH mass. With this preliminary result, NGC 4151 is now among the small sample of galaxies in which the BH mass has been constrained from two independent techniques, and the mass values we find for both bulge inclinations are in reasonable agreement with the recent estimate from reverberation mapping (4.57[+0.57/-0.47]e7 M_sun) published by Bentz et al.Comment: 20 pages, including 11 low-res figures. Accepted for publication in ApJ. High resolution version available upon reques

Prescription refill records as a screening tool to identify antidepressant non-adherence

Non-adherence is a significant problem with antidepressants. Identifying patients at highest risk for discontinuing antidepressant treatment can be used to target clinical management. Accordingly, our purpose was to determine the shortest gap in medication supply that is predictive of discontinuation, while minimizing false positive results