Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project. Phase 1 Report: Accomplishments and Lessons Learned

Executive Summary Initiated in June 2014, the Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project (Intergovernmental Pilot Project or IPP) convened at Old Dominion University is an effort to use the knowledge skills and expertise of all regional stakeholders to create a framework or template for intergovernmental strategic planning that can be used outside the region; and, to implement that integrated strategy in Hampton Roads, Virginia creating an effective and efficient method for planning holistically for sea level rise and recurrent flooding. With active stakeholders from the Department of Defense, federal agencies and the White House as well as the Commonwealth of Virginia and many localities across Hampton Roads, Virginia, the IPP is truly a “whole of government” effort. Knowing water knows no jurisdictional bounds, that level of intergovernmental collaboration is necessary to develop integrated regional solutions and implement effective sea level rise preparedness and resilience strategies. Additionally, the wider community in Hampton Roads recognizes that they too will be affected by not only sea level rise itself, but also the adaptation strategies implemented in preparation. Thus, IPP stakeholders include representatives from private industry, infrastructure, non-profits, the real estate community, and vulnerable communities. Furthermore, while the IPP was conceived in Hampton Roads, the IPP recognizes that sea level rise affects the entire Commonwealth, and a successful ‘whole of government and community’ approach must eventually include regions beyond Hampton Roads and reach across the Coastal Virginia and the Commonwealth as a whole. Throughout the past year stakeholders have attended numerous IPP meetings and many supporting events, but they have also, through their own personal and professional lives driven the resilience conversation in Hampton Roads and beyond. The IPP is completely unfunded and exists not as an entity, but as an experiment, bringing together the community, and leveraging and building upon other initiatives from the Secure Commonwealth Panel’s Subcommittee on Sea Level Rise to Urban Land Institute’s Resilient Region Reality Checks to NOAA and NASA scientists. The first Phase of this two-Phase, two-year project came to completion during the summer of 2015 with a daylong leadership retreat. This report summarizes the stakeholder engagement and due-diligence process stakeholders undertook during Phase 1, but does not detail each meeting or event that took place. Phase 2 will continue to build on other initiatives and count on stakeholders to use these networks and knowledge to create an enduring entity, organization, or strategy to continue using economies of scale and the “whole of government and community” model for sea level rise preparedness and resilience in Hampton Roads and elsewhere

What nutritional deficiencies and toxic exposures are associated with nail changes?

Infants with iron deficiency have a higher rate of koilonychia--concavity of the outer surface of the nail--(strength of recommendation [SOR]: C, one case-control study). Vitamin B12 deficiency is associated with various nail pigment changes that are reversible with treatment (SOR: C, case reports). Muehrcke's lines (transverse white bands that run parallel to the lunula) occur in a minority of patients with hypoalbuminemia. (SOR: C, one cross-sectional study). Fingernail clubbing has been found in most patients with kwashiorkor, or protein malnutrition (SOR: C, one cross-sectional study). Transplacental exposure to polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) has been associated with nail deformities and color changes (SOR: C, one case-control study)

Draft Genome Sequence of Bacillus velezensis CE2, Which Genetically Encodes a Novel Multicomponent Lantibiotic.

Bacillus velezensis CE2 produces potent antimicrobial compound(s). The draft genome sequence of the strain reported here is 4.1 Mb with a G+C content of 46.1%. Whole-genome sequencing revealed that the strain genetically encodes a novel multicomponent lantibiotic, velezensicidin

Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project. Phase 2 Report: Recommendations, Accomplishments and Lessons Learned

Executive Summary After two years, the Hampton Roads Sea level Rise and Resilience Intergovernmental Planning Pilot Project (Intergovernmental Pilot Project or IPP), convened at Old Dominion University, has come to a successful close. Although the conclusion of the project is different than originally imagined by the drafters of the IPP Charter, the process in and of itself brought hundreds of stakeholders together, built lasting and ongoing relationships, and produced many workable recommendations for the region that can be accomplished by a variety of partnerships. The key deliverables include a whole of government mitigation and adaptation planning process and an integrated regional recommendation, both which can serve as a template for other regions. Additionally the IPP demonstrated a new role for an urban campus to act as a community convener, matching focused research and curriculum development with public service across the university and the region. Initiated in June 2014, the IPP was an effort to use the knowledge, skills and expertise of all regional stakeholders to create a framework or template for intergovernmental strategic planning that could be used outside the region; and, to implement that integrated strategy in Hampton Roads, Virginia, creating an effective and efficient method for planning holistically for sea level rise and recurrent flooding. This “Whole of Government and Community” effort would not have been successful without the hundreds of stakeholders and volunteer leaders from across all levels of government, academia, and the community who participated out of a sense of duty to their community and commitment to the collaboration. Knowing water knows no jurisdictional bounds, a high level of intergovernmental collaboration is necessary to develop integrated regional solutions and implement effective sea level rise preparedness and resilience strategies. Additionally, the wider community in Hampton Roads recognizes that they too will be affected by not only sea level rise itself, but also the adaptation strategies implemented in preparation. Executive Summary Phase 2 Report: Recommendations, Accomplishments and Lessons Learned Executive Summary 11 Phase 1 of the project, from June 2014 through June 2015, saw the drafting and signing of a Charter, the recruitment of a steering committee, a host of events, and the development of working group and advisory committees comprised of subject matter experts. Phase 2, from June 2015 through June 2016, included heavy discussion with regard to ongoing strategies for intergovernmental collaboration as well as research, a number of case studies carried out by committees and working groups, and the careful development of recommendations for the region. The IPP concludes successfully with a series of recommendations from each working group and committee as well as a final resolution drafted by the Legal Working Group and containing the consensus views of steering committee members. Though the recommendations vary in specificity and subject area, a few themes are clear. In order to move forward regionally, local stakeholders need to maintain, institutionalize and build relationships with each other in order to facilitate effective collaboration and information sharing. Institutionalizing these relationships and partnerships is key, as people shift positions throughout their careers. Additionally, while more data is needed, the methods by which that data is integrated and shared are equally important. Further, some form of the Whole of Government and Community approach that focuses on the watershed as opposed to jurisdictional boundaries is essential to accomplishing the recommendations set forth in this report. The IPP has been a success because of the dedicated volunteers committed to a resilient Hampton Roads. During the last two years, this project advanced regional adaptation through the evaluation and recommendation of a future governance structure, the development of working group and committee recommendations, building public awareness, building awareness of the need for federal agency involvement locally and building relationships among numerous organizations involved in the Pilot Project. All of this work, which in pieces may be specific only to a unique circumstance or area, when taken as a whole, brings foundational change. It builds on previous work accomplished by other leaders in the Hampton Roads region and should be leveraged in the future to accelerate regional adaptation

MouseCyc: a curated biochemical pathways database for the laboratory mouse

MouseCyc is a database of curated metabolic pathways for the laboratory mouse

Acute Physiological and Psychological Stress Response in Youth at Clinical High-Risk for Psychosis

Deficits in stress-response systems are a characteristic of schizophrenia and psychosis spectrum illnesses, and recent evidence suggests that this impairment may be evident in those at clinical high-risk (CHR) for the development of a psychotic disorder. However, there is limited research specifically investigating biological and subjective stress reactivity in CHR individuals. In the present study, 38 CHR individuals and group of 38 control individuals participated in the Trier Social Stress Test (TSST), an experimentally induced psychosocial stressor. Changes in salivary cortisol and alpha amylase, as well as self-reported units of distress (SUDS), were evaluated. Interestingly, the TSST did not induce a change in cortisol levels in either group, though the CHR group did show higher overall cortisol levels throughout the TSST (pre-anticipation period through recovery period). However, indicative of an effective task manipulation, the TSST did illicit an increase in alpha amylase in both groups. CHR participants exhibited higher levels of subjective stress prior to the stressor compared to the control group and CHR SUDs did not significantly increase in response to the stressor. In contrast, the control group showed an increase in SUDS in response to the stressor. Notably, SUDS for the control group post task mirrored the levels CHR youth endorsed prior to the stressor. Taken together, these findings suggest that there may be a functional relationship between persistently elevated cortisol and chronic high levels of subjective distress in CHR individuals.</p

Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for&nbsp;Screening.

Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3&nbsp;months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p&nbsp;&lt;&nbsp;.001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed

Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2006.12.289.The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (χ2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was $30 while the total cost of the telehealth intervention for each patient was$420. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended

Implementation and Quality Improvement of a Screening and Counseling Program for Unhealthy Alcohol Use in an Academic General Internal Medicine Practice

Unhealthy alcohol use is the third leading cause of preventable death in the United States (U.S.). The U.S. Preventive Services Task Force recommends screening for unhealthy alcohol use but little is known about how best to do so. We used quality improvement techniques to implement a systematic approach to screening and counseling primary care patients for unhealthy alcohol use. Components included use of validated screening and assessment instruments; an evidence-based 2-visit counseling intervention using motivational interviewing techniques for those with risky drinking behaviors who did not have an alcohol use disorder (AUD); shared decision making about treatment options for those with an AUD; support materials for providers and patients; and training in motivational interviewing for faculty and residents. Over the course of one year, we screened 52% (N=5,352) of our clinic’s patients and identified 294 with positive screens. Of those 294, appropriate screening-related assessments and interventions were documented for 168 and 72 patients, respectively. Although we successfully implemented a systematic screening program and structured processes of care, ongoing quality improvement efforts are needed to screen the rest of our patients and to improve the consistency with which we provide and document appropriate interventions

De novoframeshift mutation in ASXL3 in a patient with global developmental delay, microcephaly, and craniofacial anomalies

BACKGROUND: Currently, diagnosis of affected individuals with rare genetic disorders can be lengthy and costly, resulting in a diagnostic odyssey and in many patients a definitive molecular diagnosis is never achieved despite extensive clinical investigation. The recent advent and use of genomic medicine has resulted in a paradigm shift in the clinical molecular genetics of rare diseases and has provided insight into the causes of numerous rare genetic conditions. In particular, whole exome and genome sequencing of families has been particularly useful in discovering de novo germline mutations as the cause of both rare diseases and complex disorders. CASE PRESENTATION: We present a six year old, nonverbal African American female with microcephaly, autism, global developmental delay, and metopic craniosynostosis. Exome sequencing of the patient and her two parents revealed a heterozygous two base pair de novo deletion, c.1897_1898delCA, p.Gln633ValfsX13 in ASXL3, predicted to result in a frameshift at codon 633 with substitution of a valine for a glutamine and introduction of a premature stop codon. CONCLUSIONS: We provide additional evidence that, truncating and frameshifting mutations in the ASXL3 gene are the cause of a newly recognized disorder characterized by severe global developmental delay, short stature, microcephaly, and craniofacial anomalies. Furthermore, we expand the knowledge about disease causing mutations and the genotype-phenotype relationships in ASXL3 and provide evidence that rare, nonsynonymous, damaging mutations are not associated with developmental delay or microcephaly