A case–control study of incident rheumatological conditions following acute gastroenteritis during military deployment

Objectives The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. Design This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. Setting We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. Participants Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008–2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. Main outcome measures The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. Results We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter\u27s diseasei (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. Conclusions Incident rheumatological conditions, even those classified as ‘non-specific,’ are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions

Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness

BACKGROUND: The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections. METHODS: We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella (nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 unexposed subjects. Medical history was analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident chronic gastrointestinal disorders. Relative risks were calculated using modified Poisson regression while controlling for the effect of covariates. RESULTS: A total of 1,753 pathogen-specific gastroenteritis cases (Campylobacter: 738, Salmonella: 624, Shigella: 376, Yersinia: 17) were identified and followed for a median of 3.8 years. The incidence (per 100,000 person-years) of PI sequelae among exposed was as follows: irritable bowel syndrome (IBS), 3.0; dyspepsia, 1.8; constipation, 3.9; gastroesophageal reflux disease (GERD), 9.7. In multivariate analyses, we found pathogen-specific increased risk of IBS, dyspepsia, constipation and GERD. CONCLUSIONS: These data confirm previous studies demonstrating risk of chronic gastrointestinal sequelae following bacterial enteric infections and highlight additional preventable burden of disease which may inform better food security policies and practices, and prompt further research into pathogenic mechanisms

Sensitivity of Snowmelt Hydrology on Mountain Slopes to Forest Cover Disturbance

Alberta Sustainable Resource Development, IP3 Network, NSERC Discovery Grants and Research Tool Instrument Grants and the University of Calgary Biogeoscience Institute.Non-Peer ReviewedMarmot Creek Research Basin was the subject of intense studies of snowmelt, water balance and streamflow generation in order to generate a five year database of precipitation inputs, snowpack dynamics and streamflow that could be used in hydrological model testing. A physically based hydrological model of the basin was constructed using the Cold Regions Hydrological Model and tested over four years of simulation. The model was found to accurately simulate snowpacks in forested and cleared landscapes and the timing and quantity of streamflow over the basin. The model was manipulated to simulate the impacts of forest disturbance on basin snow dynamics, snowmelt, streamflow and groundwater recharge. A total of 40 forest disturbance scenarios were compared to the current land use over the four simulation years. Disturbance scenarios ranged from the impact of pine beetle kill of lodgepole pine to clearing of north or south facing slopes, forest fire and salvage logging impacts. Pine beetle impacts were small in all cases with increases in snowmelt of less than 10% and of streamflow and groundwater recharge of less than 2%. This is due to only 15% of the basin area being covered with lodgepole pine and this pine being at lower elevations which received much lower snowfall and rainfall than did higher elevations and so generated much less streamflow and groundwater recharge. Forest disturbance due to fire and clearing affected much large areas of the basin and higher elevations and were generally more than twice as effective in increasing snowmelt or streamflow. For complete forest cover removal with salvage logging a 45% increase in snowmelt was simulated, however this only translated into a 5% increase in spring and summer streamflow and a 7% increase in groundwater recharge. Forest fire with retention of standing burned trunks was the most effect forest cover treatment for increasing streamflow (up to 8%) due to minimizing both sublimation of winter snow and summer evaporation rates. Peak daily streamflow discharges responded more strongly to forest cover decrease than did seasonal streamflow with increases of over 20% in peak streamflow with removal of forest cover. It is suggested that the dysynchronization of snowmelt timing with forest cover removal resulted in an ineffective translation of changes in snowmelt quantity to streamflow. This resulted in a complementary increase in groundwater recharge as well as streamflow as forest cover was reduced. Presumably, a basin with differing soil characteristics, groundwater regime or topographic orientation would provide a differing hydrological response to forest cover change and the sensitivity of these changes to basin characterisation needs further examination

Impact of Hemlock Woolly Adelgid (Hemiptera: Adelgidae) Infestation on the Jasmonic Acid-Elicited Defenses of Tsuga canadensis (Pinales: Pinaceae)

Hemlock woolly adelgid is an invasive piercing-sucking insect in eastern North America, which upon infestation of its main host, eastern hemlock (‘hemlock’), improves attraction and performance of folivorous insects on hemlock. This increased performance may be mediated by hemlock woolly adelgid feeding causing antagonism between the the jasmonic acid and other hormone pathways. In a common garden experiments using hemlock woolly adelgid infestation and induction with methyl jasmonate (MeJA) and measures of secondary metabolite contents and defense-associated enzyme activities, we explored the impact of hemlock woolly adelgid feeding on the local and systemic induction of jasmonic acid (JA)-elicited defenses. We found that in local tissue hemlock woolly adelgid or MeJA exposure resulted in unique induced phenotypes, whereas the combined treatment resulted in an induced phenotype that was a mixture of the two individual treatments. We also found that if the plant was infested with hemlock woolly adelgid, the systemic response of the plant was dominated by hemlock woolly adelgid, regardless of whether MeJA was applied. Interestingly, in the absence of hemlock woolly adelgid, hemlock plants had a very weak systemic response to MeJA. We conclude that hemlock woolly adelgid infestation prevents systemic induction of JA-elicited defenses. Taken together, compromised local JA-elicited defenses combined with weak systemic induction could be major contributors to increased folivore performance on hemlock woolly adelgid-infested hemlock

The treatment of cutaneous abscesses: Comparison of emergency medicine providers\u27 practice patterns

INTRODUCTION: Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting. METHODS: Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED. RESULTS: In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation. CONCLUSION: Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies

Team-based learning in pharmacy: The faculty experience

yesAim To assess faculty perceptions and experiences when implementing team-based learning (TBL) across a pharmacy curriculum. Study design A total of 19 faculty members participated in a series of individual semi-structured interviews that allowed freedom of discussion within a structured framework of inquiry. Data were transcribed, coded using NVivo, and analyzed to establish common themes. Participant quotations were chosen to reinforce the themes and give a voice to the participants. Findings and discussion The benefits of TBL were perceived to be enhanced student engagement, peer learning, increased faculty enjoyment of teaching, and student development of transferable skills. Challenges included increased initial workload, writing effective application exercises, and facilitating learner-centered classes. TBL may be useful in optimizing course content to ensure outcomes and activities focus on important concepts. Peer learning appears to benefit student learning. TBL may help equip students with valuable transferable skills. TBL requires an initial upfront investment in faculty development and time to prepare resources. A student-centered approach to learning may be daunting for faculty and require new skill sets. Conclusions Faculty described their support for TBL concluding that the pedagogical benefits of engaging students in active learning, the development of transferable skills for the workplace, and the personal satisfaction felt after a TBL class, outweigh the initial challenges of transitioning to TBL

Project #91: Optimizing Vascular Access to Reduce CLABSI

Henry Ford Macomb Hospital experienced an increase in Central Line Associated Bloodstream Infections (CLABSI) in 2021. A significant portion were occurring in the MICU and were associated with Candida sp. Bloodstream infections negatively impact patient outcomes, provider workload, and are costly, with a median cost of $48,108 based on a meta-analysis conducted by AHRQ in 2017. By end of 2022, HFM aimed to reduce CLABSI incidence by 50%.https://scholarlycommons.henryford.com/qualityexpo2023/1004/thumbnail.jp

Selective Alpha-Particle Mediated Depletion of Tumor Vasculature with Vascular Normalization

BACKGROUND: Abnormal regulation of angiogenesis in tumors results in the formation of vessels that are necessary for tumor growth, but compromised in structure and function. Abnormal tumor vasculature impairs oxygen and drug delivery and results in radiotherapy and chemotherapy resistance, respectively. Alpha particles are extraordinarily potent, short-ranged radiations with geometry uniquely suitable for selectively killing neovasculature. METHODOLOGY AND PRINCIPAL FINDINGS: Actinium-225 ((225)Ac)-E4G10, an alpha-emitting antibody construct reactive with the unengaged form of vascular endothelial cadherin, is capable of potent, selective killing of tumor neovascular endothelium and late endothelial progenitors in bone-marrow and blood. No specific normal-tissue uptake of E4G10 was seen by imaging or post-mortem biodistribution studies in mice. In a mouse-model of prostatic carcinoma, (225)Ac-E4G10 treatment resulted in inhibition of tumor growth, lower serum prostate specific antigen level and markedly prolonged survival, which was further enhanced by subsequent administration of paclitaxel. Immunohistochemistry revealed lower vessel density and enhanced tumor cell apoptosis in (225)Ac-E4G10 treated tumors. Additionally, the residual tumor vasculature appeared normalized as evident by enhanced pericyte coverage following (225)Ac-E4G10 therapy. However, no toxicity was observed in vascularized normal organs following (225)Ac-E4G10 therapy. CONCLUSIONS: The data suggest that alpha-particle immunotherapy to neovasculature, alone or in combination with sequential chemotherapy, is an effective approach to cancer therapy