Tuberculosis of the Central Nervous System in Immunocompromised Patients: HIV Infection and Solid Organ Transplant Recipients

Central nervous system (CNS) tuberculosis (TB) is a devastating infection with high rates of morbidity and mortality worldwide and may manifest as meningitis, tuberculoma, abscess, or other forms of disease. Immunosuppression, due to either human immunodeficiency virus infection or solid organ transplantation, increases susceptibility for acquiring or reactivating TB and complicates the management of underlying immunosuppression and CNS TB infection. This article reviews how immunosuppression alters the clinical presentation, diagnosis, treatment, and outcome of TB infections of the CNS

Factors related to leader implementation of a nationally disseminated community-based exercise program: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The benefits of community-based health programs are widely recognized. However, research examining factors related to community leaders' characteristics and roles in implementation is limited.</p> <p>Methods</p> <p>The purpose of this cross-sectional study was to use a social ecological framework of variables to explore and describe the relationships between socioeconomic, personal/behavioral, programmatic, leadership, and community-level social and demographic characteristics as they relate to the implementation of an evidence-based strength training program by community leaders. Eight-hundred fifty-four trained program leaders in 43 states were invited to participate in either an online or mail survey. Corresponding community-level characteristics were also collected. Programmatic details were obtained from those who implemented. Four-hundred eighty-seven program leaders responded to the survey (response rate = 57%), 78% online and 22% by mail.</p> <p>Results</p> <p>Of the 487 respondents, 270 implemented the program (55%). One or more factors from each category – professional, socioeconomic, personal/behavioral, and leadership characteristics – were significantly different between implementers and non-implementers, determined by chi square or student's <it>t</it>-tests as appropriate. Implementers reported higher levels of strength training participation, current and lifetime physical activity, perceived support, and leadership competence (all p < 0.05). Logistic regression analysis revealed a positive association between implementation and fitness credentials/certification (p = 0.003), program-specific self-efficacy (p = 0.002), and support-focused leadership (p = 0.006), and a negative association between implementation and educational attainment (p = 0.002).</p> <p>Conclusion</p> <p>Among this sample of trained leaders, several factors within the professional, socioeconomic, personal/behavioral, and leadership categories were related to whether they implemented a community-based exercise program. It may benefit future community-based physical activity program disseminations to consider these factors when selecting and training leaders.</p

Healthy Kids Out of School: Using Mixed Methods to Develop Principles for Promoting Healthy Eating and Physical Activity in Out-of-School Settings in the United States.

INTRODUCTION: Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention. METHODS: The Institute of Medicine\u27s L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children\u27s healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children\u27s perceptions of healthful-food access; published research, reports, policies and guidelines; and roundtables with OST organizations\u27 administrators; 2) assemble information to prioritize actionable practices; and 3) inform programmatic direction. RESULTS: Three evidence-informed guiding principles for short-duration OST resulted: 1) drink right: choose water instead of sugar-sweetened beverages; 2) move more: boost movement and physical activity in all programs; and 3) snack smart: fuel up on fruits and vegetables. CONCLUSION: Healthy Kids Out of School was launched to support the dissemination and implementation of these guiding principles in short-duration OST settings, complementing efforts in other OST settings to shift norms around eating and physical activity

A decade in review after Idiopathic Scoliosis was first called a complex trait-A tribute to the late Dr. Yves Cotrel for his support in studies of etiology of scoliosis

Adolescent Idiopathic Scoliosis (AIS) is a prevalent and important spine disorder in the pediatric age group. An increased family tendency was observed for a long time, but the underlying genetic mechanism was uncertain. In 1999, Dr. Yves Cotrel founded the Cotrel Foundation in the Institut de France, which supported collaboration of international researchers to work together to better understand the etiology of AIS. This new concept of AIS as a complex trait evolved in this setting among researchers who joined the annual Cotrel meetings. It is now over a decade since the first proposal of the complex trait genetic model for AIS. Here, we review in detail the vast information about the genetic and environmental factors in AIS pathogenesis gathered to date. More importantly, new insights into AIS etiology were brought to us through new research data under the perspective of a complex trait. Hopefully, future research directions may lead to better management of AIS, which has a tremendous impact on affected adolescents in terms of both physical growth and psychological development

A decade in review after Idiopathic Scoliosis was first called a complex trait-A tribute to the late Dr. Yves Cotrel for his support in studies of etiology of scoliosis

Adolescent Idiopathic Scoliosis (AIS) is a prevalent and important spine disorder in the pediatric age group. An increased family tendency was observed for a long time, but the underlying genetic mechanism was uncertain. In 1999, Dr. Yves Cotrel founded the Cotrel Foundation in the Institut de France, which supported collaboration of international researchers to work together to better understand the etiology of AIS. This new concept of AIS as a complex trait evolved in this setting among researchers who joined the annual Cotrel meetings. It is now over a decade since the first proposal of the complex trait genetic model for AIS. Here, we review in detail the vast information about the genetic and environmental factors in AIS pathogenesis gathered to date. More importantly, new insights into AIS etiology were brought to us through new research data under the perspective of a complex trait. Hopefully, future research directions may lead to better management of AIS, which has a tremendous impact on affected adolescents in terms of both physical growth and psychological development

Intrapopulation Diversity in Isotopic Niche Over Landscapes: Spatial Patterns Inform Conservation of Bear–Salmon Systems

Intrapopulation variability in resource acquisition (i.e., niche variation) influences population dynamics, with important implications for conservation planning. Spatial analyses of niche variation within and among populations can provide relevant information about ecological associations and their subsequent management. We used stable isotope analysis and kernel-weighted regression to examine spatial patterns in a keystone consumer–resource interaction: salmon (Oncorhynchus spp.) consumption by grizzly and black bears (Ursus arctos horribilis, n = 886; and Ursus americanus, n = 557) from 1995 to 2014 in British Columbia (BC), Canada. In a region on the central coast of BC (22,000 km2 ), grizzly bears consumed far more salmon than black bears (median proportion of salmon in assimilated diet of 0.62 and 0.06, respectively). Males of both species consumed more salmon than females (median proportions of 0.63 and 0.57 for grizzly bears and 0.06 and 0.03 for black bears, respectively). Black bears showed considerably more spatial variation in salmon consumption than grizzlies. Protected areas on the coast captured no more habitat for bears with high-salmon diets (i.e., proportions \u3e0.5 of total diet) than did unprotected areas. In a continental region (~692,000 km2 ), which included the entire contemporary range of grizzlies in BC, males had higher salmon diets than females (median proportions of 0.41 and 0.04, respectively). High-salmon diets were concentrated in coastal areas for female grizzly bears, whereas males with high-salmon diets in interior areas were restricted to areas near major salmon watersheds. To safeguard this predator–prey association that spans coastal and interior regions, conservation planners and practitioners can consider managing across ecological and jurisdictional boundaries. More broadly, our approach highlights the importance of visualizing spatial patterns of dietary niche variation within populations to characterize ecological associations and inform management

Detecting and Characterizing Young Quasars. III. The Impact of Gravitational Lensing Magnification

We test the impact of gravitational lensing on the lifetime estimates of seven high-redshift quasars at redshift $z\gtrsim6$. The targeted quasars are identified by their small observed proximity zone sizes, which indicate extremely short quasar lifetimes $(t_Q\lesssim10^5 \text{ yrs})$. However, these estimates of quasar lifetimes rely on the assumption that the observed luminosities of the quasars are intrinsic and not magnified by gravitational lensing, which would bias the lifetime estimates towards younger ages. In order to test possible effects of gravitational lensing, we obtain high-resolution images of the seven quasars with the {\em Hubble Space Telescope (HST)} and look for signs of strong lensing. We do not find any evidence of strong lensing, i.e., all quasars are well-described by point sources, and no foreground lensing galaxy is detected. We estimate that the strong lensing probabilities for these quasars are extremely small $(\sim1.4\times10^{-5})$, and show that weak lensing changes the estimated quasar lifetimes by only $\lesssim0.2$ dex. We thus confirm that the short lifetimes of these quasars are intrinsic. The existence of young quasars indicates a high obscured fraction, radiatively inefficient accretion, and/or flickering light curves for high-redshift quasars. We further discuss the impact of lensing magnification on measurements of black hole masses and Eddington ratios of quasars.Comment: 14 pages, 4 figures, 3 tables. Accepted by the Astrophysical Journa

Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Sex Differences in Opioid-Induced Enhancement of Contact Hypersensitivity

Previous research has demonstrated that, in male rats, the magnitude of contact hypersensitivity (CHS) can be enhanced by morphine treatment. The present experiments test the hypothesis that the mu-opioids morphine, etorphine, and buprenorphine would produce significant sex differences in the magnitude of 2,4-dinitrofluorobenzene-induced CHS. During tests conducted over a 192-h period, morphine, etorphine, and buprenorphine administered before elicitation of CHS on the external surface of the ear (pinna) potentiated the CHS response, and the magnitude of this enhancement was significantly greater in females than males. By contrast, morphine had no effect on croton oil-induced irritant contact dermatitis, indicating that morphine's effects on CHS do not generalize to immunologically nonspecific forms of contact dermatitis. Activation of brain mu-opioid receptors is responsible for the effects of morphine on CHS, because intracerebroventricular treatment with the mu-opioid receptor antagonist beta-funaltrexamine blocked morphine potentiation of CHS in females and males. The sex differences in morphine potentiation of CHS appear to be a result of the gonadal hormonal milieu, because castration enhanced the CHS response following vehicle and morphine treatment, whereas ovariectomy significantly attenuated the enhancement of CHS by morphine. Because ovariectomy had no effect on the CHS response following vehicle treatment, the presence of female gonadal hormones may underlie the sex differences in morphine potentiation of CHS in gonadally intact animals. Overall, these results support an increased sensitivity to the modulatory effects of opioids on the CHS response in females that depends on the interaction between gonadal hormones and the central mu-opioid system