Data-driven analytics to identify school absenteeism associated risk and protective factors for secondary school students

Chronic absenteeism (CA), defined as missing at least 15 school days/year, is recognized as a national problem in the U.S. with devastating long-term impacts for students. Previous studies have been guided by a mixture of diverse CA definitions and measurements which could potentially harm the applicability of findings. Despite the number of CA-associated factors identified, studies utilizing a unified theoretical system to a wide range of risk and protective factors has been scarce

Forest elephant movement and habitat use in a tropical forest-grassland mosaic in Gabon

Poaching of forest elephants (Loxodonta cyclotis) for ivory has decimated their populations in Central Africa. Studying elephant movement can provide insight into habitat and resource use to reveal where, when, and why they move and guide conservation efforts. We fitted 17 forest elephants with global positioning system (GPS) collars in 2015 and 2016 in the tropical forest-grassland mosaic of the Wonga Wongué Presidential Reserve (WW), Gabon. Using the location data, we quantified movement distances, home ranges, and habitat use to examine the environmental drivers of elephant movements and predict where elephants occur spatially and temporally. Forest elephants, on average, traveled 2,840 km annually and had home ranges of 713 km2, with males covering significantly larger home ranges than females. Forest elephants demonstrated both daily and seasonal movement patterns. Daily, they moved between forest and grassland at dawn and dusk. Seasonally, they spent proportionally more time in grassland than forest during the short-wet season when grasses recruit. Forest elephants also traveled faster during the short-wet season when fruit availability was greatest, likely reflecting long, direct movements to preferred fruiting tree species. Forest elephants tended to select areas with high tree and shrub density that afford cover and browse. When villages occurred in their home ranges elephants spent a disproportionate amount of time near them, particularly in the dry season, probably for access to agricultural crops and preferred habitat. Given the importance of the grassland habitat for elephants, maintenance of the forest-grassland matrix is a conservation priority in WW. Law enforcement, outreach, and education should focus on areas of potential human-elephant conflict near villages along the borders of the reserve. GPS-tracking should be extended into multi-use areas in the peripheries of protected areas to evaluate the effects of human disturbance on elephant movements and to maintain connectivity among elephant populations in Gabon

Integrating education into primary care quality and cost improvement at an academic medical center

Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical clinical guidelines for common medical conditions; measure and provide feedback on physicians' performance; and facilitate systemic changes to support appropriate care. Various methods are used to improve care, including evidence reviews, formal education, informal clinical “opinion leaders,” feedback, reminders, and procedure changes. Twenty-four common medical conditions have been addressed through this process. More than 30 measures of clinical performance have been developed and reported. Methods: This case study describes a systematic, multifaceted program to improve the quality and cost-effectiveness of primary care. Results: Illustrative results for clinical performance are presented for 2 measures of chronic care, 2 measures of preventive care, and 2 measures of acute care. All 6 measures show general improvement in performance across years, with performance near or above the National Committee for Quality Assurance's 90th percentile for Health Plan Employer Data and Information Set measures. Discussion: A systematic approach involving all relevant components of a health system integrates the synthesis of information, education about the information and how to implement it, and addressing operational barriers. Benefits include a curriculum that is shared across faculty, residents, and medical students and more uniform quality of care that faculty model for physicians-in-training.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49319/1/80_ftp.pd

African forest elephant movements depend on time scale and individual behavior.

The critically endangered African forest elephant (Loxodonta cyclotis) plays a vital role in maintaining the structure and composition of Afrotropical forests, but basic information is lacking regarding the drivers of elephant movement and behavior at landscape scales. We use GPS location data from 96 individuals throughout Gabon to determine how five movement behaviors vary at different scales, how they are influenced by anthropogenic and environmental covariates, and to assess evidence for behavioral syndromes-elephants which share suites of similar movement traits. Elephants show some evidence of behavioral syndromes along an 'idler' to 'explorer' axis-individuals that move more have larger home ranges and engage in more 'exploratory' movements. However, within these groups, forest elephants express remarkable inter-individual variation in movement behaviours. This variation highlights that no two elephants are the same and creates challenges for practitioners aiming to design conservation initiatives

Exceptional aggressiveness of cerebral cavernous malformation disease associated with PDCD10 mutations.

PurposeThe phenotypic manifestations of cerebral cavernous malformation disease caused by rare PDCD10 mutations have not been systematically examined, and a mechanistic link to Rho kinase-mediated hyperpermeability, a potential therapeutic target, has not been established.MethodsWe analyzed PDCD10 small interfering RNA-treated endothelial cells for stress fibers, Rho kinase activity, and permeability. Rho kinase activity was assessed in cerebral cavernous malformation lesions. Brain permeability and cerebral cavernous malformation lesion burden were quantified, and clinical manifestations were assessed in prospectively enrolled subjects with PDCD10 mutations.ResultsWe determined that PDCD10 protein suppresses endothelial stress fibers, Rho kinase activity, and permeability in vitro. Pdcd10 heterozygous mice have greater lesion burden than other Ccm genotypes. We demonstrated robust Rho kinase activity in murine and human cerebral cavernous malformation vasculature and increased brain vascular permeability in humans with PDCD10 mutation. Clinical phenotype is exceptionally aggressive compared with the more common KRIT1 and CCM2 familial and sporadic cerebral cavernous malformation, with greater lesion burden and more frequent hemorrhages earlier in life. We first report other phenotypic features, including scoliosis, cognitive disability, and skin lesions, unrelated to lesion burden or bleeding.ConclusionThese findings define a unique cerebral cavernous malformation disease with exceptional aggressiveness, and they inform preclinical therapeutic testing, clinical counseling, and the design of trials.Genet Med 17 3, 188-196

A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease.

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing

Gene expression signatures affected by alcohol-induced DNA methylomic deregulation in human embryonic stem cells

AbstractStem cells, especially human embryonic stem cells (hESCs), are useful models to study molecular mechanisms of human disorders that originate during gestation. Alcohol (ethanol, EtOH) consumption during pregnancy causes a variety of prenatal and postnatal disorders collectively referred to as fetal alcohol spectrum disorders (FASDs). To better understand the molecular events leading to FASDs, we performed a genome-wide analysis of EtOH's effects on the maintenance and differentiation of hESCs in culture. Gene Co-expression Network Analysis showed significant alterations in gene profiles of EtOH-treated differentiated or undifferentiated hESCs, particularly those associated with molecular pathways for metabolic processes, oxidative stress, and neuronal properties of stem cells. A genome-wide DNA methylome analysis revealed widespread EtOH-induced alterations with significant hypermethylation of many regions of chromosomes. Undifferentiated hESCs were more vulnerable to EtOH's effect than their differentiated counterparts, with methylation on the promoter regions of chromosomes 2, 16 and 18 in undifferentiated hESCs most affected by EtOH exposure. Combined transcriptomic and DNA methylomic analysis produced a list of differentiation-related genes dysregulated by EtOH-induced DNA methylation changes, which likely play a role in EtOH-induced decreases in hESC pluripotency. DNA sequence motif analysis of genes epigenetically altered by EtOH identified major motifs representing potential binding sites for transcription factors. These findings should help in deciphering the precise mechanisms of alcohol-induced teratogenesis

Evaluation of Multiple Flow Constrained Area Capacity Setting Methods for Collaborative Trajectory Options Program

The purpose of this study was to compare flow constrained area (FCA) capacity setting methods for Collaborative Trajectory Options Program (CTOP) as they pertain to the Integrated Demand Management (IDM) concept. IDM uses flow balancing to manage air traffic across multiple FCAs with a common downstream constraint, as well as constraints at the respective FCA locations. FCA capacity rates can be set manually, but generating capacities for multiple, interdependent FCAs could potentially over-burden a user. A new enhancement to CTOP called the FCA Balance Algorithm (FBA) was developed at NASA Ames Research Center to improve the process of allocating capacity across multiple flow constrained segments in the airspace. The FBA evaluates the predicted demand and capacity across multiple FCAs and dynamically generates capacity settings for the FCAs that best meet capacity limits for all identified constraints. In a human-in-the-loop simulation study, both manual and automated capacity setting methods were evaluated in terms of their overall feasibility using measures of system performance, human performance, and qualitative feedback. Subject matter experts were asked to use three different methods to allocate capacity to three FCAs, either (1) by manually setting capacity for every 60-minute time window, (2) by manually setting capacity for every 15-minute time window, or (3) by using the FBA capability to automatically generate capacity settings. Results showed no significant differences in terms of overall system performance, indicated by similar ground delay and airport throughput numbers between methods. However, differences in individual strategies afforded by the manual methods allowed some participants to achieve system-wide delay that was much lower than the average. The FBA was the fastest method of capacity setting, and it received the lowest subjective rating scores on physical task load, mental task load, task difficulty and task complexity out of the three methods. Finally, participants explained through qualitative feedback that there were many benefits to using the FBA, such as ease of use, accuracy, and low risk of human input error. Participants did not experience the same limitations with the FBA that they did with the manual methods, such as reduced accuracy in the 60-minute manual condition, or high complexity in the 15-minute/manual condition. These results suggest that the FBA automation enhancement to CTOP maintains system performance while improving human performance. Therefore, the FBA could be introduced as a way to mitigate operator workload while planning a CTOP

Persisting Language Deficit and the Minor Broca Syndrome: A Case Report

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Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial

Objective To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls