Pre-travel Health Care Utilization Among Travelers Who Visit Friends and Relatives

Introduction: Immigrants to the United States who return home to visit friends and relatives (VFRs) have high rates of travel-related infections. The data on VFR utilization of pre-travel health care is inadequate. The objective of this study was to describe the travel patterns and adherence to pre-travel recommendations of VFRs.Methods: This retrospective study compared pre-travel health care utilization between VFR and non-VFR patients in one travel clinic from 2012-2013. Study investigators reviewed patients’ electronic medical records for demographic data, travel characteristics, and rates of immunizations and preventive medication prescriptions (i.e. antimalarial prophylaxis and antibiotics for traveler’s diarrhea). Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to model adjusted associations of VFR with completion of pre-travel recommendations.Results: VFRs (n = 393) were younger than non-VFRs (n = 1680), more often required interpreters for language translation, and more commonly had government insurance coverage than non-VFRs. VFRs were more likely to travel to lower-income countries in Africa, Asia, and the Middle East. VFRs had longer durations of travel: 51% for >4 weeks vs. 21% for non-VFRs (P Conclusion: VFRs had longer travel durations and lower rates of vaccine completion than non-VFRs. More research is needed to understand this disparity and to promote changes in practice

Pharmacokinetic evaluation of the PNC disassembler metarrestin in wild-type and Pdx1-Cre;LSL-KrasG12D/+;Tp53R172H/+ (KPC) mice, a genetically engineered model of pancreatic cancer

This work is licensed under a Creative Commons Attribution 4.0 International License.Purpose Metarrestin is a first-in-class small molecule clinical candidate capable of disrupting the perinucleolar compartment, a subnuclear structure unique to metastatic cancer cells. This study aims to define the pharmacokinetic (PK) profile of metarrestin and the pharmacokinetic/pharmacodynamic relationship of metarrestin-regulated markers. Methods PK studies included the administration of single or multiple dose of metarrestin at 3, 10, or 25 mg/kg via intravenous (IV) injection, gavage (PO) or with chow to wild-type C57BL/6 mice and KPC mice bearing autochthonous pancreatic tumors. Metarrestin concentrations were analyzed by UPLC–MS/MS. Pharmacodynamic assays included mRNA expression profiling by RNA-seq and qRT-PCR for KPC mice. Results Metarrestin had a moderate plasma clearance of 48 mL/min/kg and a large volume of distribution of 17 L/kg at 3 mg/kg IV in C57BL/6 mice. The oral bioavailability after single-dose (SD) treatment was > 80%. In KPC mice treated with SD 25 mg/kg PO, plasma AUC0–∞ of 14400 ng h/mL, Cmax of 810 ng/mL and half-life (t1/2) of 8.5 h were observed. At 24 h after SD of 25 mg/kg PO, the intratumor concentration of metarrestin was high with a mean value of 6.2 µg/g tissue (or 13 µM), well above the cell-based IC50 of 0.4 µM. At multiple dose (MD) 25 mg/kg/day PO in KPC mice, mean tissue/plasma AUC0–24h ratio for tumor, spleen and liver was 37, 30 and 31, respectively. There was a good linear relationship of dosage to AUC0–24h and C24h. AUC0–24h MD to AUC0–24h SD ratios ranged from two for liver to five for tumor indicating additional accumulation in tumors. Dose-dependent normalization of FOXA1 and FOXO6 mRNA expression was observed in KPC tumors. Conclusions Metarrestin is an effective therapeutic candidate with a favorable PK profile achieving excellent intratumor tissue levels in a disease with known poor drug delivery.Intramural Research Program (IRP) of the NIHNational Cancer InstituteCenter for Cancer Research (ZIA BC 011267

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Rational Adaptation: Contextual Effects in Medical Decision Making

Research and practice in medical decision making value consistency with standardized intervention, potentially neglecting the impact of various environmental features such as workload or the constraints of local work practice. This study presents both qualitative and quantitative analyses of emergency physicians’ decision-making processes in their natural work setting to examine the impact of contextual features. We study contextual effects on two separable decision-making processes identified in quantified observational data: goal enactment and goal establishment. Whereas goal enactment responds to hospital differences and patient difficulty as main effects, goal establishment responds to their interaction. Our emphasis on goal establishment expands the scope of a medical decision-making literature focused on diagnosis, and extends to other professions and the more general conceptualization of expertise. From a theoretical perspective, we emphasize the importance of accounting for contextual variability within the bounds of expert behavior. Practically, we provide real-world examples of context effects that bear on the standardization of care, cost differences between hospitals, and the conceptualization of quality medical care

Nurses\u27 Short-Term Sickness Absences Before and After the Implementation of a Brief Napping Opportunity During Night Shifts

BACKGROUND: Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses\u27 missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses\u27 sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses. METHODS: The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital\u27s timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and -values were reported. FINDINGS: The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant ( = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant ( .001). CONCLUSION/APPLICATION TO PRACTICE: A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues

Gastroenteritis Outbreak Associated with Unpasteurized Tempeh, North Carolina, USA

During an investigation of an outbreak of gastroenteritis caused by Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+), we identified unpasteurized tempeh as a novel food vehicle and Rhizopus spp. starter culture as the source of the contamination. Safe handling of uncooked, unpasteurized tempeh should be emphasized for prevention of foodborne illnesses