Automated surveillance of 911 call data for detection of possible water contamination incidents

<p>Abstract</p> <p>Background</p> <p>Drinking water contamination, with the capability to affect large populations, poses a significant risk to public health. In recent water contamination events, the impact of contamination on public health appeared in data streams monitoring health-seeking behavior. While public health surveillance has traditionally focused on the detection of pathogens, developing methods for detection of illness from fast-acting chemicals has not been an emphasis.</p> <p>Methods</p> <p>An automated surveillance system was implemented for Cincinnati's drinking water contamination warning system to monitor health-related 911 calls in the city of Cincinnati. Incident codes indicative of possible water contamination were filtered from all 911 calls for analysis. The 911 surveillance system uses a space-time scan statistic to detect potential water contamination incidents. The frequency and characteristics of the 911 alarms over a 2.5 year period were studied.</p> <p>Results</p> <p>During the evaluation, 85 alarms occurred, although most occurred prior to the implementation of an additional alerting constraint in May 2009. Data were available for analysis approximately 48 minutes after calls indicating alarms may be generated 1-2 hours after a rapid increase in call volume. Most alerts occurred in areas of high population density. The average alarm area was 9.22 square kilometers. The average number of cases in an alarm was nine calls.</p> <p>Conclusions</p> <p>The 911 surveillance system provides timely notification of possible public health events, but did have limitations. While the alarms contained incident codes and location of the caller, additional information such as medical status was not available to assist validating the cause of the alarm. Furthermore, users indicated that a better understanding of 911 system functionality is necessary to understand how it would behave in an actual water contamination event.</p

Staphylococcus aureus toxin LukSF dissociates from its membrane receptor target to enable renewed ligand sequestration

Staphylococcus aureus Panton-Valentine leukocidin is a pore-forming toxin targeting the human C5a receptor (hC5aR), enabling this pathogen to battle the immune response by destroying phagocytes through targeted lysis. The mechanisms that contribute to rapid cell lysis are largely unexplored. Here, we show that cell lysis may be enabled by a process of toxins targeting receptor clusters and present indirect evidence for receptor recycling that allows multiple toxin pores to be formed close together. With the use of live cell single-molecule super-resolution imaging, Forster resonance energy transfer and nanoscale total internal reflection fluorescence colocalization microscopy, we visualized toxin pore formation in the presence of its natural docking ligand. We demonstrate disassociation of hC5aR from toxin complexes and simultaneous binding of new ligands. This effect may free mobile receptors to amplify hyperinflammatory reactions in early stages of microbial infections and have implications for several other similar bicomponent toxins and the design of new antibiotics.Haapasalo, K., Wollman, A. J. M., de Haas, C. J. C., van Kessel, K. P. M., van Strijp, J. A. G., Leake, M. C. Staphylococcus aureus toxin LukSF dissociates from its membrane receptor target to enable renewed ligand sequestration.Peer reviewe

Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial.

BackgroundThe AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity.ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes.SettingUnited States-based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization).MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis.ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P &lt; .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders.ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior

Achieving Microparticles with Cell-Instructive Surface Chemistry by Using Tunable Co-Polymer Surfactants

© 2020 The Authors. Published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim A flow-focusing microfluidic device is used to produce functionalized monodisperse polymer particles with surface chemistries designed to control bacterial biofilm formation. This is achieved by using molecularly designed bespoke surfactants synthesized via catalytic chain transfer polymerization. This novel approach of using polymeric surfactants, often called surfmers, containing a biofunctional moiety contrasts with the more commonly employed emulsion methods. Typically, the surface chemistry of microparticles are dominated by unwanted surfactants that dilute/mask the desired surface response. Time of flight secondary ion mass spectrometry (ToF-SIMS) analysis of particles demonstrates that the comb-graft surfactant is located on the particle surface. Biofilm experiments show how specifically engineered surface chemistries, generated by the surfactants, successfully modulate bacterial attachment to both polymer films, and microparticles. Thus, this paper outlines how the use of designed polymeric surfactants and droplet microfluidics can exert control over both the surface chemistry and size distribution of microparticle materials, demonstrating their critical importance for controlling surface-cell response

High-yield methods for accurate two-alternative visual psychophysics in head-fixed mice

Research in neuroscience increasingly relies on the mouse, a mammalian species that affords unparalleled genetic tractability and brain atlases. Here, we introduce high-yield methods for probing mouse visual decisions. Mice are head-fixed, facilitating repeatable visual stimulation, eye tracking, and brain access. They turn a steering wheel to make two alternative choices, forced or unforced. Learning is rapid thanks to intuitive coupling of stimuli to wheel position. The mouse decisions deliver high-quality psychometric curves for detection and discrimination and conform to the predictions of a simple probabilistic observer model. The task is readily paired with two-photon imaging of cortical activity. Optogenetic inactivation reveals that the task requires mice to use their visual cortex. Mice are motivated to perform the task by fluid reward or optogenetic stimulation of dopamine neurons. This stimulation elicits a larger number of trials and faster learning. These methods provide a platform to accurately probe mouse vision and its neural basis

Eccentric, nonspinning, inspiral, Gaussian-process merger approximant for the detection and characterization of eccentric binary black hole mergers

We present $\texttt{ENIGMA}$, a time domain, inspiral-merger-ringdown waveform model that describes non-spinning binary black holes systems that evolve on moderately eccentric orbits. The inspiral evolution is described using a consistent combination of post-Newtonian theory, self-force and black hole perturbation theory. Assuming eccentric binaries that circularize prior to coalescence, we smoothly match the eccentric inspiral with a stand-alone, quasi-circular merger, which is constructed using machine learning algorithms that are trained with quasi-circular numerical relativity waveforms. We show that $\texttt{ENIGMA}$ reproduces with excellent accuracy the dynamics of quasi-circular compact binaries. We validate $\texttt{ENIGMA}$ using a set of $\texttt{Einstein Toolkit}$ eccentric numerical relativity waveforms, which describe eccentric binary black hole mergers with mass-ratios between $1 \leq q \leq 5.5$, and eccentricities $e_0 \lesssim 0.2$ ten orbits before merger. We use this model to explore in detail the physics that can be extracted with moderately eccentric, non-spinning binary black hole mergers. We use $\texttt{ENIGMA}$ to show that GW150914, GW151226, GW170104, GW170814 and GW170608 can be effectively recovered with spinning, quasi-circular templates if the eccentricity of these events at a gravitational wave frequency of 10Hz satisfies $e_0\leq \{0.175,\, 0.125,\,0.175,\,0.175,\, 0.125\}$, respectively. We show that if these systems have eccentricities $e_0\sim 0.1$ at a gravitational wave frequency of 10Hz, they can be misclassified as quasi-circular binaries due to parameter space degeneracies between eccentricity and spin corrections. Using our catalog of eccentric numerical relativity simulations, we discuss the importance of including higher-order waveform multipoles in gravitational wave searches of eccentric binary black hole mergers.Comment: 19 pages, 10 figures, 1 Appendix. v2: we use numerical relativity simulations to quantify the importance of including higher-order waveform multipoles for the detection of eccentric binary black hole mergers, references added. Accepted to Phys. Rev.

Beyond Simple AGN Unification with Chandra-observed 3CRR Sources at 0.5 &lt; z &lt; 1

Low-frequency radio selection finds radio-bright galaxies regardless of the amount of obscuration by gas and dust. We report \chandra\ observations of a complete 178~MHz-selected, and so orientation unbiased, sample of 44 $0.5<z<1$ 3CRR sources. The sample is comprised of quasars and narrow-line radio galaxies (NLRGs) with similar radio luminosities, and the radio structure serves as both an age and an orientation indicator. Consistent with Unification, intrinsic obscuration (measured by \nh, X-ray hardness ratio, and X-ray luminosity) generally increases with inclination. However, the sample includes a population not seen in high-$z$ 3CRR sources: NLRGs viewed at intermediate inclination angles with \nh~$<10^{22}$~cm$^{-2}$. Multiwavelength analysis suggests these objects have lower $L/L_{\rm Edd}$ than typical NLRGs at similar orientation. Thus both orientation and $L/L_{\rm Edd}$ are important, and a "radiation-regulated Unification" provides a better explanation of the sample's observed properties. In comparison with the 3CRR sample at $1<z<2$, our lower-redshift sample shows a higher fraction of Compton-thin NLRGs (45\% vs.\ 29\%) but similar Compton-thick fraction (20\%), implying a larger covering factor of Compton-thin material at intermediate viewing angles and so a more "puffed-up" torus atmosphere. We posit that this is due to a range of $L/L_{\rm Edd}$ extending to lower values in this sample. In contrast, at high redshifts the narrower range and high $L/L_{\rm Edd}$ values allowed orientation (and so simple Unification) to dominate the sample's observed properties

The Impact of the COVID-19 Pandemic on Racial Disparities in Patients Undergoing Total Shoulder Arthroplasty in the United States

INTRODUCTION: The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the US and to determine whether these disparities were affected by the COVID-19 pandemic. METHODS: Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April-December from 2019-2020. Utilization was assessed for White/Black/Hispanic/Asian populations to determine if COVID-19 affected these groups differently. A regression model adjusted for age/sex/CMS-Hierarchical Condition Categories (HCC) score, dual enrollment (proxy for socioeconomic status), time fixed effects, and Core-based Statistical Area (CBSA) fixed effects was used to study difference across groups. RESULTS: In 2019, TSA volume/1000 beneficiaries was 1.51 for White and 0.57 for non-White, a 2.6-fold difference. In 2020, the rate of TSA in White patients (1.30/1000) was 2.9 times higher than non-White (0.45/1000) during the COVID-19 pandemic (P\u3c0.01). There was an overall 14% decrease in TSA volume/1000 Medicare beneficiaries in 2020; non-White patients had a larger percentage decrease in TSA volume than White (21% vs. 14%, estimated difference;8.7%,p = 0.02). Black patients experienced the most pronounced disparity with estimated difference of 10.1%,p = 0.05, compared with White patients. Similar disparities were observed when categorizing procedures into anatomic and reverse TSA, but not proximal humerus fracture. CONCLUSIONS: During the COVID-19 pandemic, overall TSA utilization decreased by 14% with White patients experiencing a decrease of 14%, and non-White patients experiencing a decrease of 21%. This trend was observed for elective TSA while disparities were less apparent for proximal humerus fracture