396 Characterizing inpatient hospitalizations for hidradenitis suppurativa and assessing the impact of outpatient dermatology care on hospitalizations

Introduction: Hidradenitis suppurativa (HS) is associated with a significant disease burden. The use of high-cost settings care are common among HS patients. Objective: To explore factors that may influence hospital admissions and readmissions among HS patients. Methods: Using ICD-9/10 codes (705.83 and L73.2), we extracted the medical records of adult HS patients who visited the Henry Ford Health System (HFHS) ED between 2010 and 2020. Results: Of the 100 HS patients, 52 (52%) were admitted to an inpatient service. Hypertension (OR:2.55,95% CI:1.11-5.83, p value=0.027), diabetes mellitus (OR:2.42, 95%CI:1.05-5.61, p value =0.039), cellulitis (OR: 19.28, 95%CI:4.23-87.96 p\u3c0.001), sepsis (OR:10.25, 95%CI:1.34-89.24, p value=0.025), and depression (OR:3.32, 95%CI:1.10-10.04, p value =0.002) were significant predictors of admission. Chronic kidney disease (OR:3.05, 95% CI:1.00-9.23,p value=0.049), congestive heart failure (OR:4.06, 95%CI:1.19-13.80, p value =0.025), coronary artery disease (OR:15.20, 95%CI:2.80-82.65, p value=0.002), chronic obstructive pulmonary disease (OR:8.94, 95%: 1.51-52.86, p value =0.003), cellulitis (OR:4.62, 95%CI:1.66-12.88, p=0.003), sepsis (OR:3.75, 95%CI:1.02-13.82,p value =0.047), and depression (OR:4.50, 95%CI:1.54-13.18, p value=0.006) were positively associated with readmission. Those who received outpatient dermatology care had a lower risk of being admitted (n=87, 28.7% vs n=13,100%, p \u3c0.001) and readmitted (n=10, 11.5% vs n=5, 38.5%, p value =0.0108). Discussion: In this study, we demonstrate that certain comorbidities, that are common among HS patients, are significant determinants of admission to an inpatient service. Furthermore, the increase access to outpatient dermatology care significantly reduces the likelihood of HS patients being admitted and readmitted. Conclusion: The findings of this study illuminate the pivotal role of dermatologists in improving patients’ health outcomes while minimizing the avoidable use of high-cost settings care

A principled approach to the measurement of situation awareness in commercial aviation

The issue of how to support situation awareness among crews of modern commercial aircraft is becoming especially important with the introduction of automation in the form of sophisticated flight management computers and expert systems designed to assist the crew. In this paper, cognitive theories are discussed that have relevance for the definition and measurement of situation awareness. These theories suggest that comprehension of the flow of events is an active process that is limited by the modularity of attention and memory constraints, but can be enhanced by expert knowledge and strategies. Three implications of this perspective for assessing and improving situation awareness are considered: (1) Scenario variations are proposed that tax awareness by placing demands on attention; (2) Experimental tasks and probes are described for assessing the cognitive processes that underlie situation awareness; and (3) The use of computer-based human performance models to augment the measures of situation awareness derived from performance data is explored. Finally, two potential example applications of the proposed assessment techniques are described, one concerning spatial awareness using wide field of view displays and the other emphasizing fault management in aircraft systems

An Integrated Model of Multiple-Condition ChIP-Seq Data Reveals Predeterminants of Cdx2 Binding

Regulatory proteins can bind to different sets of genomic targets in various cell types or conditions. To reliably characterize such condition-specific regulatory binding we introduce MultiGPS, an integrated machine learning approach for the analysis of multiple related ChIP-seq experiments. MultiGPS is based on a generalized Expectation Maximization framework that shares information across multiple experiments for binding event discovery. We demonstrate that our framework enables the simultaneous modeling of sparse condition-specific binding changes, sequence dependence, and replicate-specific noise sources. MultiGPS encourages consistency in reported binding event locations across multiple-condition ChIP-seq datasets and provides accurate estimation of ChIP enrichment levels at each event. MultiGPS's multi-experiment modeling approach thus provides a reliable platform for detecting differential binding enrichment across experimental conditions. We demonstrate the advantages of MultiGPS with an analysis of Cdx2 binding in three distinct developmental contexts. By accurately characterizing condition-specific Cdx2 binding, MultiGPS enables novel insight into the mechanistic basis of Cdx2 site selectivity. Specifically, the condition-specific Cdx2 sites characterized by MultiGPS are highly associated with pre-existing genomic context, suggesting that such sites are pre-determined by cell-specific regulatory architecture. However, MultiGPS-defined condition-independent sites are not predicted by pre-existing regulatory signals, suggesting that Cdx2 can bind to a subset of locations regardless of genomic environment. A summary of this paper appears in the proceedings of the RECOMB 2014 conference, April 2–5.National Science Foundation (U.S.) (Graduate Research Fellowship under Grant 0645960)National Institutes of Health (U.S.) (grant P01 NS055923)Pennsylvania State University. Center for Eukaryotic Gene Regulatio

A signalome screening approach in the autoinflammatory disease TNF Receptor Associated Periodic Syndrome (TRAPS) highlights the anti-inflammatory properties of drugs for repurposing

TNF Receptor Associated Periodic Syndrome (TRAPS) is an autoinflammatory disease caused by mutations in TNF Receptor 1 (TNFR1). Current therapies for TRAPS are limited and do not target the pro-inflammatory signalling pathways that are central to the disease mechanism. Our aim was to identify drugs for repurposing as anti-inflammatories based on their ability to down-regulate molecules associated with inflammatory signalling pathways that are activated in TRAPS. This was achieved using rigorously optimised, high through- put cell culture and reverse phase protein microarray systems to screen compounds for their effects on the TRAPS-associated inflammatory signalome. 1360 approved, publically available, pharmacologically active substances were investigated for their effects on 40 signalling molecules associated with pro-inflammatory signalling pathways that are constitutively upregulated in TRAPS. The drugs were screened at four ten-fold concentrations on cell lines expressing both wild-type (WT) TNFR1 and TRAPS-associated C33Y mutant TNFR1, or WT TNFR1 alone; signalling molecule levels were then determined in cell lysates by the reverse phase protein microarray. A novel mathematical methodology was developed to rank the compounds for their ability to reduce the expression of signalling molecules in the C33Y-TNFR1 transfectants towards the level seen in the WT-TNFR1 transfectants. Seven high-ranking drugs were selected and tested by RPPA for effects on the same 40 signalling molecules in lysates of peripheral blood mononuclear cells (PBMCs) from C33Y-TRAPS patients compared to PBMCs from normal controls. The fluoroquinolone antibiotic lomefloxacin, as well as others from this class of compounds, showed the most significant effects on multiple pro-inflammatory signalling pathways that are constitutively activated in TRAPS; lomefloxacin dose-dependently significantly reduced expression of 7/40 signalling molecules across the Jak/Stat, MAPK, NF-kB and PI3K/AKT pathways. This study demonstrates the power of signalome screening for identifying candidates for drug repurposing

Small and medium-sized enterprise policy: Designed to fail?

Significant doubts persist over the effectiveness of government policy to increase the numbers or performance of small and medium-sized enterprises in the UK economy. We analyse UK political manifestoes from 1964-2015 to examine the development of SME policy in political discourse. We do this by analysing how the broadly-defined category of ‘SME’ has been characterised in the manifestoes and assess these characterisations in relation to the empirical evidence base. We highlight three consistent themes in UK political manifestoes during 1964-2015 where SMEs have been characterised as having the potential for growth, struggling to access finance and being over-burdened by regulation. We argue that homogenising the broad range of businesses represented by the SME category and characterising them in these terms misrepresents them, undermining policies developed in relation to this mischaracterisation

Protein misfolding and dysregulated protein homeostasis in autoinflammatory diseases and beyond.

Cells have a number of mechanisms to maintain protein homeostasis, including proteasome-mediated degradation of ubiquitinated proteins and autophagy, a regulated process of ‘self-eating’ where the contents of entire organelles can be recycled for other uses. The unfolded protein response prevents protein overload in the secretory pathway. In the past decade, it has become clear that these fundamental cellular processes also help contain inflammation though degrading pro-inflammatory protein complexes such as the NLRP3 inflammasome. Signaling pathways such as the UPR can also be co-opted by toll-like receptor and mitochondrial reactive oxygen species signaling to induce inflammatory responses. Mutations that alter key inflammatory proteins, such as NLRP3 or TNFR1, can overcome normal protein homeostasis mechanisms, resulting in autoinflammatory diseases. Conversely, Mendelian defects in the proteasome cause protein accumulation, which can trigger interferon-dependent autoinflammatory disease. In non-Mendelian inflammatory diseases, polymorphisms in genes affecting the UPR or autophagy pathways can contribute to disease, and in diseases not formerly considered inflammatory such as neurodegenerative conditions and type 2 diabetes, there is increasing evidence that cell intrinsic or environmental alterations in protein homeostasis may contribute to pathogenesis

Estimation of population size when capture probability depends on individual state

We develop a multi-state model to estimate the size of a closed population from capture–recapture studies. We consider the case where capture–recapture data are not of a simple binary form, but where the state of an individual is also recorded upon every capture as a discrete variable. The proposed multi-state model can be regarded as a generalisation of the commonly applied set of closed population models to a multi-state form. The model allows for heterogeneity within the capture probabilities associated with each state while also permitting individuals to move between the different discrete states. A closed-form expression for the likelihood is presented in terms of a set of sufficient statistics. The link between existing models for capture heterogeneity is established, and simulation is used to show that the estimate of population size can be biased when movement between states is not accounted for. The proposed unconditional approach is also compared to a conditional approach to assess estimation bias. The model derived in this paper is motivated by a real ecological data set on great crested newts, Triturus cristatus. Supplementary materials accompanying this paper appear online

A novel copro-diagnostic molecular method for qualitative detection and identification of parasitic nematodes in amphibians and reptiles

© 2017 Huggins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Anthropogenic disturbance via resource acquisition, habitat fragmentation and climate change, amongst other factors, has led to catastrophic global biodiversity losses and species extinctions at an accelerating rate. Amphibians are currently one of the worst affected classes with at least a third of species categorised as being threatened with extinction. At the same time, they are also critically important for many habitats and provide man with a powerful proxy for ecosystem health by acting as a bioindicator group. Whilst the causes of synchronised amphibian losses are varied recent research has begun to highlight a growing role that macroparasites are playing in amphibian declines. However, diagnosing parasite infection in the field can be problematic, principally relying on collection and euthanasia of hosts, followed by necropsy and morphological identification of parasites in situ. The current study developed a non-invasive PCR-based methodology for sensitive detection and identification of parasitic nematode DNA released in the faeces of infected amphibians as egg or tissue fragments (environmental DNA). A DNA extraction protocol optimised for liberation of DNA from resilient parasite eggs was developed alongside the design of a novel, nematode universal, degenerate primer pair, thus avoiding the difficulties of using species specific primers in situations where common parasite species are unknown. Used in conjunction this protocol and primer pair was tested on a wide range of faecal samples from captive and wild amphibians. The primers and protocol were validated and detected infections, including a Railletnema nematode infection in poison dart frogs from ZSL London Zoo and Mantella cowani frogs in the wild. Furthermore, we demonstrate the efficacy of our PCR-based protocol for detecting nematode infection in other hosts, such as the presence of pinworm (Aspiculuris) in two tortoise species and whipworm (Trichuris muris) in mice. Our environmental DNA approach mitigates problems associated with microscopic identification and can be applied to detect nematode parasitoses in wild and captive hosts for infection surveillance and maintenance of healthy populations