Meningococcal Disease in Patients With Human Immunodeficiency Virus Infection: A Review of Cases Reported Through Active Surveillance in the United States, 2000-2008.

BackgroundAlthough human immunodeficiency virus (HIV) infection is an established risk factor for several bacterial infections, the association between HIV infection and meningococcal disease remains unclear.MethodsExpanded chart reviews were completed on persons with meningococcal disease and HIV infection reported from 2000 through 2008 from 9 US sites participating in an active population-based surveillance system for meningococcal disease. The incidence of meningococcal disease among patients meeting Centers for Disease Control and Prevention acquired immune deficiency syndrome (AIDS) surveillance criteria was estimated using data from the National HIV Surveillance System for the participating sites.ResultsThirty-three cases of meningococcal disease in individuals with HIV infection were reported from participating sites, representing 2.0% of all reported meningococcal disease cases. Most (75.8%) persons with HIV infection were adult males aged 25 to 64 years old. Among all meningococcal disease cases aged 25 to 64 years old, case fatality ratios were similar among HIV-infected and HIV-uninfected persons (13.3% vs 10.6%; P = .6). The cumulative, mean incidence of meningococcal disease among patients aged 25 to 64 years old with HIV infection ever classified as AIDS was 3.5 cases per 100000 person years (95% confidence interval [CI], 2.1-5.6), compared with 0.3 cases per 100000 person years (95% CI, 0.3-0.3) for persons of the same age group not reported to have AIDS (relative risk = 12.9; 95% CI, 7.9-20.9).ConclusionsIndividuals with HIV infection meeting the AIDS surveillance case definition have a higher incidence of meningococcal disease compared with the general adult population

The Role of Limited English Proficiency and Access to Health Insurance and Health Care in the Affordable Care Act Era

Purpose: Limited English proficiency adversely impacts people\u27s ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA). Methods: Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted n=240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: How well do you speak English? Would you say... Very well; well; Not well; Not at all? (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and What language do you speak at home? Would you say... English, Spanish, Other. Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report. Results: Among those \u3c 65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those \u3e /=65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates. Conclusion: Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English

Weight gain prevention in the school worksite setting: Results of a multi-level cluster randomized trial

OBJECTIVE: To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. METHOD: A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. RESULTS: At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. CONCLUSION: This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees

Randomized Crossover Study Showing Nurse-Led Same Day Review Replacing Next Day Review in Uneventful Phacoemulsification to Be Safe and Efficacious

Purpose. To study whether nurse led same-day review (SDR) after uneventful phacoemulsification can replace next-day review (NDR) in terms of safety and efficacy. Setting. Patients are recruited from an ophthalmology outpatient clinic in Hong Kong. Design. A prospective, randomized crossover study conducted from November 2012 to 2014. Methods. Inclusion criteria include cataract surgery naïve patients undergoing phacoemulsification under local anaesthesia. All patients were seen by our ophthalmic nurse 2 hours after surgery. Before undergoing phacoemulsification of the first eye, patients were randomized to be reviewed on day 1 or 7 after surgery. Surgeons and reviewing doctors were blinded to patient allocation. For the patients’ second eye surgery, group allocation will cross over. Primary outcome measures include visual improvement and patient satisfaction questionnaire. Other measures include cataract characteristics, surgical details, and complications. Statistical tests include paired t-test, Wilcoxon signed rank test, and Chi-square test. Results. 164 eyes from 82 patients were available. Visual improvement, satisfaction, and complications were comparable between both groups. Conclusions. A nurse led SDR can replace NDR in uneventful phacoemulsification in terms of safety and efficacy. Patient satisfaction is also comparable in the setting of Asian culture and when transportation is not a major concern

A unified framework for the orbital structure of bars and triaxial ellipsoids

We examine a large random sample of orbits in two self-consistent simulations of N-body bars. Orbits in these bars are classified both visually and with a new automated orbit classification method based on frequency analysis. The well-known prograde x1 orbit family originates from the same parent orbit as the box orbits in stationary and rotating triaxial ellipsoids. However, only a small fraction of bar orbits (~4%) have predominately prograde motion like their periodic parent orbit. Most bar orbits arising from the x1 orbit have little net angular momentum in the bar frame, making them equivalent to box orbits in rotating triaxial potentials. In these simulations a small fraction of bar orbits (~7%) are long-axis tubes that behave exactly like those in triaxial ellipsoids: they are tipped about the intermediate axis owing to the Coriolis force, with the sense of tipping determined by the sign of their angular momentum about the long axis. No orbits parented by prograde periodic x2 orbits are found in the pure bar model, but a tiny population (~2%) of short-axis tube orbits parented by retrograde x4 orbits are found. When a central point mass representing a supermassive black hole (SMBH) is grown adiabatically at the center of the bar, those orbits that lie in the immediate vicinity of the SMBH are transformed into precessing Keplerian orbits that belong to the same major families (short-axis tubes, long-axis tubes and boxes) occupying the bar at larger radii. During the growth of an SMBH, the inflow of mass and outward transport of angular momentum transform some x1 and long-axis tube orbits into prograde short-axis tubes. This study has important implications for future attempts to constrain the masses of SMBHs in barred galaxies using orbit-based methods like the Schwarzschild orbit superposition scheme and for understanding the observed features in barred galaxies

Evolution of the Dark Matter Phase-Space Density Distributions of LCDM Halos

We study the evolution of phase-space density during the hierarchical structure formation of LCDM halos. We compute both a spherically-averaged surrogate for phase-space density (Q) and the coarse-grained distribution function f(x,v) for dark matter particles that lie within~2 virial radii of four Milky-Way-sized dark matter halos. The estimated f(x,v) spans over four decades at any radius. Dark matter particles that end up within two virial radii of a Milky-Way-sized DM halo at $z=0$ have an approximately Gaussian distribution in log(f) at early redshifts, but the distribution becomes increasingly skewed at lower redshifts. The value corresponding to the peak of the Gaussian decreases as the evolution progresses and is well described by a power-law in (1+z). The highest values of f are found at the centers of dark matter halos and subhalos, where f can be an order of magnitude higher than in the center of the main halo. The power-law Q(r) profile likely reflects the distribution of entropy (K = sigma^2/rho^{2/3} \propto r^{1.2}), which dark matter acquires as it is accreted onto a growing halo. The estimated f(x, v), on the other hand, exhibits a more complicated behavior. Although the median coarse-grained phase-space density profile F(r) can be approximated by a power-law in the inner regions of halos and at larger radii the profile flattens significantly. This is because phase-space density averaged on small scales is sensitive to the high-f material associated with surviving subhalos, as well as relatively unmixed material (probably in streams) resulting from disrupted subhalos, which contribute a sizable fraction of matter at large radii. (ABRIDGED)Comment: Closely matches version accepted for publicatio

The Spitzer Survey of the Small Magellanic Cloud: S3MC Imaging and Photometry in the Mid- and Far-Infrared Wavebands

We present the initial results from the Spitzer Survey of the Small Magellanic Cloud (S3MC), which imaged the star-forming body of the Small Magellanic Cloud (SMC) in all seven MIPS and IRAC wavebands. We find that the F_8/F_24 ratio (an estimate of PAH abundance) has large spatial variations and takes a wide range of values that are unrelated to metallicity but anticorrelated with 24 um brightness and F_24/F_70 ratio. This suggests that photodestruction is primarily responsible for the low abundance of PAHs observed in star-forming low-metallicity galaxies. We use the S3MC images to compile a photometric catalog of ~400,000 mid- and far-infrared point sources in the SMC. The sources detected at the longest wavelengths fall into four main categories: 1) bright 5.8 um sources with very faint optical counterparts and very red mid-infrared colors ([5.8]-[8.0]>1.2), which we identify as YSOs. 2) Bright mid-infrared sources with mildly red colors (0.16<[5.8]-[8.0]<0.6), identified as carbon stars. 3) Bright mid-infrared sources with neutral colors and bright optical counterparts, corresponding to oxygen-rich evolved stars. And, 4) unreddened early B stars (B3 to O9) with a large 24 um excess. This excess is reminiscent of debris disks, and is detected in only a small fraction of these stars (<5%). The majority of the brightest infrared point sources in the SMC fall into groups one to three. We use this photometric information to produce a catalog of 282 bright YSOs in the SMC with a very low level of contamination (~7%).Comment: Accepted for publication in The Astrophysical Journal. Given the draconian figure file-size limits implemented in astro-ph, readers are encouraged to download the manuscript with full quality images from http://celestial.berkeley.edu/spitzer/publications/s3mcsurvey.pd

The histone deacetylase complex MiDAC regulates a neurodevelopmental gene expression program to control neurite outgrowth

The mitotic deacetylase complex (MiDAC) is a recently identified histone deacetylase (HDAC) complex. While other HDAC complexes have been implicated in neurogenesis, the physiological role of MiDAC remains unknown. Here, we show that MiDAC constitutes an important regulator of neural differentiation. We demonstrate that MiDAC functions as a modulator of a neurodevelopmental gene expression program and binds to important regulators of neurite outgrowth. MiDAC upregulates gene expression of pro-neural genes such as those encoding the secreted ligands SLIT3 and NETRIN1 (NTN1) by a mechanism suggestive of H4K20ac removal on promoters and enhancers. Conversely, MiDAC inhibits gene expression by reducing H3K27ac on promoter-proximal and -distal elements of negative regulators of neurogenesis. Furthermore, loss of MiDAC results in neurite outgrowth defects that can be rescued by supplementation with SLIT3 and/or NTN1. These findings indicate a crucial role for MiDAC in regulating the ligands of the SLIT3 and NTN1 signaling axes to ensure the proper integrity of neurite development

Lead Exposure during Early Human Development and DNA Methylation of Imprinted Gene Regulatory Elements in Adulthood

BACKGROUND: Lead exposure during early development causes neurodevelopmental disorders by unknown mechanisms. Epidemiologic studies have focused recently on determining associations between lead exposure and global DNA methylation; however, such approaches preclude the identification of loci that may alter human disease risk. OBJECTIVES: The objective of this study was to determine whether maternal, postnatal, and early childhood lead exposure can alter the differentially methylated regions (DMRs) that control the monoallelic expression of imprinted genes involved in metabolism, growth, and development. METHODS: Questionnaire data and serial blood lead levels were obtained from 105 participants (64 females, 41 males) of the Cincinnati Lead Study from birth to 78 months. When participants were adults, we used Sequenom EpiTYPER assays to test peripheral blood DNA to quantify CpG methylation in peripheral blood leukocytes at DMRs of 22 human imprinted genes. Statistical analyses were conducted using linear regression. RESULTS: Mean blood lead concentration from birth to 78 months was associated with a significant decrease in PEG3 DMR methylation (β = -0.0014; 95% CI: -0.0023, -0.0005, p = 0.002), stronger in males (β = -0.0024; 95% CI: -0.0038, -0.0009, p = 0.003) than in females (β = -0.0009; 95% CI: -0.0020, 0.0003, p = 0.1). Elevated mean childhood blood lead concentration was also associated with a significant decrease in IGF2/H19 (β = -0.0013; 95% CI: -0.0023, -0.0003, p = 0.01) DMR methylation, but primarily in females, (β = -0.0017; 95% CI: -0.0029, -0.0006, p = 0.005) rather than in males, (β = -0.0004; 95% CI: -0.0023, 0.0015, p = 0.7). Elevated blood lead concentration during the neonatal period was associated with higher PLAGL1/HYMAI DMR methylation regardless of sex (β = 0.0075; 95% CI: 0.0018, 0.0132, p = 0.01). The magnitude of associations between cumulative lead exposure and CpG methylation remained unaltered from 30 to 78 months. CONCLUSIONS: Our findings provide evidence that early childhood lead exposure results in sex-dependent and gene-specific DNA methylation differences in the DMRs of PEG3, IGF2/H19, and PLAGL1/HYMAI in adulthood. CITATION: Li Y, Xie C, Murphy SK, Skaar D, Nye M, Vidal AC, Cecil KM, Dietrich KN, Puga A, Jirtle RL, Hoyo C. 2016. Lead exposure during early human development and DNA methylation of imprinted gene regulatory elements in adulthood. Environ Health Perspect 124:666-673; http://dx.doi.org/10.1289/ehp.1408577