Out and About in Medicine: GW Out For Health

The time is right to devise and implement a more coordinated approach to LGBT patient care and health professional training within the Washington, DC metropolitan area and beyond. The following George Washington University School of Medicine and Health Sciences (GWSMHS) and Hospital (GWUH) LGBT Health Initiative proposal highlights possible strategies for addressing this need through a more centralized fashion. The seven focus areas proposed for the GW LGBT Health Initiative include: 1) Climate/Visibility; 2) Health Education; 3) Policy/Advocacy; 4) Community Outreach; 5) Research; 6) Patient Care; and 7) HIV/AIDS. A key stakeholder that is helping to realize this vision of a comprehensive, coordinated GW LGBT Health Initiative is the student organization GW Out for Health (GWOFH). Led by an executive board of medical students and a faculty advisor, GWOFH has been working to improve the climate for LGBT and ally professional health students and visibility of LGBT health issues on campus through grass roots efforts. GWOFH has approached these goals by emulating aspects of successful student organizations, namely Student National Medical Association, as well as reaching out and building relationships with LGBT resources in the community. Altogether, members of the group will provide critical perspectives on the initial needs assessment and gap analysis of LGBT health at GWSMHS and GWUH necessary to developing a strategic plan for the GW LGBT Health Initiative. In the past year, GWOFH has achieved concrete steps towards improving the climate and visibility of LGBT health issues by building up their organizational infrastructure and membership, which is evidenced by the three-fold growth in membership and creation of a private campus Listserv. To provide social support for LGBT and ally medical students, GWOFH hosted a welcome potluck for GWSMHS students and a social mixer with the LGBT student organizations at Georgetown and Howard medical schools. To improve the visibility of LGBT health issues on campus, GWOFH launched a successful Lunchtime Lecture Series on current research and best practices for reducing LGBT health disparities. GWOFH’s accomplishments have set a solid foundation for providing professional and social support for incoming LGBT and ally professional health students. Furthermore, GWOFH’s reputable presence on campus will be leveraged to help support the proposed GW LGBT Health Initiative in the coming year by providing an advisory role on the development of an initial needs assessment and gap analysis, especially in the areas of climate and visibility, health education, political advocacy, and patient care

Panton Valentine leukocidin MSSA leading to multi-organ failure.

We report a case of a 15-year-old boy who developed multiple organ failure secondary to a sport injury leading to infection with a Panton Valentine Leukocidin (PVL) secreting Community-Acquired Methicillin Sensitive Staphylococcus Aureus (CA MSSA). Aggressive antibiotic therapy eventually led to recovery

Evaluating Current Practices in Shelf Life Estimation

The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) methods for determining the supported shelf life of a drug product, described in ICH guidance documents Q1A and Q1E, are evaluated in this paper. To support this evaluation, an industry data set is used which is comprised of 26 individual stability batches of a common drug product where most batches are measured over a 24 month storage period. Using randomly sampled sets of 3 or 6 batches from the industry data set, the current ICH methods are assessed from three perspectives. First, the distributional properties of the supported shelf lives are summarized and compared to the distributional properties of the true shelf lives associated with the industry data set, assuming the industry data set represents a finite population of drug product batches for discussion purposes. Second, the results of the ICH poolability^ tests for model selection are summarized and the separate shelf life distributions from the possible alternative models are compared. Finally, the ICH methods are evaluated in terms of their ability to manage risk. Shelf life estimates that are too long result in an unacceptable percentage of nonconforming batches at expiry while those that are too short put the manufacturer at risk of possibly having to prematurely discard safe and efficacious drug product. Based on the analysis of the industry data set, the ICH-recommended approach did not produce supported shelf lives that effectively managed risk. Alternative approaches are required

Spatio-temporal distribution of Spiroplasma infections in the tsetse fly (Glossina fuscipes fuscipes) in northern Uganda

Copyright: © 2019 Schneider 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. Tsetse flies (Glossina spp.) are vectors of parasitic trypanosomes, which cause human (HAT) and animal African trypanosomiasis (AAT) in sub-Saharan Africa. In Uganda, Glossina fuscipes fuscipes (Gff) is the main vector of HAT, where it transmits Gambiense disease in the northwest and Rhodesiense disease in central, southeast and western regions. Endosymbionts can influence transmission efficiency of parasites through their insect vectors via conferring a protective effect against the parasite. It is known that the bacterium Spiroplasma is capable of protecting its Drosophila host from infection with a parasitic nematode. This endosymbiont can also impact its host\u27s population structure via altering host reproductive traits. Here, we used field collections across 26 different Gff sampling sites in northern and western Uganda to investigate the association of Spiroplasma with geographic origin, seasonal conditions, Gff genetic background and sex, and trypanosome infection status. We also investigated the influence of Spiroplasma on Gff vector competence to trypanosome infections under laboratory conditions. Generalized linear models (GLM) showed that Spiroplasma probability was correlated with the geographic origin of Gff host and with the season of collection, with higher prevalence found in flies within the Albert Nile (0.42 vs 0.16) and Achwa River (0.36 vs 0.08) watersheds and with higher prevalence detected in flies collected in the intermediate than wet season. In contrast, there was no significant correlation of Spiroplasma prevalence with Gff host genetic background or sex once geographic origin was accounted for in generalized linear models. Additionally, we found a potential negative correlation of Spiroplasma with trypanosome infection, with only 2% of Spiroplasma infected flies harboring trypanosome co-infections. We also found that in a laboratory line of Gff, parasitic trypanosomes are less likely to colonize the midgut in individuals that harbor Spiroplasma infection. These results indicate that Spiroplasma infections in tsetse may be maintained by not only maternal but also via horizontal transmission routes, and Spiroplasma infections may also have important effects on trypanosome transmission efficiency of the host tsetse. Potential functional effects of Spiroplasma infection in Gff could have impacts on vector control approaches to reduce trypanosome infections

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Perceptions of counselor effectiveness within rural America\u27s heartland

It has been suggested that clients who receive a treatment they believe in and perceive to be effective will engage early, work hard, and continue in treatment, leading to better therapeutic outcomes. The purpose of the present study was to examine the effects of therapeutic style, level of geographic rurality, and the interaction of these aspects on the perceived therapeutic effectiveness from a sample of adult participants living within America’s rural heartland. Participants included 175 adults who were native residents of Nebraska, Kansas, or Oklahoma. Participants were randomly assigned to listen to 1 of 2 therapeutic approaches (i.e., client-centered therapy or cognitive behavioral therapy) portrayed within an audio-recorded simulated therapy session. Following the recording, each participant completed the Counselor Rating Scale-Short Version, answered one corresponding open-ended item, and finished a demographic questionnaire. Results indicated participants perceived the cognitive-behavioral approach to be more effective than the client-centered approach. Level of rurality did not have an independent effect on perceived therapeutic effectiveness. Similarly, there was no interaction between therapeutic style and level of rurality on perceived therapeutic effectiveness. The following implications, limitations, and directions for future research were discussed: (a) promoting and implementing services in rural communities, (b) ethical responsibility to acknowledge and adapt services, and (c) offering services with consideration of the rural cultural context.

Evaluating Current Practices in Shelf Life Estimation

The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) methods for determining the supported shelf life of a drug product, described in ICH guidance documents Q1A and Q1E, are evaluated in this paper. To support this evaluation, an industry data set is used which is comprised of 26 individual stability batches of a common drug product where most batches are measured over a 24 month storage period. Using randomly sampled sets of 3 or 6 batches from the industry data set, the current ICH methods are assessed from three perspectives. First, the distributional properties of the supported shelf lives are summarized and compared to the distributional properties of the true shelf lives associated with the industry data set, assuming the industry data set represents a finite population of drug product batches for discussion purposes. Second, the results of the ICH poolability^ tests for model selection are summarized and the separate shelf life distributions from the possible alternative models are compared. Finally, the ICH methods are evaluated in terms of their ability to manage risk. Shelf life estimates that are too long result in an unacceptable percentage of nonconforming batches at expiry while those that are too short put the manufacturer at risk of possibly having to prematurely discard safe and efficacious drug product. Based on the analysis of the industry data set, the ICH-recommended approach did not produce supported shelf lives that effectively managed risk. Alternative approaches are required

Cumulative risk, infant sleep, and infant social-emotional development

The effect of cumulative biological, psychosocial, and demographic risk and infant sleep on infant social-emotional functioning in 12-month-old infants (46% female) was examined in data from racially (30% Black, 60% White, 10% multiracial/other) and socioeconomically (41% below median income) diverse caregivers (N = 468, M = 30.42 years old, SD = 5.65) recruited from two midwestern states in 2019–2020. Due to the major changes in sleep patterns during infancy and the reported association between sleep and social-emotional functioning, this study also examined whether sleep moderates the association between risk and infant social-emotional functioning and potentially promotes healthy social-emotional functioning despite risk. Greater cumulative risk was associated with poorer sleep efficiency and more social-emotional problems, but was not associated with the general acquisition of social-emotional milestones. Results also suggested that poorer sleep efficiency was associated with more social-emotional problems and poorer social-emotional milestone acquisition. No significant interaction effects were found between cumulative risk and infant sleep. Risk and sleep appear to have unique associations with infant social-emotional problems and development; thus both could be targeted in early intervention to promote social-emotional functioning during infancy and early childhood

Longitudinal changes in term and preterm infant night wakings: The role of caregiver anxious‐depression

Changes in infant night waking during the first year of life are associated with individual (e.g., prematurity) and family (e.g., caregiver psychopathology) factors. This study examined the association between infant night waking and caregiver anxious-depressive symptoms during the first year of life in preterm and term infants. We considered between-person differences and within-person changes in caregiver anxious-depressive symptoms in relation to changes in infant night waking from 2- to 9-months. Racially (30.0% Black, 60.4% White, 9.5% multiracial/other) and socioeconomically (40.0% below median household income) diverse caregivers (N = 445) of full term (n = 258) and preterm (n = 187) infants were recruited from hospitals and clinics in two midwestern states. Caregivers completed measures of anxious-depression and their infant’s night waking at four sampling periods (2-, 4-, 6-, and 9-months). Infant night wakings declined from 2- to 9-months. Between-person differences were observed, such that caregivers with higher average anxious-depressive symptoms or infants born full term reported more night wakings. Within-person effects of caregiver anxious-depressive symptoms were not significant. Caregiver anxious-depression is closely associated with infant night wakings. By considering a caregiver’s average severity of anxious-depression, healthcare providers can more effectively plan infant sleep interventions. If caregiver anxious-depressive symptoms are ameliorated, night wakings may also decrease.ResumenLos cambios en el despertar nocturno del infante durante el primer año de vida se asocian con factores individuales (v.g. nacimiento prematuro) y familiares (v.g. sicopatología de quien presta el cuidado). Este estudio examinó la asociación entre el despertar nocturno del infante y los síntomas de depresión por ansiedad de quien presta el cuidado durante el primer año de vida de infantes nacidos prematuramente y de ciclo completo. Tomamos en cuenta las diferencias entre las personas y los cambios dentro de las personas en los síntomas de depresión por ansiedad de quien presta el cuidado con relación a los cambios en el despertar nocturno del infante de los 2 a los 9 meses. Se reclutaron en hospitales y clínicas de dos estados del medio oeste cuidadores (N = 445) racial (30.0% de raza negra, 60.4% blancos, 9.5% multirraciales o de otra raza) y socioeconómicamente (40.0% por debajo del promedio de ingresos caseros) diversos, de infantes de ciclo completo (n = 258) y prematuros (n = 187). Los cuidadores completaron medidas de depresión por ansiedad y el despertar nocturno de sus infantes en cuatro períodos muestra (a los 2, 4, 6 y 9 meses). El despertar nocturno del infante declinó de los 2 a los 9 meses. Se observaron las diferencias entre personas, de tal manera que los cuidadores con un promedio mayor de síntomas de depresión por ansiedad o infantes nacidos en el ciclo completo reportaron más despertar nocturno. Los efectos de dentro de las personas de los síntomas de depresión por ansiedad del cuidador no fueron significativos. La depresión por ansiedad del cuidador se asocia cercanamente con el despertar nocturno del infante. Por medio de considerar el promedio de la severidad de la depresión por ansiedad del cuidador, quienes ofrecen el cuidado de salud pueden planear más eficazmente las intervenciones en cuanto al sueño del infante. Si se mejoran los síntomas de depresión por ansiedad de quien presta el cuidado, el despertar nocturno también podría disminuir.RésuméLes changements dans le réveil nocturne du bébé pendant la première année sont liés à des facteurs individuels (par exemple la prématurité) et familiaux (par exemple la psychopathologie de la personne prenant soin de l’enfant). Cette étude a examiné le lien entre le réveil nocturne du bébé et les symptômes anxieux-dépressifs de la personne prenant soin de l’enfant durant la première année de vie de bébés prématurés et à terme. Nous avons considéré les différences entre les personnes et les changements au sein de la personne dans les symptômes anxieux-dépressifs de la personne prenant soin de l’enfant, en lien aux changements dans le réveil nocturne du bébé de 2 à 9 mois. Des personnes (N = 445) prenant soin d’un bébé à plein terme (n = 258) et prématuré (n = 187), divers du point de vue de leur race (30,0% noirs, 60,4% blancs, 9,5% multiracial/autre) et de leur statut socioéconomique (40,0% en dessous du revenu moyen d’une famille) ont été recrutés dans des hôpitaux et des cliniques des états au centre nord des Etats-Unis. Les personnes prenant soin du bébé ont rempli des mesures de dépression anxiété et de la nuit de leur bébé à quatre périodes de prélèvement des renseignements (2-, 4-, 6-, et 9- mois). Les réveils nocturnes du bébé ont décliné de 2- à 9- mois. Des différences entre les personnes ont été observées, au point que les personnes prenant soin du bébé avec la moyenne de symptômes anxieux-dépressifs la plus élevée ou des bébé nés à terme ont fait état de plus de réveils nocturnes. Les effets au sein de la personne des personnes prenant soin du bébé avec des symptômes anxieux-dépressifs n’étaient pas importants. La personne prenant du bébé avec une dépression anxieuse est fortement liée aux réveils nocturnes du bébé. En considérant la sévérité moyenne de la dépression anxieuse de la personne prenant soin du bébé, les prestataires de santé peuvent planifier les interventions concernant le sommeil du bébé de manière plus efficace. Si les symptômes anxieux-dépressifs de la personne prenant soin du bébé sont améliorer, alors les réveils nocturnes pourraient aussi diminuer.ZusammenfassungLängsschnittliche Veränderungen beim nächtlichen Aufwachen von Frühchen und reifgeborenen Kindern: Die Rolle von Angst und Depression bei der BetreuungspersonVeränderungen des nächtlichen Aufwachens bei Säuglingen im ersten Lebensjahr sind mit individuellen und familiären Faktoren assoziiert, wie z. B. einer Frühgeburt oder der Psychopathologie der Betreuungsperson. In dieser Studie wurde der Zusammenhang zwischen nächtlichem Aufwachen von Säuglingen während des ersten Lebensjahres (Frühchen sowie reifgeborenen Kinder) und ängstlich-depressiven Symptomen der Betreuungspersonen untersucht. In Bezug auf ängstlich-depressive Symptome der Betreuungsperson untersuchten wir sowohl between-subject Unterschiede als auch within-subject Veränderungen im Zusammenhang mit Veränderungen des nächtlichen Aufwachens von Säuglingen im Zeitraum von 2 bis 9 Monaten. Aus Krankenhäusern und Kliniken in zwei Staaten des Mittleren Westens wurden ethnisch (30,0 % Schwarze, 60,4 % Weiße, 9,5 % gemischt/andere) und sozioökonomisch (40,0 % unter dem mittleren Haushaltseinkommen) diverse Betreuungspersonen (N = 445) von reifgeborenen Kindern (n = 258) und Frühchen (n = 187) rekrutiert. Die Betreuungspersonen füllten in vier Stichprobenzeiträumen (2-, 4-, 6- und 9-Monate) Maße für Angst/Depression und das nächtliche Aufwachen ihres Kindes aus. Das nächtliche Aufwachen von Säuglingen nahm zwischen dem zweiten und dem neunten Monat ab. Bezüglich der between-subject Unterschiede wurde beobachtet, dass Betreuungspersonen mit höheren durchschnittlichen ängstlich-depressiven Symptomen oder reifgeborenen Säuglingen mehr nächtliches Aufwachen berichteten. Die within-subject Effekte der ängstlich-depressiven Symptome der Betreuungspersonen waren nicht signifikant. Angst und Depressionen der Betreuungspersonen stehen in engem Zusammenhang mit nächtlichem Aufwachen von Säuglingen. Durch die Berücksichtigung des durchschnittlichen Schweregrads von Angst und Depression bei einer Betreuungsperson könnten Gesundheitsdienstleister auf wirksamere Art und Weise Interventionen für den Säuglingsschlaf planen. Wenn sich ängstlich-depressiven Symptome bei der Betreuungsperson bessern, könnte auch das nächtliche Aufwachen abnehmen.抄録生後1年間の乳児の夜間覚醒の変化は、個人 (例:未熟性) および家族 (例:養育者の精神病理学) 因子と関連する。本研究では、早産児と正期産児の生後1年間の乳児の夜間覚醒と養育者の不安抑うつ症状との関連を検討した。2カ月から9カ月までの乳児の夜間覚醒の変化と養育者の不安抑うつ症状の個人間差および個人内変化を検討した。満期産児 (258人) および早産児 (187人) の養育者で、人種的 (30％が黒色人種、60.4％が白色人種、9.5％が多民族/その他) ならびに社会経済学的 (40.0％は平均以下の世帯収入) に多様な養育者 (N = 445人) を、中西部2州の病院および診療所から募集した。4つのサンプリング期間 (2ヶ月、4ヶ月、6ヶ月、9ヶ月) に、養育者は自分の不安抑うつとわが子の夜間覚醒の測定に取り組んだ。乳児の夜間覚醒は生後2カ月から9カ月にかけて減少した。個人間差異が観察され、平均的な不安抑うつ症状がより高い養育者、または満期産の乳児により多くの夜間覚醒が報告された。養育者の不安抑うつ症状の個人内効果は有意ではなかった。養育者の不安抑うつ症状は、乳児の夜間覚醒と密接に関連している。養育者の不安抑うつ状態の平均的な重症度を考慮することで、医療従事者はより効果的に乳児の睡眠介入を計画することができる。養育者の不安抑うつ症状が改善されれば、夜間覚醒も減少する可能性がある。摘要婴儿出生后第一年的夜醒变化与个体 (如早产) 和家庭 (如看护者精神病理) 等因素相关。本研究调查了早产儿和足月儿在出生后的第一年内, 婴儿夜醒与看护者焦虑抑郁症状之间的关系。我们关注了看护者焦虑抑郁症状的人与人之间的差异以及个体内部的变化, 与2至9个月婴儿夜醒变化之间的关系。从中西部两个州的医院和诊所招募了种族 (30.0%黑人, 60.4%白人, 9.5%多种族/其他) 和社会经济条件 (40.0%低于家庭收入中位数) 不同的足月婴儿 (n = 258) 和早产婴儿 (n = 187) 的看护者 (N = 445) 。看护者在四个采样期 (2个月、4个月、6个月和9个月) 完成了焦虑抑郁和婴儿夜醒情况的测量。婴儿夜醒的次数从2个月到9个月递减。我们观察到了人与人之间的差异, 即平均焦虑抑郁症状较高的看护者或足月出生的婴儿报告了更多的夜醒活动。看护者焦虑抑郁症状对个体内部的影响不显著。看护者焦虑抑郁与婴儿夜醒密切相关。通过考虑看护者焦虑抑郁的平均严重程度, 医疗保健提供者可以更有效地规划婴儿睡眠干预措施。如果看护者的焦虑抑郁症状得到改善, 婴儿夜醒次数也可能减少。ملخصترتبط التغييرات في الاستيقاظ الليلي للرضع خلال السنة الأولى من الحياة بعوامل فردية (على سبيل المثال ، الخداج) والعائلة (على سبيل المثال ، التشخيصات النفسية لمقدم الرعاية). تناولت هذه الدراسة العلاقة بين الاستيقاظ الليلي للرضع وأعراض القلق والاكتئاب لدى مقدم الرعاية خلال السنة الأولى من العمر عند الخدج والرضع الناضجين. أخذنا في الاعتبار الاختلافات بين الأشخاص والتغيرات داخل الشخص في أعراض القلق والاكتئاب لدى مقدم الرعاية فيما يتعلق بالتغيرات في استيقاظ الرضيع ليلاً من شهرين إلى تسعة أشهر. اشترك في الدراسة مجموعة متنوعة من مقدمي الرعاية (N = 445) عرقيًا (30.0٪ أسود ، 60.4٪ أبيض ، 9.5٪ متعدد الأعراق) واجتماعيًا واقتصاديًا (40.0٪ أقل من متوسط دخل الأسرة) للرضع كاملي المدة (العدد = 258) والخدج (العدد = 187) حيث تم إشراكهم من خلال المستشفيات والعيادات في ولايتين في الغرب الأوسط. أكمل مقدمو الرعاية مقاييس القلق والاكتئاب واستيقاظ رضيعهم ليلاً في أربع فترات أخذ عينات (2 و 4 و 6 و 9 أشهر). انخفض معدل الاستيقاظ في الليل عند الرضع من شهرين إلى تسعة أشهر. لوحظت الفروق بين الأشخاص ، مثل أن مقدمي الرعاية الذين يعانون من أعراض القلق والاكتئاب المرتفعة أو الأطفال المولودين لفترة كاملة أبلغوا عن استيقاظهم ليلا أكثر. لم تكن التأثيرات الداخلية لأعراض القلق والاكتئاب لدى مقدم الرعاية مهمة. يرتبط القلق والاكتئاب لدى مقدم الرعاية ارتباطًا وثيقًا بالاستيقاظ الليلي للرضع. من خلال النظر في متوسط شدة القلق والاكتئاب لدى مقدم الرعاية ، يمكن لمقدمي الرعاية الصحية التخطيط بشكل أكثر فاعلية لتدخلات نوم الرضع. إذا تم تخفيف أعراض القلق والاكتئاب لدى مقدم الرعاية ، فقد ينخفض أيضًا الاستيقاظ ليلاً.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175740/1/imhj22024_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175740/2/imhj22024.pd