Making Medical Homes Work: Moving From Concept to Practice

Explores practical considerations for implementing a medical home program of physician practices committed to coordinating and integrating care based on patient needs and priorities, such as how to qualify medical homes and how to match patients to them

Intracranial fusarium fungal abscess in an immunocompetent patient: case report and review of the literature.

Introduction Fusarium spp is an omnipresent fungal species that may lead to fatal infections in immunocompromised populations. Spontaneous intracranial infection by Fusarium spp in immunocompetent individuals is exceedingly rare. Case Report An immunocompetent 33-year-old Hispanic woman presented with persistent headaches and was found to have a contrast-enhancing mass in the left petrous apex and prepontine cistern. She underwent a subsequent craniotomy for biopsy and partial resection that revealed a Fusarium abscess. She had a left transient partial oculomotor palsy following the operation that resolved over the next few weeks. She was treated with long-term intravenous antifungal therapy and remained at her neurologic baseline 18 months following the intervention. Discussion To our knowledge, this is the first reported case of Fusarium spp brain abscess in an immunocompetent patient. Treatment options include surgical intervention and various antifungal medications. Conclusion This case demonstrates the rare potential of intracranial Fusarium infection in the immunocompetent host, as well as its successful treatment with surgical aspiration and antifungal therapy

DESCENDO A TOCA DO COELHO: TRANSFERÊNCIA DE TECNOLOGIA NO CAMPO DA PESQUISA EM CÉLULAS-TRONCO

This article posits that collaborativemodels of technology transfer could be consideredfor their remarkable ability to maintain orincrease the pace and quality of scientificdevelopment in stem cell research rather than fortheir potential to fix problems that do notempirically exist. In light of this scientific field’slogistical constraints and its current stage ofdevelopment, the open model appears to be aparticularly suitable collaborative method oftechnology management for stem cell research.Este artigo postula que os modeloscolaborativos de transferência de tecnologiapoderiam ser considerados por sua notávelhabilidade em manter ou aumentar o ritmo e aqualidade do desenvolvimento científico napesquisa em célula tronco, ao invés de seremconsiderados por seu potencial em colocarproblemas que empiricamente não existem. À luzdestas limitações logísticas do campo científico edo seu presente estágio de desenvolvimento, omodelo aberto parece ser um método colaborativoparticularmente adequável de gestão de tecnologiapara a pesquisa em célula tronco

Blood Lead Levels and Risk Factors for Lead Exposure in a Pediatric Population in Ho Chi Minh City, Vietnam.

Although lead recycling activities are a known risk factor for elevated blood levels in South East Asia, little is known regarding the prevalence of and risk factors for elevated blood lead levels (BLL) among the general pediatric population in Vietnam. This study is a cross-sectional evaluation of 311 children from Children's Hospital #2 in Ho Chi Minh City, Vietnam. Capillary blood lead testing was performed using the LeadCare II. Mean BLLs were 4.97 μg/dL (Standard Deviation (SD) 5.50), with 7% of the participants having levels greater than 10 μg/dL. Living in Bing Duong province (OR 2.7, 95% CI 1.4-5.6.1) or the Dong Nai province (OR 2.3, 95% CI 1.0-5.1) and having an age greater than 12 months (OR 6.0, 95% CI 3.1-11.8) were associated with higher BLLs. The prevalence of elevated BLLs in Vietnam is consistent with other SE Asian countries. Mean BLLs in Ho Chi Minh City are markedly less than those seen in a separate study of children living near lead recycling activities. Additional evaluation is necessary to better detail potential risk factors if screening is to be implemented within Vietnam

Effectiveness of empiric carbapenem versus non-carbapenem therapy for extended-spectrum β-lactamase producing Enterobacterales infections in non-intensive care unit patients: a real-world investigation in a hospital with high-prevalence of extended-spectrum β-lactamase producing Enterobacterales

ObjectiveTo investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.MethodsWe performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.ResultsOf the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric non-carbapenems, most commonly ceftriaxone (49/83, 59%). Median age was 59 years. The most common infection source was urinary (71%). The carbapenem group had a higher proportion of patients who received antibiotics within 6 months of admission (55% vs 28%, P < .01) and history of ESBL (57% vs 17%, P < .01). There were no significant differences in hours until clinical stability between the carbapenem and non-carbapenem groups (22 (IQR: 0, 85) vs 19 (IQR: 0, 69), P = .54). Early clinical response (88% vs 90%, P = .79) and 30-day all-cause hospital readmission (17% vs 8%, P = .13) were similar between groups.ConclusionAmong hospitalized non-ICU patients with ESBL-producing Enterobacterales infection, we found no difference in time to clinical stability after the first empiric antibiotic dose between those receiving carbapenems and those who did not. Our data suggest that empiric carbapenem use may not be an important driver of clinical response in patients with less severe ESBL-producing Enterobacterales infection

Characterization of the caleosin gene family in the Triticeae

Background The caleosin genes encode proteins with a single conserved EF hand calcium-binding domain and comprise small gene families found in a wide range of plant species. Some members of the gene family have been shown to be upregulated by environmental stresses including low water availability and high salinity. Caleosin 3 from wheat has been shown to interact with the α-subunit of the heterotrimeric G proteins, and to act as a GTPase activating protein (GAP). This study characterizes the size and diversity of the gene family in wheat and related species and characterizes the differential tissue-specific expression of members of the gene family. Results A total of 34 gene family members that belong to eleven paralogous groups of caleosins were identified in the hexaploid bread wheat, T. aestivum. Each group was represented by three homeologous copies of the gene located on corresponding homeologous chromosomes, except the caleosin 10, which has four gene copies. Ten gene family members were identified in diploid barley, Hordeum vulgare, and in rye, Secale cereale, seven in Brachypodium distachyon, and six in rice, Oryza sativa. The analysis of gene expression was assayed in triticale and rye by RNA-Seq analysis of 454 sequence sets and members of the gene family were found to have diverse patterns of gene expression in the different tissues that were sampled in rye and in triticale, the hybrid hexaploid species derived from wheat and rye. Expression of the gene family in wheat and barley was also previously determined by microarray analysis, and changes in expression during development and in response to environmental stresses are presented. Conclusions The caleosin gene family had a greater degree of expansion in the Triticeae than in the other monocot species, Brachypodium and rice. The prior implication of one member of the gene family in the stress response and heterotrimeric G protein signaling, points to the potential importance of the caleosin gene family. The complexity of the family and differential expression in various tissues and under conditions of abiotic stress suggests the possibility that caleosin family members may play diverse roles in signaling and development that warrants further investigation

An intelligent interface for integrating climate, hydrology, agriculture, and socioeconomic models

Understanding the interactions between natural processes and human activities poses major challenges as it requires the integration of models and data across disparate disciplines. It typically takes many months and even years to create valid end-to-end simulations as different models need to be configured in consistent ways and generate data that is usable by other models. MINT is a novel framework for model integration that captures extensive knowledge about models and data and aims to automatically compose them together. MINT guides a user to pose a well-formed modeling question, select and configure appropriate models, find and prepare appropriate datasets, compose data and models into end-to-end workflows, run the simulations, and visualize the results. MINT currently includes hydrology, agriculture, and socioeconomic models.Office of the VP for Researc

Vegetable seed systems among ethnic minority communities in northern Vietnam

Despite the potential of vegetables for nutrition and income in Northern Vietnam, inadequate access to quality seed is a major constraint affecting production, diversity and diet quality. Both self-saved seed and bought seed are important sources for farmers and are linked to the primary purpose of production, market access, seed production knowledge and skills, and trustworthiness of the source. Vegetable diversity, seasonal availability and seed access varies with ethnic group, location, type of and specific vegetables requiring contextualisation of nutrition-sensitive interventions. There are opportunities for farmer sharing and exchange of seeds, vegetables, and knowledge, for safeguarding diversity, promote dietary quality, and improve farmer income

REFORMS: Reporting Standards for Machine Learning Based Science

Machine learning (ML) methods are proliferating in scientific research. However, the adoption of these methods has been accompanied by failures of validity, reproducibility, and generalizability. These failures can hinder scientific progress, lead to false consensus around invalid claims, and undermine the credibility of ML-based science. ML methods are often applied and fail in similar ways across disciplines. Motivated by this observation, our goal is to provide clear reporting standards for ML-based science. Drawing from an extensive review of past literature, we present the REFORMS checklist ($\textbf{Re}$porting Standards $\textbf{For}$ $\textbf{M}$achine Learning Based $\textbf{S}$cience). It consists of 32 questions and a paired set of guidelines. REFORMS was developed based on a consensus of 19 researchers across computer science, data science, mathematics, social sciences, and biomedical sciences. REFORMS can serve as a resource for researchers when designing and implementing a study, for referees when reviewing papers, and for journals when enforcing standards for transparency and reproducibility

Comparative genomic analysis of mycobacteriophage Tweety: evolutionary insights and construction of compatible site-specific integration vectors for mycobacteria

Mycobacteriophage Tweety is a newly isolated phage of Mycobacterium smegmatis. It has a viral morphology with an isometric head and a long flexible tail, and forms turbid plaques from which stable lysogens can be isolated. The Tweety genome is 58 692 bp in length, contains 109 protein-coding genes, and shows significant but interrupted nucleotide sequence similarity with the previously described mycobacteriophages Llij, PMC and Che8. However, overall the genome possesses mosaic architecture, with gene products being related to other mycobacteriophages such as Che9d, Omega and Corndog. A gene encoding an integrase of the tyrosine-recombinase family is located close to the centre of the genome, and a putative attP site has been identified within a short intergenic region immediately upstream of int. This Tweety attP–int cassette was used to construct a new set of integration-proficient plasmid vectors that efficiently transform both fast- and slow-growing mycobacteria through plasmid integration at a chromosomal locus containing a tRNALys gene. These vectors are maintained well in the absence of selection and are completely compatible with integration vectors derived from mycobacteriophage L5, enabling the simple construction of complex recombinants with genes integrated simultaneously at different chromosomal positions