Pediatric Hand Surgery Training in Nicaragua: A Sustainable Model of Surgical Education in a Resource-Poor Environment.

Recent reports have demonstrated that nearly two-thirds of the world's population do not have access to adequate surgical care, a burden that is borne disproportionately by residents of resource-poor countries. Although the reasons for limited access to surgical care are complex and multi-factorial, among the most substantial barriers is the lack of trained surgical providers. This is particularly true in surgical subspecialties that focus on life-improving, rather than life-saving, treatments, such as pediatric hand and upper extremity surgery, which manages such conditions as congenital malformations, trauma and post-traumatic deformities including burns, and neuromuscular conditions (brachial plexus birth palsy, spinal cord injury, and cerebral palsy). Many models of providing surgical care in resource-limited environments have been described and implemented, but few result in sustainable models of health-care delivery. We present our experience developing a pediatric hand and upper extremity surgery training program in Nicaragua, a resource-limited nation, that grew out of a collaboration of American and Nicaraguan orthopedic surgeons. We compare this experience to that of surgeons undergoing subspecialty training in pediatric upper limb surgery in the US, highlighting the similarities and differences of these training programs. Finally, we assess the results of this training program and identify areas for further growth and development

Safety and preliminary efficacy of vorinostat with R-EPOCH in high-risk HIV-associated non-Hodgkin\u27s lymphoma (AMC-075)

We performed a phase I trial of vorinostat (VOR) given on days 1 to 5 with R-EPOCH (rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride) in patients with aggressive HIV-associated non-Hodgkin lymphoma. VOR was tolerable at 300 mg and seemingly efficacious with chemotherapy with complete response rate of 83% and 1-year event-free survival of 83%. VOR did not significantly alter chemotherapy steady-state concentrations, CD4+ cell counts, or HIV viral loads. Vorinostat (VOR), a histone deacetylase inhibitor, enhances the anti-tumor effects of rituximab (R) and cytotoxic chemotherapy, induces viral lytic expression and cell killing in Epstein-Barr virus-positive (EBV+) or human herpesvirus-8-positive (HHV-8+) tumors, and reactivates latent human immunodeficiency virus (HIV) for possible eradication by combination antiretroviral therapy (cART). We performed a phase I trial of VOR given with R-based infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride) (n = 12) and cART in aggressive HIV-associated B-cell non-Hodgkin lymphoma (NHL) in order to identify safe dosing and schedule. VOR (300 or 400 mg) was given orally on days 1 to 5 with each cycle of R-EPOCH for 10 high-risk patients with diffuse large B-cell lymphoma (1 EBV+), 1 EBV+/HHV-8+ primary effusion lymphoma, and 1 unclassifiable NHL. VOR was escalated from 300 to 400 mg using a standard 3 + 3 design based on dose-limiting toxicity observed in cycle 1 of R-EPOCH. The recommended phase II dose of VOR was 300 mg, with dose-limiting toxicity in 2 of 6 patients at 400 mg (grade 4 thrombocytopenia, grade 4 neutropenia), and 1 of 6 treated at 300 mg (grade 4 sepsis from tooth abscess). Neither VOR, nor cART regimen, significantly altered chemotherapy steady-state concentrations. VOR chemotherapy did not negatively impact CD4+ cell counts or HIV viral loads, which decreased or remained undetectable in most patients during treatment. The response rate in high-risk patients with NHL treated with VOR(R)-EPOCH was 100% (complete 83% and partial 17%) with a 1-year event-free survival of 83% (95% confidence interval, 51.6%-97.9%). VOR combined with R-EPOCH was tolerable and seemingly efficacious in patients with aggressive HIV-NHL

Seroprevalence of select bloodborne pathogens and associated risk behaviors among injection drug users in the Paso del Norte region of the United States – Mexico border

<p>Abstract</p> <p>Background</p> <p>The region situated where the borders of Mexico, Texas and New Mexico meet is known as 'Paso del Norte'. The Paso del Norte Collaborative was formed to study the seroprevalence of select pathogens and associated risk behaviors among injection drug users (IDUs) in the region.</p> <p>Methods</p> <p>Respondent-driven sampling (RDS) was used: 459 IDU participants included 204 from Mexico; 155 from Texas; and 100 from New Mexico. Each of the three sites used a standardized questionnaire that was verbally administered and testing was performed for select bloodborne infections.</p> <p>Results</p> <p>Participants were mostly male (87.4%) and Hispanic/Latino (84.7%) whose median age was 38. In Mexico, Texas and New Mexico, respectively: hepatitis B virus (HBV) was seen in 88.3%, 48.6% and 59.6% of participants; hepatitis C virus (HCV) in 98.7%, 76.4% and 80.0%; human immunodeficiency virus (HIV) in 2.1%, 10.0% and 1.0%; and syphilis in 4.0%, 9.9% and 3.0%. Heroin was the drug injected most often. More IDUs in New Mexico were aware of and used needle exchange programs compared with Texas and Mexico.</p> <p>Conclusion</p> <p>There was mixed success using RDS: it was more successfully applied after establishing good working relationships with IDU populations. Study findings included similarities and distinctions between the three sites that will be used to inform prevention interventions.</p

Survey of Farmers Market Managers in California: Food Safety Perspectives

We conducted a survey to characterize certified California farmers markets (FMs) regarding location, seasonality, size, product, product labeling, advertising methods, postharvest practices, regulations governing vendors, training offered, and training interests. Data obtained from the survey highlight the need for improvement regarding food safety and can serve as a basis for development of collaborative education by Extension educators, regulatory agencies, and FMs. Extension professionals can play a proactive role in such training opportunities, focusing outreach efforts for training according to applicable findings and including online training venues to maximize reach to stakeholders

Piolhos hematófagos podem disseminar infecção pelo Trypanosoma cruzi em babuínos

Trypanosoma cruzi (Schyzotrypanum, Chagas, 1909), and Chagas disease are endemic in captive-reared baboons at the Southwest Foundation for Biomedical Research, San Antonio, Texas. We obtained PCR amplification products from DNA extracted from sucking lice collected from the hair and skin of T. cruzi-infected baboons, with specific nested sets of primers for the protozoan kinetoplast DNA, and nuclear DNA. These products were hybridized to their complementary internal sequences. Selected sequences were cloned and sequencing established the presence of T. cruzi nuclear DNA, and minicircle kDNA. Competitive PCR with a kDNA set of primers determined the quantity of approximately 23.9 ± 18.2 T. cruzi per louse. This finding suggests that the louse may be a vector incidentally contributing to the dissemination of T. cruzi infection in the baboon colony.As infecções pelo Trypanosoma cruzi e a doença de Chagas são endêmicas em babuínos (Papio hamadryas) reproduzidos em cativeiro na Southwest Foundation for Biomedical Research, em Santo Antonio, Texas. Nós obtivemos produtos de amplificação por PCR do DNA extraído de piolhos colhidos do cabelo e da pele de babuínos chagásicos, com primers aneladores específicos para DNAs nuclear e de cinetoplasto do protozoário. Esses produtos foram hibridizados com suas respectivas seqüências internas complementares. Seqüências selecionadas foram clonadas e o sequenciamento demonstrou a presença de DNA nuclear de T. cruzi, e de minicírculo de kDNA. A PCR competitiva com primers de kDNA determinou a quantidade de aproximadamente 23.9 ± 18.2 T. cruzi por piolho. Este achado sugere que o piolho pode ser um vetor contribuindo para a disseminação de T. cruzi na colônia de babuínos

Developing a Common Framework for Evaluating the Implementation of Genomic Medicine Interventions in Clinical Care: The IGNITE Network’s Common Measures Working Group

Purpose Implementation research provides a structure for evaluating the clinical integration of genomic medicine interventions. This paper describes the Implementing GeNomics In PracTicE (IGNITE) Network’s efforts to promote: 1) a broader understanding of genomic medicine implementation research; and 2) the sharing of knowledge generated in the network. Methods To facilitate this goal the IGNITE Network Common Measures Working Group (CMG) members adopted the Consolidated Framework for Implementation Research (CFIR) to guide their approach to: identifying constructs and measures relevant to evaluating genomic medicine as a whole, standardizing data collection across projects, and combining data in a centralized resource for cross network analyses. Results CMG identified ten high-priority CFIR constructs as important for genomic medicine. Of those, eight didn’t have standardized measurement instruments. Therefore, we developed four survey tools to address this gap. In addition, we identified seven high-priority constructs related to patients, families, and communities that did not map to CFIR constructs. Both sets of constructs were combined to create a draft genomic medicine implementation model. Conclusion We developed processes to identify constructs deemed valuable for genomic medicine implementation and codified them in a model. These resources are freely available to facilitate knowledge generation and sharing across the field

Nucleic Acid-Sensing and Interferon-Inducible Pathways Show Differential Methylation in MZ Twins Discordant for Lupus and Overexpression in Independent Lupus Samples: Implications for Pathogenic Mechanism and Drug Targeting.

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune inflammatory disease with genomic and non-genomic contributions to risk. We hypothesize that epigenetic factors are a significant contributor to SLE risk and may be informative for identifying pathogenic mechanisms and therapeutic targets. To test this hypothesis while controlling for genetic background, we performed an epigenome-wide analysis of DNA methylation in genomic DNA from whole blood in three pairs of female monozygotic (MZ) twins of European ancestry, discordant for SLE. Results were replicated on the same array in four cell types from a set of four Danish female MZ twin pairs discordant for SLE. Genes implicated by the epigenetic analyses were then evaluated in 10 independent SLE gene expression datasets from the Gene Expression Omnibus (GEO). There were 59 differentially methylated loci between unaffected and affected MZ twins in whole blood, including 11 novel loci. All but two of these loci were hypomethylated in the SLE twins relative to the unaffected twins. The genes harboring these hypomethylated loci exhibited increased expression in multiple independent datasets of SLE patients. This pattern was largely consistent regardless of disease activity, cell type, or renal tissue type. The genes proximal to CpGs exhibiting differential methylation (DM) in the SLE-discordant MZ twins and exhibiting differential expression (DE) in independent SLE GEO cohorts (DM-DE genes) clustered into two pathways: the nucleic acid-sensing pathway and the type I interferon pathway. The DM-DE genes were also informatically queried for potential gene-drug interactions, yielding a list of 41 drugs including a known SLE therapy. The DM-DE genes delineate two important biologic pathways that are not only reflective of the heterogeneity of SLE but may also correlate with distinct IFN responses that depend on the source, type, and location of nucleic acid molecules and the activated receptors in individual patients. Cell- and tissue-specific analyses will be critical to the understanding of genetic factors dysregulating the nucleic acid-sensing and IFN pathways and whether these factors could be appropriate targets for therapeutic intervention

An evaluation of the Adverse Childhood Experience Trauma Informed Multi-agency Early Action Together (ACE TIME) training: national roll out to police and partners

In a rapidly changing society, modern policing faces new pressures and increasing demands to respond to incidents of high threat, harm, risk and vulnerability. Responding to such incidents has become a core element of policing across the UK. Whilst the police are well placed to identify and respond to vulnerability, research has highlighted that traditional policing methods, training and systems are not designed to meet the changing levels and types of vulnerability demand. The National Police Chiefs’ Council (NPCC) and College of Policing (CoP) have highlighted the need to transform policing within the UK to develop a workforce of confident professionals with the skills to respond to vulnerability and the complex needs of the local community. The pan-Wales Early Action Together (E.A.T.) programme aimed to develop a whole systems response to vulnerability to enable police and multi-agency (MA) partners to recognise signs of vulnerability at the earliest opportunity and to work together to provide access to support beyond statutory services. Key to achieving this was the development and delivery of the Adverse Childhood Experience Trauma Informed Multi-agency Early Action Together (ACE TIME) training programme. The ACE TIME training aims to ensure that police and MA partners have the appropriate knowledge and skill to respond to vulnerability using an ACE and trauma-informed approach. The training built on a small-scale pilot carried out within South Wales police1 and was further developed by the ACE Coordinator Service positioned within Barnardo’s and the E.A.T. national programme team. Public Health Wales and Bangor University undertook an independent evaluation of the ACE TIME training to capture its immediate impact on police and MA partners’ knowledge, practice, competence and confidence when responding to vulnerability. The evaluation comprised a number of pre and post-training questionnaires that incorporated previously validated measures1 and a number of open-ended questions (see pg. 21) with open text boxes for participant’s comments. The current report evaluated the phase one roll out of the ACE TIME training (from September 2018 to January 2019). During the data collection period, 1,034 professionals were trained, of which 996 participated in the evaluation (849 police officers or staff and 147 MA partners). Police and MA partners across Wales from a range of different operational roles and teams took part in the evaluation (see table 3, pg. 24). Among police participants, approximately half worked in response roles (i.e., ‘999’ response; 51%). A further 21% worked within neighbourhood policing teams (NPT); and those from the public protection unit (PPU), custody, criminal investigation department (CID) and other investigative roles made up the remainder of departments (28%). Among MA partners, approximately 22% worked with children and young people’s education services; 22% within safeguarding, social care and family sector, 22% within the health and well-being sector and 16% in housing, community and local authority

2009- 2010 UNLV McNair Journal

Journal articles based on research conducted by undergraduate students in the McNair Scholars Program Table of Contents Biography of Dr. Ronald E. McNair Statements: Dr. Neal J. Smatresk, UNLV President Dr. Juanita P. Fain, Vice President of Student Affairs Dr. William W. Sullivan, Associate Vice President for Retention and Outreach Mr. Keith Rogers, Deputy Executive Director of the Center for Academic Enrichment and Outreach McNair Scholars Institute Staf