Nontuberculous Mycobacterium (NTM) Infection in Aquatic Workers with Purified Protein Derivative (PPD) and Gold QuantiFERON Tests.

Background: Nontuberculous mycobacteria (NTM) infections are commonly caused by Mycobacterium marinum and fortuitum with M. marinum more likely to cause skin infections. Aquatic environments are a potential source of contact with M. marinum and fortuitum. Patients with NTM infections may present with positive tuberculin purified protein derivative (PPD) and/or gold QuantiFERON tests. However, PPD cannot differentiate between NTM infection and other tuberculous infections caused by different mycobacterial strains. We present a patient a marine biologist who was asymptomatic and presented for further evaluation as she has a h/o positive PPD and gold QuantiFERON test. Methods: Patient informed consent was obtained for this case report. Results: A 31 years old, healthy, female marine biologist employed in an aquatic environment presented to the clinic with a positive PPD and a positive gold QuantiFERON test. Her job exposes her to sea creatures that maybe infected with Mycobacterium marinum and fortuitum. She denied any history that was suggestive of tuberculous infection. A referral was made to specialist service for further evaluation at which time a repeat gold QuantiFERON test was performed and was noted to be positive. Following this work up, the patient preferred to follow a conservative treatment approach to monitor for any symptoms of active tuberculosis and seek follow up as needed. Conclusion: Clinicians should not downplay the importance of aquatic occupations and hobbies in patients who exhibit positive PPD and gold QuantiFERON test. Healthcare providers should consider NTM infection in their differential diagnosis when examining patient populations exposed to aquarium water, saltwater, and freshwater environments. Preventative apparel like waterproof gloves can protect the exposed skin from infection. Clinicians can prevent NTM infections by increasing awareness and promoting prevention measures in at-risk populations, particularly since infection can be prevented from appropriate protective attire

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery

Autonomy and Relatedness in Inner-City Families of Substance Abusing Adolescents

This study examined parent-adolescent autonomous-relatedness functioning in inner-city, ethnic minority families of adolescents exhibiting drug abuse and related problem behaviors. Seventy-four parent-adolescent dyads completed a structured interaction task prior to the start of treatment that was coded using an established autonomous-relatedness measure. Adolescent drug use, externalizing, and internalizing behaviors were assessed. Parents and adolescents completed assessment instruments measuring parenting style and family conflict. Confirmatory factor analysis found significant differences in the underlying dimensions of parent and adolescent autonomous-relatedness in this sample versus previous samples. It was also found that autonomous-relatedness was associated with worse adolescent symptomatology and family impairment. Results based on both self-report and observational measures contribute to the understanding of key family constructs in this population and provide insight for both researchers and the treatment community

Linking Session Focus to Treatment Outcome in Evidence-Based Treatments for Adolescent Substance Abuse

The relation between specific therapy techniques and treatment outcome was examined for 2 empirically supported treatments for adolescent substance abuse: individual cognitive–behavioral therapy and multidimensional family therapy. Participants were 51 inner-city, substance-abusing adolescents receiving outpatient psychotherapy within a larger randomized trial. One session per case was evaluated using a 17-item observational measure of model-specific techniques and therapeutic foci. Exploratory factor analysis identified 2 subscales, Adolescent Focus and Family Focus, with strong interrater reliability and internal consistency. Process–outcome analyses revealed that family focus, but not adolescent focus, predicted posttreatment improvement in drug use, externalizing symptoms, and internalizing symptoms within both study conditions. Implications for the implementation and dissemination of individual-based and family-based approaches for adolescent drug use are discussed

Academic Libraries on Social Media: Finding the Students and the Information They Want

Librarians from Purdue University wanted to determine which social media platforms students use, which platforms they would like the library to use, and what content they would like to see from the library on each of these platforms. We conducted a survey at four of the nine campus libraries to determine student social media habits and preferences. Results show that students currently use Facebook, YouTube, and Snapchat more than other social media types; however, students responded that they would like to see the library on Facebook, Instagram, and Twitter. Students wanted nearly all types of content from the libraries on Facebook, Twitter, and Instagram, but they did not want to receive business news or content related to library resources on Snapchat. YouTube was seen as a resource for library service information. We intend to use this information to develop improved communication channels, a clear libraries social media presence, and a cohesive message from all campus libraries

Mathematical modelling of tissue-engineering angiogenesis

We present a mathematical model for the vascularisation of a porous scaffold following implantation in vivo. The model is given as a set of coupled non-linear ordinary differential equations (ODEs) which describe the evolution in time of the amounts of the different tissue constituents inside the scaffold. Bifurcation analyses reveal how the extent of scaffold vascularisation changes as a function of the parameter values. For example, it is shown how the loss of seeded cells arising from slow infiltration of vascular tissue can be overcome using a prevascularisation strategy consisting of seeding the scaffold with vascular cells. Using certain assumptions it is shown how the system can be simplified to one which is partially tractable and for which some analysis is given. Limited comparison is also given of the model solutions with experimental data from the chick chorioallantoic membrane (CAM) assay

Community pharmacy-based medication therapy management services: financial impact for patients

This is the published version. Copyright 2012 Centro de Investigaciones y Publicaciones Farmaceuticas.Objective: To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM) interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists’ recommended MTM interventions. Methods: This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-ofpocket prescription medication expense as a result of MTM services. Results: Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69)) while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001). Pharmacists attempted a total of 732 recommendations; 391 (53%) were accepted by both the patient and their prescriber. A total of 341 (47%) recommendations were not accepted because of patient refusal (290, 85%) or prescriber refusal (51, 15%). Conclusions: Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists’ recommended interventions (53%) were accepted by patients and prescribers

Integration over song classification replicates: Song variant analysis in the hihi

Human expert analyses are commonly used in bioacoustic studies and can potentially limit the reproducibility of these results. In this paper, a machine learning method is presented to statistically classify avian vocalizations. Automated approaches were applied to isolate bird songs from long field recordings, assess song similarities, and classify songs into distinct variants. Because no positive controls were available to assess the true classification of variants, multiple replicates of automatic classification of song variants were analyzed to investigate clustering uncertainty. The automatic classifications were more similar to the expert classifications than expected by chance. Application of these methods demonstrated the presence of discrete song variants in an island population of the New Zealand hihi (Notiomystis cincta). The geographic patterns of song variation were then revealed by integrating over classification replicates. Because this automated approach considers variation in song variant classification, it reduces potential human bias and facilitates the reproducibility of the results