Kansas Provider Report of Adolescent Vaccinations in Their Practice

Introduction. Kansas falls consistently below average for adolescentvaccination of meningococcal (MCV), human papillomavirus(HPV), and influenza. Methods. For this study, the members of Kansas Chapter of theAmerican Academy of Pediatrics were emailed a confidential electronicsurvey soliciting their impressions of vaccination in theirpractice. Results. Of 137 providers emailed, 61 (45%) completed the survey.Thirteen providers were excluded as they did not see/vaccinate adolescentsor did not complete the survey. Tetanus, diphtheria, pertussis(Tdap), and MCV vaccines were most commonly up to date with31 (65%) and 20 (42%) respondents reporting greater than 90%immunization rates, respectively. HPV (n = 42, 89%) and influenza(n = 40, 83%) vaccines had refusal rates greater than 25% in mostclinics. Most practices (n = 44, 92%) used internal electronic medicalrecords to track vaccinations, although 29 practices (60%) utilizedthe state immunization information system. Providers requestedvaccine-specific patient education tools, positive media coverage,staffing support, and best-practices workshops to support vaccinationefforts. Conclusion. Kansas providers may not be optimizing availableresources to enhance these rates, such as Web IZ tracking and immunizationreminders. Patient education supplies, specific to HPV andInfluenza vaccination, potentially could increase vaccination rates.KS J Med 2017;10(4):84-87

Pediatric Resident Knowledge, Confidence, and Experience in Transitioning Youth with Special Healthcare Needs

Background. The transition from pediatric to adult healthcare is vital to the 17% of adolescents with special healthcare needs (SHCN). Barriers to successful transition exist. The purpose of this study was to assess the baseline knowledge, confidence, and experience of pediatric residents in our state on transitioning adolescents with SHCN from pediatric to adult-oriented health care. Methods. An anonymous, voluntary, self-report survey was distributed electronically via Survey Monkey® to 2011-2012 pediatric residents in the state of Kansas (n = 39). Results. Of 39 pediatric residents, 21 (54%) completed the survey. Most (71%) had two or fewer adolescents with SHCN on their patient panel. Overall, the majority categorized their knowledge (71%) and experience (81%) transitioning adolescents with SHCN as minimal or very minimal. Conclusions. Pediatric residents report a general lack of knowledge, confidence, and experience in transitioning youth with SHCN. Additional training opportunities are needed to overcome the barriers in successful transition planning

Low Temperature District Heating for Future Energy Systems

The building sector is responsible for more than one third of the final energy consumption of societies and produces the largest amount of greenhouse gas emissions of all sectors. This is due to the utilisation of combustion processes of mainly fossil fuels to satisfy the heating demand of the building stock. Low temperature district heating (LTDH) can contribute significantly to a more efficient use of energy resources as well as better integration of renewable energy (e.g. geothermal or solar heat), and surplus heat (e.g. industrial waste heat) into the heating sector. LTDH offers prospects for both the demand side (community building structure) and the supply side (network properties or energy sources). Especially in connection with buildings that demand only low temperatures for space heating. The utilisation of lower temperatures reduces losses in pipelines and can increase the overall efficiency of the total energy chains used in district heating. To optimise the exergy efficiency of community supply systems the LowEx approach can be utilised, which entails matching the quality levels of energy supply and demand in order to optimise the utilisation of high-value resources, such as combustible fuels, and minimising energy losses and irreversible dissipation. The paper presents the international co-operative work in the framework of the International Energy Agency (IEA), the Technology Cooperation Programme on District Heating and Cooling including Combined Heat and Power (DHC|CHP) Annex TS1

The natural history of spina bifida in children pilot project : Research protocol

Background: Population-based empirical information to inform health care professionals working with children with spina bifida currently is lacking. Spina bifida is a highly complex condition that not only affects mobility but many additional aspects of life. We have developed a pilot project that focuses on a broad range of domains: Surgeries, development and learning, nutrition and physical growth, mobility and functioning, general health, and family demographics. Specifically, we will: (1) explore the feasibility of identifying and recruiting participants using different recruitment sources, (2) test a multidisciplinary module to collect the data, (3) determine the utility of different methods of retrieving the data, and (4) summarize descriptive information on living with spina bifida. Objective: The overall objective of the project was to provide information for a future multistate prospective study on the natural history of spina bifida. Methods: Families with a child 3 to 6 years of age with a diagnosis of spina bifida were eligible for enrollment. Eligible families were identified through a US population-based tracking system for birth defects and from a local spina bifida clinic. Results: This is an ongoing project with first results expected in 2013. Conclusions: This project, and the planned multistate follow-up project, will provide information both to health care professionals experienced in providing care to patients with spina bifida, and to those who have yet to work with this population. The long-term purpose of this project is to increase the knowledge about growing up with spina bifida and to guide health care practices by prospectively studying a cohort of children born with this condition

A novel multistep mechanism for initial lymphangiogenesis in mouse embryos based on ultramicroscopy

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Enrichment of B cell receptor signaling and epidermal growth factor receptor pathways in monoclonal gammopathy of undetermined significance: a genome-wide genetic interaction study

Background: Recent identification of 10 germline variants predisposing to monoclonal gammopathy of undetermined significance (MGUS) explicates genetic dependency of this asymptomatic precursor condition with multiple myeloma (MM). Yet much of genetic burden as well as functional links remain unexplained. We propose a workflow to expand the search for susceptibility loci with genome-wide interaction and for subsequent identification of genetic clusters and pathways. Methods: Polygenic interaction analysis on 243 cases/1285 controls identified 14 paired risk loci belonging to unique chromosomal bands which were then replicated in two independent sets (case only study, 82 individuals; case/control study 236 cases/ 2484 controls). Further investigation on gene-set enrichment, regulatory pathway and genetic network was carried out with stand-alone in silico tools separately for both interaction and genome-wide association study-detected risk loci. Results: Intronic-PREX1 (20q13.13), a reported locus predisposing to MM was confirmed to have contribution to excess MGUS risk in interaction with SETBP1, a well-established candidate predisposing to myeloid malignancies. Pathway enrichment showed B cell receptor signaling pathway (P < 5.3 × 10− 3) downstream to allograft rejection pathway (P < 5.6 × 10− 4) and autoimmune thyroid disease pathway (P < 9.3 × 10− 4) as well as epidermal growth factor receptor regulation pathway (P < 2.4 × 10− 2) to be differentially regulated. Oncogene ALK and CDH2 were also identified to be moderately interacting with rs10251201 and rs16966921, two previously reported risk loci for MGUS. Conclusions: We described novel pathways and variants potentially causal for MGUS. The methodology thus proposed to facilitate our search streamlines risk locus-based interaction, genetic network and pathway enrichment analyses

On the Location of the Gamma-ray Emission in the 2008 Outburst in the BL Lacertae Object AO 0235+164 through Observations across the Electromagnetic Spectrum

We present observations of a major outburst at centimeter, millimeter, optical, X-ray, and gamma-ray wavelengths of the BL Lacertae object AO 0235+164. We analyze the timing of multi-waveband variations in the flux and linear polarization, as well as changes in Very Long Baseline Array (VLBA) images at 7mm with 0.15 milliarcsecond resolution. The association of the events at different wavebands is confirmed at high statistical significance by probability arguments and Monte-Carlo simulations. A series of sharp peaks in optical linear polarization, as well as a pronounced maximum in the 7 mm polarization of a superluminal jet knot, indicate rapid fluctuations in the degree of ordering of the magnetic field. These results lead us to conclude that the outburst occurred in the jet both in the quasi-stationary "core" and in the superluminal knot, both parsecs downstream of the supermassive black hole. We interpret the outburst as a consequence of the propagation of a disturbance, elongated along the line of sight by light-travel time delays, that passes through a standing recollimation shock in the core and propagates down the jet to create the superluminal knot. The multi-wavelength light curves vary together on long time-scales (months/years), but the correspondence is poorer on shorter time-scales. This, as well as the variability of the polarization and the dual location of the outburst, agrees with the expectations of a multi-zone emission model in which turbulence plays a major role in modulating the synchrotron and inverse Compton fluxes.Comment: Accepted for Publication in the Astrophysical Journal Letters. 7 pages (including 5 figures). Minor corrections with regard to previous version, as proposed by the refere

EGFL7 loss correlates with increased VEGF-D expression, upregulating hippocampal adult neurogenesis and improving spatial learning and memory

Correction: Volume: 80 Issue: 8 DOI: 10.1007/s00018-023-04835-3 Article Number: 201 Published: AUG 2023Neural stem cells reside in the subgranular zone, a specialized neurogenic niche of the hippocampus. Throughout adulthood, these cells give rise to neurons in the dentate gyrus, playing an important role in learning and memory. Given that these core cognitive processes are disrupted in numerous disease states, understanding the underlying mechanisms of neural stem cell proliferation in the subgranular zone is of direct practical interest. Here, we report that mature neurons, neural stem cells and neural precursor cells each secrete the neurovascular protein epidermal growth factor-like protein 7 (EGFL7) to shape this hippocampal niche. We further demonstrate that EGFL7 knock-out in a Nestin-CreERT2-based mouse model produces a pronounced upregulation of neurogenesis within the subgranular zone. RNA sequencing identified that the increased expression of the cytokine VEGF-D correlates significantly with the ablation of EGFL7. We substantiate this finding with intraventricular infusion of VEGF-D upregulating neurogenesis in vivo and further show that VEGF-D knock-out produces a downregulation of neurogenesis. Finally, behavioral studies in EGFL7 knock-out mice demonstrate greater maintenance of spatial memory and improved memory consolidation in the hippocampus by modulation of pattern separation. Taken together, our findings demonstrate that both EGFL7 and VEGF-D affect neurogenesis in the adult hippocampus, with the ablation of EGFL7 upregulating neurogenesis, increasing spatial learning and memory, and correlating with increased VEGF-D expression.Peer reviewe