Health Literacy Practices in Primary Care Settings: Examples From the Field

Presents findings from a survey and interviews on practices to improve health literacy among patients. Identifies five promising practices as well as barriers to implementing such practices, and recommends better training, quality of care, and research

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection.

Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)-positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58-92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures

Generation of Internal Waves by Eddies Impinging on the Western Boundary of the North Atlantic

This is the final version. Available from the American Meteorological Society via the DOI in this recordDespite the major role played by mesoscale eddies in redistributing the energy of the large-scale circulation, our understanding of their dissipation is still incomplete. This study investigates the generation of internal waves by decaying eddies in the North Atlantic western boundary. The eddy presence and decay are measured from the altimetric surface relative vorticity associated with an array of full-depth current meters extending ~100 km offshore at 26.5°N. In addition, internal waves are analyzed over a topographic rise from 2-yr high-frequency measurements of an acoustic Doppler current profiler (ADCP), which is located 13 km offshore in 600-m deep water. Despite an apparent polarity independence of the eddy decay observed from altimetric data, the flow in the deepest 100 m is enhanced for anticyclones (25.2 cm s−1) compared with cyclones (−4.7 cm s−1). Accordingly, the internal wave field is sensitive to this polarity-dependent deep velocity. This is apparent from the eddy-modulated enhanced dissipation rate, which is obtained from a finescale parameterization and exceeds 10−9 W kg−1 for near-bottom flows greater than 8 cm s−1. The present study underlines the importance of oceanic western boundaries for removing the energy of low-mode westward-propagating eddies to higher-mode internal waves.The RAPID-WATCH MOC monitoring project is funded by the U.K. Natural Environment Research Council, the U.S. National Science Foundation, and the U.S. National Oceanic and Atmospheric Administration. L. Clément was supported by NERC Grant NE/I528626/1. The participation of K. L. Sheen and J. A. Brearley in this study was supported by NERC Grants NE/E007058/1 and NE/E005667/1. A.C.N.G. acknowledges the support of a Philip Leverhulme Prize

Generation of internal waves by eddies impinging on the western boundary of the North Atlantic

Despite the major role played by mesoscale eddies in redistributing the energy of the large-scale circulation, our understanding of their dissipation is still incomplete. This study investigates the generation of internal waves by decaying eddies in the North Atlantic western boundary. The eddy presence and decay are measured from the altimetric surface relative vorticity associated with an array of full-depth current meters extending ~100 km offshore at 26.5°N. In addition, internal waves are analysed over a topographic rise from 2-year high-frequency measurements of an Acoustic Doppler Current Profiler (ADCP), which is located 13 km offshore in 600 m deep water. Despite an apparent polarity independence of the eddy decay observed from altimetric data, the flow in the deepest 100 m is enhanced for anticyclones (25.2 cm s−1) compared with cyclones (-4.7 cm s−1). Accordingly, the internal wave field is sensitive to this polarity-dependent deep velocity. This is apparent from the eddy-modulated enhanced dissipation rate, which is obtained from a finescale parameterization and exceeds 10−9 W kg−1 for near-bottom flows greater than 8 cm s−1. The present study underlines the importance of oceanic western boundaries for removing the energy of low-mode westward-propagating eddies to higher-mode internal waves

F. John's stability conditions vs. A. Carasso's SECB constraint for backward parabolic problems

In order to solve backward parabolic problems F. John [{\it Comm. Pure. Appl. Math.} (1960)] introduced the two constraints "$\|u(T)\|\le M$" and $\|u(0) - g \| \le \delta$ where $u(t)$ satisfies the backward heat equation for $t\in(0,T)$ with the initial data $u(0).$ The {\it slow-evolution-from-the-continuation-boundary} (SECB) constraint has been introduced by A. Carasso in [{\it SIAM J. Numer. Anal.} (1994)] to attain continuous dependence on data for backward parabolic problems even at the continuation boundary $t=T$. The additional "SECB constraint" guarantees a significant improvement in stability up to $t=T.$ In this paper we prove that the same type of stability can be obtained by using only two constraints among the three. More precisely, we show that the a priori boundedness condition $\|u(T)\|\le M$ is redundant. This implies that the Carasso's SECB condition can be used to replace the a priori boundedness condition of F. John with an improved stability estimate. Also a new class of regularized solutions is introduced for backward parabolic problems with an SECB constraint. The new regularized solutions are optimally stable and we also provide a constructive scheme to compute. Finally numerical examples are provided.Comment: 15 pages. To appear in Inverse Problem

Mental health supportive services during COVID-19: Proposing an online, self-guided Acceptance and Commitment Therapy program for parents in the disability community

Parents of Children with Intellectual and Developmental Disabilities (I/DD) often experience stress, and the COVID-19 pandemic has likely increased their stress. In the current paper, we describe four things. First, we describe how mental telehealth treatments can effectively decrease parent stress, including programs that target behavior training and those that provide therapy. Teleheath programs are delivered by phone, computer, or fully online. Second, we describe challenges of these programs and explain how online, self-guided programs may help address these challenges. Third, we explain our online, self-guided program based in Acceptance and Commitment Therapy (ACT). ACT is a specific type of therapy that helps people notice their moods and their thoughts to help manage stress. Finally, we conclude by proposing a call for collaboration to improve and expand our online, self-guided, ACT program

Genetic diversity of Mycobacterium tuberculosis in Peru and exploration of phylogenetic associations with drug resistance.

BACKGROUND: There is limited available data on the strain diversity of M tuberculosis in Peru, though there may be interesting lessons to learn from a setting where multidrug resistant TB has emerged as a major problem despite an apparently well-functioning DOTS control programme. METHODS: Spoligotyping was undertaken on 794 strains of M tuberculosis collected between 1999 and 2005 from 553 community-based patients and 241 hospital-based HIV co-infected patients with pulmonary tuberculosis in Lima, Peru. Phylogenetic and epidemiologic analyses permitted identification of clusters and exploration of spoligotype associations with drug resistance. RESULTS: Mean patient age was 31.9 years, 63% were male and 30.4% were known to be HIV+. Rifampicin mono-resistance, isoniazid mono-resistance and multidrug resistance (MDR) were identified in 4.7%, 8.7% and 17.3% of strains respectively. Of 794 strains from 794 patients there were 149 different spoligotypes. Of these there were 27 strains (3.4%) with novel, unique orphan spoligotypes. 498 strains (62.7%) were clustered in the nine most common spoligotypes: 16.4% SIT 50 (clade H3), 12.3% SIT 53 (clade T1), 8.3% SIT 33 (LAM3), 7.4% SIT 42 (LAM9), 5.5% SIT 1 (Beijing), 3.9% SIT 47 (H1), 3.0% SIT 222 (clade unknown), 3.0% SIT1355 (LAM), and 2.8% SIT 92 (X3). Amongst HIV-negative community-based TB patients no associations were seen between drug resistance and specific spoligotypes; in contrast HIV-associated MDRTB, but not isoniazid or rifampicin mono-resistance, was associated with SIT42 and SIT53 strains. CONCLUSION: Two spoligotypes were associated with MDR particularly amongst patients with HIV. The MDR-HIV association was significantly reduced after controlling for SIT42 and SIT53 status; residual confounding may explain the remaining apparent association. These data are suggestive of a prolonged, clonal, hospital-based outbreak of MDR disease amongst HIV patients but do not support a hypothesis of strain-specific propensity for the acquisition of resistance-conferring mutations

Effect of Impurity Scattering on the Nonlinear Microwave Response in High-Tc Superconductors

We theoretically investigate intermodulation distortion in high-Tc superconductors. We study the effect of nonmagnetic impurities on the real and imaginary parts of nonlinear conductivity. The nonlinear conductivity is proportional to the inverse of temperature owing to the dependence of the damping effect on energy, which arises from the phase shift deviating from the unitary limit. It is shown that the final-states interaction makes the real part predominant over the imaginary part. These effects have not been included in previous theories based on the two-fluid model, enabling a consistent explanation for the experiments with the rf and dc fields