Post-transplantation cutaneous and renal Aspergillus infection

A 68-year old renal transplant recipient suffered multiple complications following initial good graft function from a deceased-donor transplant. Late in the first week he was oliguric with haematuria; the graft failed in week 2 following development of a haematoma from rupture of a renal artery aneurysm. He had a recurrent bleed from the internal iliac graft site and subsequently developed painful dark patches on his leg, distal to where the transplant had been. Histology from the explanted graft and skin biopsies demonstrated Aspergillus flavus; this was also grown in culture of the external iliac artery tissue. Systemic aspergillosis is rare but well recognised, especially in the immunocompromised. Presentations include mycotic aneurysms and secondary cutaneous aspergillosis from haematogenous spread. Diagnosis requires confirmation by histology or direct culture, but a high beta-glucan concentration and positive galactomannan antigen can suggest invasive fungal infection in the early stages of the disease. Cases should be managed with systemic antifungals and involvement of local microbiology services; unfortunately, prognosis is poor

Strengths-Based Case Management: Implementation With High-Risk Youth

This is the publisher's version, also available electronically from http://alliance1.metapress.com/home/main.mpx.Few effective methods of intervention exist for youth at risk for negative life outcomes. One method used successfully with both adults with chronic mental illness and adults with substance abuse problems is strengths-based case management (SBCM). Based on the principles of strengths theory, SBCM aims to assist individuals in identifying and achieving personal goals, with an emphasis on the case manager-client relationship and client self-determination. In the current study, the authors report findings from a feasibility study that implemented SBCM with adolescent runaways. Challenges to implementation, such as financial status, the role of families, abuse and neglect, developmental issues, education, peer relationships, and transportation, are examined. The current findings suggest that it is feasible to successfully implement SBCM with adolescents, but the challenges to application are different with this group compared with adults, given the developmental differences between adolescents and adults

2002 John Marshall National Moot Court Competition in Information Technology and Privacy Law: Bench Memorandum, 21 J. Marshall J. Computer & Info. L. 37 (2002)

In this moot court competition bench memo, the Supreme Court the state of Marshall has three issues to decide: (1) whether the Court of Appeals erred in holding that the Plaintiff failed to established the requisite elements to evidence a theory of intrusion upon seclusion as defined by the Restatement of Torts; (2) whether the Court of Appeals erred in holding that the Defendant’s statements to third parties were not defamatory but rather opinions or fair comment; and (3) whether the Court of Appeals erred in applying a strict breach of contract analysis to Plaintiff’s claim for deceptive business practices, pursuant to the State of Marshall’s Deceptive Business Practices statute, Marshall Revised Code, 505 MRC 815/2, and holding that the Defendant had no contractual obligation to inform Plaintiff that it employed GPS technology to track its vehicles. Plaintiff was a 21-year-old college sophomore in Capitol City who contacted the defendant in order to rent a rental truck for three days as a local move. He was a student who is receiving an academic scholarship in this college. He was asked to provide information such as name and address when he rented the truck. The rental agreement stated that he would depart with the truck on August 20 and return August 23. The move took longer than anticipated and, as a result, plaintiff parked the rental truck on the night of August 23 in a parking lot in a mall which has a convenience store, a cleaner and an adult bookstore. He attempted to return the truck on August 24 after the closing, so he left the key in the after-hour box before returning to school. In the meantime, defendant received a notice from its corporate office that there is a possible terrorist threat where its rental trucks might be used to carry explosive to Capitol City. Defendant immediately turned on the GPS system tracking the trucks and found plaintiff\u27s rented one parked in front of an adult bookstore. Defendant then contacted plaintiff\u27s reference, who happened to evaluate plaintiff\u27s scholarship eligibility, informing the connection of possible terrorist threat and the location of the truck. Consequently, upon plaintiff\u27s arrival on campus, plaintiff was informed that his scholarship was revoked and he needed to pay more for his rental truck. As a result, plaintiff filed this three count complaint against defendant

Chiropteran types I and II interferon genes inferred from genome sequencing traces by a statistical gene-family assembler

<p>Abstract</p> <p>Background</p> <p>The rate of emergence of human pathogens is steadily increasing; most of these novel agents originate in wildlife. Bats, remarkably, are the natural reservoirs of many of the most pathogenic viruses in humans. There are two bat genome projects currently underway, a circumstance that promises to speed the discovery host factors important in the coevolution of bats with their viruses. These genomes, however, are not yet assembled and one of them will provide only low coverage, making the inference of most genes of immunological interest error-prone. Many more wildlife genome projects are underway and intend to provide only shallow coverage.</p> <p>Results</p> <p>We have developed a statistical method for the assembly of gene families from partial genomes. The method takes full advantage of the quality scores generated by base-calling software, incorporating them into a complete probabilistic error model, to overcome the limitation inherent in the inference of gene family members from partial sequence information. We validated the method by inferring the human IFNA genes from the genome trace archives, and used it to infer 61 type-I interferon genes, and single type-II interferon genes in the bats <it>Pteropus vampyrus </it>and <it>Myotis lucifugus</it>. We confirmed our inferences by direct cloning and sequencing of IFNA, IFNB, IFND, and IFNK in <it>P. vampyrus</it>, and by demonstrating transcription of some of the inferred genes by known interferon-inducing stimuli.</p> <p>Conclusion</p> <p>The statistical trace assembler described here provides a reliable method for extracting information from the many available and forthcoming partial or shallow genome sequencing projects, thereby facilitating the study of a wider variety of organisms with ecological and biomedical significance to humans than would otherwise be possible.</p

The speaking vocabulary of grade two

Thesis (M.A.)--Boston Universit

Methylation and protein expression of DNA repair genes: association with chemotherapy exposure and survival in sporadic ovarian and peritoneal carcinomas

<p>Abstract</p> <p>Background</p> <p>DNA repair genes critically regulate the cellular response to chemotherapy and epigenetic regulation of these genes may be influenced by chemotherapy exposure. Restoration of BRCA1 and BRCA2 mediates resistance to platinum chemotherapy in recurrent BRCA1 and BRCA2 mutated hereditary ovarian carcinomas. We evaluated BRCA1, BRCA2, and MLH1 protein expression in 115 sporadic primary ovarian carcinomas, of which 31 had paired recurrent neoplasms collected after chemotherapy. Additionally, we assessed whether promoter methylation of BRCA1, MLH1 or FANCF influenced response to chemotherapy or explained alterations in protein expression after chemotherapy exposure.</p> <p>Results</p> <p>Of 115 primary sporadic ovarian carcinomas, 39 (34%) had low BRCA1 protein and 49 (42%) had low BRCA2 expression. BRCA1 and BRCA2 protein expression were highly concordant (p < 0.0001). MLH1 protein loss occurred in 28/115 (24%) primary neoplasms. BRCA1 protein loss in primary neoplasms was associated with better survival (p = 0.02 Log Rank test) and remained significant after accounting for either stage or age in a multivariate model (p = 0.04, Cox proportional hazards). In paired specimens, BRCA1 protein expression increased in 13/21 (62%) and BRCA2 protein expression increased in 15/21 (71%) of recurrent carcinomas with low or intermediate protein in the paired primary. In contrast MLH1 expression was rarely decreased in recurrent carcinomas (1/33, 3%). Similar frequencies of MLH1, BRCA1, and FANCF promoter methylation occurred in primary carcinomas without previous chemotherapy, after neoadjuvant chemotherapy, or in recurrent neoplasms.</p> <p>Conclusion</p> <p>Low BRCA1 expression in primary sporadic ovarian carcinoma is associated with prolonged survival. Recurrent ovarian carcinomas commonly have increased BRCA1 and/or BRCA2 protein expression post chemotherapy exposure which could mediate resistance to platinum based therapies. However, alterations in expression of these proteins after chemotherapy are not commonly mediated by promoter methylation, and other regulatory mechanisms are likely to contribute to these alterations.</p

Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA.

OBJECTIVE: Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids. METHODS: Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus. RESULTS: Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases. CONCLUSIONS: Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation

“It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

Background: Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods: This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results: While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions: Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all

It\u27s way more than just writing a prescription : A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

BACKGROUND: Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. METHODS: This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. RESULTS: While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). CONCLUSIONS: Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all