Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system

Background: Abuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products. We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control. Results: We identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder. Conclusions: Clinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry

Overcoming health-systems constraints to achieve the Millennium Development Goals.

Effective interventions exist for many priority health problems in low income countries; prices are falling, and funds are increasing. However, progress towards agreed health goals remains slow. There is increasing consensus that stronger health systems are key to achieving improved health outcomes. There is much less agreement on quite how to strengthen them. Part of the challenge is to get existing and emerging knowledge about more (and less) effective strategies into practice. The evidence base also remains remarkably weak, partly because health-systems research has an image problem. The forthcoming Ministerial Summit on Health Research seeks to help define a learning agenda for health systems, so that by 2015, substantial progress will have been made to reducing the system constraints to achieving the MDGs

Operation and Application of a Regional High-Frequency Radar Network in the Mid-Atlantic Bight

The Mid-Atlantic Regional Coastal Ocean Observing System (MARCOOS) High- Frequency Radar Network, which comprises 13 long-range sites, 2 medium-range sites, and 12 standard-range sites, is operated as part of the Integrated Ocean Observing System. This regional implementation of the network has been operational for 2 years and has matured to the point where the radars provide consistent coverage from Cape Cod to Cape Hatteras. A concerted effort was made in the MARCOOS project to increase the resiliency of the radar stations from the elements, power issues, and other issues that can disable the hardware of the system. The quality control and assurance activities in the Mid-Atlantic Bight have been guided by the needs of the Coast Guard Search and Rescue Office. As of May,, 2009, these quality-controlled MARCOOS High-Frequency Radar totals are being served through the Coast Guard\u27s Environmental Data Server to the Coast Guard Search and Rescue Optimal Planning System. In addition to the service to U.S. Coast Guard Search and Rescue Operations, these data support water quality, physical oceanographic, and fisheries research throughout the Mid-Atlantic Bight

Variant antigen repertoires in Trypanosoma congolense populations and experimental infections can be profiled from deep sequence data using universal protein motifs

African trypanosomes are vector-borne hemoparasites of humans and animals. In the mammal, parasites evade the immune response through antigenic variation. Periodic switching of the Variant Surface Glycoprotein (VSG) coat covering their cell surface allows sequential expansion of serologically distinct parasite clones. Trypanosome genomes contain many hundreds of VSG genes, subject to rapid changes in nucleotide sequence, copy number and chromosomal position. Thus, analysing, or even quantifying, VSG diversity over space and time presents an enormous challenge to conventional techniques. Indeed, previous population genomic studies have overlooked this vital aspect of pathogen biology for lack of analytical tools. Here we present a method for analysing population-scale VSG diversity in Trypanosoma congolense from deep sequencing data. Previously, we suggested that T. congolense VSG segregate into defined 'phylotypes' that do not recombine. In our dataset comprising 41 T. congolense genome sequences from across Africa, these phylotypes are universal and exhaustive. Screening sequence contigs with diagnostic protein motifs accurately quantifies relative phylotype frequencies, providing a metric of VSG diversity, called the 'Variant Antigen Profile'. We applied our metric to VSG expression in the tsetse fly, showing that certain, rare VSG phylotypes may be preferentially expressed in infective, metacyclic-stage parasites. Hence, variant antigen profiling accurately and rapidly determines VSG gene and transcript repertoire from sequence data, without need for manual curation or highly contiguous sequences. It offers a tractable approach to measuring VSG diversity across strains and during infections, which is imperative to understanding the host-parasite interaction at population and individual scales. [Abstract copyright: Published by Cold Spring Harbor Laboratory Press.

Improving Blood Pressure Control Through Blood Pressure Measurement in an Ambulatory Urban Family Medicine Clinic

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of \u3c140/90 from a baseline of 58% to 68% by April 2020

The dependence of galaxy group star formation rates and metallicities on large scale environment

We construct a sample of 75,863 star forming galaxies with robust metallicity and star formation rate measurements from the Sloan Digital Sky Survey Data Release 7 (SDSS DR7), from which we select a clean sample of compact group (CG) galaxies. The CGs are defined to be close configurations of at least 4 galaxies that are otherwise apparently isolated. Our selection results in a sample of 112 spectroscopically identified compact group galaxies, which can be further divided into groups that are either embedded within a larger structure, such as a cluster or large group, or truly isolated systems. The compact groups then serve as a probe into the influence of large scale environment on a galaxy's evolution, while keeping the local density fixed at high values. We find that the star formation rates (SFRs) of star forming galaxies in compact groups are significantly different between isolated and embedded systems. Galaxies in isolated systems show significantly enhanced SFR, relative to a control sample matched in mass and redshift, a trend not seen in the embedded systems. Galaxies in isolated systems exhibit a median SFR enhancement at fixed stellar mass of +0.07 \pm 0.03 dex. These dependences on large scale environment are small in magnitude relative to the apparent influence of local scale effects found in previous studies, but the significance of the difference in SFRs between our two samples constrains the effect of large scale environment to be non-zero. We find no significant change in the gas-phase interstellar metallicity for either the isolated or embedded compact group sample relative to their controls. However, simulated samples that include artificial offsets indicate that we are only sensitive to metallicity changes of log O/H >0.13 dex (at 99% confidence), which is considerably larger than the typical metallicity differences seen in previous environmental studies.Comment: Accepted for publication in MNRAS. 16 pages, 9 figure

The nature of proximate damped Lyman alpha systems

We present high resolution echelle spectra of 7 proximate damped Lyman alpha (PDLA) systems whose relative velocity separation from the background quasar is Delta V < 3000 km/s. Combining our sample with a further 9 PDLAs from the literature we compare the chemical properties of the proximate systems with a control sample of intervening DLAs. Taken at face value, the sample of 16 PDLAs exhibits a wide range of metallicities, ranging from Z ~ 1/3 Z_sun down to Z ~ 1/1000 Z_sun, including the DLA with the lowest N(SiII)/N(HI) yet reported in the literature. We find several pieces of evidence that indicate enhanced ionization and the presence of a hard ionizing spectrum in PDLAs which lead to properties that contrast with the intervening DLAs, particularly when the N(HI) is low. The abundances of Zn, Si and S in PDLAs with log N(HI) > 21, where ionization corrections are minimized, are systematically higher than the intervening population by a factor of around 3. We also find possible evidence for a higher fraction of NV absorbers amongst the PDLAs, although the statistics are still modest. 6/7 of our echelle sample show high ionization species (SiIV, CIV, OVI or NV) offset by >100 km/s from the main low ion absorption. We analyse fine-structure transitions of CII* and SiII* to constrain the PDLA distance from the QSO. Lower limits range from tens of kpc up to >160 kpc for the most stringent limit. We conclude that (at least some) PDLAs do exhibit different characteristics relative to the intervening population out to 3000 km/s (and possibly beyond). Nonetheless, the PDLAs appear distinct from lower column density associated systems and the inferred QSO-absorber separations mean they are unlikely to be associated with the QSO host. We speculate that the PDLAs preferentially sample more massive galaxies in more highly clustered regions of the high redshift universe.Comment: Accepted for publication in MNRAS. Abstract abridged

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis

Background:Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation.Objective:This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users.Methods:We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff.Results:Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety.Conclusions:This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability

Association of Genetic Markers with CSF Oligoclonal Bands in Multiple Sclerosis Patients

Objective:to explore the association between genetic markers and Oligoclonal Bands (OCB) in the Cerebro Spinal Fluid (CSF) of Italian Multiple Sclerosis patients.Methods:We genotyped 1115 Italian patients for HLA-DRB1*15 and HLA-A*02. In a subset of 925 patients we tested association with 52 non-HLA SNPs associated with MS susceptibility and we calculated a weighted Genetic Risk Score. Finally, we performed a Genome Wide Association Study (GWAS) with OCB status on a subset of 562 patients. The best associated SNPs of the Italian GWAS were replicated in silico in Scandinavian and Belgian populations, and meta-analyzed.Results:HLA-DRB1*15 is associated with OCB+: p = 0.03, Odds Ratio (OR) = 1.6, 95% Confidence Limits (CL) = 1.1-2.4. None of the 52 non-HLA MS susceptibility loci was associated with OCB, except one SNP (rs2546890) near IL12B gene (OR: 1.45; 1.09-1.92). The weighted Genetic Risk Score mean was significantly (p = 0.0008) higher in OCB+ (7.668) than in OCB- (7.412) patients. After meta-analysis on the three datasets (Italian, Scandinavian and Belgian) for the best associated signals resulted from the Italian GWAS, the strongest signal was a SNP (rs9320598) on chromosome 6q (p = 9.4×10-7) outside the HLA region (65 Mb).Discussion:genetic factors predispose to the development of OCB