The Global Health interactive Curricula Experience (iCE) Platform & App : Technology that Enables Inter-professional Innovation

Global Health Initiatives Committee (GHIC) Serves the Jefferson community as the premier point of engagement for students & faculty interested in medical and public health issues that transcend national boundaries Creates an institutional focus on preparing students for public service careers in population health and public policy at local, national, and global levels To enable all TJU faculty to: - Deliver global health education, in a friendly, interactive format - Does not require an expert to deliver - Can be used in very small or large pieces depending on your need

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Genome remodelling in a basal-like breast cancer metastasis and xenograft

Massively parallel DNA sequencing technologies provide an unprecedented ability to screen entire genomes for genetic changes associated with tumour progression. Here we describe the genomic analyses of four DNA samples from an African-American patient with basal-like breast cancer: peripheral blood, the primary tumour, a brain metastasis and a xenograft derived from the primary tumour. The metastasis contained two de novo mutations and a large deletion not present in the primary tumour, and was significantly enriched for 20 shared mutations. The xenograft retained all primary tumour mutations and displayed a mutation enrichment pattern that resembled the metastasis. Two overlapping large deletions, encompassing CTNNA1, were present in all three tumour samples. The differential mutation frequencies and structural variation patterns in metastasis and xenograft compared with the primary tumour indicate that secondary tumours may arise from a minority of cells within the primary tumour

Mushishi : post modern representation of otherness in and outside human bodies

Recent decades have witnessed a resurgence of fantasies in novels, films as well as manga and anime, reflecting our ambivalent feelings (fear and hope) towards techno-scientific advancements spreading through everyday life. These hybrid fantasies are largely genre-hybrids and incorporate traditional folklore, combining magic and psychic powers with information and biotechnologies. Urushibara Yuki's manga and anime, Mushishi (1999-2008) introduces a number of invisible, shapeless, or shape-shifting mushi (spirits). They are generally parasitical, attaching to human bodies and things. When they cause suffering to their human hosts, they are often removed by the main protagonist, Mushishi (lit., Mushi Master), Ginko. Mushi, however, are neither intrinsically good nor evil. What do such mushi represent? Do they manifest our anxieties about invisible threats caused by infectious viruses, pollutants, genetic manipulations, biochemical weapons, or radiation? Or do they represent the invasive use of information technology in our everyday life and living spaces? Is cyberspace, with its elusive connectedness, an analogue of the world with mushi? Is the world of Mushishi a metaphor for our environment? This paper will discuss human's ambiguous visions of life, bodies, and co-existence through the characterisations of parasitical mushi in Urushibara's Mushishi in comparison with Miyazaki Hayao's Kaze no tani no Nausicaä (Nausicaä of the Valley of the Wind).9 page(s

Manga and anime : fluidity and hybridity in global imagery

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Manga and anime : fluidity and hybridity in global imagery

Along with the rapid spread of manga and anime in the global media market in recent years, there has been a growing interest in how this diffusion has occurred. With this in mind, this paper explores the ways in which manga and anime have been manipulated to generate diverse, hybridised commodities. It also examines how manga and anime have become a site of fluid, multilayered cultural interpenetration: translation involves reinterpretation of these media on multiple levels, in which representations and perceptions of the source culture continuously change; cultural interpenetration also occurs when consumers interact with manga and anime, and each other, in both virtual and physical worlds.22 page(s

Movement and Apparent Survival of Acoustically Tagged Juvenile Late-Fall Run Chinook Salmon Released Upstream of Shasta Reservoir, California

Stakeholder interests have spurred the reintroduction of the critically endangered populations of Chinook Salmon to tributaries upstream of Shasta Dam, in northern California. We released two groups of acoustically tagged, juvenile hatchery, late-fall Chinook Salmon to determine how juvenile salmon would distribute and survive. We measured travel times to Shasta Dam, and the number of fish that moved between locations within Shasta Reservoir. We used mark-recapture methods to determine detection and apparent survival probabilities of the tagged fish as they traveled through five reaches of the Sacramento River from the McCloud River to San Francisco Bay (~590 km) over the two 3-month observation periods. After our first (February) release of 262 tagged fish, 182 fish (70%) were detected at least once at the dam, 41 (16%) were detected at least once downstream of Shasta Dam, and 3 (1%) traveled as far as San Francisco Bay. After the second (November) release of 355 tagged fish, only 4 (1%) were detected at Shasta Dam. No fish were detected below Shasta Dam, so we could not estimate survival for this second release group. The first release of fish was fortuitously exposed to exceptionally high river flows and dam discharges, which may have contributed to the more distant downstream migration and detection of these fish — though other factors such as season, diploid versus triploid, and fish maturation and size may have also contributed to release differences. The reported fish travel times as well as detection and survival rates are the first estimates of juvenile salmon emigration from locations above Shasta Dam in more than 70 years. This information should help inform resource managers about how best to assess juvenile winter-run Chinook Salmon and assist in their reintroduction to watersheds upstream of Shasta Dam