A Mobile Health Tool for Peer Support of Individuals Reentering Communities After Incarceration

Individuals just released from prison, or returning citizens (RCs), face high mortality rates during the reentry period, with cardiovascular disease (CVD) being a leading cause. Peer mentors can support RCs' health, but they traditionally work in person, which may not always be feasible, particularly during pandemic outbreaks such as COVID-19. We used human-centered design to build a prototype of RCPeer, a web/mobile application (app) to support peer-led reentry efforts through CVD risk screening, action planning, linkage to resources addressing reintegration needs (e.g., housing, transportation), and goal-setting. We assessed feasibility, acceptability, and usability of RCPeer using mixed-methods. System Usability Scale (SUS) scores were 68 for peers and 66 for RCs, indicating good usability. Qualitative data suggests that RCPeer can support reentry tasks through RCs and peers sharing data, strengthen RC-peer relationships, and facilitate RCs meeting their goals. Future work is needed to enhance usability for RCs with limited technology experience.

Genetic dissection reveals diabetes loci proximal to the gimap5 lymphopenia gene

Congenic DRF.(f/f) rats are protected from type 1 diabetes (T1D) by 34 Mb of F344 DNA introgressed proximal to the gimap5 lymphopenia gene. To dissect the genetic factor(s) that confer protection from T1D in the DRF.(f/f) rat line, DRF.(f/f) rats were crossed to inbred BBDR or DR.(lyp/lyp) rats to generate congenic sublines that were genotyped and monitored for T1D, and positional candidate genes were sequenced. All (100%) DR.(lyp/lyp) rats developed T1D by 83 days of age. Reduction of the DRF.(f/f) F344 DNA fragment by 26 Mb (42.52-68.51 Mb) retained complete T1D protection. Further dissection revealed that a 2 Mb interval of F344 DNA (67.41-70.17 Mb) (region 1) resulted in 47% protection and significantly delayed onset (P < 0.001 compared with DR.(lyp/lyp)). Retaining <1 Mb of F344 DNA at the distal end (76.49-76.83 Mb) (region 2) resulted in 28% protection and also delayed onset (P < 0.001 compared with DR.(lyp/lyp)). Comparative analysis of diabetes frequency in the DRF.(f/f) congenic sublines further refined the RNO4 region 1 interval to approximately 670 kb and region 2 to the 340 kb proximal to gimap5. All congenic DRF.(f/f) sublines were prone to low-grade pancreatic mononuclear cell infiltration around ducts and vessels, but <20% of islets in nondiabetic rats showed islet infiltration. Coding sequence analysis revealed TCR Vbeta 8E, 12, and 13 as candidate genes in region 1 and znf467 and atp6v0e2 as candidate genes in region 2. Our results show that spontaneous T1D is controlled by at least two genetic loci 7 Mb apart on rat chromosome 4.

Increased lipid oxidation heralds diabetes onset in DR.lyp/lyp rats

AIM

The BB rat model of type 1 diabetes exhibits altered body weight gain and body temperature regulation prior to hyperglycemia onset, implying the existence of as yet unidentified biomarkers of autoimmune processes that destroy pancreatic beta cells. To investigate this hypothesis, we compared the metabolic profile of diabetes-resistant DR.lyp/+ rats and their diabetes-prone, congenic DR.lyp/lyp littermates in the days leading up to diabetes onset.

METHODS

Except for the Gimap5 mutation on chromosome 4, congenic DR.lyp/lyp rats are genetically identical to DR.lyp/+ littermates. They invariably develop hyperglycemia at 46-81 days of age, whereas DR.lyp/+ rats do not develop diabetes. In addition to daily food intake and body weight, indirect calorimetry was performed continuously on male DR.lyp/lyp and DR.lyp/+ rats (n=6/group) for 6-18 days to measure locomotor activity, VO (2), VCO (2) and RQ.

RESULTS

DR.lyp/lyp rats exhibited a progressive decrease of RQ compared to DR.lyp/+ rats 0.005+/-0.001 units/day (p<0.005). Limiting the analysis to the six days prior to diabetes onset revealed a larger decrease of 0.007+/-0.002 units/day (p<0.001) in DR.lyp/lyp animals, whereas RQ of the DR.lyp/+ rats remained unchanged. This metabolic change occurred prior to hyperglycemia onset and was not associated with changes of any other parameter.

CONCLUSIONS

Diabetes onset in DR.lyp/lyp rats is heralded by a progressive shift towards lipid oxidation relative to carbohydrate metabolism.

Randomized, placebo-controlled clinical trial of oral azithromycin prophylaxis against respiratory infections in a high-risk, young adult population

Military Special Forces trainees undergo intense psychological and physical stressors that often lead to respiratory infection. During 1998-2000, 477 Navy Special Forces trainees were enrolled in a double-blind trial of oral azithromycin (1 g given weekly) plus a placebo injection, compared with benzathine penicillin G (1.2 million U) plus azithromycin placebo tablets. Among the 464 subjects with complete data, 44 developed acute respiratory infection (20 with pneumonia) during the 2 weeks of most intense training; of these subjects, 12 (27.3%) had evidence of Chlamydia pneumoniae infection and 7 (15.9%) had evidence of Mycoplasma pneumoniae infection. Trainees who received azithromycin were less likely than were trainees who received benzathine penicillin G to develop acute respiratory infection (risk ratio, 0.50; 95% confidence interval [CI], 0.28-0.92) and less likely at the end of training to report episodes of breathing difficulty (odds ratio [OR], 0.59; 95% CI, 0.34-1.01) or sore throat (OR, 0.66; 95% CI, 0.41-1.05). Compared with benzathine penicillin G prophylaxis, weekly oral azithromycin was superior in preventing respiratory infection in this population at transient high risk.

Prospective study of respiratory infections at the U.S. Naval Academy

Midshipmen at the U.S. Naval Academy have recently suffered epidemics of upper respiratory tract infections. Seeking to determine cause, in June 1998 we enrolled 1,243 (99.5%) of 1,249 new midshipmen (plebes) and followed them during their first 11 months of training. Eighty-five plebes sought medical attention for acute respiratory disease. Using culture, serologic studies, and polymerase chain reaction, considerable evidence for respiratory pathogen infection was found among the ill subjects: Chlamydia pneumoniae in 41 (52.6%), Mycoplasma pneumoniae in 19 (25.3%), influenza in 11 (14.2%), Streptococcus pneumoniae in 6 (7.3%), and adenovirus in 1 (1.2%). Additionally, 873 (81%) the 1,077 plebes who completed an end-of-year questionnaire complained of having one or more respiratory symptoms (> 12 hours) during their first year of school. Of these, 132 (15%) reported that the symptoms significantly affected their performance. Study results suggest that respiratory infections were frequent, had a significant adverse impact on training, and were often attributable to bacterial pathogens.

Prospective study of respiratory infections at the U.S. Naval Academy

Midshipmen at the U.S. Naval Academy have recently suffered epidemics of upper respiratory tract infections. Seeking to determine cause, in June 1998 we enrolled 1,243 (99.5%) of 1,249 new midshipmen (plebes) and followed them during their first 11 months of training. Eighty-five plebes sought medical attention for acute respiratory disease. Using culture, serologic studies, and polymerase chain reaction, considerable evidence for respiratory pathogen infection was found among the ill subjects: Chlamydia pneumoniae in 41 (52.6%), Mycoplasma pneumoniae in 19 (25.3%), influenza in 11 (14.2%), Streptococcus pneumoniae in 6 (7.3%), and adenovirus in 1 (1.2%). Additionally, 873 (81%) the 1,077 plebes who completed an end-of-year questionnaire complained of having one or more respiratory symptoms (> 12 hours) during their first year of school. Of these, 132 (15%) reported that the symptoms significantly affected their performance. Study results suggest that respiratory infections were frequent, had a significant adverse impact on training, and were often attributable to bacterial pathogens.

Modulation of monocyte chemotactic protein-1 production by hyperoxia: importance of RNA stability in control of cytokine production

Pulmonary oxygen toxicity occurs after prolonged administration of increased fractions of inspired oxygen. Lung damage in this setting manifests as diffuse alveolar damage. In animals exposed to hyperoxia, increased numbers of alveolar macrophages are noted 72 h after initiation of high concentrations of oxygen. Monocyte chemotactic protein-1 (MCP-1) is a cytokine released by a number of cell types that has potent chemotactic activity for monocytes, precursor cells for alveolar macrophages. In the current study, we examined whether MCP-1 production was increased in response to hyperoxia. We used the monocyte/ histiocytic U937 cell line and exposed these cells to hyperoxia for variable amounts of time, then determined MCP-1 concentrations by enzyme-linked immunosorbent assay and MCP-1 mRNA levels by Northern blot analysis. We also examined the effects of dexamethasone on the response of U937 cells to hyperoxia. Finally, as a potential mechanism for regulation of U937 MCP-1 production, we examined effects of hyperoxia on MCP-1 mRNA stability. The results demonstrate that hyperoxia stimulates MCP-1 production after 6 and 24 h of exposure. MCP-1 mRNA levels are also increased after initiation of hyperoxia in part through effects on MCP-1 transcript stability. Dexamethasone significantly reduces MCP-1 production and mRNA levels also in part through effects on transcript stability. These studies suggest monocytes may be attracted to hyperoxia-exposed lungs through enhanced MCP-1 production. MCP-1 production appears to be upregulated in part through post-transcriptional processes in this setting.

Gastrointestinal complications after human transplantation and mechanical heart replacement

One hundred fifty-three patients underwent 159 heart transplants; 7 of these patients received 8 artificial hearts used as a bridge before implantation. The 1-year survival rate was 81 percent. One hundred forty gastrointestinal complications developed in 70 patients. Thirty-eight operations were required. Twenty-nine were intraabdominal operations. Of these, 22 were elective and 7 were emergency procedures. Five of the seven patients who underwent emergency procedures died, for an overall total mortality rate of 17 percent for major intraabdominal interventions. There were no complications or deaths in patients who underwent elective procedures. Major elective intraabdominal surgical interventions can be safely carried out in heart transplant patients. Repeated physical examination, aggressive use of endoscopy and imaging techniques, sound surgical judgement and a mutual relationship of trust and respect between cardiac and general surgeons are keys to a successful outcome.

Serum immunoglobulins after surgical operation

We measured immunoglobulins in the sera of 33 patients on days 1, 3, 6, 10, and 17 and three to four weeks after surgical operations (mostly hysterectomy or appendectomy) or (six patients) after spinal injury. In the absence of infection or blood transfusion, IgG usually decreased slightly and transiently after hysterectomy or appendectomy, as did IgA or IgM after hysterectomy. IgD concentrations showed no consistent changes, but in one patient after hysterectomy and with minimal infection IgD concentration decreased sharply, which contrasted with significant and early increases in IgG, IgA, and IgM. IgD concentration was not correlated with type of operation, presence of infection, or changes in the other immunoglobulins. IgE concentrations either die not change or, in some patients, increased or decreased initially, after operation. We conclude that immunoglobulin concentrations in serum are subject to multiple, unpredictable influences after trauma.