An Equity Response to COVID-19 in Allegheny County, Pennsylvania: The Development and Work of the Black Equity Coalition

From the onset of the pandemic in the United States, racial disparities in COVID-19 outcomes have been evident. In April 2020, several events prompted a concerned group of colleagues to form the Black Equity Coalition (BEC), a Black-led coalition in Allegheny County, Pennsylvania, which brings together professionals from multiple sectors who aim to ensure an equitable response to the COVID-19 pandemic. Several significant milestones have been achieved, and this article describes the development, functioning, and outcomes of the Coalition in the first 15 months of operation (April 2020-June 2021). COVID-19 was the reason for such an unprecedented effort, but this BEC infrastructure will be needed long after COVID-19 is controlled. In addition to short-term activities and reactive measures to prevent and mitigate COVID-19 in Black populations, the BEC is serving as a crucial link between government, health care stakeholders, and communities to produce long-term systemic change.

Transcriptomic analysis reveals pronounced changes in gene expression due to sub-lethal pyrethroid exposure and ageing in insecticide resistance Anopheles coluzzii

BACKGROUND

Malaria control is heavily reliant on the use of insecticides that target and kill the adult female Anopheline vector. The intensive use of insecticides of the pyrethroid class has led to widespread resistance in mosquito populations. The intensity of pyrethroid resistance in some settings in Africa means mosquitoes can contact bednets treated with this insecticide class multiple times with minimal mortality effects. Furthermore, both ageing and diel cycle have been shown to have large impacts on the resistance phenotype. Together, these traits may affect other aspects of vector biology controlling the vectorial capacity or fitness of the mosquito.

RESULTS

Here we show that sublethal exposure of a highly resistant Anopheles coluzzii population originally from Burkina Faso to the pyrethroid deltamethrin results in large and sustained changes to transcript expression. We identify five clear patterns in the data showing changes to transcripts relating to: DNA repair, respiration, translation, behaviour and oxioreductase processes. Further, we highlight differential regulation of transcripts from detoxification families previously linked with insecticide resistance, in addition to clear down-regulation of the oxidative phosphorylation pathway both indicative of changes in metabolism post-exposure. Finally, we show that both ageing and diel cycle have major effects on known insecticide resistance related transcripts.

CONCLUSION

Sub-lethal pyrethroid exposure, ageing and the diel cycle results in large-scale changes in the transcriptome of the major malaria vector Anopheles coluzzii. Our data strongly supports further phenotypic studies on how transcriptional changes such as reduced expression of the oxidative phosphorylation pathway or pyrethroid induced changes to redox state might impact key mosquito traits, such as vectorial capacity and life history traits.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Economic Impact of Implementing Malnutrition Screening and Nutritional Management in Older Adults in General Practice

OBJECTIVES

Malnutrition is a common and significant public health problem, especially for older adults, as the consequences are costly. National guidelines (NICE CG32/QS24) highlight the need to identify and manage malnutrition, the implementation of which was deemed "high impact to produce cost savings". The 'Malnutrition Pathway', endorsed by NICE and other professional bodies, is a practical evidence-based guide to help community healthcare professionals (HCP) to implement guidance on malnutrition management. Published evaluations of its use are needed.

DESIGN

This service evaluation in older adults assessed the impact of implementing the 'Malnutrition Pathway' on health care use and costs, as well as the acceptability of the management strategies and effect on malnutrition risk.

SETTING

5 GP surgeries in Gloucestershire.

PARTICIPANTS

163 older adults (80±9 years) with a range of primary diagnoses, living in their own home, were screened using the Malnutrition Universal Screening Tool ('MUST') (n50 low risk (LR); n41 medium risk (MR); n72 high risk (HR)). All patients were managed according to risk (LR: no further management; MR: dietary advice (DA); and HR: DA plus two oral nutritional supplements (ONS) (1 serve 300kcal, 18g protein; 125ml).

MEASUREMENTS

At each review (6weeks, 3 and 6 months), 'MUST' score, compliance and satisfaction to their management plan were recorded. Healthcare use was collected from GP records 6 months before and after implementation of the pathway. A simple cost analysis was completed.

RESULTS

Implementing appropriate management of malnutrition led to significant reductions in hospital admissions (p=0.028), length of hospital stay (p=0.05), GP visits (p=0.007) and antibiotic prescriptions (p=0.05). Over 6 months, the costs to manage malnutrition (HCP time, ONS) were more than offset by the savings associated with these reductions in health care use (per patient savings of -£395.64 MR+HR; -£997.02 HR). The proportion of individuals at risk of malnutrition reduced over time, and patients reported being satisfied with the DA (97%) and ONS (96%), consuming 90% of their ONS prescription.

CONCLUSION

Managing malnutrition significantly reduces healthcare use, with a positive budget impact, in older malnourished patients in primary care. This represents an opportunity to improve patient care with benefit on health care spend.

Synthesis and thermoluminescence of erbium-activated lithium niobate

Erbium-activated lithium niobate; 1, 2, and 4 mol% (LN-1, LN-2 and LN-4 respectively) were synthesized by solid-state method and their thermoluminescent (TL) properties were analyzed. The glow curve of LN-4 showed a maximum at 177 °C and its linear dose-response interval ranged from 50 to 350 Gy. Its TL intensity was two orders of magnitude greater compared to those of pure lithium niobate (LN), LN-1 and LN-2. We conclude that LN-4 is an interesting material for TL dosimetry applications.

Effect of rest stop duration during long-distance transport on welfare indicators in recently weaned beef calves

Forty newly weaned beef calves (260 ± 32.6 kg) were transported 15 h in a livestock trailer (7.3 by 2.1 m) on 2 separate hauls 1 wk apart (20 calves/haul) to evaluate the effect of rest stop duration on indicators of calf welfare. Immediately following the 15-h journey, 15 calves/haul were randomly unloaded at a feedlot and randomly assigned to 1 of 3 rest stop treatments; calves without resting time (5 calves/haul) remained on the trailer and were used as the control group. Treatments included 0- (Control [CON]), 5- (RS5), 10- (RS10), or 15-h (RS15) rest periods in pens containing ad libitum access to water and long-stem hay. Following each rest period, calves were reloaded onto the same trailer and taken on another 5-h journey, before they were unloaded at the same feedlot, for a total transport event lasting 20 h. Control calves did not have access to feed or water until the end of the 20-h transit event. Behavioral measurements included bunk attendance (min/d) and standing and lying duration (min/d) recorded for 5 h after the 20-h transport event. Physiological measurements included saliva and hair cortisol, complete blood cell count, serum NEFA, haptoglobin, and substance P concentrations. All physiological measurements as well as BW were taken immediately prior to initial loading, at arrival at the feedlot after the 20-h event, and 48 h after the transport to the same feedlot. Hair cortisol was collected prior to the initial loading and 25 d after transportation. No differences ( = 0.78) in BW loss were observed among treatments after transportation. Standing time was greater ( < 0.001) in CON calves compared with RS5, RS10, and RS15 calves. Salivary cortisol was greater ( < 0.01) in CON and RS15 calves than in RS5 and RS10 calves at the end of the 20-h journey. Serum NEFA concentration was greater ( = 0.03) in RS5 and RS10 calves at arrival compared with CON and RS15 calves, but those differences were no longer observed ( = 0.49) 48 h after transportation. Concentration of substance P did not differ ( = 0.18) between treatments, and haptoglobin concentration tended to be greater ( = 0.07) in CON calves compared with the other treatments 48 h after arrival. Hair cortisol tended ( = 0.10) to be lower in RS5 calves compared with the other treatments. The results of this study indicate that rest stop periods ≥ 10 h did not prevent short- and long-term stress after transport in weaned calves.

Intelligent Techniques Using Molecular Data Analysis in Leukaemia: An Opportunity for Personalized Medicine Support System

The use of intelligent techniques in medicine has brought a ray of hope in terms of treating leukaemia patients. Personalized treatment uses patient's genetic profile to select a mode of treatment. This process makes use of molecular technology and machine learning, to determine the most suitable approach to treating a leukaemia patient. Until now, no reviews have been published from a computational perspective concerning the development of personalized medicine intelligent techniques for leukaemia patients using molecular data analysis. This review studies the published empirical research on personalized medicine in leukaemia and synthesizes findings across studies related to intelligence techniques in leukaemia, with specific attention to particular categories of these studies to help identify opportunities for further research into personalized medicine support systems in chronic myeloid leukaemia. A systematic search was carried out to identify studies using intelligence techniques in leukaemia and to categorize these studies based on leukaemia type and also the task, data source, and purpose of the studies. Most studies used molecular data analysis for personalized medicine, but future advancement for leukaemia patients requires molecular models that use advanced machine-learning methods to automate decision-making in treatment management to deliver supportive medical information to the patient in clinical practice.

Modelling Predictors of Molecular Response to Frontline Imatinib for Patients with Chronic Myeloid Leukaemia

BACKGROUND

Treatment of patients with chronic myeloid leukaemia (CML) has become increasingly difficult in recent years due to the variety of treatment options available and challenge deciding on the most appropriate treatment strategy for an individual patient. To facilitate the treatment strategy decision, disease assessment should involve molecular response to initial treatment for an individual patient. Patients predicted not to achieve major molecular response (MMR) at 24 months to frontline imatinib may be better treated with alternative frontline therapies, such as nilotinib or dasatinib. The aims of this study were to i) understand the clinical prediction 'rules' for predicting MMR at 24 months for CML patients treated with imatinib using clinical, molecular, and cell count observations (predictive factors collected at diagnosis and categorised based on available knowledge) and ii) develop a predictive model for CML treatment management. This predictive model was developed, based on CML patients undergoing imatinib therapy enrolled in the TIDEL II clinical trial with an experimentally identified achieving MMR group and non-achieving MMR group, by addressing the challenge as a machine learning problem. The recommended model was validated externally using an independent data set from King Faisal Specialist Hospital and Research Centre, Saudi Arabia.

PRINCIPLE FINDINGS

The common prognostic scores yielded similar sensitivity performance in testing and validation datasets and are therefore good predictors of the positive group. The G-mean and F-score values in our models outperformed the common prognostic scores in testing and validation datasets and are therefore good predictors for both the positive and negative groups. Furthermore, a high PPV above 65% indicated that our models are appropriate for making decisions at diagnosis and pre-therapy. Study limitations include that prior knowledge may change based on varying expert opinions; hence, representing the category boundaries of each predictive factor could dramatically change performance of the models.

Termoluminiscencia de titanato de indio activado con europio

El titanato de indio, In2TiO5, es un buen aislante a temperatura ambiente debido a su ancho de banda prohibida que es de  3.2 eV. En este trabajo se reportan las propiedades termoluminiscentes de In2TiO5 activado con europio que fue sintetizado mediante reacción de estado sólido. El material fue caracterizado con microscopía electrónica de barrido, espectroscopia de dispersión de energía y por difracción de rayos X. La intensidad termoluminiscente del In2TiO5 activado con europio se incrementó cerca de seis veces respecto a la observada para In2TiO5 sin ion activador. La cuva de brillo de In2TiO5: Eu, es una banda ancha y con un máximo en 382 K. Se realizó análisis de deconvolución a las curvas de brillo asumiendo el modelo de cinética de orden general. Se determinaron cinco picos con máximos en 372, 382, 432, 488 y 556 K, los cuales coinciden con los datos experimentales obtenidos con el método de blanqueo térmico Tm-Tstop. La respuesta termoluminiscente respecto a la dosis gama fue lineal entre 31 y 1200 Gy, seguido de una región de saturación a partir de 1400 Gy. La reproducibilidad de la señal termoluminiscente fue 5.7 % en su desviación estándar. El desvanecimiento de la señal TL a temperatura ambiente, fue significativamente influenciado por el pico de baja temperatura (382 K). Los resultados obtenidos sugieren que In2TiO5: Eu podría ser considerado como un fósforo para dosimetría de alta radiación gamma.

BK Virus Associated Nephropathy, a Cause of Early Renal Allograft Dysfunction: A Single Centre Study

BACKGROUND

BK virus associated nephropathy (BKVN) is an important cause of early graft dysfunction in renal transplant recipients. The present study was carried out to determine the burden of BKVN in a single renal transplant centre in Australia.

METHOD

A retrospective analysis of de novo renal transplant recipients from 2010 to 2013 was performed to identify biopsy proven BKVN. Estimated glomerular filtration rate (eGFR) was compared at baseline, at BKVN diagnosis and 3 and 12 months postdiagnosis.

RESULT

Of the 317 de novo renal transplants recipients in the study period, 20 (6.3%) developed BKVN. The mean age was 54.8 ± 13.1 years and 13 (65%) were male. The mean time from transplant to BKVN was 8.7 ± 6.7 months with 17 (85%) diagnosed within 12 months. Four recipients each were diagnosed BKVN on 3 and 12 month surveillance biopsy. Six (30%) had normal eGFR at diagnosis. Mean eGFR at diagnosis was 38.8 ± 19.2 ml/min/1.73 m2, which was significantly lower (p < 0.01) than that at baseline (50.3 ± 16.4 ml/min/1.73 m2). eGFR improved numerically at 3 and 12 months post-diagnosis, however the difference was not significant. One patient had graft failure, 19 months after diagnosis.

CONCLUSION

BKVN generally occurs in first post-transplant year and is an important cause of early graft dysfunction. Surveillance biopsy helps in detecting subclinical BKVN.

Thermoluminescence response and glow curve structure of Sc₂TiO₅ ß-irradiated

Discandium titanate (Sc2TiO5) powder was synthesized in order to analyze its thermoluminescence (TL) response. The TL glow curve structure shows two peaks: at 453-433 K and at 590-553 K. The TL beta dose-response has a linear behavior over the dose range 50-500 Gy. The T(stop) preheat method shows five glow peaks that were taken into account to calculate the kinetic parameters using the CGCD procedure. TL results support the possible use of Sc2TiO5 as a new phosphor in high ß-dose dosimetry.

Investigating the feasibility of mid infrared spectroscopy for monitoring an industrial de-racemization biotransformation process

Biotransformation processes have become industrially important in recent years as routes to the manufacture of high value chemical intermediates. However, measurements of key process features and analyte concentrations during these processes are still typically carried out using off-line analysis methods. Vibrational spectroscopic techniques have been extensively utilised for the monitoring and control of a variety of industrial processes. Despite the techniques success with a range of challenging biological matrices, including fermentation and cell culture systems, application of this approach to biotransformation systems has been limited. In the present study the potential of mid infrared spectroscopy to monitor an industrially relevant de-racemization biotransformation process has been investigated. This process presents a number of difficulties due to the optically challenging sample media, close structural similarities and stoichiometric relationship between the key analytes of interest. A PLS model based on the mid infrared spectra obtained during three replicates of the biotransformation process was constructed. In order to ensure that co-linearity within the system had been adequately addressed the spectral contributors to the model were examined. External validation of the constructed model was achieved by challenging the model with two previously unseen replicates of the process. The constructed model was able to predict the concentrations of two key analytes in various samples from these unseen replicates without the requirement for any time consuming sample pre-treatment stages, thus demonstrating the feasibility of near real-time mid infrared monitoring of such an industrial de-racemization biotransformation process.

The effect of insulin intensification in children and young persons with Type 1 diabetes differs in relation to ethnic group; a prospective observational study

AIMS

We prospectively evaluated the effect of insulin intensification on glycaemic control and lipid levels in children and young persons with Type 1 diabetes in relation to ethnicity.

METHODS

In the first 2 years of a 3-year observation period, as part of routine clinical care, 231 children and young persons (40% white, 28% South Asian, 32% black) from a single clinic were offered intensive insulin therapy. After 2 years, 222 were on intensive therapy and their data were compared between ethnic groups at the end of year 3.

RESULTS

We observed ethnic differences in HbA(1c) levels during the study [study beginning and end: white children and young persons 77 and 70 mmol/mol (9.2 and 8.6%) vs. South Asian 72 and 68 mmol/mol (8.7 and 8.4%) vs. black 83 and 79 mmol/mol (9.7 and 9.4%), P-value for ANCOVA = 0.007]. By study end, South Asians had the lowest HDL cholesterol (2.0 vs. 1.4 vs. 1.6 mmol/l, P-value = 0.03) and highest triglyceride levels (0.9 vs. 1.8 vs. 1.0 mmol/l, P-value = 0.001). In linear mixed modelling, after adjustment for socio-economic deprivation and other covariates: (1) black ethnicity was associated with poorer glycaemic control (P < 0.001) and (2) South Asian ethnicity was associated with higher triglyceride levels (P < 0.001), independent of HbA(1c).

CONCLUSIONS

The effect of insulin intensification on glycaemic control and lipid profile in children and young persons with Type 1 diabetes differs in relation to ethnic group.

Space allowance during commercial long distance transport of cattle in North America

The objective of the present work was to study space allowance in cattle during commercial long haul transport (≥400 km; n = 6,152 journeys). Surveys, delivered to livestock transport carriers, gathered information on the number, BW, and distribution of cattle by trailer compartment as well as the characteristics of the transport vehicles used. Space allowance (SA; m(2)/animal), allometric coefficient (k = SA / BW(0.6667)), and the percentage of deviation from recommended SA (DRSA; %) in the Canadian Codes of Practice were calculated for each compartment of the trailers. All quad-axle (77%) and tri-axle (23%) cattle trailers were reported with 5 compartments (nose, deck, belly, back, and doghouse). Sixty percent of all animals were carried in the middle compartments (deck and belly), 30% in the rear (back and doghouse), and 10% in the front or nose. Approximately 30% of the journeys required that the cattle be redistributed at the Canada-USA border to comply with different axle weight regulations, and most journeys moved them between the deck and the doghouse. Total loaded weight increased and the number of animals decreased with increasing BW of the animals. space allowance, k-value, and DRSA were least for calves and feeders compared with fat and cull cattle (p < 0.01). Both total loaded weight and number of animals increased with the number of axles in the trailer, being greatest in quad-axle trailers pulled by push tractors, which were most frequently used. Space allowance (k-value) was least in vehicles with greater number of axles and transporting the lightest cattle (i.e., quad-axles trailers transporting calves and feeders). Space allowance, k-value, and variability among journeys were least in the middle compartments (belly and deck), followed by the back, then doghouse and nose compartments of the trailers showing the largest values (p < 0.05). Many factors contributed to the variability in SA such as body size (smaller animals are placed more densely), compartment of the trailer (greater density in belly and deck), and number of axles on the vehicle (greater density with more axles). The present study provides a framework to assess and understand factors affecting SA during commercial long distance transport of cattle. This information is vital in assessing the consequences of changing industry standards, guidelines, recommended values, laws and regulations on animal welfare, the industry, and economics.

Factors affecting body weight loss during commercial long haul transport of cattle in North America

The objective of the present study was to identify and quantify several factors affecting shrink in cattle during commercial long-haul transport (≥400 km; n = 6,152 journeys). Surveys were designed and delivered to transport carriers to collect relevant information regarding the characteristics of animals, time of loading, origin and destination, and loaded weight before and after transport. In contrast to fat cattle, feeder cattle exhibited greater shrink (4.9 vs. 7.9 ± 0.2% of BW, respectively; P < 0.01), and experienced longer total transport durations (12.4 vs. 14.9 ± 0.99, respectively; P < 0.01) due to border crossing protocols which require mandatory animal inspection. Shrink was greater (P < 0.001) for feeder cattle loaded at ranches/farms and feed yards compared with those loaded at auction markets. Cattle loaded during the afternoon and evening shrank more than those loaded during the night and morning (P < 0.05). Shrinkage was less in cattle transported by truck drivers having 6 or more years of experience hauling livestock compared with those with 5 yr or less (P < 0.05). Shrink increased with both midpoint ambient temperature (% of BW/°C; P < 0.001) and time on truck (% of BW/h; P < 0.001). Temperature and time on truck had a multiplicative effect on each other because shrink increased most rapidly in cattle transported for both longer durations and at higher ambient temperatures (P < 0.001). The rate of shrink over time (% of BW/h) was greatest in cull cattle, intermediate in calves and feeder cattle, and slowest in fat cattle (P < 0.05) but such differences disappeared when the effects of place of origin, loading time, and experience of truck drivers were included in the model. Cull cattle, calves and feeder cattle appear to be more affected by transport compared with fat cattle going to slaughter because of greater shrink. Several factors should be considered when developing guidelines to reduce cattle transport stress and shrink including type of cattle, ambient temperature, transport duration, driving quality, and time and origin of loading.

Thermoluminescence study of polyminerals extracted from clove and marjoram for detection purposes

Food irradiation is a widely employed technology for food treatment. Since in several countries no regulations prevail, it is difficult to detect whether food has been irradiated or not. Among different analytical methods the study of the thermoluminescent (TL) emission of polymineral extracted from food is one of the most useful physical identification method. The aim of this work is to analyze the TL properties of inorganic polyminerals extracted from commercial clove (Syzygium aromaticum L.) and marjoram (Origanum majorana L.) spices exposed to (60)Co gamma radiation for detection purposes. The feasibility of using the TL method for irradiated food detection and absorbed dose determination is assessed.

Effect of virus infection on the stability and synthesis of actinomycin-resistant ribonucleic acid in baby-hamster kidney cells

1. The sucrose-gradient pattern of (32)P-labelled RNA synthesized in actinomycintreated baby-hamster kidney cells infected with foot-and-mouth-disease virus depends greatly on the period of labelling. 2. Fractions are formed in infected cells that sediment at 12-20s and have the same base composition as similar fractions found in non-infected cells that have been treated with actinomycin. 3. In the presence of guanidine, which completely inhibits viral RNA synthesis, these fractions are labelled to a greater extent than in non-infected cells.

Synthesis of ribonucleic acid in baby-hamster kidney cells in the presence of actinomycin D

1. RNA molecules with sedimentation values in sucrose gradients of 12-20s are synthesized in baby-hamster kidney cells even after prolonged incubation in medium containing 1mug. of actinomycin D/ml. 2. The rate of formation of this RNA is dependent on the age of the cultures and is greatest during the exponential phase of growth. 3. Growth of cells on nutritionally poor medium causes degradation and inhibits the synthesis of these RNA fractions. 4. Replacement of the nutritionally poor medium with a rich medium stimulates the synthesis of actinomycin-resistant RNA. This stimulation is blocked by cycloheximide. 5. The base composition of this RNA is characterized by low cytidine and high guanosine values.

How to select end user clinical data entry devices. Rush University Medical Center develops tool to identify the quantity of devices needed for the implementation of a new EMR and CPOE system

Selecting the right types and quantities of computers to support data entry to an inpatient Electronic Medical Record (EMR) can be challenging. In addition to software and hardware considerations, many other variables affect the decision including staffing levels, hospital workflows, and floor plans. Rush University Medical Center (RUMC) developed a tool to help identify the quantity of devices needed in a Patient Care Unit (PCU). RUMC successfully used the tool in selecting the quantity of devices needed for the implementation of a new EMR and Computerized Provider Order Entry (CPOE) system. This case study describes the use of the tool to determine quantities of PCU devices, the advantages and disadvantages of different types of computing devices for bedside documentation and areas that require special considerations in the selection of devices.