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Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
To determine accessibility of the primary healthcare system for patients with stroke recently discharged from hospital.
This project mapped retrospective patient location data and the location of primary healthcare services in the same region. Patient location data were from all patients with stroke (N = 1595: January 2011–January 2017) discharged from one metropolitan hospital to the local Primary Health Network. Geographic Information System technology was used to map the patient discharge locations and the spatial distribution of primary healthcare services (general practitioner, pharmacy, allied health) across the region. Road network data were used to measure the level of access from each patient’s discharge location to the services.
Access to primary healthcare services was variable. Areas with larger proportions of patients with stroke did not necessarily have good service access. With an increase in travel time, the number of services accessible to patients also increased. However, the spatial variation of access to services remained largely unchanged.
Access to primary healthcare services for patients with stroke varies spatially, with a trend towards relatively low levels of accessibility for many patients. There is an urgent need for future planning to consider geographical access to primary healthcare services for patients with stroke.
OBJECTIVES/SPECIFIC AIMS: Early life stress is known to greatly impact neurodevelopment during critical periods, conferring risk for various psychopathologies, including the onset and exacerbation of schizophrenia and anxiety disorders. The endocannabinoid system is highly integrated into the stress response and may be one means by which early life stress produces such deleterious effects. Using a naturalistic, ecologically valid animal model, this study explored interactions between the stress response and endocannabinoid systems within the cerebellum, a region dense with the CB1 endocannabinoid receptors and shown to be susceptible to stress. METHODS/STUDY POPULATION: This study explored behavioral and neural impacts of early life stress in Long-Evans rats reared with or without limited access to bedding material during postnatal day (PND) 2-9. Corticosterone (CORT) levels were measured at PND8 and 70. During PND50-70, rats were assessed on Novel Object Recognition to test memory, Rotarod to evaluate cerebellar integrity, Elevated Plus Maze to assay anxiety, Social Preference, and Eyeblink Conditioning, a cerebellar-dependent and endocannabinoid-mediated task. Lipid analysis was performed on PND70 tissue samples of cerebellar interpositus (IP) nucleus via high-performance liquid chromatography and tandem mass spectrometry. RESULTS/ANTICIPATED RESULTS: Both male and female rats experiencing early life stress exhibited significantly impaired recognition memory (N = 16-20/group). Female rats having undergone stress exhibited decreased social preference compared to normally reared females (N = 11/group). Stressed males showed facilitated eyblink conditioning compared to normally reared males (N = 7-9/group). There were no group differences in rotarod or elevated plus maze performance or CORT levels at PND8 or 70 across rearing groups. At PND70, male rats experiencing early life stress exhibited a significant decrease in 2-arachidonoyl glycerol (2-AG) and arachidonic acid levels in the IP nucleus compared to normally reared males (N = 8-9/group). Compared to normally reared females, those experiencing early life stress exhibited a significant increase in prostaglandin E2 levels in the IP nucleus (N = 6-7/group). DISCUSSION/SIGNIFICANCE OF IMPACT: Early life stress, induced by limited bedding, resulted in sex-specific behavioral and lipid impairments. Results suggest that stress causes long-term alterations in endocannabinoid dynamics in males in the cerebellar IP nucleus and sex-related lipids in female cerebellum. These changes may contribute to observed long-term behavioral aberrations. Moreover, findings suggest these behavioral changes may be the result of negative-feedback dysfunction (as evidenced by decreased endocannabinoids in males) or increased neural inflammation or proliferation (as evidenced by increased prostaglandins in females). Future analysis will quantify mRNA and protein for cannabinoid receptors to better characterize aberrations to this system. Moreover, other neural regions dense with cannabinoid receptors (i.e., PFC, hippocampus) will be investigated. This work provides a basis for understanding stress impacts on the development of cognitive deficits observed in psychotic and anxiety disorders. Specifically, facilitation of eyblink conditioning complements research in humans with anxiety disorders. Broadly, understanding stress-related endocannabinoid dysregulation may provide insights into risks for, and the development of, psychopathology and uncover novel therapeutic targets with high translational power.
Depression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.
We conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.
Seventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.
Significance of results
Major depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.
This Review describes the objectives and methodology of the DairyWater project as it aims to aid the Irish dairy processing industry in achieving sustainability as it expands. With the abolition of European milk quotas in March 2015, the Republic of Ireland saw a surge in milk production. The DairyWater project was established in anticipation of this expansion of the Irish dairy sector in order to develop innovative solutions for the efficient management of water consumption, wastewater treatment and the resulting energy use within the country's dairy processing industry. Therefore, the project can be divided into three main thematic areas: dairy wastewater treatment technologies and microbial analysis, water re-use and rainwater harvesting and environmental assessment. In order to ensure the project remains as relevant as possible to the industry, a project advisory board containing key industry stakeholders has been established. To date, a number of large scale studies, using data obtained directly from the Irish dairy industry, have been performed. Additionally, pilot-scale wastewater treatment (intermittently aerated sequencing batch reactor) and tertiary treatment (flow-through pulsed ultraviolet system) technologies have been demonstrated within the project. Further details on selected aspects of the project are discussed in greater detail in the subsequent cluster of research communications.
In this Research Communication we investigate potential correlations between key bacterial groups and nutrient removal efficiency in an Intermittently Aerated Sequencing Batch Reactor (IASBR) treating synthetic dairy processing wastewater. Reactor aeration rates of 0·6 and 0·4 litre per minute (LPM) were applied to an 8 l laboratory scale system and the relative impacts on IASBR microbial community structure and orthophosphate (PO4-P) and ammonium (NH4-N) removal efficiencies compared. Aeration at 0·6 LPM over several sludge retention times (SRTs) resulted in approximately 92% removal efficiencies for both PO4-P and NH4-N. Biomass samples subjected to next-generation sequencing (NGS), 16S rRNA profiling revealed a concomitant enrichment of Polaromonas under 0·6 LPM conditions, up to ~50% relative abundance within the reactor biomass. The subsequent shift in reactor aeration to 0·4 LPM, over a period of 3 SRTs, resulted in markedly reduced nutrient removal efficiencies for PO4-P (50%) and NH4-N (45%). An 85·7% reduction in the genus level relative abundance of Polaromonas was observed under 0·4 LPM aeration conditions over the same period.
This Research Communication describes an investigation into the viability of an Intermittently Aerated Sequencing Batch Reactor (IASBR) for the treatment of dairy processing wastewater at laboratory-scale. A number of operational parameters have been varied and the effect has been monitored in order to determine optimal conditions for maximising removal efficiencies. These operational parameters include Hydraulic Retention Time (HRT), Solids Retention Time (SRT), aeration rate and cycle length. Real dairy processing wastewater and synthetic wastewater have been treated using three laboratory-scale IASBR units in a temperature controlled room. When the operational conditions were established, the units were seeded using sludge from a municipal wastewater treatment plant for the first experiment, and sludge from a dairy processing factory for the second and third experiment. In experiment three, the reactors were fed on real wastewater from the wastewater treatment plant at this dairy processing factory. These laboratory-scale systems will be used to demonstrate over time that the IASBR system is a consistent, viable option for treatment of dairy processing wastewater in this sector. In this study, the capacity of a biological system to remove both nitrogen and phosphorus within one reactor will be demonstrated. The initial operational parameters for a pilot-scale IASBR system will be derived from the results of the study.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.
To examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition.
ICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation.
Routine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians.
There were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged.
ICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors.
Nexus is the official publication of the biennial German Jewish Studies Workshop, which was inaugurated at Duke University in 2009, and is now held at the University of Notre Dame. Together, Nexus and the Workshop constitute the first ongoing forum in North America for German Jewish Studies. Nexus publishes innovative research in German Jewish Studies, introducing new directions, analyzing the development and definition of the field, and considering its place vis-à-vis both German Studies and Jewish Studies. Additionally, it examines issues of pedagogy and programming at the undergraduate, graduate, and community levels. Nexus 3 features special forum sections on Heinrich Heine and Karl Kraus. Renowned Heine scholar Jeffrey Sammons offers a magisterial critical retrospective on this towering "German Jewish" author, followed by a response from Ritchie Robertson, while the dean of Kraus scholarship, Edward Timms, reflects on the challenges and rewards oftranslating German Jewish dialect into English. Paul Reitter provides a thoughtful response.
Contributors: Angela Botelho, Jay Geller, Abigail Gillman, Jeffrey A. Grossman, Leo Lensing, Georg Mein, Paul Reitter, Ritchie Robertson, Jeffrey L. Sammons, Egon Schwarz, Edward Timms, Liliane Weissberg, Emma Woelk.
William Collins Donahue is the John J. Cavanaugh Professor of the Humanities at the University of Notre Dame, where he chairs the Department of German and Russian. Martha B. Helfer is Professor of German and an affiliate member of the Department of Jewish Studies at Rutgers, The State University of New Jersey.
Subjective reports on the effectiveness of and satisfaction with writing interventions in medical populations have indicated that they can have a profound impact on patients. Further, past research on these programs has demonstrated that they can lead to a number of different positive outcomes depending on the personal characteristics of the participating patients and the type of writing with which they are tasked. For this reason, a flexible and individually tailored writing intervention may be particularly effective for patients, molding its approach to their desires and backgrounds. This paper examines Visible Ink, a writing program for cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) that follows this model.
At Visible Ink's First Fall Writing Festival in November 2012, an optional survey was provided to all program participants in attendance, capturing both quantitative and qualitative information on patient experiences in the program. Twenty-nine surveys were completed.
The program appears to have a variety of positive effects, including fostering personal growth and providing a positive distraction. Respondents reported that they write in a number of different genres on topics both related and not related to their illnesses, which supports the flexible model of the program. All respondents indicated that they would recommend the program to others, and satisfaction with the program's general approach (i.e., individualized work with a writing coach) was unanimous. A few areas for potential improvement were also identified, most of which involved expanding the services and events offered by the program.
Significance of results:
Despite the limitations of this survey (e.g., small sample size and low response rate), its results support the promise of the Visible Ink model and demonstrate participants' satisfaction with the program. Future research can more thoroughly examine Visible Ink's effectiveness, and additional resources could enable the program to expand.
A large body of research has shown that suffixes—both inflectional and derivational—can be primed with adult native speakers, which informs our understanding of storage and access to morphology in mature systems. However, this line of research has not yet been conducted from an acquisition perspective: Little is known about whether or not representations of suffixes are formed after very little exposure to new morphology and, if so, about the nature of those representations or about the influence of attentional orientation and meaning at this initial stage. The three experiments reported here begin to address this gap by investigating the nature of suffixal representations following exposure to a small regular system of suffixed words. The experiment used crossmodal priming of recognition memory judgments to probe morphological representation. Although the lack of priming suggested that abstract morphological representations were not yet established, recognition judgments showed a clear sensitivity to sublexical morphemic units. The pattern of results was unaffected by the orientation of attention or the assignation of meaning to the words or suffixes during training. Offline tests of learning stem and suffix meanings also showed that both were learned to some extent even when attention was not oriented to their meanings and that the resulting knowledge was partially implicit. Thus, there was evidence of sensitivity to both the forms and meanings of the suffixes but not at the level required to support crossmodal priming. We argue that the reason for this may lie in the episodic nature of the knowledge gained after brief exposure.