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Typical enteropathogenic Escherichia coli (tEPEC) infection is a major cause of diarrhoea and contributor to mortality in children <5 years old in developing countries. Data were analysed from the Global Enteric Multicenter Study examining children <5 years old seeking care for moderate-to-severe diarrhoea (MSD) in Kenya. Stool specimens were tested for enteric pathogens, including by multiplex polymerase chain reaction for gene targets of tEPEC. Demographic, clinical and anthropometric data were collected at enrolment and ~60-days later; multivariable logistic regressions were constructed. Of 1778 MSD cases enrolled from 2008 to 2012, 135 (7.6%) children tested positive for tEPEC. In a case-to-case comparison among MSD cases, tEPEC was independently associated with presentation at enrolment with a loss of skin turgor (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) 1.37–3.17), and convulsions (aOR 2.83, 95% CI 1.12–7.14). At follow-up, infants with tEPEC compared to those without were associated with being underweight (OR 2.2, 95% CI 1.3–3.6) and wasted (OR 2.5, 95% CI 1.3–4.6). Among MSD cases, tEPEC was associated with mortality (aOR 2.85, 95% CI 1.47–5.55). This study suggests that tEPEC contributes to morbidity and mortality in children. Interventions aimed at defining and reducing the burden of tEPEC and its sequelae should be urgently investigated, prioritised and implemented.
The excitation of low frequency dust acoustic (or dust density) waves in a dusty plasma can be driven by the flow of ions relative to dust. We consider the nonlinear development of the ion–dust streaming instability in a highly collisional plasma, where the ion and dust collision frequencies are a significant fraction of their corresponding plasma frequencies. This collisional parameter regime may be relevant to dusty plasma experiments under microgravity or ground-based conditions with high gas pressure. One-dimensional particle-in-cell simulations are presented, which take into account collisions of ions and dust with neutrals, and a background electric field that drives the ion flow. Ion flow speeds of the order of a few times thermal are considered. Waveforms of the dust density are found to have broad troughs and sharp crests in the nonlinear phase. The results are compared with the nonlinear development of the ion–dust streaming instability in a plasma with low collisionality.
Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke.
We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery.
We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone.
Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%.
The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.
OBJECTIVES/GOALS: Regardless of their career choices, today’s biomedical researchers need to blend great science with core skills ininnovation and entrepreneurship (I&E). The objective of this NIH-funded education program was to develop and test a pragmatic training program to teach relevant I&E skills. METHODS/STUDY POPULATION: We used a modified Delphi approach to identify 15 relevant competencies for I&E and the essential topics to include in the program. Learner interviews identified preferences for online training programs (short, high-quality audio-visual content, ability to self-navigate, peer and instructor interactions). The inaugural program included 7 short, online courses that addressed how to identify and validate opportunities for innovation, sell your innovation to diverse audiences, assess its ethical consequences, work in teams, and develop resilience as an innovator. It also included mentor support, a team-based capstone project, and an optional in-person boot camp. RESULTS/ANTICIPATED RESULTS: 51 students enrolled and 41 participants from 9 institutions completed the program, including pre- and post-doctoral students and junior faculty. They organized into 10 teams to complete the capstone project, with 6 teams pitching their innovation to fellow students and mentors at the boot camp. Students rated satisfaction with courses highly overall, with 79% stating they would be disappointed if the program was no longer available. Preliminary results suggest participants increased their knowledge about and ability to perform tasks taught throughout the program. Suggestions for improvement included providing more practical advice and real-world examples to complement educational videos. DISCUSSION/SIGNIFICANCE OF IMPACT: The inaugural E4B program was well received and effective in increasing I&E skills. Improvements will include increased opportunity for mentor interactions and for advanced entrepreneurial training. The program is open for biomedical research trainees from all institutions with a CTSA award.
A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.
We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.
Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.
High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.
Chapter 4 directly links the regulations introduced in Chapter 3 with public meetings. This chapter focuses on why proposals end up in public meetings and what types of issues members of the public and zoning officials raise. We introduce the novel data on meeting minutes from Massachusetts cities and towns that we use in Chapters 4, 5, and 6. Using these meeting minutes, we trace 100 randomly selected proposals in which we collected especially detailed project and meeting information. We show that once a project requires a public hearing, members of the public raise any and all concerns—not just those directly pertaining to the regulations that necessitated a meeting in the first place. The regulations described in Chapter 3 provide the opportunities for neighborhood defenders to air virtually all of their concerns and objections.
Chapter 2 develops our theory, highlighting how land use regulations and participatory inequalities come together to constrain the supply of new housing. We use a detailed case study of a Catholic Church redevelopment project to illustrate how neighbors opposed to development are able to delay development and reduce what gets built by participating in the planning and permitting process.
Chapter 1 uses several illustrative case studies to introduce the central argument of this book: that land use institutions ostensibly designed to empower underrepresented neighborhood groups actually amplify the power of neighborhood defenders to stop and delay the construction of new housing. We then situate this argument in the broader context of rising national housing costs, and the negative social, economic, and environmental consequences of the nationwide housing crunch.
Chapter 3 uses land use regulation and housing permitting data to: (1) clearly describe how land use regulations operate and (2) statistically link their proliferation with a diminished housing supply. We show how regulations create opportunities for opponents to file lawsuits, and how these lawsuits in turn reduce development. In order to address potential selection bias in our empirical analyses, we then use the redevelopment of Catholic Church properties across the greater Boston area as a natural experiment, and show that zoning regulations of all types decreased the density of the housing built on former church sites.
Chapter 6 then explores how these individuals stymy housing development using a mix of quantitative analysis of meeting minutes, in-depth case studies, and dozens of interviews with government officials, developers, and community activists. We analyze the wide range of concerns raised by meeting attendees and how commenters use in-depth knowledge of local zoning regulations to raise objections to special permits and variances.