Proton Pump Inhibitor Use and Iron Deficiency Anemia in Celiac Patients.

INTRODUCTION: We sought to evaluate the effect of proton pump inhibitor (PPI) use on the development and severity of iron deficiency anemia (IDA) in celiac disease (CD). METHODS: We conducted a retrospective chart review of patients older than 18 years of age at Milton S. Hershey Medical Center who were diagnosed with CD. We analyzed four cohorts of celiac patients: (1) IDA diagnosis with PPI usage, (2) no IDA diagnosis with PPI usage, (3) IDA diagnosis with no PPI usage, and (4) no IDA diagnosis with no PPI usage. We also stratified celiac patients with IDA by anemia severity. RESULTS: Of 366 celiac patients, 92 (25.1%) were diagnosed with IDA, of which 60 (65.2%) were on a PPI. The mean Hgb of celiac patients with IDA on a PPI was 11.1 g/dL and 12.1 g/dL for those without PPI (p = 0.04). For all celiac patients on a PPI without IDA, the mean was 13.3 g/dL and 13.7 g/dL for those without PPI (p = 0.02). PPI use occurred in 12 (70.6%) of the 17 patients with low severity anemia, 11 (64.7%) of the 17 patients with medium severity and 6 (85.7%) of the 7 patients with severe (p = 0.55). CONCLUSIONS: There is significant association between PPI use and IDA in celiac patients (p < 0.0001). Of those with IDA on PPIs, the distribution of the severity of anemia is not statistically different compared to those not on PPI. Discontinuation of PPIs or usage of alternative acid suppressive treatments may be indicated in patients with CD and iron deficiency anemia.

Anaplasmosis in Pennsylvania: Clinical Features, Diagnosis, and Outcomes of Patients Diagnosed With Anaplasma phagocytophilum Infection at Hershey Medical Center From 2008 to 2021.

Anaplasmosis is an emerging infection in the United States and in particular, Pennsylvania. We highlight the abrupt rise in cases of anaplasmosis in the past decade in the state of Pennsylvania with the hope of increasing clinician awareness. We identified a cohort of 61 patients diagnosed with anaplasmosis at our institution as well as cases reported to the Department of Health. From our review, we identified not only an increase in cases over time but what appears to be an expansion further into central and western Pennsylvania over time.

Opportunities for Antibiotic Reduction in Pediatric Patients With Urinary Tract Infection After Discharge From the Emergency Department.

OBJECTIVES: The aim of this study was to evaluate how often antibiotics are adjusted by providers, specifically discontinued or de-escalated to a more narrow-spectrum agent, based on final culture and susceptibility results, when treating patients diagnosed with a urinary tract infection (UTI) in the pediatric emergency department (ED). METHODS: This was a retrospective study of pediatric patients younger than 18 years who were discharged home from the ED with a diagnosis of UTI between January 1, 2018, and December 31, 2019. Patients were included if a urine culture was sent as part of their UTI workup and were excluded if they had been pretreated with antibiotics before the diagnosis. Discontinuation was considered possible if the urine culture had no or insignificant bacterial growth. De-escalation was defined as changing to a more narrow-spectrum antibiotic based on susceptibility testing. RESULTS: Empiric antibiotics were prescribed in 131 of 136 UTI episodes. Cefdinir (39%) and cephalexin (36%) were most commonly prescribed, but agents and durations were inconsistent. Discontinuation occurred in only 4 of 52 possible episodes (8%), resulting in a median of 6 extra days of unnecessary antibiotics per episode. For 62 of the 78 cases (79%) with culture confirmation, the prescribed empiric antibiotic was active against the isolated pathogen. A narrower agent could have been used in 29 of 62 (47%) of these cases. However, de-escalation was never attempted. Lack of de-escalation in these episodes resulted in a median of 7 extra days of unnecessary broad-spectrum antibiotic exposure. CONCLUSIONS: Inconsistent empiric antibiotics and inaccurate diagnosis result in excess antibiotic exposures for pediatric patients diagnosed with UTI. Postdischarge antimicrobial stewardship interventions are needed to reduce unnecessary antibiotic exposure in children.

Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis : A Randomized Clinical Trial.

BACKGROUND: Yoga is a mind-body exercise typically done in groups in person, but this delivery method can be inconvenient, inaccessible, and costly. Effective online programs may increase access to exercise for knee osteoarthritis. OBJECTIVE: To evaluate the effectiveness of an unsupervised 12-week online yoga program. DESIGN: Two-group superiority randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620000012976). SETTING: Community. PARTICIPANTS: 212 adults with symptomatic knee osteoarthritis. INTERVENTION: Both groups received online osteoarthritis information (control). The yoga group also received access to an unsupervised online yoga program delivered via prerecorded videos over 12 weeks (1 video per week, with each session to be performed 3 times per week), with optional continuation thereafter. MEASUREMENTS: Primary outcomes were changes in knee pain during walking (0 to 10 on a numerical rating scale) and physical function (0 to 68 on the Western Ontario and McMaster Universities Osteoarthritis Index) at 12 weeks (primary time point) and 24 weeks, analyzed using mixed-effects linear regression models. Secondary outcomes were self-reported overall knee pain, stiffness, depression, anxiety, stress, global change, quality of life, self-efficacy, fear of movement, and balance confidence. Adverse events were also collected. RESULTS: A total of 195 (92%) and 189 (89%) participants provided 12- and 24-week primary outcomes, respectively. Compared with control at 12 weeks, yoga improved function (between-group mean difference in change, -4.0 [95% CI, -6.8 to -1.3]) but not knee pain during walking (between-group mean difference in change, -0.6 [CI, -1.2 to 0.1]), with more yoga participants than control participants achieving the minimal clinically important difference (MCID) for both outcomes. At 12 weeks, knee stiffness, quality of life, and arthritis self-efficacy improved more with yoga than the control intervention. Benefits were not maintained at 24 weeks. Adverse events were minor. LIMITATION: Participants were unblinded. CONCLUSION: Compared with online education, an unsupervised online yoga program improved physical function but not knee pain at 12 weeks in people with knee osteoarthritis, although the improvement did not reach the MCID and was not sustained at 24 weeks. PRIMARY FUNDING SOURCE: National Health and Medical Research Council and Centres of Research Excellence.

Vitamin D regulation of the immune system and its implications for COVID-19: A mini review.

The novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is at the origin of the current pandemic, predominantly manifests with severe respiratory symptoms and a heightened immune response. One characteristic of SARS-CoV-2 is its capacity to induce cytokine storm leading to acute respiratory distress syndrome. Consequently, agents with the ability to regulate the immune response, such as vitamin D, could become tools either for the prevention or the attenuation of the most severe consequences of the coronavirus disease 2019 (COVID-19). Vitamin D has shown antimicrobial as well as anti-inflammatory properties. While SARS-CoV-2 promotes the release of proinflammatory cytokines, vitamin D attenuates the release of at least some of these same molecules. Inflammatory cytokines have been associated with the clinical phenomena of COVID-19 and in particular with its most dangerous complications. Therefore, the goals of this article are as follows: first, present the numerous roles vitamin D plays in modulating the immune response; second, gather data currently available on COVID-19 clinical presentation and its relation to cytokines and similar molecules; third, expose what it is known about how coronaviruses elicit an inflammatory reaction; and fourth, discuss the potential contribution of vitamin D in reducing the risk and severity of COVID-19.

Neuroendoscopic colloid cyst resection: a case cohort with follow-up and patient satisfaction.

OBJECTIVE: To analyze the safety and efficacy of neuroendoscopic colloid cyst resection and to assess patient satisfaction. METHODS: A retrospective analysis of a single surgeon's experience with neuroendoscopic resection of colloid cysts was performed. Surgeries performed in 56 patients were reviewed. Surgeries involved an anterolateral neuroendoscopic technique. Patients were followed postoperatively for an average of 14.9 months. Patients were also interviewed regarding their preoperative symptoms, resolution of symptoms postoperatively, and their degree of satisfaction. RESULTS: The median operative time was 82 minutes, and the median duration of hospital stay was 5 days. During surgery, the ventricles were explored for residual cyst wall or cyst content, and none were encountered. On immediate postoperative imaging, cyst recurrence was not noted for any patient, and only 1 patient has had evidence of recurrence on long-term follow-up. Various preoperative symptoms were described by patients; depending on the specific symptoms, 70%-100% resolution of symptoms was shown after surgery. Along with clinical follow-up, patients were interviewed regarding their perception of surgery and recovery. Of the patients contacted, 100% reported satisfaction with the surgery, and 91% noted satisfaction with their recovery. Reported complications included memory loss, infection, deep vein thrombosis, and postoperative hematoma. There were 2 perioperative deaths (3.5%) related to surgery. CONCLUSIONS: Neuroendoscopic colloid cyst resection can reliably achieve complete lesion removal with short operative times. In addition, there is a high level of reported patient satisfaction. To our knowledge, this is the largest case series of neuroendoscopic colloid cyst resections from a single surgeon.

William james, gustav fechner, and early psychophysics.

American psychologist and philosopher William James devoted the entirety of his career to exploring the nature of volition, as expressed by such phenomena as will, attention, and belief. As part of that endeavor, James's unorthodox scientific pursuits, from his experiments with nitrous oxide and hallucinogenic drugs to his investigation of spiritualist mediums, represent his attempt to address the "hard problems" of consciousness for which his training in brain physiology and experimental psychology could not entirely account. As a student, James's reading in chemistry and physics had sparked his interest in the concepts of energy and force, terms that he later deployed in his writing about consciousness and in his arguments against philosophical monism and scientific materialism, as he developed his "radically empiricist" ideas privileging discontinuity and plurality. Despite James's long campaign against scientific materialism, he was, however, convinced of the existence of a naturalistic explanation for the more "wayward and fitful" aspects of mind, including transcendent experiences associated with hysteria, genius, and religious ecstasy. In this paper, I examine aspects of James's thought that are still important for contemporary debates in psychology and neuroscience: his "transmission theory" of consciousness, his ideas on the "knowing of things together," and, finally, the related concept of "the compounding of consciousness," which postulates the theoretical possibility for individual entities within a conscious system of thought to "know" the thoughts of others within the system. Taken together, these ideas suggest that James, in spite of, or perhaps because of, his forays into metaphysics, was working toward a naturalistic understanding of consciousness, what I will term a "distributive model," based on his understanding of consciousness as an "awareness" that interacts dynamically within, and in relation to, its environment.

Factors contributing to the effectiveness of four school-based sexual violence interventions.

This study extends past research by examining factors associated with changes in attitudes, knowledge, and intended behaviors related to sexual assault. This study included 1,182 participants from four unique multiple-session school-based sexual violence interventions. Implementation and participant factors examined include single- versus mixed-gender groups, group setting versus classroom lecture setting, and participant gender. Participants completed self-administered, paper-and-pencil pre- and postsurveys. A significant desired overall effect was found on participants' reports of positive attitudes, beliefs, and behavior regarding sexual harassment and personal boundaries and positive dating relationship norms (from pretest to posttest). There were steeper increases over time in both measures, with larger mixed-gender/single-gender differences among boys than among girls. Differences in the impact of participating in mixed- versus single-gender groups depended on classroom versus small group settings. The implications of these findings are discussed for sexual assault prevention programs.

Logic models as a tool for sexual violence prevention program development.

Sexual violence is a growing public health problem, and there is an urgent need to develop sexual violence prevention programs. Logic models have emerged as a vital tool in program development. The Centers for Disease Control and Prevention funded an empowerment evaluation designed to work with programs focused on the prevention of first-time male perpetration of sexual violence, and it included as one of its goals, the development of program logic models. Two case studies are presented that describe how significant positive changes can be made to programs as a result of their developing logic models that accurately describe desired outcomes. The first case study describes how the logic model development process made an organization aware of the importance of a program's environmental context for program success; the second case study demonstrates how developing a program logic model can elucidate gaps in organizational programming and suggest ways to close those gaps.

Empowering programs with evaluation technical assistance: outcomes and lessons learned.

Although empowerment evaluation has gained widespread currency, few reports have described its outcomes. This article combines perspectives of participants and technical assistance providers to describe the process and outcomes of the Evaluation Assistance for Sexual Violence Programs project. Participating programs reported substantial enhancements in evaluation capacity, resources devoted to evaluation, and the extent and sophistication of their evaluation practice, as well as numerous examples of the application of evaluation findings to program improvement. Experiences from evaluation technical assistance providers identified aspects of the process that were particularly useful in achieving these outcomes, including investing in collaborative relationships, maximizing participation among program staff, tailoring the content and form of technical assistance to program preferences, and combining structured learning with program-specific technical assistance.

Correlates of HIV-related risk behaviors in African American adolescents from substance-using families: patterns of adolescent-level factors associated with sexual experience and substance use.

PURPOSE: To examine adolescent-level correlates of HIV-related risk behaviors among urban African American adolescents whose mothers use crack cocaine. METHODS: Interviews were conducted with 208 African American adolescents (aged 12-17 years) to assess psychosocial, behavioral, and perceived environment correlates of HIV-related risk behavior. Adolescents were children of community-recruited African American women not currently in drug treatment who reported crack cocaine use (in last 6 months). Bivariate and multivariate regression models were used to evaluate associations among adolescent-level factors, sexual experience, and substance use. RESULTS: Of the adolescents, 30% reported being sexually experienced, and 23% reported alcohol or drug use in the past month. Older age and lower school satisfaction were associated with both sexual experience and substance use, but no other factors were associated with both risk behaviors. Male gender, current substance use, high HIV/AIDS knowledge, and high risk perception were associated with being sexual experienced. Sexual experience and lower expectations for future life outcomes were associated with substance use. A general pattern of protective factors related to attitudes about future goals, help-seeking behavior, and positive feelings about school emerged for substance use. CONCLUSIONS: These results suggest that the patterns of adolescent-level risk and protective factors for sexual experience and substance use may be unique in African American adolescents from substance-abusing families. Instead of an increase in problem behaviors associated with using substances, protective factors were evident, suggesting these adolescents may have resiliency for dealing with environmental stressors related to substance use. Implications for HIV prevention programs involving mentoring and goal development are discussed.

Children of African-American mothers who use crack cocaine: parenting influences on youth substance use.

OBJECTIVE: To examine relationships between parenting behaviors, parent-child relationship, and moderating effects of age on youth substance use among a community sample of African-American mothers who use crack cocaine and their children (12-17 years). METHODS: Maternal-child dyads (n = 208) were recruited through street outreach and snowball sampling and completed interviews about substance use and parenting. RESULTS: Regression analyses found significant main effects of youth age, family conflict, warmth, and disapproval of youth substance use on children's substance use. Age x Parenting interactions were significant for conflict and disapproval. Higher family conflict increased older youths' risk, while higher perceived maternal disapproval protected against substance use for older youth. CONCLUSIONS: Family influences may offer risk and protective effects for adolescent children of maternal drug users. Outreach and family-focused interventions that address family conflict and communication of disapproval of substance use may help reduce intergenerational risk transmission. However, longitudinal research with comprehensive parenting assessments is needed.

Stress and stress reduction among African American women: a brief report.

This brief report looks at the impact of discrimination, poverty and daily hassles on the stress and the subsequent health of African American women. Using this contextual framework, an Africentric, female-centered stress reduction program is presented to address the specific needs of this population. Thirty-three African American women between the ages of 22 and 63 participated in either an 8-h pilot of the proposed Africentric program or a 7-h standard stress reduction intervention. Descriptions of both interventions are presented. Implications for the use of stress reduction techniques in health promotion efforts among African American women are discussed.

Role and regulation of the Shigella flexneri sit and MntH systems.

Shigella flexneri possesses at least two putative high-affinity manganese acquisition systems, SitABCD and MntH. Mutations in the genes encoding the components of both of these systems were constructed in S. flexneri. The sitA mntH mutant showed reduced growth, relative to the wild type, in Luria broth (L broth) containing the divalent metal chelator ethylene diamino-o-dihydroxyphenyl acetic acid, and the addition of either iron or manganese restored growth to the level of the wild-type strain. Although the sitA mntH mutant was not defective in surviving exposure to superoxide generators, it was defective in surviving exposure to hydrogen peroxide. The sitA mntH mutant formed wild-type plaques on Henle cell monolayers but had a reduced ability to survive in activated macrophage lines. Expression of the S. flexneri sit and mntH promoters was higher when Shigella was in Henle cells than when it was in L broth. Expression of both the sit and mntH promoters was repressed by either iron or manganese, and this repression was partially dependent upon Fur and MntR, respectively. The mntH promoter, but not the sit promoter, exhibited OxyR-dependent induction in the presence of hydrogen peroxide.

Central opioid receptors differentially regulate the nalmefene-induced suppression of ethanol- and saccharin-reinforced behaviors in alcohol-preferring (P) rats.

The exact opioid-sensitive receptors participating in EtOH-seeking behaviors remains unclear. Previous studies have reported higher densities of micro-opioid receptor binding in the nucleus accumbens (NACC) of P relative to NP rats; however, no differences were seen in delta-receptor binding. In contrast to the NACC, substantially lower levels of micro-receptor binding have been observed in the ventral tegmental area (VTA) of both P and NP rats, albeit no line differences have been observed. In the present study, opioid receptors in the NACC, VTA, and hippocampus were evaluated for their capacity to regulate both EtOH- and saccharin-motivated behaviors in the genetically selected alcohol-preferring (P) rat. To accomplish this, nalmefene, an opiate antagonist with preferential binding affinity for the micro-opioid receptor was unilaterally or bilaterally infused during concurrent availability of 1 h daily EtOH (10% v/v) and saccharin (0.025 or 0.050% w/v) solutions. Rats performed under a two-lever fixed ratio (FR) schedule in which four responses on one lever produced the EtOH solution, and four on a second lever produced the saccharin solution. The results demonstrated that when responding maintained by both EtOH and saccharin are matched at basal levels, unilateral (1-60 microg) or bilateral (0.5-10 microg) microinjections of nalmefene into the NACC produced selective dose-dependent reductions on responding maintained by EtOH. Unilateral (40, 60 microg) and bilateral (10 microg) VTA infusions were also observed to selectively reduced EtOH responding; however, greater nalmefene doses were required and the magnitude of suppression on EtOH responding was markedly less compared with the NACC. The greater sensitivity of nalmefene to suppress EtOH responding in the NACC is likely due to the greater number of opioid receptors in the NACC relative to the VTA. Only bilateral infusion of the 40 microg dose in the NACC and VTA suppressed responding maintained by both EtOH and saccharin. In contrast, intrahippocampal infusions dose dependently suppressed EtOH- and saccharin-maintained responding over a range of doses (1-20 microg). The present study provides evidence that nalmefene suppresses EtOH-motivated behaviors via blockade of opioid receptors within the NACC and VTA, and under various dose conditions both reinforcer and neuroanatomical specificity can be observed.

Altering cytochrome P4501A activity affects polycyclic aromatic hydrocarbon metabolism and toxicity in rainbow trout (Oncorhynchus mykiss).

The polycyclic aromatic hydrocarbons (PAHs) phenanthrene and retene (7-isopropyl-1-methyl phenanthrene) are lethal to rainbow trout (Oncorhynchus mykiss) larvae during chronic exposures. Phenanthrene is a low-toxicity, non-cytochrome P4501A (CYP1A)-inducing compound that accumulates in fish tissues during exposure to lethal concentrations in water. Retene is a higher toxicity CYP1A-inducing compound that is not detectable in tissue at lethal exposure concentrations. The metabolism, excretion, and toxicity of retene and phenanthrene were examined in juvenile and larval rainbow trout during coexposure to the model CYP1A inducer beta-naphthoflavone (betaNF), or to the inducer-inhibitor piperonyl butoxide to determine if modulating CYP1A activity affected PAH metabolism and toxicity. Phenanthrene metabolism, excretion rate, and toxicity increased with coexposure to betaNE Piperonyl butoxide inhibited phenanthrene metabolism and reduced the excretion of all phenanthrene metabolites. As a consequence, embryo mortality rates increased but rates of sublethal effects did not. Coexposure of trout to retene and betaNF caused no change in retene metabolism and excretion, but retene toxicity increased, perhaps due to additivity. Piperonyl butoxide inhibited retene metabolism, decreased the excretion of some retene metabolites while increasing the excretion of others, and increased the toxicity of retene. These results support the role of CYP1A activity in PAH metabolism and excretion, and the role ofthe CYP1A-generatedmetabolites of PAHs in chronic toxicity to larval fish.