A case of transfusion-transmission Anaplasma phagocytophilum from leukoreduced red blood cells.

BACKGROUND: Anaplasma phagocytophilum is a tick-borne bacterium and the cause of human granulocytic anaplasmosis (HGA). Here, we report a case of transfusion-transmitted (TT)-HGA involving a leukoreduced (LR) red blood cell (RBC) unit. CASE REPORT: A 64-year-old woman with gastric adenocarcinoma and multiple myeloma who received weekly blood transfusions developed persistent fevers, hypotension, and shortness of breath 1 week after receiving an RBC transfusion. Persistent fevers, new thrombocytopenia, and transaminitis suggested a tick-borne infection. RESULTS: The absence of blood parasites on thick and thin blood smears suggested that malaria and Babesia infection were not present, and the recipient tested negative for antibodies to Borrelia burgdorferi. Blood testing by polymerase chain reaction (PCR) for Ehrlichia and Anaplasma species identified A. phagocytophilum. Treatment with doxycycline resolved the infection; however, the recipient expired due to complications of her known malignancies. The recipient lived in a nursing home and did not have pets or spend time outdoors. The donor was a female in her 70s from Maine who was diagnosed with HGA 3 weeks after donating blood and whose LR-RBCs from the donation were transfused to the recipient 9 days following collection. CONCLUSION: This is a confirmed case of TT-HGA. Although rare, TT-HGA has been reported with LR-RBCs and platelets. In endemic areas, testing for tick-borne associated infections should be considered when investigating post-transfusion complications.

Exploring Calcium Manganese Oxide as a Promising Cathode Material for Calcium-Ion Batteries.

The dependence on lithium for the energy needs of the world, coupled with its scarcity, has prompted the exploration of postlithium alternatives. Calcium-ion batteries are one such possible alternative owing to their high energy density, similar reduction potential, and naturally higher abundance. A critical gap in calcium-ion batteries is the lack of suitable cathodes for intercalating calcium at high voltages and capacities while also maintaining structural stability. Transition metal oxide postspinels have been identified as having crystal structures that can provide low migration barriers, high voltages, and facile transport pathways for calcium ions and thus can serve as cathodes for calcium-ion batteries. However, experimental validation of transition metal oxide postspinel compounds for calcium ion conduction remains unexplored. In this work, calcium manganese oxide (CaMn2O4) in the postspinel phase is explored as an intercalation cathode for calcium-ion batteries. CaMn2O4 is first synthesized via solid-state synthesis, and the phase is verified with X-ray diffraction (XRD). The redox activity of the cathode is investigated with cyclic voltammetry (CV) and galvanostatic (GS) cycling, identifying oxidation potentials at 0.2 and 0.5 V and a broad insertion potential at -1.5 V. CaMn2O4 can cycle at a capacity of 52 mAh/g at a rate of C/33, and calcium cycling is verified with energy-dispersive X-ray spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS) and modeled with density functional theory (DFT) simulations. The results from the investigation concluded that CaMn2O4 is a promising cathode for calcium-ion batteries.

Plating and Stripping Calcium Metal in Potassium Hexafluorophosphate Electrolyte toward a Stable Hybrid Solid Electrolyte Interphase.

The use of calcium (Ca) metal anodes in batteries is currently challenged by the development of a suitable solid electrolyte interface (SEI) that enables effective Ca2+ ion transport. Native calcium electrolytes produce a passivation layer on the surface of the calcium electrodes during cycling, causing a decrease in capacity during cycling and the need for large overpotentials. The use of a hybrid SEI is a strategy to mitigate the uncontrolled production of a passivation layer and reduce the overpotentials needed for the plating and stripping of calcium. Here, we report the development of a hybrid potassium (K)/Ca SEI layer investigated in symmetric Ca//Ca cell configurations. Using KPF6 salt in a ternary mixture of carbonate solvent (EC/EMC/DMC), Ca//Ca cells can be cycled up to 200 h at a capacity of 0.15 mAh/cm2 with a current density of 0.025 mA/cm2. The symmetrical cells consistently cycle at overpotentials of 1.8 V. Ex-situ X-ray diffraction (XRD) of cycled electrodes reveals plating and stripping of both calcium and potassium. Energy dispersive X-ray (EDX) maps confirm the plating of calcium and potassium during galvanostatic cycling. Scanning electron microscopy (SEM) cross-sectional views of the calcium electrodes reveal a continuous SEI layer formed over the calcium metal. XRD analysis reveals the SEI layer consists of K-based inorganics along with the identification of permanent and transient phases. FTIR outlines the parallel plating of both calcium and potassium at both regions of redox activity. Raman spectroscopy of the electrolyte reveals compositional changes over the course of cycling that promote increased plating and stripping. The results indicate that potassium electrolytes are a possible route for tuning the SEI to enable reversible calcium electrochemical cycling.

Social capital I: measurement and associations with economic mobility.

Social capital-the strength of an individual's social network and community-has been identified as a potential determinant of outcomes ranging from education to health1-8. However, efforts to understand what types of social capital matter for these outcomes have been hindered by a lack of social network data. Here, in the first of a pair of papers9, we use data on 21 billion friendships from Facebook to study social capital. We measure and analyse three types of social capital by ZIP (postal) code in the United States: (1) connectedness between different types of people, such as those with low versus high socioeconomic status (SES); (2) social cohesion, such as the extent of cliques in friendship networks; and (3) civic engagement, such as rates of volunteering. These measures vary substantially across areas, but are not highly correlated with each other. We demonstrate the importance of distinguishing these forms of social capital by analysing their associations with economic mobility across areas. The share of high-SES friends among individuals with low SES-which we term economic connectedness-is among the strongest predictors of upward income mobility identified to date10,11. Other social capital measures are not strongly associated with economic mobility. If children with low-SES parents were to grow up in counties with economic connectedness comparable to that of the average child with high-SES parents, their incomes in adulthood would increase by 20% on average. Differences in economic connectedness can explain well-known relationships between upward income mobility and racial segregation, poverty rates, and inequality12-14. To support further research and policy interventions, we publicly release privacy-protected statistics on social capital by ZIP code at https://www.socialcapital.org .

Social capital II: determinants of economic connectedness.

Low levels of social interaction across class lines have generated widespread concern1-4 and are associated with worse outcomes, such as lower rates of upward income mobility4-7. Here we analyse the determinants of cross-class interaction using data from Facebook, building on the analysis in our companion paper7. We show that about half of the social disconnection across socioeconomic lines-measured as the difference in the share of high-socioeconomic status (SES) friends between people with low and high SES-is explained by differences in exposure to people with high SES in groups such as schools and religious organizations. The other half is explained by friending bias-the tendency for people with low SES to befriend people with high SES at lower rates even conditional on exposure. Friending bias is shaped by the structure of the groups in which people interact. For example, friending bias is higher in larger and more diverse groups and lower in religious organizations than in schools and workplaces. Distinguishing exposure from friending bias is helpful for identifying interventions to increase cross-SES friendships (economic connectedness). Using fluctuations in the share of students with high SES across high school cohorts, we show that increases in high-SES exposure lead low-SES people to form more friendships with high-SES people in schools that exhibit low levels of friending bias. Thus, socioeconomic integration can increase economic connectedness in communities in which friending bias is low. By contrast, when friending bias is high, increasing cross-SES interactions among existing members may be necessary to increase economic connectedness. To support such efforts, we release privacy-protected statistics on economic connectedness, exposure and friending bias for each ZIP (postal) code, high school and college in the United States at https://www.socialcapital.org .

Primary vs nodal site PET/CT response as a prognostic marker in oropharyngeal squamous cell carcinoma treated with intensity-modulated radiation therapy.

BACKGROUND: Positron emission tomography/computed tomography (PET/CT) in staging of advanced oropharyngeal squamous cell carcinoma (OPSCC) and at 3 months posttreatment (PETpost) is often utilized to assess response. The significance of lymph node vs primary site treatment response is incompletely understood. METHODS: We reviewed 230 patients treated with radiation therapy. PETpost response was graded at primary and nodal sites and correlated with survival. RESULTS: Median age was 58, and 83% were p16-positive. Median follow-up was 24.3 months. Nodal response at PETpost predicted improved 2-year local recurrence-free survival (LRFS) (93% vs 72%, P =.004), 2-year disease-free survival (DFS) (80% vs 61.3%, P =.021), and 2-year overall survival (OS) (89% vs 83%, P =.051), while primary response only predicted improved 2-year LRFS (91% vs 76% P = .035). CONCLUSION: In OPSCC patients, both nodal and primary response at 3 months on PET/CT predicted for improved LRFS, but only nodal response predicted DFS and OS.

Evaluation of the Measles Surveillance System in Kaduna State, Nigeria (2010-2012).

OBJECTIVE: To evaluate the case-based measles surveillance system in Kaduna State of Nigeria and identify gaps in its operation. INTRODUCTION: In Africa, approximately 13 million cases, 650,000 deaths due to measles occur annually, with sub-Saharan Africa having the highest morbidity and mortality. Measles infection is endemic in Nigeria and has been documented to occur all year round, despite high measles routine and supplemental immunization coverage. The frequent outbreaks of measles in Kaduna State prompted the need for the evaluation of the measles case-based surveillance system. METHODS: We interviewed stakeholders and conducted a retrospective record review of the measles case-based surveillance data from 2010 - 2012 and adapted the 2001 CDC guidelines on surveillance evaluation and the Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks, to assess the systems usefulness, representativeness, timeliness, stability, acceptability and data quality. We calculated the annualized detection rate of measles and non-measles febrile rash, proportion of available results, proportion of LGAs (Districts) that investigated at least one case with blood, proportion of cases that were IgM positive and the incidence of measles. We compared the results with WHO(2004) recommended performance indicators to determine the quality and effectiveness of measles surveillance system. RESULTS: According to the Stakeholders, the case-based surveillance system was useful and acceptable. Median interval between specimen collection and release of result was 7days (1 - 25 days) in 2010, 38 days (Range: 16 - 109 days) in 2011 and 11 days (Range: 1 - 105 days) in 2012. The annualized detection rate of measles rash in 2010 was 2.1 (target: 32), 1.0 (target: 32) in 2011 and 1.4 (target: 32) in 2012. The annualized detection rate of non-measles febrile rash in 2010 was 2.1 (target: 32), 0.6 (target: 32) in 2011 and 0.8 (target: 32) in 2012. Case definitions are simple and understood by all the operators. CONCLUSION: This evaluation showed that the surveillance system was still useful. Also, the efficiency and effectiveness of the laboratory component as captured by the "median interval between specimen collection and the release of results improved in 2010 and 2012 compared to 2011. However, there was a progressive decline in the timeliness and completeness of weekly reports in the years under review.

Transplantation of solid organs procured from influenza A H1N1 infected donors.

Following the influenza A H1N1 (swine flu) pandemic, there remains little evidence informing the safety of transplanting organs from donors suspected or diagnosed with H1N1. Limited guidelines from the major transplant societies leave the use of such organs at the discretion of individual transplant centres, and practice varies considerably both nationally and internationally. We present the largest published series of outcome following transplantation of organs from H1N1 positive donors and demonstrate that these organs can be transplanted safely and with good short-term outcome. We discuss our local policy for treatment of recipients with Oseltamivir.

Leiomyoma of the urinary bladder presenting as urinary retention in the female.

A case of leiomyoma of the urinary bladder, a rare benign tumor, in a 56-year-old female first seen with bilateral flank pain radiating to both groins, is reported. Examination showed a well developed female with obesity (260 pounds) and elevated blood pressure (132/90 mmHg). Evaluation with ultrasound, cystoscopy, urodynamics, and cytology contributed to the diagnosis of urinary bladder leiomyoma. Ultrasound detected a mass in the urinary bladder, and it was confirmed by cystoscopy to be a 5 cm to 6 cm bladder mass on the anterior bladder wall. The mass was prolapsing as a ball valve into the urethra at the level of the bladder neck. Frozen section of the mass showed it to be leiomyoma.

Systematic review and validation of prognostic models in liver transplantation.

A model that can accurately predict post-liver transplant mortality would be useful for clinical decision making, would help to provide patients with prognostic information, and would facilitate fair comparisons of surgical performance between transplant units. A systematic review of the literature was carried out to assess the quality of the studies that developed and validated prognostic models for mortality after liver transplantation and to validate existing models in a large data set of patients transplanted in the United Kingdom (UK) and Ireland between March 1994 and September 2003. Five prognostic model papers were identified. The quality of the development and validation of all prognostic models was suboptimal according to an explicit assessment tool of the internal, external, and statistical validity, model evaluation, and practicality. The discriminatory ability of the identified models in the UK and Ireland data set was poor (area under the receiver operating characteristic curve always smaller than 0.7 for adult populations). Due to the poor quality of the reporting, the methodology used for the development of the model could not always be determined. In conclusion, these findings demonstrate that currently available prognostic models of mortality after liver transplantation can have only a limited role in clinical practice, audit, and research.