Atrazine degradation through a heterogeneous dual-effect process using Fe-TiO2-allophane catalysts under sunlight.

This study investigated the novel application of Fe-TiO2-allophane catalysts with 6.0 % w/w of iron oxide and two TiO2 proportions (10 % and 30 % w/w) for degrading atrazine (ATZ) using the heterogeneous dual-effect (HDE) process under sunlight. Comparative analyses with Fe-allophane and TiO2-allophane catalysts were conducted in both photocatalysis (PC) and HDE processes. FTIR spectra reveal the unique hydrous feldspathoids structure of allophane, showing evidence of new bond formation between Si-O groups of allophane clays and iron hydroxyl species, as well as Si-O-Ti bonds that intensified with higher TiO2 content. The catalysts exhibited an anatase structure. In Fe-TiO2-allophane catalysts, iron oxide was incorporated through the substitution of Ti4+ by Fe3+ in the anatase crystal lattice and precipitation on the surface of allophane clays, forming small iron oxide particles. Allophane clays reduced the agglomeration and particle size of TiO2, resulting in an enhanced specific surface area and pore volume for all catalysts. Iron oxide incorporation decreased the band gap, broadening the photoresponse to visible light. In the PC process, TiO2-allophane achieves 90 % ATZ degradation, attributed to radical species from the UV component of sunlight. In the HDE process, Fe-TiO2-allophane catalysts exhibit synergistic effects, particularly with 30 % w/w TiO2, achieving 100 % ATZ degradation and 85 % COD removal, with shorter reaction time as TiO2 percentage increased. The HDE process was performed under less acidic conditions, achieving complete ATZ degradation after 6 h without iron leaching. Consequently, Fe-TiO2-allophane catalysts are proposed as a promising alternative for degrading emerging pollutants under environmentally friendly conditions.

Cross-lingual hate speech detection using domain-specific word embeddings.

THIS ARTICLE USES WORDS OR LANGUAGE THAT IS CONSIDERED PROFANE, VULGAR, OR OFFENSIVE BY SOME READERS. Hate speech detection in online social networks is a multidimensional problem, dependent on language and cultural factors. Most supervised learning resources for this task, such as labeled datasets and Natural Language Processing (NLP) tools, have been specifically tailored for English. However, a large portion of web users around the world speak different languages, creating an important need for efficient multilingual hate speech detection approaches. In particular, such approaches should be able to leverage the limited cross-lingual resources currently existing in their learning process. The cross-lingual transfer in this task has been difficult to achieve successfully. Therefore, we propose a simple yet effective method to approach this problem. To our knowledge, ours is the first attempt to create a multilingual embedding model specific to this problem. We validate the effectiveness of our approach by performing an extensive comparative evaluation against several well-known general-purpose language models that, unlike ours, have been trained on massive amounts of data. We focus on a zero-shot cross-lingual evaluation scenario in which we classify hate speech in one language without having access to any labeled data. Despite its simplicity, our embeddings outperform more complex models for most experimental settings we tested. In addition, we provide further evidence of the effectiveness of our approach through an ad hoc qualitative exploratory analysis, which captures how hate speech is displayed in different languages. This analysis allows us to find new cross-lingual relations between words in the hate-speech domain. Overall, our findings indicate common patterns in how hate speech is expressed across languages and that our proposed model can capture such relationships significantly.

Evaluating equity in a national virtual care management intervention: Delivery and outcomes by race/ethnicity among Veterans with hypertension and diabetes.

OBJECTIVE: To evaluate whether the Preventive Health Inventory (PHI)-a virtual care management intervention addressing hypertension and diabetes management implemented nationally in the Veterans Health Administration (VHA)-was delivered equitably among racial/ethnic groups and if existing inequities in hypertension and diabetes outcomes changed following PHI receipt. DATA SOURCES AND STUDY SETTING: We used data from the VHA Corporate Data Warehouse among Veterans enrolled in primary care nationally from February 28, 2021 to March 31, 2022. STUDY DESIGN: We used logistic regression to evaluate PHI receipt and hypertension and diabetes outcomes after PHI implementation among Veterans with hypertension and/or diabetes. We conducted unadjusted analyses and analyses adjusting for clinic fixed effects using dummy variables. DATA COLLECTION/EXTRACTION METHODS: We identified Veterans engaged in primary care with documented race/ethnicity and hypertension and/or diabetes diagnoses in all months during the study period. PRINCIPLE FINDINGS: Prior to PHI, Non-Hispanic Black (NHB) (42.2%) and Hispanic (39.5%) Veterans were less likely to have controlled hypertension vs. Non-Hispanic White (NHW) Veterans (47.5%); NHB Veterans (32.9%) were more likely to have uncontrolled diabetes vs. NHW Veterans (25.1%). Among 1,805,658 Veterans, 5.7% NHW (N = 68,744), 5.6% NHB (N = 22,580), 10.2% Hispanic (N = 13,313), 6.2% Asian/Pacific Islander/Native Hawaiian (N = 1868), 5.1% American Indian/Native Alaskan (N = 744), and 5.6% multiple races or other race (N = 1647) Veterans received PHI. We found no significant racial inequities in PHI receipt in unadjusted and adjusted models. Hypertension and diabetes measures improved more in the intervention group compared with the group who did not receive the intervention. There were no new or worsened inequities after PHI, and in pre-/post-intervention analysis, among NHB Veterans, the inequity in uncontrolled diabetes improved by 1.9 percentage points (95% CI 0.2, 3.6). CONCLUSIONS: Our findings suggest the PHI intervention was equitably deployed across race/ethnicity groups without significantly impacting most existing inequities in diabetes and hypertension.

Surveillance of sand flies (Psychodidae, Phlebotominae) from Mexico: Altitudinal and climatic patterns after historical and new geographic records in endemic areas of leishmaniasis.

This study updates knowledge on historical geographic distribution of sand fly species through identifying altitudinal and bioclimatic patterns in leishmaniasis endemic areas in Mexico. We analyze and identify sand fly specimens obtained through national efforts by the Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE, Mexico), collected between 1995 and 2001, 2008-2012, and 2017-2023, and add bibliographic information (427 additional records). After a principal components analysis of WorldClim variables and altitudinal ranges, variables that better explain the distribution of sand fly species were chosen (BIO6, BIO12, and BIO16, explaining 72 % of variation). A total of 1,187 specimens of 22 species were retrieved from eight states, providing 29 new municipalities and 48 new localities, being Lutzomyia cruciata, Micropygomyia chiapanensis, and Psathyromyia shannoni the most common species. We presented new historical records of distribution for sand fly species from Morelos (3), Oaxaca (7) and Tabasco (1). The 82.7 % of sand fly species analyzed were distributed in areas with altitudinal ranges below 420 m. The anthropophilic species Psathyromyia shannoni, and Lutzomyia cruciata showed the greatest variability regarding altitudinal range, and climatic preferences, while several wild species showed abiotic preferences. It is likely that the effect of urbanization and climate change generate new beneficial biotopes for the proliferation of the vector sand fly species. Complementary studies that consider seasonality, vegetation types, and change in land use could provide new information to better understand the spread of vector-borne diseases.

Identifying Patterns of Primary Care In-Person and Telemedicine Use in the Veterans Health Administration: A Latent Class Analysis.

BACKGROUND: The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. OBJECTIVE: Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. DESIGN: A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. PARTICIPANTS: A random national sample consisting of 564,580 primary care empaneled veterans in June 2021. MAIN MEASURES: Latent class membership. KEY RESULTS: We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). CONCLUSIONS: Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.

Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O, p < 0.01). Of note, children with a Vt less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H2O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H2O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H2O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

New records of Rhipicephalus linnaei infected by Rickettsia massiliae from Central Mexico.

BACKGROUND: On the American continent, Rhipicephalus sanguineus s.l. comprises two species: Rhipicephalus linnaei and R. sanguineus s.s. Each species has been identified as a potential vector of at least one of five species of pathogenic bacteria of the genus Rickettsia. In particular, Rickettsia massiliae is one of three species with the greatest importance in public health at the continental level. In Mexico, this species is reported exclusively in the Nearctic states of Baja California and Chihuahua. AIM: For this reason, the aim of this work was to provide new records of R. massiliae for the centre of the country derived from active acarological surveillance. MATERIALS AND METHODS: During the period of February-October 2019, 29 dogs from six municipalities in the state of Morelos were sampled. Hosts were visually inspected, and ticks were recovered and identified morphologically and molecularly by amplification of the 16S rDNA gene. Subsequently, five genes from members of the genus Rickettsia were amplified and sequenced. RESULTS: A total of 229 (117♀, 98♂ and 14 N) ticks identified as R. linnaei were recovered, two of which were positive for R. massiliae strains related to those recovered from Argentina and the United States. CONCLUSIONS: This work provides the second record of R. massiliae infecting R. linnaei in Mexico and the Americas, increasing the geographic distribution of this Rickettsia species in the Neotropical region, and providing information on the possible role of R. linnaei as a potential vector of this microorganism.

Molecular Evidence of Ehrlichia canis (Rickettsiales: Anaplasmataceae) in Ticks (Ixodida: Ixodidae) Associated with Dogs (Carnivora: Canidae) from Nuevo Leon, Mexico.

Background: Ehrlichia canis is transmitted by ticks causing Canine monocytic ehrlichiosis, which is considered one of the most critical tickborne pathogens. Materials and Methods: This study aimed to identify by PCR technique E. canis in ticks associated with dogs from urban and rural homes in Nuevo Leon, Mexico. The study was conducted at 13 localities in eight municipalities from 2012 to 2021. Results: A total of 1873 ticks of three species were captured: Amblyomma tenellum, Dermacentor variabilis, and Rhipicephalus sanguineus s.l. The overall infection rate of E. canis in ticks was 59.12% (149/252). Of the 15 sequences, three haplotypes were identified. Conclusion: The urban transmission cycle of canine ehrlichiosis is demonstrated, where the potential vector is the tick R. sanguineus s.l.

Species diversity, barcode, detection of pathogens and blood meal pattern in Phlebotominae (Diptera: Psychodidae) from northeastern Mexico.

More than 90 species of phlebotomines are vectors of parasites, bacteria, and viruses, which cause disease in animals and humans. Therefore, their study is necessary to establish prevention and control strategies. Mexico is an endemic country for leishmaniasis, mostly in the center and southern regions of the country, yet only few studies have been conducted in the northern part of the country. The present study aims to: (a) assess the alpha diversity of Phlebotominae in an annual cycle, (b) to correlate climatic variables with abundance, (c) to generate barcodes of these insects as part of the integrative taxonomy, and (d) to detect Leishmania, Wolbachia and blood sources in an area close to where a case of autochthonous leishmaniasis has been detected in Nuevo Leon, Mexico. A systematic sampling was conducted during three consecutive nights from 17:00 to 22:00 h., placing Shannon traps, CDC traps with incandescent light, and BG Sentinel 2 + BG Lure traps. A total catch effort of 660 nights/traps/hours was achieved, in which a total number of 707 phlebotomines (58% female and 42% male) of six species were collected and identified. The most abundant species were Psathyromyia cratifer (57%) and Psathyromyia shannoni sensu stricto (26%). The highest abundance (72%; 507/707) was collected during March, April and May 2021. Barcodes were generated for four species of phlebotomines, which represent new records for Mexico. For the molecular detection of microorganisms, 302 specimens were analyzed, although no specimens were positive for Leishmania spp. Wolbachia strains were detected in phlebotomines with an infection rate of 1.32% (4/302) and found in Pa. cratifer and Lu. cruciata. Likewise, human DNA was identified in female Lu. cruciata and Pa. cratifer phlebotomines. These findings indicate the presence of potential vector species of the parasite Leishmania spp. This result shows the need for further entomological surveillance to elucidate the transmission mechanisms in these northern areas of the country.

Extracting forced vital capacity from the electronic health record through natural language processing in rheumatoid arthritis-associated interstitial lung disease.

PURPOSE: To develop a natural language processing (NLP) tool to extract forced vital capacity (FVC) values from electronic health record (EHR) notes in patients with rheumatoid arthritis-interstitial lung disease (RA-ILD). METHODS: We selected RA-ILD patients (n = 7485) in the Veterans Health Administration (VA) between 2000 and 2020 using validated ICD-9/10 codes. We identified numeric values in proximity to FVC string patterns from clinical notes in the EHR. Subsequently, we performed processing steps to account for variability in note structure, related pulmonary function test (PFT) output, and values copied across notes, then assigned dates from linked administrative procedure records. NLP-derived FVC values were compared to values recorded directly from PFT equipment available on a subset of patients. RESULTS: We identified 5911 FVC values (n = 1844 patients) from PFT equipment and 15 383 values (n = 4982 patients) by NLP. Among 2610 date-matched FVC values from NLP and PFT equipment, 95.8% of values were within 5% predicted. The mean (SD) difference was 0.09% (5.9), and values strongly correlated (r = 0.94, p < 0.001), with a precision of 0.87 (95% CI 0.86, 0.88). NLP captured more patients with longitudinal FVC values (n = 3069 vs. n = 1164). Mean (SD) change in FVC %-predicted per year was similar between sources (-1.5 [30.0] NLP vs. -0.9 [16.6] PFT equipment; standardized response mean = 0.05 for both). CONCLUSIONS: NLP of EHR notes increases the capture of accurate, longitudinal FVC values by three-fold over PFT equipment. Use of this NLP tool can facilitate pharmacoepidemiologic research in RA-ILD and other lung diseases by capturing this critical measure of disease severity.

Updated checklist of the mosquitoes (Diptera: Culicidae) of Mexico.

Based on historical and recent records, an updated list of 244 nominal species and three undescribed mosquitoes from Mexico is presented. Since 1990, 15 species have been recorded for the first time in Mexico: Aedes guatemala, Ae. brelandi, Ae. insolitus, Ae. melanimon, Ae. albopictus, Culex daumastocampa, Cx. metempsytus, Cx. erethyzonfer, Culiseta melanura, Limatus asulleptus, Sabethes gymnothorax, Trichoprosopon pallidiventer, Toxorhynchites moctezuma, Uranotaenia socialis, and Wyeomyia chalcocephala. Five species were discovered and described: Ae. amaterui, Ae. lewnielseni, Cx. diamphidius, Shannoniana huasteca, and Tr. mixtli. Three species were discovered without yet describing or naming them: Ae. (Protomacleaya) sp. 1, Ae. (Ochlerotatus) sp. 2, and Wyeomyia sp. 3. Five species had been removed from the Mexican mosquito fauna: Ae. stigmaticus, Cx. imitator, Onirion personatum, Sa. tarsopus, and Tx. theobaldi. With the intention of updating the checklist of the mosquito species in Mexico, historical and recent species records were reviewed, as well as the review of entomological collections, resulting in the confirmation of the presence in Mexico of Ae. thelcter, Cs. impatiens, and Orthopodomyia alba. Morphological and molecular evidence confirms the presence of Wy. jocosa, while Anopheles atropos, Psorophora confinnis, Cx. jenningsi, Mansonia indubitans, Tr. pallidiventer, and Tr. soaresi are removed from the Mexican mosquito fauna.

Design and Evaluation of a Sticky Attractant Trap for Intra-Domiciliary Surveillance of Aedes aegypti Populations in Mexico.

Surveillance consists of systematic data collection, analysis, and interpretation and is essential for planning and implementing control activities. The lack of success in the control and surveillance of the Ae. aegypti mosquito elsewhere demands the development of new accessible and effective strategies. This work aimed to develop and evaluate an adhesive lure trap for household indoor surveillance of Ae. aegypti. Based on a bibliographic review, four compounds that have significant attraction percentages for Ae. aegypti were considered. Our more effective blend was determined through preliminary bioassays using the high-throughput screening system (HITSS) and 90 × 90 cm mosquito cages. We designed a low-cost, pyramid-shaped, sticky cardboard trap to incorporate the selected blend. Semi-field 2 × 2 m cages and field tests were utilized to evaluate its effectiveness through mosquito capture percentages. In laboratory tests, blend number 2 presented an attraction percentage of 47.5 ± 4.8%; meanwhile, in semi-field cages, a 4-inch, 110 v powered fan was used to disperse the attractants, and then a similar capture percentage of 43.2 ± 4.0% was recorded. Results were recorded during the field evaluation of the at-house indoor environment and were compared with those recorded with the golden-standard BG-Sentinel trap, i.e., our prototype trapped an average of 6.0 ± 1.5 mosquitoes versus 10.0 ± 2.6. In most Latin American countries, there is a lack of formal and accessible strategies for monitoring adult populations of Ae. Aegypti; therefore, we must develop tools that reinforce entomological surveillance methods.

Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening: A Randomized Clinical Trial.

Importance: Optimal strategies for population-based outreach for breast cancer screening remain unknown. Objective: To evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy. Design, Setting, and Participants: This pragmatic randomized clinical trial was conducted from April 2022 to January 2023 at a single Veterans Affairs (VA) medical center. Participants were female veterans aged 45 to 75 years who were eligible for breast cancer screening and enrolled in VA primary care. Intervention: Veterans were randomized 1:1 to receive either an automatic mammography referral (opt-out arm) or an automated telephone call with an option for mammography referral (opt-in arm). Main Outcomes and Measures: The primary outcome was completed mammography 100 days after outreach. Secondary outcomes were scheduled or completed mammography by 100 days after outreach and referrals canceled if mammography was not scheduled within 90 days. Both intention-to-treat analyses and a restricted analysis were conducted. The restricted analysis excluded veterans who were unable to be reached by telephone (eg, a nonworking number) or who were found to be ineligible after randomization (eg, medical record documentation of recent mammography). Results: Of 883 veterans due for mammography (mean [SD] age, 59.13 [8.24] years; 656 [74.3%] had received prior mammography), 442 were randomized to the opt-in group and 441 to the opt-out group. In the intention-to-treat analysis, there was no significant difference in the primary outcome of completed mammography at 100 days between the opt-out and opt-in groups (67 [15.2%] vs 66 [14.9%]; P = .90) or the secondary outcome of completed or scheduled mammography (84 [19%] vs 106 [24.0%]; P = .07). A higher number of referrals were canceled in the opt-out group compared with the opt-in group (104 [23.6%] vs 24 [5.4%]; P < .001). The restricted analysis demonstrated similar results except more veterans completed or scheduled mammography within 100 days in the opt-out group compared with the opt-in group (102 of 388 [26.3%] vs 80 of 415 [19.3%]; P = .02). Conclusions and Relevance: In this randomized clinical trial, an opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion but did lead to substantially more canceled mammography referrals, increasing staff burden. Trial Registration: ClinicalTrials.gov Identifier: NCT05313737.

Species diversity and detection of pathogens in phlebotomine sand flies collected from forest management areas of Quintana Roo, Mexico.

Sand flies have expanded their areas of distribution, thereby increasing the risk of pathogen transmission in non-endemic areas. To establish efficient prevention and control strategies for the transmission of vector-borne pathogens, it is important to understand seasonal dynamics of their vectors. In Mexico, there are several areas where the contact between sand flies, hosts and reservoirs favours the transmission of the pathogen. We compared sand fly communities in a forest management area and a conserved area in Noh-Bec, Quintana Roo, Mexico. The analysis included species diversity, activity peaks and molecular detection of pathogens. Sand flies were collected from November to December 2021 and April to May 2022, during 84 night-traps. The conserved area showed higher numbers and greater species heterogeneity of sand flies as compared with the other sites. The ß-diversity analysis revealed that sites disturbed by logging (S1, S2, S3) had greater similarity (90%) in their sand fly species composition than a conserved area (S4) (similarity = 36%). Although none of the specimens were infected with Leishmania, we detected Wolbachia (19.4%) in all four sites, as well as Bartonella (3.25%) only in the disturbed sites. Further studies on the dynamics of sand fly populations and their association with pathogens are necessary.

Peritonitis asociada a diálisis peritoneal causada por el complejo Paecilomyces variotii / Peritonitis associated with peritoneal dialysis caused by Paecilomyces variotii complex

La peritonitis asociada a diálisis peritoneal es una complicación grave en el paciente con este tipo de modalidad de terapia de reemplazo renal, siendo la etiología fúngica una de las que conlleva mayor morbimortalidad. Presentamos el caso de un paciente de 22 años que desarrolló una peritonitis asociada a diálisis peritoneal causada por el complejo Paecilomyces variotii; un hongo filamentoso poco frecuente en este grupo de pacientes.

Peritonitis associated with peritoneal dialysis is a serious complication in patients with this type of renal replacement therapy modality, with fungal aetiology being one of the most associated with morbidity and mortality. We present the case of a 22-year-old patient who developed fungal peritonitis associated with peritoneal dialysis caused by Paecilomyces variotii complex; a rare cause of peritonitis in this group of patients.

Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy.

OBJECTIVE: In the Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial, 65% of patients with rheumatoid arthritis (RA) in low disease activity (LDA) on stable biologic therapy successfully tapered glucocorticoids. We aimed to evaluate real-world rates of glucocorticoid tapering among similar patients in the Veterans Affairs Rheumatoid Arthritis registry. METHODS: Within a multicenter, prospective RA cohort, we used registry data and linked pharmacy claims from 2003 to 2021 to identify chronic prednisone users achieving LDA after initiating a new biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD). We defined the index date as first LDA occurring 60 to 180 days after b/tsDMARD initiation. The primary outcome of successful tapering, assessed at day 180 after LDA, required a 30-day averaged prednisone dose both less than or equal to 5mg/day and at least 50% lower than at the index date. The secondary outcome was discontinuation, defined as a prednisone dose of 0 mg/day at days 180 through 210. We used univariate statistics to compare patient characteristics by fulfillment of the primary outcome. RESULTS: We evaluated 100 b/tsDMARD courses among 95 patients. Fifty-four courses resulted in successful tapering; 33 resulted in discontinuation. Positive rheumatoid factor, higher erythrocyte sedimentation rate, more background DMARDs, shorter time from b/tsDMARD initiation to LDA, and higher glucocorticoid dose 30 days before LDA were associated with greater likelihood of successful tapering. CONCLUSION: In a real-world RA cohort of chronic glucocorticoid users in LDA, half successfully tapered and a third discontinued prednisone within 6 months of initiating a new b/tsDMARD. Claims-based algorithms of glucocorticoid tapering and discontinuation may be useful to evaluate predictors of tapering in administrative data sets.

Molecular and Serological Identification of Anaplasma marginale and Borrelia burgdorferi in Cattle and Ticks from Nuevo Leon, Northern Mexico.

Ticks and tick-borne diseases affect livestock productivity and cause significant economic losses. Therefore, surveillance of these pathogens and vectors is paramount to reducing these effects in livestock. This study aimed to identify Anaplasma marginale and Borrelia burgdorferi sensu lato in ticks collected from cattle. Molecular biology techniques were utilized to identify A. marginale for both types of samples, i.e., ticks and bovine blood. Serology of cattle using indirect immunofluorescence assay (IFA) was conducted to determine antibodies to B. burgdorferi s.l. from seven locations in Nuevo Leon, Mexico, between 2015 and 2017. From 404 bovines, 2880 ticks were collected: Rhipicephalus microplus (2391 females and 395 males), Amblyomma spp. (51 females and 42 males) and Dermacentor variabilis (1 female). Rhipicephalus microplus represented the largest specimens captured, with 96.7% within the seven study sites. PCR processed only 15% (442) of tick samples to identify A. marginale. Field genera proportions were followed to select testing tick numbers. Results showed that 9.9% (44/442) of A. maginale infected the pooled tick species, whereas the highest percent corresponded to 9.4% (38/404) in R. microplus. Regarding the molecular analysis of blood samples, 214 of 337 (63.5%) were positive for A. maginale. In each of the seven locations, at least one bovine sample tested positive for A. maginale. Borrelia burgdorferi s.l. was not found either in the ticks or serum samples. Two A.marginale DNA nucleotide sequences obtained in this study were deposited in the GenBank with the following accession numbers OR050501 cattle, and OR050500 R.microplus tick. Results of this work point to current distribution of bovine anaplasmosis in northern Mexico.

Temperature inhomogeneities cause the abundance discrepancy in H II regions.

H II regions are ionized nebulae surrounding massive stars. They exhibit a wealth of emission lines that form the basis for estimation of chemical composition. Heavy elements regulate the cooling of interstellar gas, and are essential to the understanding of several phenomena such as nucleosynthesis, star formation and chemical evolution1,2. For over 80 years3, however, a discrepancy exists of a factor of around two between heavy-element abundances derived from collisionally excited lines and those from the weaker recombination lines, which has thrown our absolute abundance determinations into doubt4,5. Here we report observational evidence that there are temperature inhomogeneities within the gas, quantified by t2 (ref. 6). These inhomogeneities affect only highly ionized gas and cause the abundance discrepancy problem. Metallicity determinations based on collisionally excited lines must be revised because these may be severely underestimated, especially in regions of lower metallicity such as those recently observed with the James Webb Space Telescope in high-z galaxies7-9. We present new empirical relations for estimation of temperature and metallicity, critical for a robust interpretation of the chemical composition of the Universe over cosmic time.

Enhancing the identification of rheumatoid arthritis-associated interstitial lung disease through text mining of chest computerized tomography reports.

OBJECTIVES: Algorithms have been developed to identify rheumatoid arthritis-interstitial lung disease (RA-ILD) in administrative data with positive predictive values (PPVs) between 70 and 80%. We hypothesized that including ILD-related terms identified within chest computed tomography (CT) reports through text mining would improve the PPV of these algorithms in this cross-sectional study. METHODS: We identified a derivation cohort of possible RA-ILD cases (n = 114) using electronic health record data from a large academic medical center and performed medical record review to validate diagnoses (reference standard). ILD-related terms (e.g., ground glass, honeycomb) were identified in chest CT reports by natural language processing. Administrative algorithms including diagnostic and procedural codes as well as specialty were applied to the cohort both with and without the requirement for ILD-related terms from CT reports. We subsequently analyzed similar algorithms in an external validation cohort of 536 participants with RA. RESULTS: The addition of ILD-related terms to RA-ILD administrative algorithms increased the PPV in both the derivation (improvement ranging from 3.6 to 11.7%) and validation cohorts (improvement 6.0 to 21.1%). This increase was greatest for less stringent algorithms. Administrative algorithms including ILD-related terms from CT reports exceeded a PPV of 90% (maximum 94.6% derivation cohort). Increases in PPV were accompanied by a decline in sensitivity (validation cohort -3.9 to -19.5%). CONCLUSIONS: The addition of ILD-related terms identified by text mining from chest CT reports led to improvements in the PPV of RA-ILD algorithms. With high PPVs, use of these algorithms in large data sets could facilitate epidemiologic and comparative effectiveness research in RA-ILD.