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1.
Emerg Infect Dis ; 28(6): 1117-1127, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35608555

RESUMO

Foodborne outbreaks reported to national surveillance systems represent a subset of all outbreaks in the United States; not all outbreaks are detected, investigated, and reported. We described the structural factors and outbreak characteristics of outbreaks reported during 2009-2018. We categorized states (plus DC) as high (highest quintile), middle (middle 3 quintiles), or low (lowest quintile) reporters on the basis of the number of reported outbreaks per 10 million population. Analysis revealed considerable variation across states in the number and types of foodborne outbreaks reported. High-reporting states reported 4 times more outbreaks than low reporters. Low reporters were more likely than high reporters to report larger outbreaks and less likely to implicate a setting or food vehicle; however, we did not observe a significant difference in the types of food vehicles identified. Per capita funding was strongly associated with increased reporting. Investments in public health programming have a measurable effect on outbreak reporting.

2.
Sci Adv ; 8(16): eabm3791, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35452278

RESUMO

Biomimetic on-chip tissue models serve as a powerful tool for studying human physiology and developing therapeutics; however, their modeling power is hindered by our inability to develop highly ordered functional structures in small length scales. Here, we demonstrate how high-precision fabrication can enable scaled-down modeling of organ-level cardiac mechanical function. We use two-photon direct laser writing (TPDLW) to fabricate a nanoscale-resolution metamaterial scaffold with fine-tuned mechanical properties to support the formation and cyclic contraction of a miniaturized, induced pluripotent stem cell-derived ventricular chamber. Furthermore, we fabricate microfluidic valves with extreme sensitivity to rectify the flow generated by the ventricular chamber. The integrated microfluidic system recapitulates the ventricular fluidic function and exhibits a complete pressure-volume loop with isovolumetric phases. Together, our results demonstrate a previously unexplored application of high-precision fabrication that can be generalized to expand the accessible spectrum of organ-on-a-chip models toward structurally and biomechanically sophisticated tissue systems.

3.
Foodborne Pathog Dis ; 19(4): 281-289, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35171001

RESUMO

Hypothesis generation about potential food and other exposures is a critical step in an enteric disease outbreak investigation, helping to focus investigation efforts and use of limited resources. Historical outbreak data are an important source of information for hypothesis generation, providing data on common food- and animal-pathogen pairs and other epidemiological trends. We developed a model to predict vehicles for Shiga toxin-producing Escherichia coli and Salmonella outbreaks using demographic and outbreak characteristics from outbreaks in the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System (1998-2019) and Animal Contact Outbreak Surveillance System (2009-2019). We evaluated six algorithmic methods for prediction based on their ability to predict multiple class probabilities, selecting the random forest prediction model, which performed best with the lowest Brier score (0.0953) and highest accuracy (0.54). The model performed best for outbreaks transmitted by animal contact and foodborne outbreaks associated with eggs, meat, or vegetables. Expanding the criteria to include the two highest predicted vehicles, 83% of egg outbreaks were predicted correctly, followed by meat (82%), vegetables (74%), poultry (67%), and animal contact (62%). The model performed less well for fruit and poultry vehicles, and it did not predict any dairy outbreaks. The final model was translated into a free, publicly available online tool that can be used by investigators to provide data-driven hypotheses about outbreak vehicles as part of ongoing outbreak investigations. Investigators should use the tool for hypothesis generation along-side other sources, such as food-pathogen pairs, descriptive data, and case exposure assessments. The tool should be implemented in the context of individual outbreaks and with an awareness of its limitations, including the heterogeneity of outbreaks and the possibility of novel food vehicles.


Assuntos
Infecções por Escherichia coli , Doenças Transmitidas por Alimentos , Escherichia coli Shiga Toxigênica , Animais , Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Doenças Transmitidas por Alimentos/epidemiologia , Salmonella , Verduras
4.
Foodborne Pathog Dis ; 19(4): 290-292, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35020464

RESUMO

The rate of enteric infections reported to public health surveillance decreased during 2020 amid the coronavirus disease 2019 (COVID-19) pandemic. Changes in medical care-seeking behaviors may have impacted the diagnosis of enteric infections contributing to these declines. We examined trends in outpatient medical care-seeking behavior for acute gastroenteritis (AGE) in Colorado during 2020 compared with the that of previous 3 years using electronic health record data from the Colorado Health Observation Regional Data Service (CHORDS). Outpatient medical encounters for AGE were identified using diagnoses codes from the International Classification of Diseases 10th Revision and aggregated by year, quarter, age group, and encounter type. The rate of encounters was calculated by dividing the number of AGE encounters by the corresponding total number of encounters. There were 9064 AGE encounters in 2020 compared with an annual average of 18,784 from 2017 to 2019 (p < 0.01), representing a 52% decrease. The rate of AGE encounters declined after the first quarter of 2020 and remained significantly lower for the rest of the year. Moreover, previously observed trends, including seasonal patterns and the preponderance of pediatric encounters, were no longer evident. Telemedicine modalities accounted for 23% of all AGE encounters in 2020. AGE outpatient encounters in Colorado in 2020 were substantially lower than during the previous 3 years. Decreases remained stable over the second, third, and fourth quarters of 2020 (April-December) and were especially pronounced for children <18 years of age. Changes in medical care-seeking behavior likely contributed to declines in the number of enteric disease cases and outbreaks reported to public health. It is unclear to what extent people were ill with AGE and did not seek medical care because of concerns about the infection risk during a health care visit or to what extent there were reductions in certain exposures and opportunities for disease transmission resulting in less illness.


Assuntos
COVID-19 , Gastroenterite , COVID-19/epidemiologia , Criança , Pré-Escolar , Colorado/epidemiologia , Gastroenterite/epidemiologia , Gastroenterite/terapia , Humanos , Pacientes Ambulatoriais , Pandemias
5.
Clin Infect Dis ; 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34950950

RESUMO

BACKGROUND: Sepsis causes a major health burden in the United States. To better understand the role of sepsis as a driver of the burden and cost of foodborne illness in the United States, we estimated the frequency and treatment cost of sepsis among U.S. patients hospitalized with 31 pathogens commonly transmitted through food or with unspecified AGI. METHODS: Using data from the National Inpatient Sample from 2012-2015, we identified sepsis hospitalizations using two approaches- explicit ICD-9-CM codes for sepsis and a coding scheme developed by Angus that identifies sepsis using specific ICD-9-CM diagnosis codes indicating an infection plus organ failure. We examined differences in the frequency and the per-case cost of sepsis across pathogens and AGI and estimated total hospitalization costs using prior estimates of foodborne hospitalizations. RESULTS: Using Explicit Sepsis Codes, sepsis hospitalizations accounted for 4.6% of hospitalizations with a pathogen commonly transmitted through food or unspecified AGI listed as a diagnosis; this was 33.2% using Angus Sepsis Codes. The average per-case cost was $35,891 and $20,018, respectively. Applying the proportions of hospitalizations with sepsis from this study to prior estimates of the number foodborne hospitalizations, the total annual cost was $248 million annually using Explicit Sepsis Codes and $889 million using Angus Sepsis Codes. CONCLUSION: Sepsis is a serious complication among patients hospitalized with a foodborne pathogen infection or AGI resulting in a large burden of illness. Hospitalizations that are diagnosed using explicit sepsis codes are more severe and costly, but likely underestimate the burden of foodborne sepsis.

6.
Lab Chip ; 21(9): 1724-1737, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33949395

RESUMO

We have developed a microfluidic platform for engineering cardiac microtissues in highly-controlled microenvironments. The platform is fabricated using direct laser writing (DLW) lithography and soft lithography, and contains four separate devices. Each individual device houses a cardiac microtissue and is equipped with an integrated strain actuator and a force sensor. Application of external pressure waves to the platform results in controllable time-dependent forces on the microtissues. Conversely, oscillatory forces generated by the microtissues are transduced into measurable electrical outputs. We demonstrate the capabilities of this platform by studying the response of cardiac microtissues derived from human induced pluripotent stem cells (hiPSC) under prescribed mechanical loading and pacing. This platform will be used for fundamental studies and drug screening on cardiac microtissues.


Assuntos
Células-Tronco Pluripotentes Induzidas , Engenharia Tecidual , Humanos , Dispositivos Lab-On-A-Chip , Lasers , Microfluídica , Transdutores , Redação
7.
Am J Epidemiol ; 190(10): 2188-2197, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33878169

RESUMO

Hypothesis generation is a critical, but challenging, step in a foodborne outbreak investigation. The pathogens that contaminate food have many diverse reservoirs, resulting in seemingly limitless potential vehicles. Identifying a vehicle is particularly challenging for clusters detected through national pathogen-specific surveillance, because cases can be geographically dispersed and lack an obvious epidemiologic link. Moreover, state and local health departments could have limited resources to dedicate to cluster and outbreak investigations. These challenges underscore the importance of hypothesis generation during an outbreak investigation. In this review, we present a framework for hypothesis generation focusing on 3 primary sources of information, typically used in combination: 1) known sources of the pathogen causing illness; 2) person, place, and time characteristics of cases associated with the outbreak (descriptive data); and 3) case exposure assessment. Hypothesis generation can narrow the list of potential food vehicles and focus subsequent epidemiologic, laboratory, environmental, and traceback efforts, ensuring that time and resources are used more efficiently and increasing the likelihood of rapidly and conclusively implicating the contaminated food vehicle.


Assuntos
Surtos de Doenças , Reservatórios de Doenças , Monitoramento Epidemiológico , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância em Saúde Pública/métodos , Humanos
8.
Macromol Biosci ; 21(5): e2100051, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33738917

RESUMO

Direct laser writing (DLW) via two-photon polymerization is an emerging highly precise technique for the fabrication of intricate cellular scaffolds. Despite recent progress in using two-photon-polymerized scaffolds to probe fundamental cell behaviors, new methods to direct and modulate microscale cell alignment and selective cell adhesion using two-photon-polymerized microstructures are of keen interest. Here, a DLW-fabricated 2D and 3D hydrogel microstructures, with alternating soft and stiff regions, for precisely controlled cell alignment are reported. The use of both cell-adhesive and cell-repellent hydrogels allows selective adhesion and alignment of human mesenchymal stem cells within the printed structure. Importantly, DLW patterning enables cell alignment on flat surfaces as well as irregular and curved 3D microstructures, which are otherwise challenging to pattern with cells.


Assuntos
Hidrogéis/química , Lasers , Células-Tronco Mesenquimais/citologia , Humanos , Fótons , Engenharia Tecidual/métodos , Tecidos Suporte/química
9.
Nat Commun ; 12(1): 393, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452253

RESUMO

Resolution and field-of-view often represent a fundamental tradeoff in microscopy. Atomic force microscopy (AFM), in which a cantilevered probe deflects under the influence of local forces as it scans across a substrate, is a key example of this tradeoff with high resolution imaging being largely limited to small areas. Despite the tremendous impact of AFM in fields including materials science, biology, and surface science, the limitation in imaging area has remained a key barrier to studying samples with intricate hierarchical structure. Here, we show that massively parallel AFM with >1000 probes is possible through the combination of a cantilever-free probe architecture and a scalable optical method for detecting probe-sample contact. Specifically, optically reflective conical probes on a comparatively compliant film are found to comprise a distributed optical lever that translates probe motion into an optical signal that provides sub-10 nm vertical precision. The scalability of this approach makes it well suited for imaging applications that require high resolution over large areas.

10.
Foodborne Pathog Dis ; 18(3): 189-191, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33216638

RESUMO

Typically conducted by telephone, routine enteric disease case interviews are critical for foodborne illness surveillance, outbreak detection, and disease control. However, an increasing case load, along with the increased use of mobile telephones, has made case interviews more challenging to complete. For this reason, the Colorado Integrated Food Safety Center of Excellence developed and evaluated a pilot program using online surveys to supplement routine telephone-based enteric disease case investigations. From April to September 2019, investigators offered laboratory-confirmed Giardia cases from three Colorado counties the option of either a telephone interview or an online survey. The paper-based Giardia case investigation form was mapped to an online survey in Research Electronic Data Capture. We evaluated the pilot project response rates, timeliness, data quality, demographics, and user feedback. Of the 32 Giardia cases contacted, 66% requested the online survey, and of these, 81% completed the survey. Online survey cases were slightly younger (median: 42 vs. 48 years) and the majority agreed that the survey was easy to use (93%), did not take too much time (87%), and was easy to understand (67%). Staff time decreased for online surveys compared with telephone interviews (median: 6 vs. 19 min); however, the time from case report to interview completion doubled (median: 4 vs. 2 d for telephone interview cases) and data quality decreased slightly. Given limited public health agency resources, supplementing telephone interviews with online surveys may increase the efficiency of routine enteric case investigations. The results of this pilot project indicate online surveys are popular with enteric disease cases and substantially reduce staff time. Methods to improve the timeliness and data quality of online surveys should be explored to reduce the impact on disease control and outbreak detection activities.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Enterite/epidemiologia , Doenças Transmitidas por Alimentos/epidemiologia , Intervenção Baseada em Internet , Vigilância da População/métodos , Adulto , Colorado/epidemiologia , Confiabilidade dos Dados , Enterite/microbiologia , Feminino , Inocuidade dos Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Telefone
11.
Nat Commun ; 11(1): 4191, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32826892

RESUMO

The nascent field of bioelectronic medicine seeks to decode and modulate peripheral nervous system signals to obtain therapeutic control of targeted end organs and effectors. Current approaches rely heavily on electrode-based devices, but size scalability, material and microfabrication challenges, limited surgical accessibility, and the biomechanically dynamic implantation environment are significant impediments to developing and deploying peripheral interfacing technologies. Here, we present a microscale implantable device - the nanoclip - for chronic interfacing with fine peripheral nerves in small animal models that begins to meet these constraints. We demonstrate the capability to make stable, high signal-to-noise ratio recordings of behaviorally-linked nerve activity over multi-week timescales. In addition, we show that multi-channel, current-steering-based stimulation within the confines of the small device can achieve multi-dimensional control of a small nerve. These results highlight the potential of new microscale design and fabrication techniques for realizing viable devices for long-term peripheral interfacing.


Assuntos
Microeletrodos , Nervos Periféricos/fisiologia , Impressão Tridimensional , Animais , Engenharia Biomédica , Eletrodos Implantados , Potenciais Evocados , Tentilhões/fisiologia , Masculino , Microtecnologia , Modelos Animais , Nervos Periféricos/cirurgia , Razão Sinal-Ruído
12.
J Am Vet Med Assoc ; 257(1): 87-96, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32538697

RESUMO

OBJECTIVE: To assess production animal medicine veterinarians' prescription practices and identify factors influencing their use of antimicrobial drugs (AMDs) and their perceptions of and attitudes toward antimicrobial resistance (AMR). SAMPLE: 157 production animal veterinarians in the United States. PROCEDURES: An online cross-sectional survey and digital diary were used to gather information regarding perceptions on AMD use and AMR and on treatment recommendations for production setting-specific disease scenarios. Results were compared across respondents grouped by their selected production setting scenarios and reported years as veterinarians. RESULTS: The most commonly selected production setting disease scenarios were dairy cattle (96/157 [61.1%]), backgrounding cattle (32/157 [20.4%]), and feedlot cattle (20/157 [12.7%]). Because few respondents selected swine (5/157 [3.2%]) or poultry (4/157 [2.5%]) scenarios, those responses were excluded from statistical analysis of AMD prescription practices. Most remaining respondents (147/148 [99.3%]) reported that they would recommend AMD treatment for an individual ill animal; however, responses differed for respondents grouped by their selected production setting scenarios and reported years as veterinarians when asked about AMD treatment of an exposed group or high-risk disease-free group. Most respondents reported that government regulations influenced their AMD prescribing, that owner and producer compliance was a veterinary-related factor that contributed to AMR, and that environmental modifications to prevent disease could be effective to mitigate AMR. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study helped fill important knowledge gaps pertaining to prescription practices and influencing factors for AMD use in production animal medicine and provided baseline information for future assessments. This information could be used to inform future interventions and training tools to mitigate the public health threat of AMR.


Assuntos
Anti-Infecciosos , Preparações Farmacêuticas , Médicos Veterinários , Animais , Antibacterianos/uso terapêutico , Atitude , Bovinos , Estudos Transversais , Farmacorresistência Bacteriana , Humanos , Percepção , Prescrições , Inquéritos e Questionários , Suínos
13.
Am J Public Health ; 110(6): 790-795, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298168

RESUMO

Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.


Assuntos
Cannabis , Inocuidade dos Alimentos , Alimentos/normas , Uso da Maconha , Saúde Pública , Doces/análise , Doces/normas , Colorado , Humanos , Maconha Medicinal
14.
Am J Physiol Renal Physiol ; 318(1): F76-F85, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31736354

RESUMO

Renal transplant recipients (RTRs) and patients with nondialysis chronic kidney disease display elevated circulating microparticle (MP) counts, while RTRs display immunosuppression-induced infection susceptibility. The impact of aerobic exercise on circulating immune cells and MPs is unknown in RTRs. Fifteen RTRs [age: 52.8 ± 14.5 yr, estimated glomerular filtration rate (eGFR): 51.7 ± 19.8 mL·min-1·1.73 m-2 (mean ± SD)] and 16 patients with nondialysis chronic kidney disease (age: 54.8 ± 16.3 yr, eGFR: 61.9 ± 21.0 mL·min-1·1.73 m-2, acting as a uremic control group), and 16 healthy control participants (age: 52.2 ± 16.2 yr, eGFR: 85.6 ± 6.1 mL·min-1·1.73 m-2) completed 20 min of walking at 60-70% peak O2 consumption. Venous blood samples were taken preexercise, postexercise, and 1 h postexercise. Leukocytes and MPs were assessed using flow cytometry. Exercise increased classical (P = 0.001) and nonclassical (P = 0.002) monocyte subset proportions but decreased the intermediate subset (P < 0.001) in all groups. Exercise also decreased the percentage of platelet-derived MPs that expressed tissue factor in all groups (P = 0.01), although no other exercise-dependent effects were observed. The exercise-induced reduction in intermediate monocyte percentage suggests an anti-inflammatory effect, although this requires further investigation. The reduction in the percentage of tissue factor-positive platelet-derived MPs suggests reduced prothrombotic potential, although further functional assays are required. Exercise did not cause aberrant immune cell activation, suggesting its safety from an immunological standpoint (ISRCTN38935454).


Assuntos
Micropartículas Derivadas de Células/fisiologia , Exercício Físico/fisiologia , Sistema Imunitário/fisiologia , Transplante de Rim , Insuficiência Renal/cirurgia , Transplantados , Adulto , Idoso , Biomarcadores , Feminino , Citometria de Fluxo , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Período Pós-Operatório , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia
15.
Adv Healthc Mater ; 9(1): e1901217, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31746140

RESUMO

Direct laser writing via two-photon polymerization (2PP) is an emerging micro- and nanofabrication technique to prepare predetermined and architecturally precise hydrogel scaffolds with high resolution and spatial complexity. As such, these scaffolds are increasingly being evaluated for cell and tissue engineering applications. This article first discusses the basic principles and photoresists employed in 2PP fabrication of hydrogels, followed by an in-depth introduction of various mechanical and biological characterization techniques used to assess the fabricated structures. The design requirements for cell and tissue related applications are then described to guide the engineering, physicochemical, and biological efforts. Three case studies in bone, cancer, and cardiac tissues are presented that illustrate the need for structured materials in the next generation of clinical applications. This paper concludes by summarizing the progress to date, identifying additional opportunities for 2PP hydrogel scaffolds, and discussing future directions for 2PP research.


Assuntos
Hidrogéis/química , Engenharia Tecidual , Tecidos Suporte/química , Regeneração Óssea/fisiologia , Matriz Extracelular/química , Humanos , Lasers , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Fótons , Polimerização
16.
Nanoscale ; 11(7): 3261-3267, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30714605

RESUMO

The construction of a complex, 3D optical metamaterial challenges conventional nanofabrication techniques. These metamaterials require patterning of both a deformable mechanical substrate and an optically-active structure with ∼200 nm resolution and precision. The soft nature of the deformable mechanical materials often precludes the use of resist-based techniques for patterning. Furthermore, FIB deposition approaches produce metallic structures with considerable disorder and impurities, impairing their optical response. In this paper we discuss a novel solution to this nanofabrication challenge - the integration of direct laser writing and MEMS stencil patterning. We demonstrate a variety of methods that enable this integration and then show how one can produce optically-active, 3D metamaterials. We present optical characterization data on one of these metamaterials to demonstrate the viability of our nanofabrication approach.

17.
Biofabrication ; 11(2): 021001, 2019 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-30721899

RESUMO

Cell migration, critical to numerous biological processes, can be guided by surface topography. Studying the effects of topography on cell migration is valuable for enhancing our understanding of directional cell migration and for functionally engineering cell behavior. However, fabrication limitations constrain topography studies to geometries that may not adequately mimic physiological environments. Direct Laser Writing (DLW) provides the necessary 3D flexibility and control to create well-defined waveforms with curvature and length scales that are similar to those found in physiological settings, such as the luminal walls of blood vessels that endothelial cells migrate along. We find that endothelial cells migrate fastest along square waves, intermediate along triangular waves, and slowest along sine waves and that directional cell migration on sine waves decreases as sinusoid wavelength increases. Interestingly, inhibition of Rac1 decreases directional migration on sine wave topographies but not on flat surfaces with micropatterned lines, suggesting that cells may utilize different molecular pathways to sense curved topographies. Our study demonstrates that DLW can be employed to investigate the effects and mechanisms of topography on cell migration by fabricating a wide array of physiologically-relevant surfaces with curvatures that are challenging to fabricate using conventional manufacturing techniques.


Assuntos
Movimento Celular , Imageamento Tridimensional , Lasers , Fibronectinas/metabolismo , Células Endoteliais da Veia Umbilical Humana/citologia , Humanos
18.
Clin Infect Dis ; 69(9): 1545-1552, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30602004

RESUMO

BACKGROUND: The early detection of enteric infections in older adults is challenging because typical signs and symptoms of disease may be less common, absent, or overlooked. Understanding illness characteristics of enteric infections among older adults could improve the timeliness and accuracy of clinical diagnoses, thereby improving patient outcomes and increasing cases reported to surveillance. METHODS: Here, we describe illness characteristics (percentage reporting bloody diarrhea, fever, vomiting, abdominal pain; percentage hospitalized; duration of hospitalization; and duration of illness) among older adults (≥65 years) with acute gastroenteritis and culture-confirmed Campylobacter and nontyphoidal Salmonella infections in Australia, Canada, and the United States and compare these characteristics with those among younger people (<5 years, 5-24 years, and 25-64 years). RESULTS: A significant negative correlation was found between all symptoms and increasing age group, except for bloody diarrhea in cases of acute gastroenteritis. Adults aged ≥85 years reported bloody diarrhea in only 9% of nontyphoidal Salmonella and 4% of Campylobacter infections compared with 59% and 55% among children aged <5 years. Conversely, a greater percentage of older adults (≥65) than younger persons (<5, 5-24, 25-64) reported being hospitalized, with an increasing linear relationship in age groups 65 years and older. CONCLUSIONS: Although older adults are more likely to have severe illness and be hospitalized, we found that the proportion of persons reporting symptoms typically associated with enteric infections decreases with age. These findings have implications for clinical recognition and treatment of gastrointestinal illness, as well as for public health research.


Assuntos
Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Campylobacter/patogenicidade , Gastroenterite/tratamento farmacológico , Gastroenterite/microbiologia , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Austrália , Canadá , Criança , Pré-Escolar , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
19.
Clin Exp Nephrol ; 23(1): 32-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29961156

RESUMO

BACKGROUND: Chronic kidney disease (CKD) patients have reduced exercise capacity. Possible contributing factors may include impaired muscle O2 utilisation through reduced mitochondria number and/or function slowing the restoration of muscle ATP concentrations via oxidative phosphorylation. Using near-infrared spectroscopy (NIRS), we explored changes in skeletal muscle haemoglobin/myoglobin O2 saturation (SMO2%) during exercise. METHODS: 24 CKD patients [58.3 (± 16.5) years, eGFR 56.4 (± 22.3) ml/min/1.73 m2] completed the incremental shuttle walk test (ISWT) as a marker of exercise capacity. Using NIRS, SMO2% was measured continuously before, during, and after (recovery) exercise. Exploratory differences were investigated between exercise capacity tertiles in CKD, and compared with six healthy controls. RESULTS: We identified two discrete phases; a decline in SMO2% during incremental exercise, followed by rapid increase upon cessation (recovery). Compared to patients with low exercise capacity [distance walked during ISWT, 269.0 (± 35.9) m], patients with a higher exercise capacity [727.1 (± 38.1) m] took 45% longer to reach their minimum SMO2% (P = .038) and recovered (half-time recovery) 79% faster (P = .046). Compared to controls, CKD patients took significantly 56% longer to recover (i.e., restore SMO2% to baseline, full recovery) (P = .014). CONCLUSIONS: Using NIRS, we have determined for the first time in CKD, that favourable SMO2% kinetics (slower deoxygenation rate, quicker recovery) are associated with greater exercise capacity. These dysfunctional kinetics may indicate reduced mitochondria capacity to perform oxidative phosphorylation-a process essential for carrying out even simple activities of daily living. Accordingly, NIRS may provide a simple, low cost, and non-invasive means to evaluate muscle O2 kinetics in CKD.


Assuntos
Exercício Físico , Hemoglobinas/metabolismo , Músculo Esquelético/metabolismo , Insuficiência Renal Crônica/metabolismo , Adulto , Idoso , Limiar Anaeróbio , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço , Feminino , Taxa de Filtração Glomerular , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Mioglobina/análise , Mioglobina/metabolismo , Consumo de Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho
20.
Small ; 14(19): e1800162, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29603624

RESUMO

Atomic force microscope (AFM) probes and AFM imaging by extension are the product of exceptionally refined silicon micromachining, but are also restricted by the limitations of these fabrication techniques. Here, the nanoscale additive manufacturing technique direct laser writing is explored as a method to print monolithic cantilevered probes for AFM. Not only are 3D printed probes found to function effectively for AFM, but they also confer several advantages, most notably the ability to image in intermittent contact mode with a bandwidth approximately ten times larger than analogous silicon probes. In addition, the arbitrary structural control afforded by 3D printing is found to enable programming the modal structure of the probe, a capability that can be useful in the context of resonantly amplifying nonlinear tip-sample interactions. Collectively, these results show that 3D printed probes complement those produced using conventional silicon micromachining and open the door to new imaging techniques.

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