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BACKGROUND: Implementing national recommendations for syphilis screening is not feasible in the emergency department (ED) setting. The purpose of this study was to determine the syphilis screening rate among ED patients tested for gonorrhea and chlamydia (GC/CT) and the syphilis prevalence among those who were tested. METHODS: A 1-year retrospective cohort study in an urban ED. At the time of this study, there were no explicit syphilis screening guidelines and testing was at the discretion of the treating physician. We determined the proportion of all GC/CT-tested patients who also underwent syphilis screening and the prevalence of syphilis among this group. Predictors of syphilis screening among patients tested for GC/CT were identified. RESULTS: GC/CT tests were performed in 3951 (4.7%) of the 83,988 ED visits, of which 332 (8.4%) were reactive. The mean age of GC/CT-tested patients was 22.6 ± 12 years, most were female (67%), black (47%), and English speaking (74%). Syphilis screening was completed in 1218 (31%) of the GC/CT-tested patients, 17 tests (1.4%) were reactive, which included 8 (0.7%) unique patients with newly diagnosed syphilis. In multivariable analysis, the following variables were predictive of syphilis screening: empirical GC/CT treatment (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.6-2.3), evaluation in the low acuity section of the ED (OR: 1.8, 95% CI: 1.4-2.3), a reactive GC/CT test (OR: 1.3, 95% CI: 1.0-1.6), and age ≤25 years (OR: 1.2, 95% CI: 1.0-1.4). CONCLUSION: Among ED patients tested for GC/CT, less than one-third were screened for syphilis. Failure to screen these patients likely resulted in missed opportunities for syphilis diagnosis.
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Infecciones por Chlamydia/diagnóstico , Servicio de Urgencia en Hospital , Gonorrea/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Sífilis/diagnóstico , Adolescente , Adulto , California/epidemiología , Niño , Infecciones por Chlamydia/epidemiología , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Gonorrea/epidemiología , Humanos , Masculino , Análisis Multivariante , Proyectos Piloto , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Sífilis/epidemiología , Sífilis/genética , Población Urbana , Adulto JovenRESUMEN
A Rosaceae family-level candidate gene approach was used to identify genes associated with sugar content in blackberry (Rubus subgenus Rubus). Three regions conserved among apple (Malus × domestica), peach (Prunus persica), and alpine strawberry (Fragaria vesca) were identified that contained previously detected sweetness-related quantitative trait loci (QTL) in at least two of the crops. Sugar related genes from these conserved regions and 789 sugar-associated apple genes were used to identify 279 Rubus candidate transcripts. A Hyb-Seq approach was used in conjunction with PacBio sequencing to generate haplotype level sequence information of sugar-related genes for 40 cultivars with high and low soluble solids content from the University of Arkansas and USDA blackberry breeding programs. Polymorphisms were identified relative to the 'Hillquist' blackberry (R. argutus) and ORUS 4115-3 black raspberry (R. occidentalis) genomes and tested for their association with soluble solids content (SSC). A total of 173 alleles were identified that were significantly (α = 0.05) associated with SSC. KASP genotyping was conducted for 92 of these alleles on a validation set of blackberries from each breeding program and 48 markers were identified that were significantly associated with SSC. One QTL, qSSC-Ruh-ch1.1, identified in both breeding programs accounted for an increase of 1.5 °Brix and the polymorphisms were detected in the intron space of a sucrose synthase gene. This discovery represents the first environmentally stable sweetness QTL identified in blackberry. The approach demonstrated in this study can be used to develop breeding tools for other crops that have not yet benefited directly from the genomics revolution.
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Fragaria , Malus , Rosaceae , Rubus , ADN , Fragaria/genética , Frutas , Malus/genética , Fitomejoramiento , Rosaceae/genética , Rubus/genéticaRESUMEN
OBJECTIVES: The Broselow tape is a length-based tool used for the rapid estimation of pediatric weight and was developed to reduce dosage-related errors during emergencies. This study seeks to assess the accuracy of the Broselow tape and age-based formulas in predicting weights of South Sudanese children of varying nutritional status. METHODS: This was a retrospective, cross-sectional study using data from existing acute malnutrition screening programs for children less than 5 years of age in South Sudan. Using anthropometric measurements, actual weights were compared with estimated weights from the Broselow tape and three age-based formulas. Mid-upper arm circumference was used to determine if each child was malnourished. Broselow accuracy was assessed by the percentage of measured weights falling into the same color zone as the predicted weight. For each method, accuracy was assessed by mean percentage error and percentage of predicted weights falling within 10% of actual weight. All data were analyzed by nutritional status subgroup. RESULTS: Only 10.7% of malnourished and 26.6% of nonmalnourished children had their actual weight fall within the Broselow color zone corresponding to their length. The Broselow method overestimated weight by a mean of 26.6% in malnourished children and 16.6% in nonmalnourished children (p < 0.001). Age-based formulas also overestimated weight, with mean errors ranging from 16.2% over actual weight (Advanced Pediatric Life Support in nonmalnourished children) to 70.9% over actual (Best Guess in severely malnourished children). CONCLUSIONS: The Broselow tape and age-based formulas selected for comparison were all markedly inaccurate in both the nonmalnourished and the malnourished populations studied, worsening with increasing malnourishment. Additional studies should explore appropriate methods of weight and dosage estimation for populations of low- and low-to-middle-income countries and regions with a high prevalence of malnutrition.