Examining community-level social vulnerability and emergency department use for people living with sickle cell disease in Michigan.

This study examined associations between emergency department (ED) visits and social vulnerability index (SVI) among Michigan's population with sickle cell disease (SCD) using data from the Michigan Sickle Cell Data Collection program (n = 3658 in 2018). SVI was higher among census tracts where people with SCD resided (mean SVI = 0.67; SD = 0.27) compared to census tracts without SCD residents (mean SVI = 0.39; SD = 0.25; p < .001). For children with SCD, for every 0.1 increase in SVI score, the number of ED visits increased by 6% (IRR = 1.061; SE = 0.03; p = .038). Future research should investigate the association between SVI and ED use, at the community and household levels, to elucidate strategies to reduce ED use among children with SCD.

Telehealth Use Before and During the COVID-19 Pandemic Among Children with Sickle Cell Anemia.

Introduction: Sickle cell anemia (SCA) is a genetic condition that predominantly affects minority populations in the United States. A lack of access to care is strongly associated with poor outcomes and quality of care among children and adolescents with SCA. The use of telehealth, which has rapidly expanded during the COVID-19 pandemic, has been shown to improve access to care for many conditions. However, the adoption of telehealth among children and adolescents with SCA is unknown. Methods: We identified children 1-17 years old with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The number of in-person and telehealth outpatient visits (both urgent and routine) were summarized prepandemic (January 2019-February 2020) and during the pandemic (March 2020-December 2020); National Provider Identifier was used to identify provider specialty for telehealth visits. Results: The study population comprised 493 children with SCA with a mean age of 8.7 (±4.9) years at study entry. Prepandemic, there were 4,367 outpatient visits; 4,348 (99.6%) were in-person and 19 (0.4%) were telehealth. During the pandemic, there were 2,307 outpatient visits; 2,059 (89.3%) were in-person and 248 (10.7%) were telehealth. Telehealth visits peaked in April 2020 and declined thereafter. The majority of telehealth visits were to hematology (49%), followed by adult subspecialists (27%) and pediatrics/family medicine (14%). Discussion/Conclusions: While the overall number of outpatient visits declined during the initial months of the pandemic compared with 2019, use of telehealth rapidly increased among children and adolescents with SCA. Additional research is needed to understand patient and provider preferences for telehealth and the roles that federal and state policies can play in facilitating telehealth adoption among children and adolescents with SCA.

Necessity, Entailment, Shared Agonism.

This short paper offers a series of responses to Jochem Zwier and Timothy Barker's comments on my extended paper 'Taking Exception: Philosophy of Technology as a Multidimensional Problem Space.' Part one responds to questions concerning the modality of the renewed understanding of the theme of the transcendental that was argued for in my initial paper: I argue for the deep contingency of such a move, against any sense that it is necessary. Part two takes this consideration of modality further, considering the possibilities that a renewal of the theme of the transcendental stands to offer philosophy of technology today. I argue that the contingency of our contemporary sense of the transcendental can be precisely what makes it valuable. Whereas parts one and two turn on incisive questions posed by Zwier, part three closes by reconsidering the claims for a 'multidimensional problem space' offered in my initial paper. In response to an acute insight from Barker, I close by arguing that philosophy of technology's problem space should be explored in terms of a notion of 'shared agonism'.

Inertial confinement fusion: a defence context.

Almost 30 years since the last UK nuclear test, it remains necessary regularly to underwrite the safety and effectiveness of the National Nuclear Deterrent. To do so has been possible to date because of the development of continually improving science and engineering tools running on ever more powerful high-performance computing platforms, underpinned by cutting-edge experimental facilities. While some of these facilities, such as the Orion laser, are based in the UK, others are accessed by international collaboration. This is most notably with the USA via capabilities such as the National Ignition Facility, but also with France where a joint hydrodynamics facility is nearing completion following establishment of a Treaty in 2010. Despite the remarkable capability of the science and engineering tools, there is an increasing requirement for experiments as materials age and systems inevitably evolve further from what was specifically trialled at underground nuclear tests (UGTs). The data from UGTs will remain the best possible representation of the extreme conditions generated in a nuclear explosion, but it is essential to supplement these data by realizing new capabilities that will bring us closer to achieving laboratory simulations of these conditions. For high-energy-density physics, the most promising technique for generating temperatures and densities of interest is inertial confinement fusion (ICF). Continued research in ICF by the UK will support the certification of the deterrent for decades to come; hence the UK works closely with the international community to develop ICF science. UK Ministry of Defence © Crown Owned Copyright 2020/AWE. This article is part of a discussion meeting issue 'Prospects for high gain inertial fusion energy (part 1)'.

Information theory and signal transduction systems: from molecular information processing to network inference.

Sensing and responding to the environment are two essential functions that all biological organisms need to master for survival and successful reproduction. Developmental processes are marshalled by a diverse set of signalling and control systems, ranging from systems with simple chemical inputs and outputs to complex molecular and cellular networks with non-linear dynamics. Information theory provides a powerful and convenient framework in which such systems can be studied; but it also provides the means to reconstruct the structure and dynamics of molecular interaction networks underlying physiological and developmental processes. Here we supply a brief description of its basic concepts and introduce some useful tools for systems and developmental biologists. Along with a brief but thorough theoretical primer, we demonstrate the wide applicability and biological application-specific nuances by way of different illustrative vignettes. In particular, we focus on the characterisation of biological information processing efficiency, examining cell-fate decision making processes, gene regulatory network reconstruction, and efficient signal transduction experimental design.

Leucine-enriched protein feeding does not impair exercise-induced free fatty acid availability and lipid oxidation: beneficial implications for training in carbohydrate-restricted states.

Given that the enhanced oxidative adaptations observed when training in carbohydrate (CHO)-restricted states is potentially regulated through free fatty acid (FFA)-mediated signalling and that leucine-rich protein elevates muscle protein synthesis, the present study aimed to test the hypothesis that leucine-enriched protein feeding enhances circulating leucine concentration but does not impair FFA availability or whole body lipid oxidation during exercise. Nine males cycled for 2 h at 70% VO2peak when fasted (PLACEBO) or having consumed a whey protein solution (WHEY) or a leucine-enriched whey protein gel (GEL), administered as 22 g 1 h pre-exercise, 11 g/h during and 22 g 30 min post-exercise. Total leucine administration was 14.4 g and 6.3 in GEL and WHEY, respectively. Mean plasma leucine concentrations were elevated in GEL (P = 0.001) compared with WHEY and PLACEBO (375 ± 100, 272 ± 51, 146 ± 14 µmol L(-1), respectively). No differences (P = 0.153) in plasma FFA (WHEY 0.53 ± 0.30, GEL 0.45 ± 0.25, PLACEBO 0.65 ± 0.30, mmol L(-1)) or whole body lipid oxidation during exercise (WHEY 0.37 ± 0.26, GEL 0.36 ± 0.24, PLACEBO 0.34 ± 0.24 g/min) were apparent between trials, despite elevated (P = 0.001) insulin in WHEY and GEL compared with PLACEBO (38 ± 16, 35 ± 16, 22 ± 11 pmol L(-1), respectively). We conclude that leucine-enriched protein feeding does not impair FFA availability or whole body lipid oxidation during exercise, thus having practical applications for athletes who deliberately train in CHO-restricted states to promote skeletal muscle adaptations.

Calculation of livestock biomass and value by province in Indonesia: Key information to support policymaking.

Accurate estimations of the biomass and value of livestock in Indonesia are of great use in supporting investment decisions by the public and private sector and as a basis for estimating the losses due to animal disease. Biomass and the partial direct use value for key livestock species (cattle, buffalo, sheep, goats, pigs, chickens) for all provinces of Indonesia were derived from secondary data using a novel spreadsheet-based model. Using beef cattle as an example, we also explored the use of a herd dynamics model to validate base data on populations and productivity used to generate biomass values, and these were found to be generally robust. Total partial direct use value of livestock is estimated to be almost USD54 billion in 2021, comprising almost USD33 billion of population value and almost USD21 billion of production value. Beef cattle account for 44% of total value and chicken (broiler, layer and native chickens) account for a further 36% of the total. Breaking the data down by province reveals the regional importance of some livestock types that are of relatively minor importance nationally (pigs in East Nusa Tenggara and sheep in West Java). It also reveals the importance of livestock in the poorest provinces of Indonesia, where livestock acts as a store of wealth and serves socio-cultural purposes.

Closed-loop organic waste management systems for family farmers in Brazil.

Family farmers in Brazil could diversify their sources of income and improve agriculture practices by adopting circular economy principles on their farms. Closed-loop technological systems can be used to manage organic waste and produce fertiliser and biogas thereby generating revenue. Anaerobic Digestion (AD) is a proven technology that can produce digestate (i.e. fertiliser) and biogas from organic waste, although digestate application in soil and crops without treatment can have adverse effects. However, in practice, there is a lack of knowledge about the benefits of recycling organic waste in farming communities in Brazil. Therefore, the main aim of this paper is to provide conceptual design configurations of closed-loop systems that manage organic waste and generate revenue for small farms in Brazil. A literature review of selected technologies and interviews with Brazilian family farmers were used to inform the components of the proposed conceptual designs. The proposed designs are based on circular economy principles, incorporating AD, pyrolysis for biochar, hydroponics and vermifiltration in various configurations. A complete closed-loop system consisting of a 7.5 m3 digester, pyrolysis unit, a combined hydroponic and vermifilter unit and a shredder is estimated to cost around USD$1600 (R$ 6600). The flexibility of the proposed systems has the potential to increase resilience and income for small-scale farmers, whilst encouraging good practices for waste management. The conceptual designs can be used as a basis for further research and development of small-scale organic waste management solutions in Brazil.

Influenza immunization coverage of children with sickle cell disease.

OBJECTIVES: To assess receipt of annual flu immunization among children living with sickle cell disease (SCD). METHODS: Receipt of flu immunization (2014-2019) by SCD status was assessed among all Michigan children <18 years of age using the statewide immunization registry. Logistic regression was used to estimate the odds of annual flu immunization by SCD status and age. RESULTS: Annual flu immunization coverage was higher among children with SCD (46.9%; n = 751) than without (23.2%; n = 2,012,846). The annual adjusted odds of flu immunization for those with SCD were 2.8 (95% CI: 2.5-3.1) times higher than for those without SCD; there were no significant differences by age among children with SCD. Among those without SCD, adolescents aged 13-17 were 2.2 (95% CI: 2.2-2.2) times less likely to receive annual flu immunization than children 6-35 months. CONCLUSIONS: Children with SCD had higher annual flu immunization rates than those without SCD, but >50% remain unimmunized.

Investigating the Socio-Economic and Livelihoods Impacts of African Swine Fever in Timor-Leste: An Application of Spatial Group Model Building.

Small-scale pig farming is highly important to the economic and social status of households in Timor-Leste. The presence of an African Swine Fever (ASF) outbreak in Timor-Leste was confirmed in 2019, a major concern given that around 70% of agricultural households practice pig farming. This research used a virtual spatial group model building process to construct a concept model to better understand the main feedback loops that determine the socio-economic and livelihood impacts of the ASF outbreak. After discussing the interaction of reinforcing and balancing feedback loops in the concept model, potential leverage points for intervention are suggested that could reduce the impacts of ASF within socio-economic spheres. These include building trust between small-scale farmers and veterinary technicians, strengthening government veterinary services, and the provision of credit conditional on biosecurity investments to help restock the industry. This conceptual model serves as a starting point for further research and the future development of a quantitative system dynamics (SD) model which would allow ex-ante scenario-testing of various policy and technical mitigation strategies of ASF outbreaks in Timor-Leste and beyond. Lessons learned from the blended offline/online approach to training and workshop facilitation are also explored in the paper.

Primary Immunization Series Coverage of Children With Sickle Cell Disease.

INTRODUCTION: Children with sickle cell disease are at increased risk of serious infections, many of which can be prevented by receipt of recommended immunizations. Study objectives were to (1) assess the primary immunization series coverage among children with sickle cell disease and (2) compare the coverage with that of those without sickle cell disease. METHODS: The Michigan Care Improvement Registry was used to obtain primary immunization series doses and sickle cell disease status for all eligible children in Michigan born in 2001-2016 (analysis was conducted in 2019). Completion of series and each individual vaccine were assessed for every child at ages 19 and 35 months. Proportions were stratified by sickle cell disease status and compared using chi-square tests. Logistic regression was used to model the odds of completing the series at each age, as predicted by sickle cell disease status and adjusting for the presence of Medicaid identification number. RESULTS: The proportion of children who completed the immunization series was higher for those with sickle cell disease than for those without sickle cell disease at 19 months (58.5% vs 48.0%) and 35 months (74.7% vs 59.6%) (both p<0.0001). The odds of completing the series were 1.4 times higher at 19 months (95% CI=1.2, 1.6) and 1.7 times higher at 35 months (95% CI=1.5, 2.0) for children with sickle cell disease than for those without, adjusting for the presence of Medicaid identification number. CONCLUSIONS: Although children with sickle cell disease had higher immunization rates than those without sickle cell disease, >40% of children with sickle cell disease did not receive all recommended immunizations by age 19 months. Immunization information systems should be utilized to improve routine immunization coverage of children with sickle cell disease.

Beyond Numbers: Determining the Socioeconomic and Livelihood Impacts of African Swine Fever and Its Control in the Philippines.

The impacts of African Swine Fever (ASF) have most frequently been described quantitatively though it is increasingly acknowledged these impacts extend well beyond numbers. During 2020, a multidisciplinary team of researchers developed a framework for Socioeconomic and Livelihood Impact Assessment (SELIA) of livestock diseases in smallholder communities. Two key innovations within this SELIA framework are the integration of sustainable livelihoods concepts to capture rich information beyond financial impacts, and the inclusion of stakeholders across the value chain, beyond farmers. This paper focuses on the findings from one of the first applications of the SELIA framework. In late 2020 the research team applied participatory tools from the SELIA Framework (8 focus group discussions, 14 key informant interviews, and 2 network mapping activities) to gather data to describe the impact of ASF in backyard pig-farming communities and value chains. This was undertaken across two locations in the Philippines, in turn highlighting potential leverage points for intervention. Owing to COVID-19 travel restrictions and risks, modifications to training and field activities were made. Findings from focus groups and interviews revealed the deep, emotional impacts of ASF and the associated control measures. Pigs were considered pets by many farmers and some women described them as being like their children. Animal health-workers (AHWs) also recognised the emotional toll on farmers and were sometimes strongly criticised by community members due to their involvement in depopulation campaigns. Misinformation early in the epidemic also led farmers to hide their animals from AHWs, and to dispose of them inappropriately. While the overall impact of ASF on society was negative, the impacts across different communities, scales of production and different value chain actors varied. The losses experienced by backyard farmers resulted in significant losses to linked value chain actors, such as input suppliers. This trial application of the SELIA framework revealed some complex and varied impacts of ASF. This included significant differences in livelihood and socio-economic impacts amongst different actors within value chains and also among different categories of actors (for example small, medium and large-scale traders). Repeated themes and triangulated findings suggest two leverage points for further consideration. Firstly, it is recommended a One Welfare approach to ASF control in the Philippines is explored. Emphasising careful communication between animal health-workers and farmers, and humane and sensitive pig depopulation practices. Secondly, consideration of ASF support programs tailored to sectoral and specific communities is recommended.

Counting the cost: The potential impact of African Swine Fever on smallholders in Timor-Leste.

In September 2019, Timor-Leste, where pigs are kept by more than 70 percent of households, became the eleventh Asian country to report African Swine Fever (ASF). Drawing on our recent, as-yet unpublished research we show that while national pork consumption is low, pigs hold tremendous monetary value for smallholders within the economy of ceremonies. Given the sums of money paid for live pigs, the value of the national pig herd is around USD160 million - more than USD1000 per pig keeping household. Accordingly, pigs serve to buffer families against shocks and pressures, especially for health and education expenses. While not a zoonosis, the potential for ASF to lead to significant, negative impacts for smallholder farmers in Timor-Leste - some of the world's most vulnerable people - cannot be underestimated. We argue that Timor-Leste faces significant challenges in responding to ASF and there is a strong case for international support.

Health Disparities and the Global Landscape of Lymphoma Care Today.

Lymphoma encompass a wide variety of distinct disease entities, including, but not limited to, subtypes of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). In the last 3 decades, therapeutic advancements have resulted in substantial improvements in lymphoma outcome. In most high-income regions, HL is a largely curable disease and for patients with two frequent subtypes of NHL, diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), survival has dramatically improved with the incorporation of rituximab as a standard treatment approach. Despite these advances, outcomes vary between and across populations. This review will provide updated information about health disparities in lymphoma in the United States and across the globe.

Reported dose as a measure of drug exposure after paracetamol overdose in children.

The decision to administer antidote after paracetamol overdose is based on the extent of drug exposure, and this often relies on the reported dose. Few data exist concerning the validity of this approach in children. The present observational study sought to examine the relationship between the reported dose and paracetamol concentrations in patients aged ≤18 years admitted to York Hospital between October 2008 and November 2010 inclusive. There were 77 cases and casenotes were evaluable in 61, with median age 14 years (IQR 3-15 years), and weight 54.0 kg (18.2-63.5 kg), including 47 females (71%). Paracetamol dose was 83 mg/kg (57-148 mg/kg), and interval between ingestion and serum concentration was 4.5 hours (4.0-5.4 hours). There was a positive correlation between dose and equivalent 4-hour paracetamol concentration: Spearman's rho=0.57, 95% CI 0.36-0.73, P< 0.0001. These findings support the importance of reported dose as part of initial risk assessment, especially in situations where laboratory determination is unhelpful, such as after a staggered ingestion.

Congenital cytomegalovirus infection associated with development of neonatal emphysematous lung disease.

A 26-week-gestation infant developed cystic lung changes which required lobar resection at 6 weeks of age. Lung histology showed cytomegalovirus (CMV) inclusion bodies. The authors present the radiology and histology images of this case and review the literature regarding congenital CMV infection and cystic lung disease. Lung disease caused by CMV is typically a diffuse pneumonitis. This is the first reported case of congenital CMV infection causing emphysematous lung disease to develop in the neonatal period. The case raises awareness of CMV as a possible cause of cystic lung lesions in newborns.

Abdominal pain and hyperamylasaemia--not always pancreatitis.

A raised serum amylase concentration, at least four times the upper limit of normal (ULN), is used to support the diagnosis of acute pancreatitis in a patient presenting with abdominal pain. The authors report a case of toxic shock syndrome complicated by a raised serum amylase concentration that peaked at 50 times the ULN in a patient with recurrent abdominal pain. The commonest cause of hyperamylasaemia is pancreatic; however, further investigation of serum lipase and amylase isoenzyme studies found this to be of salivary origin and attributable to soft tissue inflammation of the salivary gland. This case highlights the need to consider non-pancreatic causes of hyperamylasaemia.

Orthotopic liver transplantation for acute liver failure secondary to autoimmune hepatitis in a child with autoimmune polyglandular syndrome type 1.

Autoimmune polyglandular syndrome type 1 (APS-1) is an autosomal-recessive condition characterized by hypoparathyroidism, autoimmune Addison's disease, and chronic mucocutaneous candidiasis. Autoimmune hepatitis develops in 10-20% of affected patients and has a variable course ranging from asymptomatic chronic liver disease to lethal fulminant hepatic failure. Liver transplantation has been documented previously in only two patients. We report a 14-yr-old boy with APS-1 who developed acute liver failure secondary to associated autoimmune hepatitis. He did not respond to corticosteroid therapy and was successfully treated with an orthotopic liver transplant.