Neighborhood-level Social Determinants of Health and Waitlist Mortality for Liver Transplantation: The Liver Outcomes and Equity Index.

BACKGROUND AND AIMS: To examine neighborhood-level disparities in waitlist mortality for adult liver transplantation (LT), we developed novel area-based social determinants of health (SDOH) index using a national transplant database. METHODS: ZIP Codes of individuals listed for or received LT in the Scientific Registry of Transplant Recipients database between June 18, 2013, and May 18, 2019, were linked to 36 American Community Survey (ACS) variables across 5 SDOH domains for index development. A step-wise principal component analysis was used to construct the Liver Outcomes and Equity (LOEq) index. We then examined the association between LOEq quintiles (Q1 = worst and Q5 = best neighborhood SDOH) and waitlist mortality with competing risk regression among listed adults in the study period and acuity circle (AC) era. RESULTS: The final LOEq index consisted of 13 ACS variables. Of 59 298 adults waitlisted for LT, 30% resided in LOEq Q5 compared with only 14% in Q1. Q1 neighborhoods with worse SDOH were disproportionately concentrated in transplant regions with low median Model for End-Stage Liver Disease at transplant (MMAT) and shorter wait times. Five years cumulative incidence of waitlist mortality was 33% in Q1 in high MMAT regions versus 16% in Q5 in low MMAT regions. Despite this allocation advantage, LOEq Q1-Q4 were independently associated with elevated risk of waitlist mortality compared with Q5, with highest increased hazard of waitlist deaths of 19% (95% CI, 11%-26%) in Q1. This disparity persisted in the AC era, with 24% (95% CI, 10%-40%) increased hazard of waitlist deaths for Q1 versus Q5. CONCLUSIONS: Neighborhood SDOH independently predicts waitlist mortality in adult LT.

An Actuated Neural Probe Architecture for Reducing Gliosis-Induced Recording Degradation.

Glial encapsulation of chronically implanted neural probes inhibits recording and stimulation, and this signal loss is a significant factor limiting the clinical viability of most neural implant topologies for decades-long implantation. We demonstrate a mechanical proof of concept for silicon shank-style neural probes intended to minimize gliosis near the recording sites. Compliant whiskers on the edges of the probe fold inward to minimize tissue damage during insertion. Once implanted to the target depth and retracted slightly, these whiskers splay outward. The splayed tips, on which recording sites could be patterned, extend beyond the typical 50-100 [Formula: see text] radius of a glial scar. The whiskers are micrometer-scale to minimize or avoid glial scarring. Electrically inactive devices with whiskers of varying widths and curvature were designed and monolithically fabricated from a 5- [Formula: see text] silicon-on-insulator (SOI) wafer, and their mechanical functionality was demonstrated in a 0.6% agar brain phantom. Deflection was plotted versus deflection speed, and those that were most compliant actuated successfully. This probe requires no preparation for use beyond what is typical for a shank-style silicon probe.

The effect of exogenous glucose infusion on early embryonic development in lactating dairy cows.

The objective of this study was to examine the effect of intravenous infusion of glucose on early embryonic development in lactating dairy cows. Nonpregnant, lactating dairy cows (n = 12) were enrolled in the study (276 ± 17 d in milk). On d 7 after a synchronized estrus, cows were randomly assigned to receive an intravenous infusion of either 750 g/d of exogenous glucose (GLUC; 78 mL/h of 40% glucose wt/vol) or saline (CTRL; 78 mL/h of 0.9% saline solution). The infusion period lasted 7 d and cows were confined to metabolism stalls for the duration of the study. Coincident with the commencement of the infusion on d 7 after estrus, 15 in vitro-produced grade 1 blastocysts were transferred into the uterine horn ipsilateral to the corpus luteum. All animals were slaughtered on d 14 to recover conceptuses, uterine fluid, and endometrial tissue. Glucose infusion increased circulating glucose concentrations (4.70 ± 0.12 vs. 4.15 ± 0.12 mmol/L) but did not affect milk production or dry matter intake. Circulating ß-hydroxybutyrate concentrations were decreased (0.51 ± 0.01 vs. 0.70 ± 0.01 mmol/L for GLUC vs. CTRL, respectively) but plasma fatty acids, progesterone, and insulin concentrations were unaffected by treatment. Treatment did not affect either uterine lumen fluid glucose concentration or the mRNA abundance of specific glucose transporters in the endometrium. Mean conceptus length, width, and area on d 14 were reduced in the GLUC treatment compared with the CTRL treatment. A greater proportion of embryos in the CTRL group had elongated to all length cut-off measurements between 11 and 20 mm (measured in 1-mm increments) compared with the GLUC treatment. In conclusion, infusion of glucose into lactating dairy cows from d 7 to d 14 post-estrus during the critical period of conceptus elongation had an adverse impact on early embryonic development.

Effect of altering the type of dietary carbohydrate early postpartum on reproductive performance and milk production in pasture-grazed dairy cows.

The objective of this study was to assess the effect of increasing dietary starch for approximately 30 d postpartum on reproduction outcomes in pasture-grazed, seasonal-calving dairy cows. Cows (n = 948) from 3 commercial herds were blocked by age (2, 3, and >3 yr), breed, and expected calving date and randomly assigned to 1 of 2 postpartum treatment groups: high starch (34.7 ± 1.9% nonstructural carbohydrate; mean ± SD) or low starch (22.5 ± 0.4% nonstructural carbohydrate). The high-starch group in all 3 farms received 4.0 to 4.5 kg/d of a 75:25 cracked corn:barley grain mixture in the dairy parlor, split evenly between the morning and afternoon milkings. The low-starch cows received 5.0 to 5.5 kg/d of a 50:50 mixture of palm kernel meal:soy hulls (herds 1 and 3) fed in the parlor; low-starch cows in the remaining herd (herd 2) did not receive a concentrate feed. Cows were cograzed on ryegrass-white clover dominant pastures and were offered corn silage (herds 1 and 3) and canola, corn distillers grain, and palm kernel meal (herd 1) throughout the study. At 1 mo before the start of the seasonal breeding period, the high-starch supplement was removed, and within each herd treatment groups were managed similarly through breeding. Presence of purulent vaginal discharge was assessed at 28 DIM, and tail paint was assessed weekly from 2 to 6 wk postpartum for signs of estrus. The interval to first observed estrus was unaffected by treatment (32.7 vs. 33.5 ± 2 d for high and low starch, respectively), but there were tendencies for a herd × treatment interaction for proportion of cows pregnant to first service and for pregnancy within 6 wk. This interaction was significant for the proportion of cows finally pregnant; a lower proportion of high-starch cows were pregnant to first service, pregnant by 6 wk, and pregnant by the end of the seasonal breeding period in herd 1, but diet did not affect these outcomes in the other herds. Our results do not support a positive effect on reproduction from increasing dietary starch in seasonally bred grazing dairy cows. However, the interactions indicate variability in the herd response to dietary starch early postpartum and imply that pregnancy rate could potentially be compromised through the provision of starch to grazing dairy cows in early lactation (i.e., prebreeding). The experiment was not designed to define the reasons for these interactions, but differences should be considered in future research on the subject.

Sarcocystis neurona and Neospora caninum in Brazilian opossums (Didelphis spp.): Molecular investigation and in vitro isolation of Sarcocystis spp.

Sarcocystis neurona and Neospora spp. are protozoan parasites that induce neurological diseases in horses and other animal species. Opossums (Didelphis albiventris and Didelphis virginiana) are definitive hosts of S. neurona, which is the major cause of equine protozoal myeloencephalitis (EPM). Neospora caninum causes abortion in cattle and infects a wide range of animal species, while N. hughesi is known to induce neurologic disease in equids. The aims of this study were to investigate S. neurona and N. caninum in tissues from opossums in the northeastern Brazil, and to isolate Brazilian strains of Sarcocystis spp. from wild opossums for comparison with previously isolated strains. Carcasses of 39 opossums from Bahia state were available for molecular identification of Sarcocystis spp. and N. caninum in their tissues, and for sporocyst detection by intestinal scraping. In addition, Sarcocystis-like sporocysts from nine additional opossums, obtained in São Paulo state, were tested. Sarcocystis DNA was found in 16 (41%) of the 39 opossums' carcasses; N. caninum DNA was detected in tissues from three opossums. The sporocysts from the nine additional opossums from São Paulo state were tested by bioassay and induced infection in nine budgerigars, but in none of the gamma-interferon knockout mice. In vitro isolation was successful using tissues from all nine budgerigars. The isolated strains were maintained in CV-1 and Vero cells. Three of nine isolates presented contamination in cell culture and were discarded. Analysis of six isolates based on five loci showed that these parasites were genetically different from each other and also distinct from S. neurona, S. falcatula, S. lindsayi, and S. speeri. In conclusion, opossums in the studied regions were infected with N. caninum and Sarcocystis spp. and represent a potential source of infection to other animals. This is the first report of N. caninum infection in tissues from black-eared opossum (D. aurita or D. marsupialis) and white-eared opossum (D. albiventris). Brazilian opossums are probably infected by different Sarcocystis spp. distinct from S. neurona and S. falcatula, or present a high level of genetic recombination.

Toxoplasma gondii and Neospora caninum in sparrows (Passer domesticus) in the Northeast of Brazil.

Toxoplasma gondii is a cosmopolitan protozoan parasite of warm-blooded animals that causes high rates of infection in mammals and birds. Sparrows (Passer domesticus) are synantropic birds which are distributed worldwide. They serve as intermediate hosts for the parasite but are quite resistant to toxoplasmosis. The aims of this study were to determine the frequency of T. gondii infection in sparrows using serologic and molecular tests, and to investigate related parasites, such as Neospora caninum and Hammondia sp., using a nested PCR for Toxoplasmatinae DNA followed by sequence analysis of the PCR amplicons. A total of 293 sparrows were trapped at the states of Bahia and Pernambuco, Brazil. Tissues of 40 animals were available for molecular tests. Antibodies to T. gondii were found in 1.02% (3/293) of animals using a hemagglutination test, with titers ranging from 1:32 to 1:128. Toxoplasmatinae DNA was detected in 10/40 (25%) sparrows; after nucleotide sequencing, T. gondii was confirmed in 7/40 (17.5%) birds and N. caninum in 3/40 (7.5%) animals. Sparrows from Brazil were confirmed as intermediate hosts of T. gondii, that reinforces the potential importance of these birds on the transmission of the parasite to cats and other animals that may predate sparrows. In addition, N. caninum was detected for the first time in sparrows. To the authors' knowledge, this is the first wild synantropic bird species identified as intermediate host of N. caninum. These findings seem to have a great epidemiologic impact because of the cosmopolitan distribution of sparrows and due to their increasing population in urban and rural areas.