Tobacco treatment clinics in urban public housing: feasibility and outcomes of a hands-on tobacco dependence service in the community.

BACKGROUND: As a further extension of smoke-free laws in indoor public places and workplaces, the Department of Housing and Urban Development's declaration to propose a regulation that would make housing units smoke-free was inevitable. Of note is the challenge this regulation poses to current tenants of housing units who are active smokers. We aimed to assess the efficacy of a tobacco treatment clinic in public housing. The utilization of the clinic by tenants and tenants' respective outcomes regarding smoking status were used to determine the intervention's effectiveness. METHODS: Tobacco treatment clinics were held in two urban-based housing units for 1-year. The clinics provided on-site motivational interviewing and prescriptions for pharmacological agents if warranted. Outcomes collected include the tenants' clinic attendance and 3- and 6-month self-reported smoking status. RESULTS: Twenty-nine tobacco treatment clinic sessions were implemented, recruiting 47 tenants to participate in smoking cessation. The mean age of the cohort was 53 ± 12.3 years old. Of the 47 tenants who participated, 21 (44.7%) attended three or more clinic sessions. At the 3-month mark, five (10.6%) tenants were identified to have quit smoking; at 6-months, 13 (27.7%) tenants had quit smoking. All 13 of the tenants who quit smoking at the end of 6-months attended three or more sessions. CONCLUSION: An on-site tobacco treatment clinic to provide strategies on smoking cessation was feasible. Efforts are warranted to ensure more frequent follow-ups for tenants aiming to quit smoking. While further resources should be allocated to help tenants comply with smoke-free housing units' regulations, we believe an on-site tobacco treatment clinic is impactful.

Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab.

SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel cohort studies of outpatient and inpatient COVID-19-diagnosed adults with hypertension, we assessed associations between antihypertensive exposure (ACEI/ARB vs. non-ACEI/ARB antihypertensives, as well as between ACEI- vs. ARB) at the time of COVID-19 diagnosis, using electronic health record data from PCORnet health systems. The primary outcomes were all-cause hospitalization or death (outpatient cohort) or all-cause death (inpatient), analyzed via Cox regression weighted by inverse probability of treatment weights. From February 2020 through December 9, 2020, 11,246 patients (3477 person-years) and 2200 patients (777 person-years) were included from 17 health systems in outpatient and inpatient cohorts, respectively. There were 1015 all-cause hospitalization or deaths in the outpatient cohort (incidence, 29.2 events per 100 person-years), with no significant difference by ACEI/ARB use (adjusted HR 1.01; 95% CI 0.88, 1.15). In the inpatient cohort, there were 218 all-cause deaths (incidence, 28.1 per 100 person-years) and ACEI/ARB exposure was associated with reduced death (adjusted HR, 0.76; 95% CI, 0.57, 0.99). ACEI, versus ARB exposure, was associated with higher risk of hospitalization in the outpatient cohort, but no difference in all-cause death in either cohort. There was no evidence of effect modification across pre-specified baseline characteristics. Our results suggest ACEI and ARB exposure have no detrimental effect on hospitalizations and may reduce death among hypertensive patients diagnosed with COVID-19.

Raspberry Pi nest cameras: An affordable tool for remote behavioral and conservation monitoring of bird nests.

Bespoke (custom-built) Raspberry Pi cameras are increasingly popular research tools in the fields of behavioral ecology and conservation, because of their comparative flexibility in programmable settings, ability to be paired with other sensors, and because they are typically cheaper than commercially built models.Here, we describe a novel, Raspberry Pi-based camera system that is fully portable and yet weatherproof-especially to humidity and salt spray. The camera was paired with a passive infrared sensor, to create a movement-triggered camera capable of recording videos over a 24-hr period. We describe an example deployment involving "retro-fitting" these cameras into artificial nest boxes on Praia Islet, Azores archipelago, Portugal, to monitor the behaviors and interspecific interactions of two sympatric species of storm-petrel (Monteiro's storm-petrel Hydrobates monteiroi and Madeiran storm-petrel Hydrobates castro) during their respective breeding seasons.Of the 138 deployments, 70% of all deployments were deemed to be "Successful" (Successful was defined as continuous footage being recorded for more than one hour without an interruption), which equated to 87% of the individual 30-s videos. The bespoke cameras proved to be easily portable between 54 different nests and reasonably weatherproof (~14% of deployments classed as "Partial" or "Failure" deployments were specifically due to the weather/humidity), and we make further trouble-shooting suggestions to mitigate additional weather-related failures.Here, we have shown that this system is fully portable and capable of coping with salt spray and humidity, and consequently, the camera-build methods and scripts could be applied easily to many different species that also utilize cavities, burrows, and artificial nests, and can potentially be adapted for other wildlife monitoring situations to provide novel insights into species-specific daily cycles of behaviors and interspecies interactions.

Pancreas Transplant at the University of Maryland.

The characteristic of our diabetic population has been ever changing. No longer are our Type 1 diabetics young and thin; they too suffer from the obesity epidemic and now present later with the complications of diabetes (renal dysfunction, hypoglycemic unawareness, vision loss, neuropathy, etc.). Even with all of our medical and technological advances to combat diabetes, there are many who are not very well controlled. We evaluated the pancreas transplant recipients in the last three years at the University of Maryland to study the outcomes of these older and higher body mass index (BMI) recipients, as well as the impact of using older and higher BMI donors. We saw no difference in the survival of the patient or the allograft of recipients who were older or had higher BMIs. We also saw no difference in morbidity for these patients. There also was no difference when using older or higher BMI donor organs, longer cold ischemic times, different types of donors (donation after cardiac death versus brain dead donors), or different types of organs (simultaneous pancreas kidney, pancreas transplant alone, or pancreas after kidney). In reviewing our waitlist, our patients range widely in age and BMI. As long as they are fit for surgery, we will continue to transplant our ever growing population of older and obese diabetics without any more adverse outcomes than occur in our normal weight and younger patients.

The role of primary care in early detection and follow-up of cancer.

Primary care providers have important roles across the cancer continuum, from encouraging screening and accurate diagnosis to providing care during and after treatment for both the cancer and any comorbid conditions. Evidence shows that higher cancer screening participation rates are associated with greater involvement of primary care. Primary care providers are pivotal in reducing diagnostic delay, particularly in health systems that have long waiting times for outpatient diagnostic services. However, so-called fast-track systems designed to speed up hospital referrals are weakened by significant variation in their use by general practitioners (GPs), and affect the associated conversion and detection rates. Several randomized controlled trials have shown primary care-led follow-up care to be equivalent to hospital-led care in terms of patient wellbeing, recurrence rates and survival, and might be less costly. For primary care-led follow-up to be successful, appropriate guidelines must be incorporated, clear communication must be provided and specialist care must be accessible if required. Finally, models of long-term cancer follow-up are needed that provide holistic care and incorporate management of co-morbid conditions. We discuss all these aspects of primary care, focusing on the most common cancers managed at the GP office-breast, colorectal, prostate, lung and cervical cancers.

Disentangling the influence of salience and familiarity on infant word learning: methodological advances.

The initial stages of language learning involve a critical interaction between infants' environmental experience and their developing brains. The past several decades of research have produced important behavioral evidence of the many factors influencing this process, both on the part of the child and on the part of the environment that the child is in. The application of neurophysiological techniques to the study of early development has been augmenting these findings at a rapid pace. While the result is an accrual of data bridging the gap between brain and behavior, much work remains to make the link between behavioral evidence of infants' emerging sensitivities and neurophysiological evidence of changes in how their brains process information. Here we review the background behavioral data on how salience and familiarity in the auditory signal shape initial language learning. We follow this with a summary of more recent evidence of changes in infants' brain activity in response to specific aspects of speech. Our goal is to examine language learning through the lens of brain/environment interactions, ultimately focusing on changes in cortical processing of speech across the first year of life. We will ground our examination of recent brain data in the two auditory features initially outlined: salience and familiarity. Our own and others' findings on the influence of these two features reveal that they are key parameters in infants' emerging recognition of structure in the speech signal. Importantly, the evidence we review makes the critical link between behavioral and brain data. We discuss the importance of future work that makes this bridge as a means of moving the study of language development solidly into the domain of brain science.