Practical Considerations before Installing Ground-Based Geodetic Infrastructure for Integrated InSAR and cGNSS Monitoring of Vertical Land Motion.

Continuously operating Global Navigation Satellite Systems (cGNSS) can be used to convert relative values of vertical land motion (VLM) derived from Interferometric Synthetic Aperture Radar (InSAR) to absolute values in a global or regional reference frame. Artificial trihedral corner reflectors (CRs) provide high-intensity and temporally stable reflections in SAR time series imagery, more so than naturally occurring permanent scatterers. Therefore, it is logical to co-locate CRs with cGNSS as ground-based geodetic infrastructure for the integrated monitoring of VLM. We describe the practical considerations for such co-locations using four case-study examples from Perth, Australia. After basic initial considerations such as land access, sky visibility and security, temporary test deployments of co-located CRs with cGNSS should be analysed together to determine site suitability. Signal to clutter ratios from SAR imagery are used to determine potential sites for placement of the CR. A significant concern is whether the co-location of a deliberately designed reflecting object generates unwanted multipath (reflected signals) in the cGNSS data. To mitigate against this, we located CRs >30 m from the cGNSS with no inter-visibility. Daily RMS values of the zero-difference ionosphere-free carrier-phase residuals, and ellipsoidal heights from static precise point positioning GNSS processing at each co-located site were then used to ascertain that the CR did not generate unwanted cGNSS multipath. These steps form a set of recommendations for the installation of such geodetic ground-infrastructure, which may be of use to others wishing to establish integrated InSAR-cGNSS monitoring of VLM elsewhere.

Implementation of Clinical Decision Support to Identify and Improve Treatment for Severe PIVIE.

Pediatric patients are at high risk of peripheral intravenous infiltration or extravasation (PIVIE) leading to injury and increased costs. Most of the work in addressing PIVIE has focused on the implementation of workflow bundles and evidenced based guidelines. This project showed that Clinical Decision Support can be used to help support identification and treatment of Severe PIVIE through use of an interruptive alert that increases placement of vascular access team consults.

Development of a Victorian Falls and Balance Service Directory.

OBJECTIVES: Falls and fall-related injuries amongst older people continue to be a long-term public health issue. Access to specialist services that target fall prevention has been shown to improve outcomes. This project aimed to develop an online directory of public outpatient and ambulatory falls and balance clinics and programs in Victoria. METHOD: Environmental scan of existing services and survey of service providers between January and August 2020. RESULTS: Forty-seven community-based and 53 hospital-based falls and balance services across metropolitan (46%) and regional (54%) Victoria registered. The majority of services were programs (70%) targeting exercise and/or education, as opposed to clinics (30%), which focus on diagnosis and developing management plans. Survey responses were collated to develop an online service directory: https://www.nari.net.au/victorian-falls-directory CONCLUSIONS: The Victorian Falls and Balance Service Directory provides a centralised and accessible reference for clinicians and community members regarding available outpatient and ambulatory services that target fall prevention.

Recent resurgence of mumps in the United States.

BACKGROUND: The widespread use of a second dose of mumps vaccine among U.S. schoolchildren beginning in 1990 was followed by historically low reports of mumps cases. A 2010 elimination goal was established, but in 2006 the largest mumps outbreak in two decades occurred in the United States. METHODS: We examined national data on mumps cases reported during 2006, detailed case data from the most highly affected states, and vaccination-coverage data from three nationwide surveys. RESULTS: A total of 6584 cases of mumps were reported in 2006, with 76% occurring between March and May. There were 85 hospitalizations, but no deaths were reported; 85% of patients lived in eight contiguous midwestern states. The national incidence of mumps was 2.2 per 100,000, with the highest incidence among persons 18 to 24 years of age (an incidence 3.7 times that of all other age groups combined). In a subgroup analysis, 83% of these patients reported current college attendance. Among patients in eight highly affected states with known vaccination status, 63% overall and 84% between the ages of 18 and 24 years had received two doses of mumps vaccine. For the 12 years preceding the outbreak, national coverage of one-dose mumps vaccination among preschoolers was 89% or more nationwide and 86% or more in highly affected states. In 2006, the national two-dose coverage among adolescents was 87%, the highest in U.S. history. CONCLUSIONS: Despite a high coverage rate with two doses of mumps-containing vaccine, a large mumps outbreak occurred, characterized by two-dose vaccine failure, particularly among midwestern college-age adults who probably received the second dose as schoolchildren. A more effective mumps vaccine or changes in vaccine policy may be needed to avert future outbreaks and achieve the elimination of mumps.

Multispecialty Nursing During COVID-19:: Lessons Learned in Southern California.

A multispecialty nursing team plays a crucial role in key decision making, education, prevention, screening, assessment, diagnosis, management, data collection and dissemination of best practices during the novel coronavirus disease (COVID-19) pandemic. Using examples from a large, tertiary medical center in Los Angeles, this paper highlights contributions made by multispecialty nursing specialties to optimize health and safety for patients and frontline health care workers. Recognizing nurses' ongoing critical role encourages and informs further collaboration and serves as a catalyst to innovation for a healthier tomorrow. The result of the COVID-19 pandemic will be felt for years to come.

Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.

BACKGROUND: Measles was declared eliminated from the United States in 2000 but remains endemic worldwide. In 2005, a 17-year-old unvaccinated girl who was incubating measles returned from Romania, creating the largest documented outbreak of measles in the United States since 1996. METHODS: We conducted a case-series investigation, molecular typing of viral isolates, surveys of rates of vaccination coverage, interviews regarding attitudes toward vaccination, and cost surveys. RESULTS: Approximately 500 persons attended a gathering with the index patient one day after her return home. Approximately 50 lacked evidence of measles immunity, of whom 16 (32 percent) acquired measles at the gathering. During the six weeks after the gathering, a total of 34 cases of measles were confirmed. Of the patients with confirmed measles, 94 percent were unvaccinated, 88 percent were less than 20 years of age, and 9 percent were hospitalized. Of the 28 patients who were 5 to 19 years of age, 71 percent were home-schooled. Vaccine failure occurred in two persons. The virus strain was genotype D4, which is endemic in Romania. Although containment measures began after 20 persons were already infectious, measles remained confined mostly to children whose parents had refused to have them vaccinated, primarily out of concern for adverse events from the vaccine. Seventy-one percent of patients were from four households. Levels of measles-vaccination coverage in Indiana were 92 percent for preschoolers and 98 percent for sixth graders. Estimated costs of containing the disease were at least 167,685 dollars, including 113,647 dollars at a hospital with an infected employee. CONCLUSIONS: This outbreak was caused by the importation of measles into a population of children whose parents had refused to have them vaccinated because of safety concerns about the vaccine. High vaccination levels in the surrounding community and low rates of vaccine failure averted an epidemic. Maintenance of high rates of vaccination coverage, including improved strategies of communication with persons who refuse vaccination, is necessary to prevent future outbreaks and sustain the elimination of measles in the United States.

Perceptions of Social Networks by Adults Who Are Deafblind.

Findings are presented from a descriptive qualitative study of 10 adults who were deafblind who were interviewed about their social lives. Additional data were collected from a discussion board and e-mails from the study participants. Three findings emerged from the data: (a) Navigating adaptations was a significant part of socialization. (b) Gaps existed in work, family, and formal support networks.

Toward a Comprehensive System of Personnel Development in Deafblind Education.

Students who are deafblind are a unique population with unique needs for learning, communication, and environmental access. Two roles have been identified as important to their education: teacher of the deafblind and intervener. However, these roles are not officially recognized in most states. Because of this lack of recognition and the low incidence of deafblindness, it is difficult to sustain systems that prepare highly qualified personnel with advanced training and knowledge in educational strategies for children and youth who are deafblind. The authors propose a comprehensive system of personnel development (CSPD) for deafblind education. The components of this system are standards, preservice training, in-service/professional development, leadership development, research, and, finally, planning coordination, and evaluation. The authors describe elements of the model that are being implemented and provide suggestions to support the future development of a comprehensive system.

fecB, a gene potentially involved in iron transport in Mycobacterium avium, is not induced within macrophages.

FecB is a protein involved in the transport of iron from ferric citrate in Escherichia coli and is present in the Mycobacterium tuberculosis genome sequence. Since the ability to retrieve iron from the host is crucial and may be related to virulence, we characterized the gene fecB from Mycobacterium avium, strain 101. An E. coli-mycobacterial shuttle plasmid with a fecB-promoter green fluorescence protein (gfp)-fusion was transformed into M. avium strain 104 to study the fecB-regulation. In vitro, the fecB expression in M. avium weakly correlated with the amount of iron present in the medium but the expression was maximal when there was no iron in the culture medium. In macrophages, M. avium fec B was not induced during the early phase of infection, suggesting that the iron concentration in the mycobacterial phagosome is not sufficiently low to stimulate the expression of fecB in M. avium.

Women and cigarette smoking: does amount of weight gain following a failed quit attempt affect social disapproval?

This study examined the perception of social attractiveness and approval of smoking in a vignette of an American college female smoker after a failed quit attempt. It was hypothesized that she would be perceived more favorably when she was smoking to control her weight, compared to a non-weight related excuse during a failed quit attempt. The design was a 2 (gender: male vs. female)x4 (condition: control, 5, 10, 20 lb gain)x3 (participants' smoking status: never, former, or current smoker) factorial design with the Social Attraction Index and Perception of Smoking Index as dependent variables. Contrary to the hypothesis, perceptions of the female were not affected by her disclosed amount of weight gain. However, consistent with the literature on stigmatization of smokers, smoking participants perceived the female target as most socially attractive and nonsmokers perceived her to be the least attractive.

Direct exposure of mouse spermatozoa to very high concentrations of a serotype-2 adeno-associated virus gene therapy vector fails to lead to germ cell transduction.

In a clinical safety trial involving an adeno-associated virus (AAV) gene therapy vector encoding human factor IX, intrahepatic administration of the vector was associated with the finding of vector DNA in semen that persisted for several weeks. Uncertainty remains as to the route by which the vector reached semen, but the finding raised the prospect that mature sperm could be exposed to the vector and sustain integration of vector DNA. To provocatively test for the ability of AAV vectors to transduce mature sperm, we exposed mouse sperm to concentrations of the same vector used in clinical studies at concentrations ranging from 840 to 3400 particles per sperm cell, performed in vitro fertilization and embryo transfer, and evaluated newborn pups by Southern analysis for the presence of vector sequences. Of 102 pups analyzed, none showed evidence of vector DNA integration. We conclude from these studies that exposure of mature sperm to AAV gene therapy vectors is highly unlikely to lead to germline transduction.

DNA microarray analysis of gene expression in human optic nerve head astrocytes in response to hydrostatic pressure.

There is clinical and experimental evidence that elevated intraocular pressure (IOP), a mechanical stress, is involved in the pathogenesis of glaucomatous optic neuropathy. The mechanism by which astrocytes in the optic nerve head (ONH) respond to changes in IOP is under study. Gene transcription by ONH astrocytes exposed either to 60 mmHg hydrostatic pressure (HP) or control ambient pressure (CP) for 6, 24, and 48 h was compared using Affymetrix GeneChip microarrays to identify HP-responsive genes. Data were normalized across arrays within each gene. A linear regression model applied to test effect of time and HP on changes in expression level identified 596 genes affected by HP over time. Using GeneSpring analysis we selected genes whose average expression level increased or decreased more than 1.5-fold at 6, 24, or 48 h. Expression of selected genes was confirmed by real-time RT-PCR; protein levels were detected by Western blot. Among the genes highly responsive to HP were those involved in signal transduction, such as Rho nucleotide exchange factors, Ras p21 protein activator, tyrosine kinases and serine threonine kinases, and genes involved in transcriptional regulation, such as c-Fos, Egr2, and Smad3. Other genes that increased expression included ATP-binding cassettes, solute carriers, and genes associated with lipid metabolism. Among the genes that decreased expression under HP were genes encoding for dual activity phosphatases, transcription factors, and enzymes involved in protein degradation. These HP-responsive genes may be important in the establishment and maintenance of the ONH astrocyte phenotype under conditions of elevated IOP in glaucoma.

Young deafblind adults in action: becoming self-determined change agents through advocacy.

Six young deafblind adults took a 1-week course on civic engagement and advocacy, which provided the focus for a participatory action research study with a collective case study design. They selected advocacy topics, were briefed on these policy issues, and were paired with experienced mentors for meetings with legislators in Washington, DC. Eight themes were identified from constant comparative and in vivo analysis of classroom discussion notes, interviews, and journals: (a) defining advocacy and advocate, (b) rights and equality, (c) expectations, (d) role of education in change, (e) deafblind expertise, (f) characteristics of effective change agents, (g) advocacy is teamwork, (h) future advocacy. In the classroom, the participants learned about policy issues, communication considerations, and leadership, then applied this knowledge in the legislative arena. Through the advocacy process, they learned to apply their personal strengths as advocates and experienced the importance of teamwork in advocacy.

Successful administration of a 1-day imported fire ant rush immunotherapy protocol.

BACKGROUND: Young children with a history of systemic reactions to imported fire ant (IFA) stings are at substantial risk of recurrent stings because of their maturational inability to practice appropriate avoidance techniques. OBJECTIVE: To present 3 cases in which patients 36 months or younger completed a 1-day rush immunotherapy (RIT) protocol with IFA whole-body extract (WBE). METHODS: The 1-day RIT protocol used for these patients was modified from the Wilford Hall 2-day rush protocol previously published. A 1:1 vol/vol maintenance vial consisted of 1 mL of IFA WBE and 9 mL of human serum albumin diluent in a 10-mL vial. RESULTS: All 3 patients had positive intradermal skin test results to IFA WBE. No systemic reactions occurred during the 1-day RIT. CONCLUSIONS: This case series provides data with which we can begin to assess the efficacy and safety of a 1-day IFA RIT protocol for the prevention of anaphylaxis in IFA allergic children. Further studies with larger numbers of patients are needed to confirm the findings.

Challenges to implementing second-dose varicella vaccination during an outbreak in the absence of a routine 2-dose vaccination requirement--Maine, 2006.

In June 2005, the Advisory Committee on Immunization Practices (ACIP) recommended administering a second dose of varicella vaccine during outbreaks, supplementing the routine 1-dose requirement. From October 2005 to January 2006, a varicella outbreak occurred in Maine in a highly vaccinated elementary school population. We investigated the outbreak, held a school-based vaccination clinic, and assessed costs in implementing ACIP's outbreak-response recommendation. Parents completed questionnaires and case investigation interviews. Personnel at the Maine Center for Disease Control and Prevention, the school in which the outbreak occurred ("school A"), and physician offices completed economic surveys. Forty-eight cases occurred, with no hospitalizations or deaths. Vaccine effectiveness was 86.6% (95% confidence interval, 82.0%-90.1%). Of 240 eligible students, 132 (55.0%) received second-dose vaccination. Implementing ACIP's outbreak-response recommendation was challenging and cost approximately $26,875. Additionally, the routine 1-dose varicella vaccination policy did not confer adequate population immunity to prevent this outbreak. These findings support ACIP's June 2007 recommendation for a routine 2-dose varicella vaccination program.

Pressure induces loss of gap junction communication and redistribution of connexin 43 in astrocytes.

Astrocytes, the major glia in the nonmyelinated optic nerve head (ONH), connect via gap junctions built of connexin-43 (Cx43) to form a functional syncytium allowing communication and control of ionic and metabolic homeostasis of retinal ganglion cells (RGCs) axon. We examined gap junction intercellular communication (GJIC) by scrape loading assays in human ONH astrocytes exposed to hydrostatic (HP) or ambient pressure (CP) in vitro. Immunostaining, immunoprecipitation, and immunoblots were used to detect Cx43 distribution and phosphorylation in astrocytes exposed to HP with/without EGF receptor (EGFR) tyrosine kinase inhibitors AG1478 and AG82 and MAPK inhibitors U0126, PD98059, and SB203580. The data indicates that upon exposure to HP, astrocytes decrease GJIC and exhibit altered cellular localization and phosphorylation of Cx43. Inhibition of EGFR blocked the effects of HP on GJIC and HP-induced Cx43 tyrosine phosphorylation. Inhibitors of MAPK- ERK1/2 and -p38 caused partial closure of GJIC under CP and HP, which was maintained for 6 h. Inhibition of Big Mitogen-Activated Kinase 1/ERK5 (BMK1/ERK5) caused partial closure under CP and HP followed by full recovery after 6 h. Inhibition of MAPK did not affect the HP-induced increase in Cx43 serine 279/282 phosphorylation. We conclude that activation of the EGFR pathway in response to HP leads to decrease of GJIC via tyrosine phosphorylation of Cx43 in ONH astrocytes. In glaucoma under conditions of elevated intraocular pressure (IOP), astrocytes may lose GJIC altering the homeostasis of RGC axons, adopting the reactive phenotype, contributing to glaucomatous neuropathy.

Rates of retrieval of self-injectable epinephrine prescriptions: a descriptive report.

BACKGROUND: Some studies have demonstrated poor patient compliance with carrying and administering self-injectable epinephrine (SIE). No study has attempted to define the number or characteristics of patients who are prescribed SIE and subsequently do not retrieve the prescription. OBJECTIVES: To determine fill rates of SIE prescriptions and to provide a descriptive report of patients who do not fill those prescriptions. METHODS: This was a retrospective review of electronic medical records of patients prescribed SIE at a large military medical center in a 1-year period. Rates of prescription retrieval were determined, and patient demographic information was collected. Additional information recorded included the number of devices prescribed per prescription, the International Classification of Diseases, Ninth Revision, code associated with each prescription, and the ambulatory care setting associated with the patient encounter resulting in the prescription. Statistical analysis was performed using the chi2 test. RESULTS: There were 881 SIE prescriptions entered for 769 patients, and 630 patients (82%) filled at least 1 prescription. Individuals older than 55 years filled their SIE prescriptions more often than those 55 years and younger (P < .009), and prescriptions were filled more often from outpatient clinics compared with the emergency department (P < .01). There were no statistically significant differences in fill rates based on sex, active-duty military status, or diagnosis. CONCLUSIONS: Elderly patients and those receiving care in clinic settings are more likely to fill an SIE prescription. Determining why patients do not fill an SIE prescription may help focus patient education efforts.

Generalized cutaneous reactions to the anthrax vaccine: preliminary results of anthrax vaccine-specific cell mediated immunity and cytokine profiles.

Over two years, the Vaccine Adverse Event Reporting System reported that 0.042% of all anthrax vaccine (Biothrax, Bioport Corporation) doses administered were associated with cutaneous reactions, half of which were eczematous. This case series attempts to immunologically detail this eczematous reaction in four patients by measuring anthrax vaccine-specific cell mediated immunity (ASCMI), profiling TH1 and TH2 cytokine response to the anthrax vaccine in vitro, and analyzing of skin biopsy specimens. Results demonstrated that (1) ASCMI was variable and likely unrelated to this reaction; (2) a lack of TH1 cytokine response to anthrax vaccine may be associated with an increased risk of this eczematous reaction; and (3) skin biopsy findings were nonspecific but supportive of a clinical diagnosis of eczema. Future studies with more patients may yield data to further characterize the ASCMI response and cytokine profiles among patients with this type of reaction.