Influence of pelagic sargassum influxes on the δ15N in Thalassia testudinum of the Mexican Caribbean coastal ecosystem.

The conservation of Mexican Caribbean Ecosystems (MCE) involves ensuring their capacity to provide resources and ecosystem services to society. Monitoring programs are necessary to establish their management and ensure their sustainability. Thalassia testudinum is the community used to determine anthropogenic influence, in which wastewater is the primary anthropogenic nitrogen source. The extensive amount of pelagic sargassum that enters the area and its decomposition may be additional nitrogen sources in MCE. In the present study, the δ15N in T. testudinum was examined from 2009 to 2019 to infer the nitrogen contribution from pelagic sargassum to MCE. T. testudinum δ15N values showed significant depletion from June/October 2014 to 2019 concerning previous periods. Pelagic sargassum was an alternative nitrogen source, and its leaching reduced T. testudinum δ15N values in MCE.

Changes in the enrichment of dissolved inorganic nutrients in the coastal waters of the Mexican Caribbean, influenced by submarine groundwater discharges 2016-2019.

The resident and tourist population in the Mexican Caribbean has grown exponentially, increasing the availability of dissolved inorganic nutrients in coastal waters through submarine groundwater discharge (SGD). Recently, a new massive drift of Sargassum spp. has occurred that can provide new organic matter and enrich coastal water with nutrients. In different sites in the Mexican Caribbean, the chemical composition of the water was analyzed, and the δ15N of Thalassia testudinum was determined between 2016 and 2019. Evidence of SGD was observed in Akumal Bay due to high silicate concentrations and its negative correlation with salinity. Seasonal and interannual variation in NH4+ concentration was observed at these sites. In October 2018, SGD contributed ∼70 times more nitrogen and ∼194 times more phosphorus than the decomposition of the pelagic macroalgae Sargassum spp. The δ15N data showed that Akumal Bay received nitrogen of anthropogenic origin and that nitrogen fixation processes or probably assimilation of nitrogen of the leachates of pelagic Sargassum spp were dominant at Mahahual and Xahuayxol.

Initial experience with a novel re-sterilisable decapolar electrophysiology catheter.

PURPOSE: Diagnostic electrophysiology catheters are single-use and their expense can act as a barrier to their use. A decapolar catheter with a re-sterilisable handle and inner core was developed, along with a disposable outer sheath. This initial experience evaluated the performance of the Khelix partially recyclable steerable decapolar electrophysiology catheter. METHODS: Sequential patients requiring a decapolar steerable catheter were included in the study. Parameters such as time to positioning from right femoral vein, fluoroscopy time and dose, pacing and sensing thresholds, and the requirement for reposition and/or support sheath were recorded. A retrospective analysis from cases using a standard disposable decapolar catheter was used to compare CS cannulation success, support sheath requirement and cost. RESULTS: 11 re-sterilisable catheter handles were used in 64 patients, each time with a disposable sheath, at two New Zealand centres from December 2017 to June 2018. Pre-defined safety measures were met in all patients, with no catheter-related adverse events. The catheter was successfully positioned in the coronary sinus for 59 cases (92%). Based on initial manufacturer recommendations, the inner recyclable portion of the catheter was able to be re-used successfully up to 12 times with re-sterilisation between cases. CONCLUSIONS: This initial study of an innovative, partially reusable, steerable decapolar electrophysiology catheter demonstrates that it may be used safely and successfully. Use of such a catheter may decrease the cost required for electrophysiology studies.

A new way of rapidly screening for depression in multiple sclerosis using Emotional Thermometers.

OBJECTIVE: Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS. METHOD: Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools. RESULTS: In total, 190 patients were included. ET4 performed well as a 'rule-out' screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7. CONCLUSION: ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.

Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010-2016.

BACKGROUND: The San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors. COMMUNITY CONTEXT: We report on 3 SFHIP prevention initiatives: reducing consumption of sugar sweetened beverages (SSBs), regulating retail alcohol sales, and eliminating disparities in children's oral health. METHODS: SFHIP is governed by a steering committee. Partnership working groups for each initiative collaborate to 1) develop and implement action plans emphasizing feasible, scalable, translational-science-informed interventions and 2) consider sustainability early in the planning process by including policy and structural interventions. OUTCOME: Through SFHIP's efforts, San Francisco enacted ordinances regulating sale and advertising of SSBs and a ballot measure establishing a soda tax. Most San Francisco hospitals implemented or committed to implementing healthy-beverage policies that prohibited serving or selling SSBs. SFHIP helped prevent Starbucks and Taco Bell from receiving alcohol licenses in San Francisco and helped prevent state authorization of sale of powdered alcohol. SFHIP increased the number of primary care clinics providing fluoride varnish at routine well-child visits from 3 to 14 and acquired a state waiver to allow dental clinics to be paid for dental services delivered in schools. INTERPRETATION: The SFHIP model of collective impact emphasizing community engagement and policy change accomplished many of its intermediate goals to create an environment promoting health and health equity.

Perinatal midline astrocyte development is impaired in fibroblast growth factor 8 hypomorphic mice.

Our previous studies showed that Fgf8 mutations can cause Kallmann syndrome (KS), a form of congenital hypogonadotropic hypogonadism, in which patients do not undergo puberty and are infertile. Interestingly, some KS patients also have agenesis of the corpus callosum (ACC) suggesting that KS pathology is not limited to reproductive function. Here, we asked whether FGF8 dysfunction is the underlying cause of ACC in some KS patients. Indeed, early studies in transgenic mice with Fgf8 mutations reported the presence of failed or incomplete corpus callosum formation. Additional studies in transgenic mice showed that FGF8 function most likely prevents the prenatal elimination of glial fibrillary acidic protein (GFAP)-immunoreactive (IR) glial cells in the indusium griseum (IG) and midline zipper (MZ), two anterior-dorsal midline regions required for corpus callosum formation (i.e., between embryonic days (E) 15.5-18.5). Here, we tested the hypothesis that FGF8 function is critical for the survival of the GFAP-IR midline glial cells. First, we measured the incidence of apoptosis in the anterior-dorsal midline region in Fgf8 hypomorphic mice during embryonic corpus callosum formation. Second, we quantified the GFAP expression in the anterior-dorsal midbrain region during pre- and postnatal development, in order to study: 1) how Fgf8 hypomorphy disrupts prenatal GFAP-IR midline glial cell development, and 2) whether Fgf8 hypomorphy continues to disrupt postnatal GFAP-IR midline glial cell development. Our results indicate that perinatal FGF8 signaling is important for the timing of the onset of anterior-dorsal Gfap expression in midline glial cells suggesting that FGF8 function regulates midline GFAP-IR glial cell development, which when disrupted by Fgf8 deficiency prevents the formation of the corpus callosum. These studies provide an experimentally-based mechanistic explanation as to why corpus callosum formation may fail in KS patients with deficits in FGF signaling.

Implementing routine screening for distress, the sixth vital sign, for patients with head and neck and neurologic cancers.

This study examined the benefits of incorporating screening for distress as a routine part of care for patients with head and neck and neurologic cancers in a tertiary cancer center. Using a comparative 2-cohort pre-post implementation sequential design, consecutive outpatients with head and neck and neurologic cancers were recruited into 2 separate cohorts. Cohort 1 included patients attending clinics during April 2010, before the implementation of the screening program. The program was then implemented and patients completed the Screening for Distress Minimum Dataset (the Edmonton Symptom Assessment System [ESAS] and the Canadian Problem Checklist [CPC]) at each clinic visit. Cohort 2 included patients attending clinics during March 2011. Consenting patients completed screening and outcome measures (ESAS, CPC, and either the Functional Assessment of Cancer Therapy-Brain or the Functional Assessment of Cancer Therapy-Head and Neck). A total of 146 patients (78 head and neck and 68 neurologic) provided data for Cohort 1, and 143 (81 head and neck and 62 neurologic) provided data for Cohort 2. Compared with Cohort 1, patients with neurologic cancers in Cohort 2 reported significantly higher scores on the Functional Assessment of Cancer Therapy: General total and emotional quality of life subscale; fewer high scores (≥ 4) on the ESAS breathlessness item; and fewer problems with fears/worries, frustration/anger, finding meaning in life, and worry about friends/family. Head and neck patients in Cohort 2 reported significantly higher emotional quality of life and fewer problems with eating and weight than those in Cohort 1. Although no definitive causal attributions can be made, patients exposed to routine screening for distress reported better well-being and fewer emotional, physical, and practical problems than historical controls.

Competitive foods, discrimination, and participation in the National School Lunch Program.

Meals served through the National School Lunch Program (NSLP) must meet rigorous nutritional standards; however, barriers to student participation may limit the program's health and social equity benefits. Unsubsidized meals and food offerings competing with the NSLP offerings in school lunch environments may be lowering qualified student participation either directly or via identification of subsidized low-income students or stigmatization of the NSLP. We document a pilot intervention conducted in San Francisco in 2009 and 2010 that demonstrated gains in NSLP participation after removal of separate competitive à la carte lunch meal offerings. Our observations suggest the need for greater attention to the potential discriminatory effects of competitive foods and to the issue of stigma by school nutrition program administrators, researchers, regulators, and policymakers.

Supporting equitable food systems through food assistance at farmers' markets.

The failure to consider access to food resources in an integrated way may lead to inequalities in nutritional opportunities among populations. Working with community groups and other public agencies, the San Francisco Department of Public Health has led interagency food system planning in San Francisco, California, since 2002. We report on one of the interventions within that initiative-a partnership between a public health agency, a local nonprofit organization, and the local food stamp program to institutionalize improved access to farmers' markets for federal food assistance beneficiaries. We further report on monitoring data collected at farmers' markets that documents significant and sustained increases of utilization by food stamp recipients since the initial intervention.

The impact of iron overload and its treatment on quality of life: results from a literature review.

BACKGROUND: To assess the literature for the impact of iron overload and infusion Iron Chelation Therapy (ICT) on patients' quality of life (QoL), and the availability of QoL instruments for patients undergoing infusion ICT. Also, to obtain patients' experiences of having iron overload and receiving infusion ICT, and experts' clinical opinions about the impact of treatment on patients' lives. METHODS: A search of studies published between 1966 and 2004 was conducted using Medline and the Health Economic Evaluation Database (HEED). Qualitative results from patient and expert interviews were analysed. Hand searching of relevant conference abstracts completed the search. RESULTS: Few studies measuring the impact of ICT with deferoxamine (DFO) on patients QoL were located (n = 15). QoL domains affected included: depression; fatigue; dyspnoea; physical functioning; psychological distress; decrease in QoL during hospitalization. One theme in all articles was that oral ICT should improve QoL. No iron overload or ICT-specific QoL instruments were located in the articles. Interviews revealed that the impact of ICT on patients with thalassemia, sickle cell disease, and myelodysplastic syndromes is high. CONCLUSION: A limited number of studies assessed the impact of ICT or iron overload on QoL. All literature suggested a need for easily administered, efficacious and well tolerated oral iron overload treatments, given the impact of current ICT on adherence. Poor adherence to ICT was documented to negatively impact survival. Further research is warranted to continue the qualitative and quantitative study of QoL using validated instruments in patients receiving ICT to further understanding the issues and improve patients QoL.

A young man who could not walk.

Infections affecting the central nervous system caused by Blastomyces dermatitidis are rare but curable. We describe a case of a 24-year-old man who presented to the emergency department with progressive bilateral lower extremity weakness over 1 month. On the day of admission, he had minimal muscle strength and was hyperreflexic in the lower extremities. Sensation, however, was intact. Skin examination revealed annular, raised, crusted lesions on his face and legs. A magnetic resonance imaging (MRI) scan showed marrow replacement of the T7 and T8 vertebral bodies and an epidural mass with cord compression. A chest radiograph showed an infiltrate, and a subsequent needle biopsy revealed yeast resembling B. dermatitidis. A skin biopsy was then obtained, and the culture grew out B. dermatitidis. He received 4 weeks of amphotericin B lipid complex (total of 6 grams), followed by oral itraconazole. After 1 week on antifungals, he was able to walk with a walker and the skin lesions virtually resolved. At 5 months he was ambulatory and riding a bicycle daily. Blastomycosis should be included in the differential diagnosis of epidural masses.

Mupirocin resistance in clinical isolates of Staphylococcus aureus.

One hundred isolates of Staphylococcs aureus were collected in a laboratory serving several hospitals and clinics in southeastern Wisconsin and tested for mupirocin susceptibility. Only two isolates of S. aureus showed mupirocin resistance. The mupirocin-resistant isolates were from hospitalized patients with positive blood cultures.