Grassroots and Digital Outreach Strategies Raise Awareness of COVID-19 Information and Research in Baltimore City.

We aimed to disseminate reliable COVID-19 information to the Black and Latino communities of Baltimore City, Maryland, between July 2020 and December 2022. With community partners, we disseminated evidence-based COVID-19 information via grassroots and digital strategies, including Hopkins Opportunity for Participant Engagement, and connected volunteers to COVID-19 research. Using a multimodal approach facilitated dissemination of reliable information and raised awareness of research; evaluation of trust is ongoing. Robust, multimodal strategies are needed to foster trust and equity among diverse communities. (Am J Public Health. 2024;114(S1):S69-S73. https://doi.org/10.2105/AJPH.2023.307492).

Development and implementation of a quick reference (QR) code linked online education tool in anaesthesiology practice.

BACKGROUND: We conducted a feasibility study of an anaesthetic online educational tool that is accessed via quick reference (QR) codes. The primary objective of the study was to assess the feasibility of an online educational tool for providing satisfactory teaching to patients presenting for surgery and assess if using QR codes are a viable method for directing patients to the information. The secondary objective was to obtain feedback from anaesthesiologists. METHODS: The educational tool was developed and hosted on a password-protected website. The educational material on the website focused on anaesthesia-related processes that the patient should expect to experience in the hospital as well as fasting information. A survey was embedded into the website to obtain patient feedback. The website was redesigned following patient and staff feedback. RESULTS: Ninety-three patients accessed the online education tool. Of the 73 responses to the survey, 81% of patients reported that the tool improved their knowledge and understanding about anaesthesia. 73% of patients expressed a preference for, or were neutral regarding using online patient education. 36% of patients were familiar with QR codes and 28% were frequent users of QR codes. Most anaesthesiologists expressed satisfaction with the tool being used by their patients following the redesign process (93.1%, 89.6% and 89.6% for general anaesthesia, neuraxial anaesthesia and regional anaesthesia, respectively). CONCLUSIONS: This feasibility study demonstrated that an online anaesthetic educational tool has utility in promoting patient education about the anaesthetic experience and was well received by both patients and anaesthesiologists. QR codes are not feasible as the sole method for linking our patient population to an online education resource.

Non-linear shift from grassland to shrubland in temperate barrier islands.

Woody plant encroachment into grasslands is a major land cover change taking place in many regions of the world, including arctic, alpine and desert ecosystems. This change in plant dominance is also affecting coastal ecosystems, including barrier islands, which are known for being vulnerable to the effects of climate change. In the last century, the woody plant species Morella cerifera L. (Myricaceae), has encroached into grass covered swales in many of the barrier islands of Virginia along the Atlantic seaboard. The abrupt shift to shrub cover in these islands could result from positive feedbacks with the physical environment, though the underlying mechanisms remain poorly understood. We use a combination of experimental and modeling approaches to investigate the role of climate warming and the ability of M. cerifera to mitigate its microclimate thereby leading to the emergence of alternative stable states in barrier island vegetation. Nighttime air temperatures were significantly higher in myrtle shrublands than grasslands, particularly in the winter season. The difference in the mean of the 5% and 10% lowest minimum temperatures between shrubland and grassland calculated from two independent datasets ranged from 1.3 to 2.4°C. The model results clearly show that a small increase in near-surface temperature can induce a non-linear shift in ecosystem state from a stable state with no shrubs to an alternative stable state dominated by M. cerifera. This modeling framework improves our understanding and prediction of barrier island vegetation stability and resilience under climate change, and highlights the existence of important nonlinearities and hystereses that limit the reversibility of this ongoing shift in vegetation dominance.

Multiple metrics quantify and differentiate responses of vegetation to composition B.

Quantifying vegetation response to explosive compounds has focused predominantly on morphological impacts and uptake efficiency. A more comprehensive understanding of the total impacts of explosives on vegetation can be gained using a multivariate approach. We hypothesized that multiple variables representing morphological and physiological responses will more clearly differentiate species and treatments than any single variable. Individuals of three plant species were placed in soils contaminated with Composition B, which comprises 60% hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and 40% 2,4,6-trinitrotoluene (TNT), and grown for 2 months. Response metrics used included photosynthetic operation, water relations, growth characteristics, as well as nitrogen and carbon concentrations and isotopic compositions. Individual metrics showed high variability in response across the three species tested. Water relations and nitrogen isotopic composition exhibited the most consistent response across species. By comparing multiple variables simultaneously, better separation of both species and exposure was observed. The inclusion of novel metrics can reinforce previously established concepts and provide a new perspective. Additionally, the inclusion of various other metrics can greatly increase the ability to identify and differentiate particular groups. By using multivariate analyses and standard vegetation metrics, new aspects of the vegetation response to explosive compounds can be identified.

Attempted suicide by ingestion of hair dye containing p-phenylenediamine: a case report.

Para-phenylenediamine is widely used as a chemical in hair dyes and in combination with henna. This dye is used to paint the body for decorative reasons, to speed the processing time of henna and to intensify the results. Para-phenylenediamine is widely used in the Middle East, North Africa and India. Several reports have been published of the fatal ingestion of hair dye containing para-phenylenediamine. Here, we describe the case of a 14-year-old girl who ingested the compound but whose prompt treatment prevented her death. Ingestion of para-phenylenediamine produces a typical triad of angioneurotic oedema, rhabdomyolysis and acute tubular necrosis. Awareness of signs of these associated conditions in our patient, together with a comprehensive history, facilitated appropriate treatment to be instituted. We document the steps we took to enable her complete physical recovery.

NMR spectral properties of the tetramantanes - nanometer-sized diamondoids.

Tetramantanes, and all diamondoid hydrocarbons, possess carbon frameworks that are superimposable upon the cubic diamond lattice. This characteristic is invaluable in assigning their (1)H and (13)C NMR spectra because it translates into repeating structural features, such as diamond-cage isobutyl moieties with distinctively complex methine to methylene signatures in COSY and HMBC data, connected to variable, but systematic linkages of methine and quaternary carbons. In all tetramantane C22H28 isomers, diamond-lattice structures result in long-range (4)JHH, W-coupling in COSY data, except where negated by symmetry; there are two highly symmetrical and one chiral tetramantane (showing seven (4)JHH). Isobutyl-cage methines of lower diamondoids and tetramantanes are the most shielded resonances in their (13)C spectra (<29.5 ppm). The isobutyl methylenes are bonded to additional methines and at least one quaternary carbon in the tetramantanes. W-couplings between these methines and methylenes clarify spin-network interconnections and detailed surface hydrogen stereochemistry. Vicinal couplings of the isobutyl methylenes reveal positions of the quaternary carbons: HMBC data then tie the more remote spin systems together. Diamondoid (13) C NMR chemical shifts are largely determined by α and ß effects, however γ-shielding effects are important in [123]tetramantane. (1)H NMR chemical shifts generally correlate with numbers of 1,3-diaxial H-H interactions. Tight van der Waals contacts within [123]tetramantane's molecular groove, however, form improper hydrogen bonds, deshielding hydrogen nuclei inside the groove, while shielding those outside, indicated by Δδ of 1.47 ppm for geminal hydrogens bonded to C-3,21. These findings should be valuable in future NMR studies of diamondoids/nanodiamonds of increasing size.

Cognitive decline preceding the onset of psychosis in patients with 22q11.2 deletion syndrome.

IMPORTANCE: Patients with 22q11.2 deletion syndrome (22q11DS) have an elevated (25%) risk of developing schizophrenia. Recent reports have suggested that a subgroup of children with 22q11DS display a substantial decline in cognitive abilities starting at a young age. OBJECTIVE: To determine whether early cognitive decline is associated with risk of psychotic disorder in 22q11DS. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study. As part of an international research consortium initiative, we used the largest data set of intelligence (IQ) measurements in patients with 22q11DS reported to date to investigate longitudinal IQ trajectories and the risk of subsequent psychotic illness. A total of 829 patients with a confirmed hemizygous 22q11.2 deletion, recruited through 12 international clinical research sites, were included. Both psychiatric assessments and longitudinal IQ measurements were available for a subset of 411 patients (388 with ≥1 assessment at age 8-24 years). MAIN OUTCOMES AND MEASURES: Diagnosis of a psychotic disorder, initial IQ, longitudinal IQ trajectory, and timing of the last psychiatric assessment with respect to the last IQ test. RESULTS: Among 411 patients with 22q11DS, 55 (13.4%) were diagnosed as having a psychotic disorder. The mean (SD) age at the most recent psychiatric assessment was 16.1 (6.2) years. The mean (SD) full-scale IQ at first cognitive assessment was lower in patients who developed a psychotic disorder (65.5 [12.0]) compared with those without a psychotic disorder (74.0 [14.0]). On average, children with 22q11DS showed a mild decline in IQ (full-scale IQ, 7.04 points) with increasing age, particularly in the domain of verbal IQ (9.02 points). In those who developed psychotic illness, this decline was significantly steeper (P < .001). Those with a negative deviation from the average cognitive trajectory observed in 22q11DS were at significantly increased risk for the development of a psychotic disorder (odds ratio = 2.49; 95% CI, 1.24-5.00; P = .01). The divergence of verbal IQ trajectories between those who subsequently developed a psychotic disorder and those who did not was distinguishable from age 11 years onward. CONCLUSIONS AND RELEVANCE: In 22q11DS, early cognitive decline is a robust indicator of the risk of developing a psychotic illness. These findings mirror those observed in idiopathic schizophrenia. The results provide further support for investigations of 22q11DS as a genetic model for elucidating neurobiological mechanisms underlying the development of psychosis.

Differential effects of two explosive compounds on seed germination and seedling morphology of a woody shrub, Morella cerifera.

Soils contaminated with explosive compounds occur on a global scale. Research demolition explosive (RDX) (hexahydro-1,3,5-trinitro-1,3,5-triazine) and trinitrotoluene (TNT) (2-methyl-1,3,5-trinitrobenzene) are the most common explosive compounds in the environment. These compounds, by variably impacting plant health, can affect species establishment in contaminated areas. Our objective was to quantify comparative effects of RDX and TNT on a woody shrub, Morella cerifera, commonly found on bombing ranges along the Atlantic Coast of the United States. Two life stages of M. cerifera, Seeds and juvenile plants, were exposed to soil amended with concentrations of RDX and TNT representative of field levels; RDX up to 1,500 ppm and TNT up to 900 ppm. Percent germination was recorded for 3 weeks; morphological metrics of necrotic, reduced, and curled leaves, in addition to shoot length and number measured at the end of the experiment (8 weeks) for juvenile plants. All concentrations of RDX inhibited seed germination while TNT did not have an effect at any concentration. As contaminant concentration increased, significant increases in seedling morphological damage occurred in the presence of RDX, whereas TNT did not affect seedling morphology at any concentration. Overall the plants were more sensitive to the presence of RDX. Species specific responses to explosive compounds in the soil have the potential to act as a physiological filter, altering plant recruitment and establishment. This filtering of species may have a number of large scale impacts including: altering species composition and ecological succession.

Barrier island morphology and sediment characteristics affect the recovery of dune building grasses following storm-induced overwash.

Barrier islands are complex and dynamic systems that provide critical ecosystem services to coastal populations. Stability of these systems is threatened by rising sea level and the potential for coastal storms to increase in frequency and intensity. Recovery of dune-building grasses following storms is an important process that promotes topographic heterogeneity and long-term stability of barrier islands, yet factors that drive dune recovery are poorly understood. We examined vegetation recovery in overwash zones on two geomorphically distinct (undisturbed vs. frequently overwashed) barrier islands on the Virginia coast, USA. We hypothesized that vegetation recovery in overwash zones would be driven primarily by environmental characteristics, especially elevation and beach width. We sampled species composition and environmental characteristics along a continuum of disturbance from active overwash zones to relict overwash zones and in adjacent undisturbed environments. We compared species assemblages along the disturbance chronosequence and between islands and we analyzed species composition data and environmental measurements with Canonical Correspondence Analysis to link community composition with environmental characteristics. Recovering and geomorphically stable dunes were dominated by Ammophila breviligulata Fernaud (Poaceae) on both islands while active overwash zones were dominated by Spartina patens (Aiton) Muhl. (Poaceae) on the frequently disturbed island and bare sand on the less disturbed island. Species composition was associated with environmental characteristics only on the frequently disturbed island (p = 0.005) where A. breviligulata was associated with higher elevation and greater beach width. Spartina patens, the second most abundant species, was associated with larger sediment grain size and greater sediment size distribution. On the less frequently disturbed island, time since disturbance was the only factor that affected community composition. Thus, factors driving the abundance of dune-building grasses and subsequent recovery of dunes varied between the two geomorphically distinct islands.

The ideal laboratory information system.

CONTEXT: Laboratory information systems (LIS) are critical components of the operation of clinical laboratories. However, the functionalities of LIS have lagged significantly behind the capacities of current hardware and software technologies, while the complexity of the information produced by clinical laboratories has been increasing over time and will soon undergo rapid expansion with the use of new, high-throughput and high-dimensionality laboratory tests. In the broadest sense, LIS are essential to manage the flow of information between health care providers, patients, and laboratories and should be designed to optimize not only laboratory operations but also personalized clinical care. OBJECTIVES: To list suggestions for designing LIS with the goal of optimizing the operation of clinical laboratories while improving clinical care by intelligent management of laboratory information. DATA SOURCES: Literature review, interviews with laboratory users, and personal experience and opinion. CONCLUSIONS: Laboratory information systems can improve laboratory operations and improve patient care. Specific suggestions for improving the function of LIS are listed under the following sections: (1) Information Security, (2) Test Ordering, (3) Specimen Collection, Accessioning, and Processing, (4) Analytic Phase, (5) Result Entry and Validation, (6) Result Reporting, (7) Notification Management, (8) Data Mining and Cross-sectional Reports, (9) Method Validation, (10) Quality Management, (11) Administrative and Financial Issues, and (12) Other Operational Issues.

Phase II multicenter trial of voreloxin as second-line therapy in chemotherapy-sensitive or refractory small cell lung cancer.

INTRODUCTION: Voreloxin is an anticancer quinolone derivative that intercalates DNA and inhibits topoisomerase II, causing double-strand breaks in DNA, irreversible G2 arrest, and rapid onset of apoptosis. Based on preclinical activity of voreloxin in chemoresistant tumors, early phase I clinical activity, and a mechanism of action similar to other topoisomerase II inhibitors such as the anthracyclines and etoposide, this phase II trial was undertaken as second-line treatment of small cell lung cancer (SCLC). METHODS: Patients with extensive stage SCLC previously treated with one prior chemotherapy regimen were eligible. Patients with chemotherapy-sensitive or chemotherapy-refractory disease were considered as separate cohorts. Voreloxin (48 mg/m) was administered on the first day of each 21-day cycle for up to six cycles. The primary end point was objective response rate. RESULTS: Fifty-five patients were enrolled including 28 with refractory SCLC and 27 with sensitive SCLC; 47 were evaluable for response. Three patients with sensitive SCLC had an objective response, including one complete response and two partial responses (11% response rate based on intent to treat). No patients in the refractory cohort had a response. The primary grade 3 toxicity was neutropenia. CONCLUSION: Voreloxin has minimal activity in relapsed SCLC when administered at 48 mg/m in a 3-week schedule.

Contribution of sunflecks is minimal in expanding shrub thickets compared to temperate forest.

Ecological consequences of shrub encroachment are emerging as a key issue in the study of global change. In mesic grasslands, shrub encroachment can result in a fivefold increase in ecosystem leaf area index (LAI) and a concurrent reduction in understory light and herbaceous diversity. LAI and light attenuation are often higher for shrub thickets than for forest communities in the same region, yet little is known about the contribution of sunflecks in shrub-dominated systems. Our objective was to compare fine-scale spatial and temporal dynamics of understory light in shrub thickets to the light environment in typical forest communities. We used an array of quantum sensors to examine variation in diffuse and direct light and determined the relative contribution of sunflecks during midday in Morella cerifera shrub thickets, a 30-yr-old abandoned Pinus taeda plantation, and a mature, second-growth, deciduous forest. Instantaneous photosynthetic photon flux density (PPFD) was measured at 1-s intervals at five sites in each community during midday. In summer, understory light during midday in shrub thickets was approximately 0.8% of above-canopy light, compared to 1.9% and 5.4% in pine and deciduous forests, respectively. During summer, PPFD was uncorrelated between sensors as close as 0.075 m in shrub thickets compared to 0.175 m and 0.900 m in pine and deciduous forests, respectively, indicating that sunflecks in shrub thickets were generally small compared to sunflecks in the two forests. Sunflecks in shrub thickets were generally short (all <30 s) and relatively low in intensity (<150 micromol photons x m(-2) x s(-1)) and contributed only 5% of understory light during midday. Sunflecks were longer (up to 6 minutes) and more intense (up to 350 micromol photons x m(-2) x s(-1)) in the two forest communities and Contributed 31% and 22% of understory light during midday in pine and deciduous forest, respectively. The combination of high LAI and relatively short-stature of M. cerifera shrub thickets produces a dense canopy that reduces both diffuse light and the occurrence of sunflecks. The lack of sunflecks may limit the number of microsites with a favorable light environment and contribute to the reduction in understory cover and diversity within the shrub thickets.

2008 ACLPS panel discussion on resident education in clinical pathology.

A curriculum in clinical pathology (CP) was developed under the auspices of the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) in 2006. At the 2008 ACLPS meeting in Philadelphia, PA, a panel was convened to address the current challenges in resident education and how to overcome them. Current challenges include the heterogeneity of the discipline (which requires analytical, medical, and managerial knowledge), the diverse repertoire of clinical laboratory testing, and the need to better integrate the resident into the work flow of the laboratory, especially with respect to clinical consultation. Recommendations of the panel include the incorporation of active learning, clinical consultation, and competency assessment into CP resident training. A summary of the panel discussion is presented herein.

Previously undetected metabolic syndromes and infectious diseases among psychiatric inpatients.

OBJECTIVE: This study identified previously undetected metabolic and infectious disease among persons with serious mental illness who were admitted to psychiatric inpatient units. METHODS: Observational-naturalistic methods were used to simulate universal screening in order to document evidence of undetected disease among 588 adult psychiatric patients. Data were obtained from medical records and laboratory tests. RESULTS: Laboratory results showed that 10% of patients had HIV, 32% had hepatitis B, and 21% had hepatitis C. Glucose levels were elevated in 7%, and total cholesterol levels were elevated in 22%. Nearly 60% had body mass indices above 25. The treatment team missed a considerable proportion of infectious disease (95% of hepatitis B cases, 50% of hepatitis C cases, and 21% of HIV cases) and metabolic disorders (89% of cases with elevated total cholesterol levels and 97% of cases with elevated triglyceride levels). By contrast, only 18% of cases with elevated glucose levels were missed. CONCLUSIONS: This study demonstrated very high prevalence of both metabolic disorders and infectious diseases in a psychiatric inpatient population.

Daclizumab improves asthma control in patients with moderate to severe persistent asthma: a randomized, controlled trial.

RATIONALE: Airway inflammation in asthma is associated with increased activated CD25(+) T cells, IL-2, and soluble IL-2 receptors (IL-2Rs). OBJECTIVES: A randomized, double-blinded, placebo-controlled study was used to evaluate the safety and efficacy of daclizumab, a humanized IgG1 monoclonal antibody against the IL-2R alpha chain (CD25) of activated lymphocytes, in adults with moderate to severe persistent asthma. METHODS: Patients with obstructive pulmonary functions, despite inhaled corticosteroids (ICS), were switched to equivalent dose inhaled triamcinolone acetate acetonide (TAA). Patients dependent on ICS were randomized (3:1) to daclizumab (intravenous loading dose, 2 mg/kg, then 1 mg/kg) or placebo every 2 weeks, added to stable-dose TAA through Week 12 (Treatment Period 1). Over Weeks 12-20 (Treatment Period 2), patients tapered TAA while on the study drug, and were followed for 16 weeks off the study drug. MEASUREMENTS AND MAIN RESULTS: Among 115 evaluable patients (88 daclizumab, 27 placebo), groups had similar age, disease duration, and length of ICS use. During Treatment Period 1, daclizumab improved FEV(1) (daclizumab, 4.4 +/- 1.80% vs. placebo, 1.5 +/- 2.39%; P = 0.05), and reduced daytime asthma symptoms (P = 0.018) and short-acting inhaled beta(2)-agonist use (P = 0.009). Daclizumab treatment prolonged time to exacerbation (P = 0.024). Adverse events were evenly distributed between groups, although there were more serious adverse events in the patients treated with daclizumab. CONCLUSIONS: Daclizumab improved pulmonary function and asthma control in patients with moderate to severe chronic asthma inadequately controlled on ICS. The mechanism of action likely involves inhibition of proinflammatory cytokine generation by IL-2R blockade in activated T cells. Clinical trial registered with www.clinicaltrials.gov (NCT00028288).

Shifts in litterfall and dominant nitrogen sources after expansion of shrub thickets.

Woody encroachment into herbaceous ecosystems is emerging as an important ecological response to global change. A primary concern is alterations in C and N cycling and associated variations across a variety of ecosystems. We quantified seasonal variation in litterfall and litter N concentration in Morella cerifera shrub thickets to assess changes in litterfall and associated N input after shrub expansion on an Atlantic coast barrier island. We also used the natural abundance of (15)N to estimate the proportion of litterfall N originating from symbiotic N fixation. Litterfall for shrub thickets ranged from 8,991 +/- 247 to 3,810 +/- 399 kg ha(-1) year(-1) and generally declined with increasing thicket age. Litterfall in three of the four thickets exceeded previous estimates of aboveground annual net primary production in adjacent grasslands by 300-400%. Leaf N concentration was also higher after shrub expansion and, coupled with low N resorption efficiency and high litterfall, resulted in a return of as much as 169 kg N ha(-1) year(-1) to the soil. We estimated that approximately 70% of N returned to the soil was from symbiotic N fixation resulting in an ecosystem input of between 37 and 118 kg ha(-1) year(-1) of atmospheric N depending on site. Considering the extensive cover of shrub thickets on Virginia barrier islands, N fixation by shrubs is likely the largest single source of N to the system. The shift from grassland to shrub thicket on barrier islands results in a substantial increase in litterfall and foliar N concentration that will likely have a major impact on the size and cycling of ecosystem C and N pools. Increasing C and N availability in these nutrient-poor soils is likely to permanently reduce cover of native grasses and alter community structure by favoring species with greater N requirements.

Leaf-area index and light attenuation in rapidly expanding shrub thickets.

There is increasing interest in the changes in ecosystem services that accompany the conversion of grasslands to shrub-dominated communities. Shrub structure and associated effects on the light environment may be especially important in affecting productivity and diversity. Leaf-area index (LAI) and understory light levels of Morella cerifera shrub thickets were assessed on Hog Island, Virginia, USA, at four sites along a soil chronosequence. LAI was estimated from annual leaf litter, with allometric models relating stem diameter to leaf area, with a portable integrating radiometer (LI-COR LAI-2000), and from photosynthetically active radiation (PAR) using the Beer-Lambert law. For the two youngest thickets, LAI estimates from leaf litter (approximately 10.0) approached levels often associated with tropical rain forest. Allometric models estimated LAI values at 9.8 and 12.5 for the same thickets. High LAI in thickets also results in high light attenuation. Light levels within thickets were as low as 0.7% of above-canopy PAR in the youngest thicket. These data suggest that M. cerifera shrub thickets have a very high potential for annual net primary production. Furthermore, extreme modification of the light environment, coupled with heavy shrub litter fall, may exclude potential competitors during thicket establishment and rapidly alter community structure and ecosystem function.

Assessing the relationship between insight and everyday executive deficits in schizophrenia: a pilot study.

Past research has found that deficits in insight into illness are related to executive deficits in schizophrenia. This study further explores this relationship with the utilization of an ecologically-valid battery of executive tests. The study included 21 patients with schizophrenia who were administered the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the first three items of the Scale to Assess Unawareness of Mental Disorder. Patients were found to be impaired on the BADS and most had insight into their illness. Lack of illness awareness was not significantly correlated with all of the BADS subtests with the exception of Rule Shift Cards, a measure of cognitive flexibility. The relationship between some measures of unawareness and Rule Shift Cards was still significant or approaching significance when the effects of IQ were partialled out. These findings add to previous research by demonstrating that cognitive flexibility, specifically involving the ability to shift set, is associated with awareness of illness in schizophrenia. On the other hand, it is proposed that most of the other BADS subtests are more complex and multifactorial, thereby making it difficult to find any associations that may exist between a specific subdimension of executive function and insight into illness.