Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016.

INTRODUCTION: The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. MATERIALS AND METHODS: The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. RESULTS: For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. PRACTICE IMPLICATIONS: Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

Pulmonary hypertension: a review for nurses.

Pulmonary hypertension (PH) is a progressive disease resulting from increased pulmonary vasoconstriction, vascular remodelling and thrombosis, leading to right heart failure. Symptoms at clinical presentation are often vague and difficult to differentiate from other diseases. A good history and identification of key physical findings will facilitate earlier diagnosis resulting in tailored treatment to alleviate symptoms and improve outcomes. This article will provide an overview of PH including pathophysiology, clinical presentation, diagnostic testing, and treatment modalities with a Canadian perspective. The main focus is directed towards the care of patients with pulmonary arterial hypertension (PAH). Implications for nursing will also be discussed, focusing on education and support of patients and families.

Screening of anti-human leukocyte monoclonal antibodies for reactivity with equine leukocytes.

Three hundred and seventy-nine monoclonal antibodies (mAbs) against various human CD molecules supplied to the HLDA8 animal homologues section (including four isotype controls) were analysed for cross-reactivity with equine leukocytes. First, flow cytometric identification of positively reacting mAbs was performed in one laboratory. Thereafter, a second round of flow cytometric evaluation was performed, involving three laboratories participating in the study. The first test-round indicated 17 mAbs as potentially positive. After the second round of flow cytometric analysis, 14 mAbs remained (directed against CD2, CD11a, CD18, CD44, CD45, CD49d, CD91, CD163 and CD172) where cross-reactivity was anticipated based on similarities between the human and equine staining pattern. Additionally, there was 1 mAb with weak likely positive reactivity, 12 mAbs with positive staining, which likely do not reflect valuable data, 5 mAbs with clear alternate expression pattern from that expected from humans, 5 mAbs with a questionable staining pattern itself, i.e. that was variable between the three labs, 32 mAbs with weak-positive expression and alternate staining pattern, and 279 negative mAbs (including the four isotype controls) were detected. In 31 cases, more appropriate target cells, such as thymocytes or stem cells, were not available for the screening. The results underline the value of this "cross-reactivity" approach for equine immunology. However, as only a few mAbs against leukocyte surface antigens reacted positively (approximately 4% of the mAbs submitted), the analysis of further anti-human mAbs and directed efforts to develop species-specific anti-CD mAb are still required.

Further characterization of cross-reactive anti-human leukocyte mAbs by use of equine leukocyte cell lines EqT8888 and eCAS.

The equine leukocyte cell lines, namely eCAS (bone marrow derived) and EqT8888 (lymphoma derived) were used for further analysis, using 40 commercially available mAbs that showed reactivity with equine PBMC. Most mAbs that were detected in these previous studies to react with PBMC, however, did not react with either of these cell lines. Fifteen mAbs were positive on at least one of the cell lines and indicate opportunities to set up further tests using these cells. Notably, two mAbs directed against human CD34 were detected to react with eCAS.

Application of the comet assay for investigation of oxidative DNA damage in equine peripheral blood mononuclear cells.

Oxidative stress occurs when antioxidant defense mechanisms are overwhelmed by free radicals and may lead to DNA damage, which has been implicated in processes such as aging and diseases such as cancer. The two main techniques presently used to quantify DNA damage are measurement of 8-hydroxydeoxyguanosine and the Comet assay (also known as single-cell gel electrophoresis). The aim of this study was to apply the comet assay to equine peripheral blood mononuclear cells (PBMCs) and identify two conditions in which we hypothesized that oxidative DNA damage would be increased in PBMCs: aging and equine recurrent airway obstruction (RAO, a condition similar to human asthma). The images obtained were similar to those previously published for humans, cats, and dogs. The optimum concentration of H(2)O(2) to estimate susceptibility to exogenous damage was 50 microM. Mean intraassay coefficients of variation were 4.7 and 9.7% for endogenous and exogenous tail-DNA quantities, respectively, and 7.3 and 8.3%, respectively, for interassay coefficients. There was no significant difference in either endogenous or exogenous percentages of tail DNA for samples collected from six ponies on three consecutive days. There was no significant difference in endogenous, exogenous, or exogenous (corrected for endogenous) oxidative DNA damage between mature and aged ponies. However, young pony foals had significantly less endogenous DNA damage than mature or aged ponies (P < 0.05). RAO-affected horses without airway inflammation (i.e., in clinical remission) had significantly greater endogenous damage compared with non-RAO-affected control animals (P = 0.009). There was a significant correlation between endogenous percentage of tail DNA in PBMCs and red blood cell hemolysate glutathione concentration (r = 0.720; P < 0.001). In conclusion, the comet assay appears to be suitable for investigating DNA damage in equine PBMCs.

Age, memory load, and individual differences in working memory as determinants of class-inclusion reasoning.

We studied the effects of individual differences in speak-span scores and variations in memory demands on the class-inclusion performance of 10-, 13-, and 15-year-old children. The speak-span task was an age-appropriate modification of Daneman and Carpenter's (1980) reading-span task and was considered to be a measure of global resources. The age variable was assumed to be a global index of skill development, and some of the specific skills hypothesized to be important in class-inclusion reasoning were estimated using a mathematical model. The results from both regression analyses and the mathematical model indicated that differences in age, speak span, and memory load all affected performance. Surprisingly, the effects of speak span and memory load were independent. However, the effects of each of these variables depended on the age level of the participants. Based on these findings, we argued that (a) resources vary continuously with age, (b) both skill level and global resources should be varied in developmental studies of problem solving, and (c) resource theories (e.g., Norman & Shallice, 1986) should be modified to account for developmental change.