The harmful effects of partisan polarization on health.

Partisan polarization significantly drives stress and anxiety among Americans, and recent aggregate-level studies suggest polarization may be shaping their health. This individual-level study uses a new representative dataset of 2,752 US residents surveyed between December 2019 and January 2020, some US residents report more days of poor physical and mental health per month than others. Using negative binomial models, zero inflated models, and visualizations, we find evidence that polarization is linked to declines in physical health: the more distant an individual feels politically from the average voter in their state, the worse health outcomes he or she reports. By uncovering the individual-level political correlates of health, this study aims to encourage further study and attention to the broader consequences of political polarization on American communities.

Basophil activation test shows high accuracy in the diagnosis of peanut and tree nut allergy: The Markers of Nut Allergy Study.

BACKGROUND: Peanut and tree nut allergies are the most important causes of anaphylaxis. Co-reactivity to more than one nut is frequent, and co-sensitization in the absence of clinical data is often obtained. Confirmatory oral food challenges (OFCs) are inconsistently performed. OBJECTIVE: To investigate the utility of the basophil activation test (BAT) in diagnosing peanut and tree nut allergies. METHODS: The Markers Of Nut Allergy Study (MONAS) prospectively enrolled patients aged 0.5-17 years with confirmed peanut and/or tree nut (almond, cashew, hazelnut, pistachio, walnut) allergy or sensitization from Canadian (n = 150) and Austrian (n = 50) tertiary pediatric centers. BAT using %CD63+ basophils (SSClow/CCR3pos) as outcome was performed with whole blood samples stimulated with allergen extracts of each nut (0.001-1000 ng/mL protein). BAT results were assessed against confirmed allergic status in a blinded fashion to develop a generalizable statistical model for comparison to extract and marker allergen-specific IgE. RESULTS: A mixed effect model integrating BAT results for 10 and 100 ng/mL of peanut and individual tree nut extracts was optimal. The area under the ROC curve (AUROC) was 0.98 for peanut, 0.97 for cashew, 0.92 for hazelnut, 0.95 for pistachio, and 0.97 for walnut. The BAT outperformed sIgE testing for peanut or hazelnut and was comparable for walnut (AUROC 0.95, 0.94, 0.92) in a sub-analysis in sensitized patients undergoing OFC. CONCLUSIONS: Basophil activation test can predict allergic clinical status to peanut and tree nuts in multi-nut-sensitized children and may reduce the need for high-risk OFCs in patients.

Modified lateral orbitotomy with combined partial zygomatic arch and vertical ramus ostectomies for excision of a frontal and parietal bone osteoma in a dog.

OBJECTIVE: To describe modifications to the lateral orbitotomy for surgical excision of tumors affecting the frontal, parietal, palatine, or temporal bones. STUDY DESIGN: Case report. ANIMAL: A 5-year-old female spayed American pit bull terrier. METHODS: The dog presented for excision of a bone tumor affecting the right frontal and parietal bones. A modified lateral orbitotomy was performed with combined partial zygomatic arch and vertical ramus ostectomies to increase working space and allow drilling of the calvarium ventral to the mass. RESULTS: The dog tolerated the procedure well, and there were no complications from either the ostectomies or the craniectomy. Histopathological examination was consistent with complete excision of an osteoma. The dog survived 2 years with no recurrence and was euthanized due to an intestinal mass. CONCLUSION: The lateral orbitotomy approach can be modified with combined partial zygomatic arch and vertical ramus ostectomies to increase exposure and working space for resection of tumors affecting the frontal, parietal, palatine, or temporal bones.

A MCREXS modelling approach for the simulation of a radiological dispersal device.

Assessing the risks of radioactive dose in a radiological dispersal device (RDD) attack requires knowledge of how the radiological materials will be spread through the air surrounding the site of the detonation. Two essential parts of the accurate prediction of the behaviour of this dispersion are a characterization of the initial cloud size, directly after the blast, and detailed modelling of the behaviour of different size particulates. Capturing the transport of contaminants from the initial blast wave is integral to achieving accurate predictions, especially for regions where the blast dynamics dominates, but performing such calculations over a wide range of particle sizes and spatial scales is computationally challenging. Formulation of efficient computational techniques for such advanced models is required to provide predictive tools useful to first responders and emergency planners. In this work, a Multi-Cloud Radiological EXplosive Source (MCREXS) modelling approach for RDD is investigated. This approach combines a stochastic, particle-based, mechanistic model with a standard atmospheric dispersion model. The former is used to characterize the distribution of radioactive material near the source of the explosion, where the blast wind effects are important, while the latter is used to model the transport of the contaminant in the environment over large areas. The particle transport in the near-field of the explosion site is computed based on a Lagrangian description of the particle phase and a reconstructed-Eulerian field for the carrier phase. The information inferred from this physics-based model is then used as a starting point for a subsequent standard Gaussian puff model to calculate the dispersion of the radioactive contaminant. The predictive capabilities of the MCREXS model are assessed against the 2012 DRDC Suffield full-scale RDD experiments. The results demonstrate improved predictions relative to those performed using only a Gaussian puff calculation from an empirical initial cloud distribution.

Zurich Cementless Total Hip Replacement.

Total hip replacement (THR) is the gold standard treatment of intractable pain from hip dysplasia. THR procedures are divided into 2 main categories: cemented and cementless, with hybrid a combination. The Zurich Cementless THR system uses a combination of press-fit (acetabular component) and locking screw (femoral component) fixation designed to address the main challenge facing cemented systems (aseptic loosening) while providing the benefit of immediate stability with its novel locking screw implantation system for the femoral stem. The Zurich THR system is an effective treatment option for orthopedic conditions of the coxofemoral joint in medium to giant breed dogs.

Near-field investigation of the explosive dispersal of radioactive material based on a reconstructed spherical blast-wave flow.

A "dirty bomb" is a type of radiological dispersal device (RDD) that has been the subject of significant safety and security concerns given the disruption that would result from a postulated terrorist attack. Assessing the risks of radioactive dose in a hypothetical scenario requires models that can accurately predict dispersion in a realistic environment. Modelling a RDD is complicated by the fact that the most important phenomena occur over vastly disparate spatial and temporal length scales. Particulate dispersion in the air is generally considered on scales of hundreds to thousands of meters, and over periods of minutes and hours. Dispersion models are extremely sensitive, however, to the particle size and source characterization, which are determined in distances measured in micrometers to meters, over milliseconds or less. This study examines the extent to which the explosive blast determines the transport of contaminant particles relative to the atmospheric wind over distances relevant to "near-field" dispersion problems (i.e., hundreds of meters), which are relevant to urban environments. Our results indicate that whether or not the effect of the blast should be included in a near-field dispersion model is largely dependent on the size of the contaminant particle. Relatively large particles (i.e., >40 µm in diameter), which are most likely to be produced by a RDD, penetrate the leading shock front, thereby avoiding the reverse blast wind. Consequently, they travel much farther than suspended aerosols (<10 µm) before approaching the ambient wind velocity. This suggests that, for these "near-field" dispersion problems in urban environments, the transport of contaminants from the blast wave may be integral to accurately predicting their dispersion.

Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children.

BACKGROUND: Cow's milk allergy is one of the most common food allergies affecting young children. A subset of milk-allergic individuals can eat baked milk without allergic symptoms which is beneficial in terms of prognostication and liberalization of the diet. A retrospective study suggested that skin prick testing (SPT) with a baked milk (muffin) slurry may provide a sensitive means of predicting the outcome of a medically supervised baked milk oral food challenge. We evaluated the predictive value of SPT with baked milk to identify unheated milk-allergic children who are able to safely eat baked milk. METHODS: Children aged 2-16 years with a prior history of reaction to milk and a milk extract SPT of 8-14 mm were recruited. Investigator-blinded SPT to muffin slurry and powdered milk in triplicate and specific IgE (sIgE) to casein and milk were performed. Graded oral challenge to egg-free baked milk muffins (total 2.6 gm milk protein) was performed in the hospital. Reliability of tests was analyzed for intraclass correlation. Statistical significance for clinical characteristics of population and muffin testing versus baked milk reactivity was calculated with Fisher exact test for dichotomous and t-test for continuous variables. Wilcoxon rank sum test was used to compare immunological characteristics between individuals who tolerated or reacted to baked milk. Fitted predicted probability curves and ROC curves were generated. RESULTS: Thirty-eight children were consented and 30 met study criteria. The muffin SPT and casein sIgE were significantly different in those who passed versus failed baked milk challenge. Negative (<3 mm) baked milk tests were found in 8/30 children (27 %) and were associated with non-reactivity to baked milk (p = 0.01) with a sensitivity of 1 (0.70-1.00). All children with negative SPT for baked milk passed the oral challenge. Specificity was 0.41 (0.19-0.67). The optimal decision point for the muffin SPT was 4 mm and the casein sIgE was 6 kU/L. The powdered milk test was not helpful. CONCLUSIONS: Skin prick testing with a baked milk (muffin) slurry may have a role in clinical practice to identify baked milk tolerance in milk-allergic patients.

Yield of emergent neuroimaging among children presenting with a first complex febrile seizure.

OBJECTIVES: The objective of this study was to assess the risk of intracranial pathology requiring immediate intervention among children presenting with their first complex febrile seizure (CFS). DESIGN/METHODS: This is a retrospective cohort review of patients 6 to 60 months of age evaluated in a pediatric emergency department between 1995 and 2008 for their first CFS. Cases were identified using computerized text search followed by manual chart review. We excluded patients with a prior history of a nonfebrile seizure disorder or a prior CFS, an immune-compromised state, an underlying illness associated with seizures or altered mental status, or trauma. Data extraction included age, sex, seizure features, prior simple febrile seizures, temperature, family history of seizures, vaccination status, findings on physical examination, laboratory and imaging studies, diagnosis, and disposition. RESULTS: We identified a first CFS in 526 patients. Two hundred sixty-eight patients (50.4%) had emergent head imaging: 4 patients had a clinically significant finding: 2 had intracranial hemorrhage, 1 had acute disseminated encephalomyelitis, and 1 patient had focal cerebral edema (1.5%; 95% confidence interval, 0.5%-4.0%). Assigning low risk to patients not imaged and not returning to the emergency department within a week of the original visit, the risk of intracranial pathology in our sample was 4 (0.8%; 95% confidence interval, 0.2%-2.1%) of 526. Three of these 4 patients had other obvious findings (nystagmus, emesis, and altered mental status; persistent hemiparesis; bruises suggestive of inflicted injury). CONCLUSIONS: Very few patients with CFSs have intracranial pathology in the absence of other signs or symptoms. Patients presenting with more than one seizure in 24 hours in particular are at very low risk.

No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients.

BACKGROUND: There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. We aimed to describe the outcome of selectively applied guidelines, based on risk-stratification, to our high risk, egg-allergic, tertiary-care pediatric population. METHODS: Egg allergy was confirmed with skin testing. The vaccine administered was an adjuvunated 2009 H1N1 influenza A vaccine with < 0.165 mcg/ml ovalbumin. Patients with mild egg allergy were to receive the vaccination in 1 dose, those with severe egg allergy were to receive 2 split doses, and patients with exquisite egg allergy or significant co-morbidities were to be skin tested with the vaccine (prick full strength, intradermal 1:100 of final concentration without adjuvant) and had 5 step desensitization if the testing was positive, or 1-2 step administration if negative. Patients were observed for 60 minutes after the final dose and anaphylaxis treatment was available. We report the frequency of allergic reactions. RESULTS: Ninety-nine patients were referred and 79 had positive egg testing. Asthma was present in 67% and 30% had prior anaphylaxis to egg. We vaccinated 77 of 79 patients: 71 without performing vaccine skin testing. Two refused vaccination. No patient had a systemic reaction or required treatment. Two patients experienced positive testing to the adjuvanated intradermal vaccine, but were negative without adjuvant. CONCLUSIONS: Our results suggest that most egg-allergic tertiary care pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances. The squalene adjuvant may cause an irritant reaction with intradermal testing.

Yield of lumbar puncture among children who present with their first complex febrile seizure.

OBJECTIVE: To assess the rate of acute bacterial meningitis (ABM) among children who present with their first complex febrile seizure (CFS). DESIGN AND METHODS: This study was a retrospective, cohort review of patients aged 6 to 60 months who were evaluated in a pediatric emergency department (ED) between 1995 and 2008 for their first CFS. Cases were identified by using a computerized text search followed by a manual chart review. Exclusion criteria included prior history of nonfebrile seizures, an immunocompromised state, an underlying illness associated with seizures or altered mental status, or trauma. Data extracted included age, gender, seizure features, the number of previous simple febrile seizures, temperature, a family history of seizures, findings on physical examination, laboratory and imaging study results, and ED diagnosis and disposition. RESULTS: We identified 526 patients. The median age was 17 months (interquartile range: 13-24), and 44% were female. Ninety patients (17%) had a previous history of simple febrile seizures. Of the patients, 340 (64%) had a lumbar puncture (LP). The patients' median white blood cell count during a CFS was 1 cell per microL (interquartile range: 1-2), and 14 patients had CSF pleocytosis (2.7% [95% confidence interval [CI]: 1.5-4.5]). Three patients had ABM (0.9% [95% CI: 0.2-2.8]). Two had Streptococcus pneumoniae in a culture of their cerebrospinal fluid. Among these 2 patients, 1 was nonresponsive during presentation, and the other had a bulging fontanel and apnea. The third child appeared well; however, her blood culture grew S pneumoniae and failed the LP test. None of the patients for whom an LP was not attempted subsequently returned to the hospital with a diagnosis of ABM (0% [95% CI: 0, 0.9]). CONCLUSION: Few patients who experienced a CFS had ABM in the absence of other signs or symptoms.

Holiday ornament-related injuries in children.

OBJECTIVES: Holiday ornament injuries in children have not been well documented in the medical literature. Our aim was to investigate the patterns of injuries sustained from these ornaments as a first measure toward prevention. METHODS: This was a retrospective cohort analysis of all patients examined in an urban pediatric emergency department over a 13-year period ending in March 2008 for holiday ornament-related injuries. Cases were identified using a computer-assisted text query followed by a manual chart review. Data collected from each chart included the child's age, sex, injury characteristics, physical examination findings, radiographic imaging, interventions, and disposition. To analyze injury rates over the years, we used a multiplicative Poisson model allowing varying exposures. RESULTS: Over the study period, we identified 76 eligible patients. The median age was 2 years (interquartile range, 1.17-3.3 years); 44.7% were female. Forty-three of the 76 cases (53.9%) involved ingestions: 35 were of holiday ornaments, and 8 were of light bulbs. All but one of these ornaments were made of glass. In 28%, there was an associated bleed either from the mouth or as a delayed gastrointestinal bleed. Other patients experienced lacerations (27.6%), eye injuries (5.1%), and minor electrocution injury (2.5%). Imaging was performed in 85%. A subspecialty consult was obtained in 23%, primarily addressing a foreign body ingestion or removal after skin exploration. The incidence rate has not changed over the years. CONCLUSIONS: Holiday ornament-related injuries primarily involve foreign body ingestions and glass-related injuries. Over half of the injuries involved small light bulbs and ornaments made of glass placed at the level a toddler can reach. Pediatricians are advised to discuss these points with families during holiday season.

Glass table-related injuries in children.

OBJECTIVES: To investigate the patterns of injury sustained from glass table-related accidents to estimate whether tempered glass would prevent injuries. METHODS: We conducted a retrospective cohort analysis of all patients in an urban pediatric emergency department between October of 1995 and May for 2007 for glass table-related accidents. Data collected included age, sex, injury characteristics, examination findings, radiographic imaging, interventions, and disposition.We used a preventability score ranging from I (fully preventable injury with safety glass) to IV (unlikely to be preventable with safety glass). RESULTS: We identified 174 eligible patients during the study period. The median age was 3.4 years (interquartile range, 2.0-6.6 years); 62.1% were boys. The face was most commonly involved (45.6%) followed by lower (23.8%) and upper extremities (18.9%). Patients younger than 5 years were associated with more facial injuries (odds ratio, 6.0; 95% confidence interval, 2.9-12.6). Radiographs were obtained in 68 patients, and computed tomographic scans in 3 (total, 40.1%). Surgical repair was needed in 143 patients (82.1%), of whom 15 (10.5%) underwent procedural sedation and 8 (5.6%) required operative management. Reviewers ranked 74 patients (42.5%) as grade I, 20 patients (11.5%) as grade II, 64 patients (36.8%) as grade III, and 16 patients (9.2%) as grade IV. CONCLUSIONS: Glass table injuries are associated with significant morbidity. More than half of the injuries may have been prevented or mitigated with the use of tempered glass. Pediatricians are advised to discourage families from the purchase of nontempered glass tables, while advocating for legislation mandating the use of tempered glass.

Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age.

OBJECTIVES: American Academy of Pediatrics consensus statement recommendations are to consider strongly for infants 6 to 12 months of age with a first simple febrile seizure and to consider for children 12 to 18 months of age with a first simple febrile seizure lumbar puncture for cerebrospinal fluid analysis. Our aims were to determine compliance with these recommendations and to assess the rate of bacterial meningitis detected among these children. METHODS: A retrospective cohort review was performed for patients 6 to 18 months of age who were evaluated for first simple febrile seizure in a pediatric emergency department between October 1995 and October 2006. RESULTS: First simple febrile seizure accounted for 1% of all emergency department visits for children of this age, with 704 cases among 71 234 eligible visits during the study period. Twenty-seven percent (n = 188) of first simple febrile seizure visits were for infants 6 to 12 months of age, and 73% (n = 516) were for infants 12 to 18 months of age. Lumbar puncture was performed for 38% of the children (n = 271). Samples were available for 70% of children 6 to 12 months of age (131 of 188 children) and 25% of children 12 to 18 months of age (129 of 516 children). Rates of lumbar puncture decreased significantly over time in both age groups. The cerebrospinal fluid white blood cell count was elevated in 10 cases (3.8%). No pathogen was identified in cerebrospinal fluid cultures. Ten cultures (3.8%) yielded a contaminant. No patient was diagnosed as having bacterial meningitis. CONCLUSIONS: The risk of bacterial meningitis presenting as first simple febrile seizure at ages 6 to 18 months is very low. Current American Academy of Pediatrics recommendations should be reconsidered.

Glass thermometer injuries: it is not just about the mercury.

BACKGROUND: Glass mercury thermometers were once used as the criterion standard for measuring core body temperature. Once broken, however, there is the dual hazard of broken glass and exposure to mercury. Previous studies have focused only on the mercury hazard rather than injuries related to thermometer glass. OBJECTIVE: To identify injury patterns from glass thermometers, including glass-related injury and mercury exposure. METHODS: We performed a retrospective cohort study of glass thermometer-related injuries in children evaluated in a pediatric emergency department between October 1995 and October 2007. Case identification was performed using a computer-assisted screening tool followed by a manual chart review. Collected data included age, sex, injury characteristics, physical examination findings, radiologic imaging, interventions, and disposition. To analyze injury rates during these years, we used a multiplicative Poisson model allowing for varying exposures. RESULTS: Thirty-three patients were identified among 627,592 who presented to the emergency department during the study period. Approximately 1 to 6 patients presented every year, including 3 patients in 2007. Decline in injury incidence is less than 9% per year (P = 0.041). Median patient age was 2.4 years (interquartile range, 0.4-3.8 years); 12 patients (36%) were female. Twenty-two patients (66%) underwent radiologic imaging to identify potential foreign body (21 underwent radiography and 1 underwent computed tomographic scanning). There were 15 mouth injuries (45%), 13 anal injuries (39%), and 1 ear injury. Glass was identified by imaging in 5 patients (15%) and by sigmoidoscopic evaluation in 1 patient (3%). Mercury exposure was identified in 14 patients (42%). CONCLUSIONS: Persistent use of glass mercury thermometers has resulted in pediatric injury especially in children younger than 4 years. We reported the different mechanisms of injury with the hope of eliminating its use and reinforcing the use of alternative thermometers.

GrainGenes 2.0. an improved resource for the small-grains community.

GrainGenes (http://wheat.pw.usda.gov) is an international database for genetic and genomic information about Triticeae species (wheat [Triticum aestivum], barley [Hordeum vulgare], rye [Secale cereale], and their wild relatives) and oat (Avena sativa) and its wild relatives. A major strength of the GrainGenes project is the interaction of the curators with database users in the research community, placing GrainGenes as both a data repository and information hub. The primary intensively curated data classes are genetic and physical maps, probes used for mapping, classical genes, quantitative trait loci, and contact information for Triticeae and oat scientists. Curation of these classes involves important contributions from the GrainGenes community, both as primary data sources and reviewers of published data. Other partially automated data classes include literature references, sequences, and links to other databases. Beyond the GrainGenes database per se, the Web site incorporates other more specific databases, informational topics, and downloadable files. For example, unique BLAST datasets of sequences applicable to Triticeae research include mapped wheat expressed sequence tags, expressed sequence tag-derived simple sequence repeats, and repetitive sequences. In 2004, the GrainGenes project migrated from the AceDB database and separate Web site to an integrated relational database and Internet resource, a major step forward in database delivery. The process of this migration and its impacts on database curation and maintenance are described, and a perspective on how a genomic database can expedite research and crop improvement is provided.

Synteny perturbations between wheat homoeologous chromosomes caused by locus duplications and deletions correlate with recombination rates.

Loci detected by Southern blot hybridization of 3,977 expressed sequence tag unigenes were mapped into 159 chromosome bins delineated by breakpoints of a series of overlapping deletions. These data were used to assess synteny levels along homoeologous chromosomes of the wheat A, B, and D genomes, in relation to both bin position on the centromere-telomere axis and the gradient of recombination rates along chromosome arms. Synteny level decreased with the distance of a chromosome region from the centromere. It also decreased with an increase in recombination rates along the average chromosome arm. There were twice as many unique loci in the B genome than in the A and D genomes, and synteny levels between the B genome chromosomes and the A and D genome homoeologues were lower than those between the A and D genome homoeologues. These differences among the wheat genomes were attributed to differences in the mating systems of wheat diploid ancestors. Synteny perturbations were characterized in 31 paralogous sets of loci with perturbed synteny. Both insertions and deletions of loci were detected and both preferentially occurred in high recombination regions of chromosomes.

Overexpression, purification, and site-directed spin labeling of the Nramp metal transporter from Mycobacterium leprae.

It has long been recognized that the pathogenicity of a broad range of intracellular parasites depends on the availability of transition metal ions, especially iron. Nramp1 (natural resistance-associated macrophage protein 1), a proton-coupled divalent metal ion transporter, has been identified as a controlling factor in the resistance or susceptibility to infection with a diverse range of intracellular pathogens such as Toxoplasma, Salmonella, Mycobacterium, and Leishmania. The role of divalent metal ion transport is even more compelling given the existence of Nramp homologs in several intracellular parasites, such as mycobacteria. We have confirmed the functional homology of the Nramp homologue from Mycobacterium leprae by using a yeast complementation assay for divalent cation uptake. To facilitate a concerted biochemical and structural analysis of this important class of transporters, the M. leprae Nramp was expressed in Escherichia coli. Dual affinity tags were engineered at the N and C termini to allow for isolation of full-length protein at >95% purity. Site-directed spin labeling of Cys-299 reveals a flexible hinge-like domain. A weak dipolar interaction is detected between the nitroxide and paramagnetic transition ions, indicating this position is approximately 19 A from the nearest high affinity binding site.