Pilot Implementation of Guiando Buenas Decisiones, an Evidence-Based Parenting Program for Spanish-Speaking Families, in Pediatric Primary Care in a Large, U.S. Health System: A Qualitative Interview Study.

Adolescent substance use is a significant public health problem in the United States and Hispanic youth engage in substance use services at lower rates than other groups. For this under-served group, prevention services delivered in non-stigmatized, non-specialty care settings may increase access to the services. We describe findings from a feasibility pilot of the implementation of a virtual version of Guiando Buenas Decisiones (GBD), a universal, group-based substance use prevention program for parents. It was conducted with Spanish-speaking families and delivered, virtually, in pediatric primary care in a large healthcare system in the U.S. Through qualitative interviews with pediatricians (n =7) and parents (n = 26), we explored potential barriers and facilitators of GBD enrollment and engagement. Parents and pediatricians alike noted the dearth of universal prevention programming in Spanish and that GBD could help address the need for linguistically appropriate programming. Parents liked the curriculum content, materials and videos; they felt the focus on strengthening family bonds, setting clear expectations and guidelines, the use of family meetings, and the positive tools provided for navigating family conflict were well-aligned with their cultural and family values. Feedback from parents was helpful for informing more personalized and attentive approaches to program outreach and recruitment methods, and for adaptation of recruitment fliers and letters. In this pediatric primary care context serving an underserved population, we found virtual GBD feasible to implement, acceptable and appealing to parents, and judged by pediatricians as a promising, much-needed addition to their prevention armamentarium.

A DEAD-box RNA helicase mediates meiotic silencing by unpaired DNA.

During the sexual phase of Neurospora crassa, unpaired genes are subject to a silencing mechanism known as meiotic silencing by unpaired DNA (MSUD). MSUD targets the transcripts of an unpaired gene and utilizes typical RNA interference factors for its process. Using a reverse genetic screen, we have identified a meiotic silencing gene called sad-9, which encodes a DEAD-box RNA helicase. While not essential for vegetative growth, SAD-9 plays a crucial role in both sexual development and MSUD. Our results suggest that SAD-9, with the help of the SAD-2 scaffold protein, recruits the SMS-2 Argonaute to the perinuclear region, the center of MSUD activity.

Systemic contact dermatitis following oral neomycin therapy.

Systemic contact dermatitis (SCD) describes a hypersensitivity skin reaction following systemic re-exposure of an allergen in previously sensitized patients. Neomycin is an aminoglycoside antibiotic that, when taken orally, suppresses intestinal bacteria and is used in preoperative bowel surgery to reduce the risk of infection. While oral neomycin has been commonly associated with adverse reactions like nausea, vomiting, and Clostridium difficile-associated colitis, the poor intestinal absorption of oral neomycin makes systemic contact dermatitis an unusual adverse reaction. Herein we present a rare case of systemic contact dermatitis following oral neomycin administration.

Squamoid Eccrine Ductal Carcinoma: An Aggressive Mimicker of Squamous Cell Carcinoma.

Squamoid eccrine ductal carcinoma (SEDC) is an uncommon cutaneous adnexal malignancy that has the potential for an aggressive clinical course. The authors present a case of SEDC that resulted in widespread metastases and death. The clinical, histological, and immunohistochemical features of SEDC and several entities on the differential diagnosis are reviewed.

Clinical and epidemiologic characteristics of an outbreak of novel H1N1 (swine origin) influenza A virus among United States military beneficiaries.

BACKGROUND: A novel swine-origin influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. The San Diego region was an early focal point of the emerging pandemic. We describe the clinical and epidemiologic characteristics of this novel strain in a military population to assist in future outbreak prevention and control efforts. METHODS: We performed an epidemiologic evaluation of novel H1N1 virus infections diagnosed in San Diego County among 96,258 local US military beneficiaries. The structured military medical system afforded the ability to obtain precise epidemiologic information on the impact on H1N1 virus infection in a population. The novel H1N1 virus was confirmed using real-time reverse transcriptase polymerase chain reaction (rRT-PCR). RESULTS: From 21 April through 8 May 2009, 761 patients presented with influenza-like illness and underwent rRT-PCR testing. Of these patients, 97 had confirmed novel H1N1 virus infection, with an incidence rate of 101 cases per 100,000 persons. The median age of H1N1 patients with H1N1 virus infection was 21 years (interquartile range, 15-25 years). Fever was a universal symptom in patients with H1N1 virus infection; other symptoms included cough (present in 96% of patients), myalgia or arthralgia (57%), and sore throat (51%). Sixty-eight (70%) of our patients had an identifiable epidemiologic link to another confirmed patient. The largest cluster of cases of H1N1 virus infection occurred on a Navy ship and involved 32 (8%) of 402 crew members; the secondary attack rate was 6%-14%. The rapid influenza testing that was used during this outbreak had a sensitivity of 51% and specificity of 98%, compared with rRT-PCR. Only 1 patient was hospitalized, and there were no deaths. CONCLUSIONS: A novel H1N1 influenza A virus caused a significant outbreak among military beneficiaries in San Diego County, including a significant cluster of cases onboard a Navy ship. The outbreak described here primarily affected adolescents and young adults and resulted in a febrile illness without sequelae.

Monopolar radiofrequency treatment of human eyelids: a prospective, multicenter, efficacy trial.

BACKGROUND/OBJECTIVE: To evaluate the efficacy of a novel 0.25 cm(2) monopolar radiofrequency (RF) treatment tip for aesthetic rejuvenation of the eyelids. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, multicenter trial in which the eyelids of 72 patients were treated. Patients underwent a single treatment session and were then followed on a serial basis for 6 months. Cutaneous anesthesia was not required to perform the treatments. Assessments were made by the treating physician, the subjects, and by masked physician observers evaluating photographs taken at each data point. RESULTS: Upper eyelid tightening and reduction of hooding was noted in 88 and 86% of subjects, respectively. Lower eyelid tightening was noted in 71-74% of subjects. The majority of patients treated achieved at least up to 25% improvement while a smaller percentage achieved more dramatic results. There was no correlation between the amount of energy applied to the eyelids and the clinical outcome. There were no serious adverse sequelae. CONCLUSION: Human eyelids can be safely treated with monopolar RF energy delivered via a novel 0.25 cm(2) treatment tip. Using this technology non-invasive eyelid rejuvenation was achieved in the majority of subjects treated. The factors differentiating those patients who achieve the most impressive changes from others remain unclear. Further development and testing of this technology is warranted.

Vertical cross contamination of trichloroethylene in a borehole in fractured sandstone.

Boreholes drilled through contaminated zones in fractured rock create the potential for vertical movement of contaminated ground water between fractures. The usual assumption is that purging eliminates cross contamination; however, the results of a field study conducted in a trichloroethylene (TCE) plume in fractured sandstone with a mean matrix porosity of 13% demonstrates that matrix-diffusion effects can be strong and persistent. A deep borehole was drilled to 110 m below ground surface (mbgs) near a shallow bedrock well containing high TCE concentrations. The borehole was cored continuously to collect closely spaced samples of rock for analysis of TCE concentrations. Geophysical logging and flowmetering were conducted in the open borehole, and a removable multilevel monitoring system was installed to provide hydraulic-head and ground water samples from discrete fracture zones. The borehole was later reamed to complete a well screened from 89 to 100 mbgs; persistent TCE concentrations at this depth ranged from 2100 to 33,000 microg/L. Rock-core analyses, combined with the other types of borehole information, show that nearly all of this deep contamination was due to the lingering effects of the downward flow of dissolved TCE from shallower depths during the few days of open-hole conditions that existed prior to installation of the multilevel system. This study demonstrates that transfer of contaminant mass to the matrix by diffusion can cause severe cross contamination effects in sedimentary rocks, but these effects generally are not identified from information normally obtained in fractured-rock investigations, resulting in potential misinterpretation of site conditions.

Gastroenteritis in US Marines during Operation Iraqi Freedom.

BACKGROUND: Approximately 83,000 US Marines participated in the opening phase of Operation Iraqi Freedom in Spring 2003. A Navy Preventive Medicine laboratory was set up in Ad Diwaniyah, Iraq, to provide clinical diagnostic support for Marine medical units during a period of repositioning in south-central Iraq. METHODS: Specimen collection boxes were sent to >30 primary care medical stations handling 500-900 personnel each. The laboratory had capability to detect many different disease agents, especially those causing febrile illness. Diarrheal stool diagnostic evaluation included plating and biochemical identification, antigen serologic testing, fluorescent antibody antigen detection, disk diffusion antimicrobial susceptibility testing, enzyme immunoassay, and reverse-transcriptase polymerase chain reaction for norovirus (NV). Confirmation and sequencing work for NV was done at Cincinnati Children's Hospital Medical Center (Ohio). RESULTS: By far the most common reason for infectious disease sick call visits was gastrointestinal illness; no other symptoms had equivalent impact. An enteropathogen was detected in 57 (44%) of 129 stool samples, with NV detected in 30 stool samples (23%) obtained from 14 different battalion or similar-sized units; next in frequency were Shigella flexneri and Shigella sonnei, which were isolated from 26 stool samples (20%) obtained from 15 units. Sequencing the NV RNA polymerase gene demonstrated that NV strains represented 7 genetic clusters, including 2 strains from genogroup I and 5 from genogroup II. Ciprofloxacin was effective in vitro against most bacterial agents, but neither doxycyline (which was taken daily as the antimalarial prophylaxis dose) nor trimethoprim-sulfamethoxazole were effective. CONCLUSIONS: Multiple strains of Shigella species and NV predominated, probably because they do not require a large inoculum to cause infection. Otherwise, personnel remained free of infectious illness during this phase of the conflict, because other infectious agents were rare or absent.

A multivariate analysis of factors associated with differential disease and nonbattle injury and morbidity aboard ships of the U.S. Naval 5th Fleet during peacetime deployment.

Disease nonbattle injury (DNBI) surveillance is a critical component of U.S. military force health protection and has been aggressively implemented by the U.S. Central Command. This study presents a multivariate analysis of factors associated with DNBI incidence rates as well as a description of morbidity measures associated with DNBI from U.S. Navy ships deployed to the Middle East from October 2000 through September 2001. Weekly DNBI reports (N = 331) from a total of 44 individual units representing six different classes of U.S. Navy ships were included in the analysis. There were statistically significant differences in summary and categorical DNBI rates associated with ship class, season, and presence of female sailors embarked. The top three DNBI categories associated with the most lost workdays because of sick in quarters and hospitalization were other medical/surgical (36%), infectious gastrointestinal (23%), and all types of nonbattle injury combined (17%).

Disease and nonbattle injury patterns: afloat data from the U.S. Fifth Fleet (2000-2001).

Disease and nonbattle injury (DNBI) patterns were analyzed for reports from the Commander Fifth Fleet for 2000-2001 covering 217,972 person-weeks. The overall DNBI rate was 4.38 visits per 100 person-weeks with the largest subcategory being "other medical/surgical" conditions (1.36 visits/100 person-weeks and over 30% of the initial patient visits). This was followed by dermatological (0.89 visits/100 person-weeks) and respiratory conditions (0.65 visits/100 person-weeks). Collapsing total injuries would have created the third largest incidence category. The mean DNBI rate for cruisers/destroyers/ frigates (4.23 visits/100 person-weeks; SD, 2.64 visits) was not significantly different from aircraft carriers (4.76 visits/100 person-weeks; SD, 1.60, t(df = 207) = -0.91, p = 0.363) but was statistically different from supply ships (8.93 visits/100 person-weeks; SD, 2.44, t(df = 191) = -6.23, p = 0.000) and amphibious support ships (8.07 visits/100 person-weeks; SD, 3.99, t(df = 190) = -4.72, p = 0.000). These results are compared with historical data from land-based units, and the limitations in shipboard DNBI reporting are discussed.

Laser blepharoplasty: diamond laser scalpel compared to the free beam CO2 laser.

BACKGROUND: Blepharoplasty has long been employed for functional and cosmetic purposes. Different modalities have been utilized to incise and remove excess eyelid tissue in an attempt to improve surgical technique. OBJECTIVE: This study compares a free beam CO2 laser to a diamond surgical scalpel combined with a CO2 laser for performance of blepharoplasty. METHODS: Ten patients underwent bilateral upper lid blepharoplasty. One side was randomly assigned to the free beam CO2 laser technique, while the other side was performed with the diamond laser scalpel. Intraoperative surgical times and hemostasis were measured. Masked observers assessed postoperative parameters at day 1, week 1, week 2, week 4, and month 4. These assessments were analyzed clinically and statistically. RESULTS: The two modalities produced similar results for the intraoperative and postoperative parameters studied. CONCLUSION: The diamond laser scalpel has the advantage of tactile feedback and the option of use without coagulation.

Human appropriation of photosynthesis products.

Previous global estimates of the human impact on terrestrial photosynthesis products depended heavily on extrapolation from plot-scale measurements. Here, we estimated this impact with the use of recent data, many of which were collected at global and continental scales. Monte Carlo techniques that incorporate known and estimated error in our parameters provided estimates of uncertainty. We estimate that humans appropriate 10 to 55% of terrestrial photosynthesis products. This broad range reflects uncertainty in key parameters and makes it difficult to ascertain whether we are approaching crisis levels in our use of the planet's resources. Improved estimates will require high-resolution global measures within agricultural lands and tropical forests.

Physical and psychological changes with vigorous exercise in sedentary primigravidae.

PURPOSE: The present study examined the effects of exercise on physical and psychological variables in sedentary primigravidae (PRA). METHODS: A total of nine women randomly assigned to an exercise (E) (mean age = 31.3 +/- 3.1 yr) and six subjects randomly assigned to a control (C) group (mean age = 27.8 +/- 3.1 yr) fulfilled all requirements for the study. Exercise included a variety of exercise activities performed to a target heart rate of 150-156 beats x min(-1), three times per week for 15 wk. RESULTS: Results showed no significant differences between E and C groups in physical characteristics initially. A repeated measures ANOVA showed a significant group effect (P < 0.05) and a significant group by time interaction (P = 0.001) with the E group showing a significantly longer amount of time on the PWC150 test than the C group. There was no significant group, time, or group by time interaction for lactate accumulation. This occurred, despite the fact that the E group spent 56% longer on the PWC150 test and the C group spent 30% less time on the same test at the conclusion of the study. Finally, the E group in comparison to the C group showed more favorable improvements in several items related to health and well-being on the Body Cathexis Scale. There were no significant differences between E and C groups in any pregnancy outcome measures. All babies were delivered healthy at term. CONCLUSIONS: These data suggest that a vigorous exercise program can lead to significant improvements in aerobic fitness at similar lactate concentrations compared to a control group and can be well tolerated by low risk sedentary PRA without any deleterious effects occurring to herself or unborn child.

Fluency and memory differences between ischemic vascular dementia and Alzheimer's disease.

This study compared 32 patients with ischemic vascular dementia (IVD) to 32 patients with probable Alzheimer's disease (AD) on select language and verbal memory tests. The IVD and AD patients were individually matched on the basis of age, dementia severity, years of education, and gender. The IVD patients had poorer verbal fluency, but better free recall, fewer recal intrusions, and better recognition memory than the AD patients. Relationships between the neuropsychological measures and radiological indexes of cortical and subcortical pathology were also examined. Number of infarcts, white-matter lucency, and ventricular enlargement correlated with some of the neuropsychological measures; cortical atrophy correlated with most of the measures. The findings suggest that neuropsychological deficits in IVD may be related to dysfunction of frontal-subcortical circuits, although an associated degenerative cortical process may also be involved.

Characteristics and outcomes of self inflicted pediatric injuries: the role of method of suicide attempt.

OBJECTIVE: To examine the epidemiologic characteristics and clinical outcomes of self inflicted pediatric injuries in relation to the method of suicide attempt. METHODS: Using data from the National Pediatric Trauma Registry Phase II, a comparative analysis was conducted for children under 15 years of age who were admitted from 1 October 1988 through 30 April 1996 because of self inflicted injury by firearm (n = 28), hanging (n = 38), or jumping from heights (n = 21). RESULTS: Of the 87 cases under study, 90% occurred at home, and 86% occurred between noon and midnight, with a peak in early evening (between 6 pm and 7 pm)-More than one quarter (29%) had preexisting mental disorders, such as disturbance of conduct and depression. Toxicological tests were conducted on admission on 40 (46%) of the patients; 20% tested positive for alcohol or other illicit drugs. The method of suicide attempt was associated with gender and age of the patients: 75% of the firearm cases and 82% of the hanging cases were boys compared with 29% of the jumping cases (p < 0.01); 79% of the hanging cases were aged 13 years or younger compared with 39% of the firearm cases and 48% of the jumping cases (p < 0.01). The mean injury severity score was 18.6 for the firearm cases and 16.3 for the hanging cases, significantly greater than 8.5 for the jumping cases (p < 0.02). Reflecting the differences in injury severity, firearm cases and hanging cases were more likely than jumping cases to be sent to intensive care units or operating rooms from emergency departments, and to develop complications during hospitalization. The case fatality rate was 50% for the firearm cases, 32% for the hanging cases, and 5% for the jumping cases (p < 0.01). On average, these patients stayed in hospitals for 11 days and 52% of those who were alive at discharge had at least one impairment in communication, cognition, or self care functions. CONCLUSION: Boys and older children tend to use more lethal methods in suicide attempts. Even in this age group, suicide attempts often involve psychiatric disorders and acute abuse of alcohol or other illicit drugs. Firearms are associated with significantly increased risk of inhospital fatality. The clinical outcomes of self inflicted injuries appear to be worse than other injuries treated in the same trauma centers.

A comparative analysis of alcohol in fatal and nonfatal bicycling injuries.

Bicycling is the leading cause of recreational injury, resulting in more than half a million emergency department visits and about 900 deaths each year in the United States. Previous research on bicycling injury was conducted predominantly in children and focused on the effectiveness of safety helmets. Few studies have examined the role of alcohol in bicycling injuries. This study examined the magnitude of and factors related to alcohol involvement in fatal and nonfatal bicycling injuries, and tested the hypothesis that alcohol intoxication is associated with significantly increased likelihood of fatality given a serious bicycling injury. Medical examiner data on all fatally injured bicyclists aged 10 years or older from 1987 to 1994 in Maryland (fatal cases, n = 63) were compared with trauma registry data on all injured bicyclists who were treated at a regional trauma center during the same time period (nonfatal cases, n = 253) on variables related to blood alcohol concentrations (BACs), demographic characteristics, and injury circumstances. The fatal cases were more likely than the nonfatal cases to have positive BACs (30% vs. 16%, p < 0.01) and to be legally intoxicated (i.e., BACs > or = 0.10%) (22% vs. 13%, p < 0.01). For both fatal and nonfatal cases, intoxication was more prevalent among victims who were male, aged 20 to 39 years, or who were injured at nighttime (7:00 PM to 6:59 AM). Bicyclists who died at the scene were four times as likely as those who died at hospitals to be legally intoxicated (35% vs. 9%, p < 0.02). Given a serious bicycling injury, intoxication was associated with significantly increased likelihood of fatality, with an adjusted odds ratio of 2.8 (95% confidence interval, 1.3 to 6.3). This increased likelihood of fatality was probably due in part to the fact that the rate of helmet use at the time of injury among the intoxicated was much lower than among the sober (6% vs. 31%, p < 0.05). Results indicate that alcohol plays an important role in fatal and serious bicycling injuries. Preventing intoxicated biking should be incorporated into helmet campaigns and other bicycle safety programs.

Nutrient intake and psychological and physiological assessment in eumenorrheic and amenorrheic female athletes: a preliminary study.

The present study showed that amenorrheic athletes (AAs) scored higher on the Eating Attitudes Test (EAT) (p < .05) than eumenorrheic athletes (EAs), indicating more aberrant eating patterns in the first group. Scores on the EAT were inversely correlated with fat intake (p < .05), simple carbohydrate intake (p < .01), and percentage saturation of iron (p < .05) and were positively correlated with total iron binding capacity (p < .01) for the total sample. Physiological assessment of athletes revealed that there were no significant differences between groups in serum lipoproteins, with both EAs and AAs having serum lipid profiles indicative of low cardiovascular risk. Furthermore, low-density lipoprotein cholesterol was the only lipoprotein significantly and positively correlated with serum estradiol levels for the entire sample (p = .01). The present study was in agreement with previous work showing that scores of the EAT represent a primary difference between EAs and AAs; the present study was somewhat different than previous work in that serum lipoproteins were not significantly related to menstrual status.

Induced Acid-Tolerance Response Confers Limited Nisin Resistance on Listeria monocytogenes Scott A.

The presence of an inducible acid-tolerance response (ATR) in Listeria monocytogenes Scott A was established. Protection of cells with induced ATR against nisin-mediated inhibition and stress was also evaluated. ATR was induced in L. monocytogenes Scott A by culturing in brain heart infusion (BHI) broth buffered to pH 5.4. The unadapted cells were grown at pH 7.2. Both acid-adapted and unadapted cells were challenged at pH 3.3 and 4.3 at 35°C. The acid-adapted cells were 150- to 7,500-fold more resistant to acid stress at pH 3.3 than unadapted cells. Both cells were equally resistant to acid stress at pH 4.3. The acid-adapted and unadapted cells were exposed to 0, 0.3, 0.6, 1.2 and 1.5 µg of nisin per ml of buffered BHI broth at pH 6.0 for 90 min at 35°C. Cells with the induced acid-resistance trait were slightly more resistant to nisin than the unadapted cells. In the presence of 1.5 µg of nisin per ml, 47% of the acid-adapted cells survived compared to 41% of the unadapted cells. In the range of nisin concentration included in this study, there was no significant (P < 0.05) difference in the nisin resistance of adapted and unadapted cells. The data suggest that ATR induction confers very limited cross protection against nisin stress and kill.