Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults.

Importance: On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective: To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants: In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures: RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures: Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results: Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance: Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.

Fostering Governance and Information Partnerships for Chronic Disease Surveillance: The Multi-State EHR-Based Network for Disease Surveillance.

CONTEXT: Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex. PROGRAM: Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance. IMPLEMENTATION: MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures. RESULTS: The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document. DISCUSSION: The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance.

MENDS-on-FHIR: Leveraging the OMOP common data model and FHIR standards for national chronic disease surveillance.

Objective: The Multi-State EHR-Based Network for Disease Surveillance (MENDS) is a population-based chronic disease surveillance distributed data network that uses institution-specific extraction-transformation-load (ETL) routines. MENDS-on-FHIR examined using Health Language Seven's Fast Healthcare Interoperability Resources (HL7® FHIR®) and US Core Implementation Guide (US Core IG) compliant resources derived from the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to create a standards-based ETL pipeline. Materials and Methods: The input data source was a research data warehouse containing clinical and administrative data in OMOP CDM Version 5.3 format. OMOP-to-FHIR transformations, using a unique JavaScript Object Notation (JSON)-to-JSON transformation language called Whistle, created FHIR R4 V4.0.1/US Core IG V4.0.0 conformant resources that were stored in a local FHIR server. A REST-based Bulk FHIR $export request extracted FHIR resources to populate a local MENDS database. Results: Eleven OMOP tables were used to create 10 FHIR/US Core compliant resource types. A total of 1.13 trillion resources were extracted and inserted into the MENDS repository. A very low rate of non-compliant resources was observed. Discussion: OMOP-to-FHIR transformation results passed validation with less than a 1% non-compliance rate. These standards-compliant FHIR resources provided standardized data elements required by the MENDS surveillance use case. The Bulk FHIR application programming interface (API) enabled population-level data exchange using interoperable FHIR resources. The OMOP-to-FHIR transformation pipeline creates a FHIR interface for accessing OMOP data. Conclusion: MENDS-on-FHIR successfully replaced custom ETL with standards-based interoperable FHIR resources using Bulk FHIR. The OMOP-to-FHIR transformations provide an alternative mechanism for sharing OMOP data.

Impact of a Pharmacist-Managed Telemedicine Pharmacotherapy Clinic in the Era of COVID-19.

PURPOSE: Telemedicine has been essential during the coronavirus disease 2019 (COVID-19) pandemic. In March 2020, pharmacist-led chronic disease state management services at our family care centers and primary care clinics were converted to telemedicine. This study aimed to determine the impact of expanding telemedicine services on appointment adherence, clinical outcomes, and financial reimbursement. METHODS: This was a single-center, retrospective, quasi-experimental study of the impact of expanding telemedicine services on adult patients with diabetes, hypertension, and/or hyperlipidemia. The study included patients scheduled with a pharmacist at a hospital-based (HB) or physician-based (PB) clinic. The primary outcome was the difference in the mean no-show rate. The secondary outcomes were differences in mean change in HbA1c, LDL, blood pressure, and reimbursement. Mean differences between pre- and post-telemedicine groups of each clinic were measured for all outcomes. RESULTS: The mean difference (SE) in the no-show rate in the HB clinic was -12.09% (4.862; P = .014), compared to 2.88% (3.656; P = .431) in the PB clinic. The mean difference (SE) in the change in HbA1c in the HB clinic was .00% (.338; P = .992), compared to .01% (.239; P = .945) in the PB clinic. The mean difference (SE) in reimbursement in the HB clinic was $1.93 (4.209; P = .647), compared to $20.46 (3.210; P < .0001) in the PB clinic. CONCLUSION: Expansion of pharmacy telemedicine services provided evidence for improved appointment adherence in the HB clinic and increased reimbursement in the PB clinic. No change in healthcare outcomes was observed.

Speaker-induced Suppression in EEG during a Naturalistic Reading and Listening Task.

Speaking elicits a suppressed neural response when compared with listening to others' speech, a phenomenon known as speaker-induced suppression (SIS). Previous research has focused on investigating SIS at constrained levels of linguistic representation, such as the individual phoneme and word level. Here, we present scalp EEG data from a dual speech perception and production task where participants read sentences aloud then listened to playback of themselves reading those sentences. Playback was separated into immediate repetition of the previous trial and randomized repetition of a former trial to investigate if forward modeling of responses during passive listening suppresses the neural response. Concurrent EMG was recorded to control for movement artifact during speech production. In line with previous research, ERP analyses at the sentence level demonstrated suppression of early auditory components of the EEG for production compared with perception. To evaluate whether linguistic abstractions (in the form of phonological feature tuning) are suppressed during speech production alongside lower-level acoustic information, we fit linear encoding models that predicted scalp EEG based on phonological features, EMG activity, and task condition. We found that phonological features were encoded similarly between production and perception. However, this similarity was only observed when controlling for movement by using the EMG response as an additional regressor. Our results suggest that SIS operates at a sensory representational level and is dissociated from higher order cognitive and linguistic processing that takes place during speech perception and production. We also detail some important considerations when analyzing EEG during continuous speech production.

The expanded role of the transplant pharmacist: A 10-year follow-up.

The role of the transplant pharmacist is recognized by transplant programs, governmental groups, and professional organizations as an essential part of the transplant multidisciplinary team. This role has evolved drastically over the last decade with the advent of major advances in the science of transplantation and the growth of the field, which necessitate expanded pharmacy services to meet the needs of patients. Data now exist within all realms of the phases of care for a transplant recipient regarding the utility and benefit of a solid organ transplant (SOT) pharmacist. Furthermore, governing bodies now have the opportunity to use Board Certification in Solid Organ Transplant Pharmacotherapy as a mechanism to identify and recognize specialty knowledge and expertise within the field of SOT pharmacotherapy. The purpose of this paper is to provide an overarching review of the current and future state of SOT pharmacy while also identifying major changes to the profession, forthcoming challenges, and expected areas of growth.

Pediatric Phantom Dosimetry Evaluation of a New Rectangular Collimator.

Purpose: To compare the effective dose (E) of the Tru-Image® rectangular collimator and the universal round collimator of a Planmeca® wall-mounted radiograph unit for two bitewing radiographs (right and left) on a pediatric phantom.
Methods: Absorbed doses utilizing the Tru-Image ®rectangular collimator and universal round collimator were acquired using an anthropomorphic 10-year-old child phantom. Each set of 24 dosimeters was exposed to two bitewing exposures with the manufacturer's child settings. Fifty clinical exposures were completed for each set and three sets were exposed for each collimator. The average E per exposure was calculated.
Results: The overall E for the Tru-Image ®rectangular collimator and the universal round collimator were 6.3 microsieverts (µSv) and 25.3 µSv, respectively. This difference was statistically significant (P <0.001). The highest equivalent dose for both collimators was delivered to the oral mucosa. When compared to the universal round collimator, the Tru-Image ® rectangular collimator had significant dose reduction at all locations (P <0.05). When normalized and adjusted to the same source-to-end distance, there was an overall 65 percent dose reduction with the rectangular collimator.
Conclusion: The average effective dose was significantly reduced with the use of the Tru-Image ®rectangular collimator. Clinical use of this rectangular collimator should be considered in the pediatric population.

Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design.

BACKGROUND: Dialectical behaviour therapy (DBT) skills groups have shown promise as an effective treatment for clients with emotional dysregulation, especially when combined with individual DBT. However, their efficacy is not well established as an online therapy, or in the Latinx population. AIMS: This study aimed to explore satisfaction, retention and effects of an internet-based DBT group added to individual online sessions. METHOD: An ABAB withdrawal experimental single-case design was conducted to evaluate the effect of a brief online DBT skills group on emotional dysregulation, anxiety and depression for five Latinx participants. DBT skills group (phase B) were compared with placebo group sessions (phase A) and fortnightly individual DBT sessions were offered throughout to manage risk. RESULTS: Visual inspection showed a decrease in level of emotional dysregulation and a large effect size according to the Nonoverlap of All Pairs when comparing group DBT and placebo phases. Although depression symptoms decreased after introducing group DBT, anxiety indicators decreased most during the second round of group placebo sessions. DISCUSSION: Whilst only a pilot, this study suggests that online group DBT in Latinx populations is feasible and effective for changing emotional regulation processes but may not effectively target anxiety. Future research might increase the number of DBT sessions in order to enhance learning opportunities and generalization. Replication with larger sample sizes and diverse modalities is needed.

Use and Interchange of Incretin Mimetics in the Treatment of Metabolic Diseases: A Narrative Review.

PURPOSE: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and now tirzepatide, a dual GLP-1 RA/glucose-dependent insulinotropic polypeptide agonist, have numerous advantages in the treatment of type 2 diabetes and obesity, yet only 11% of patients with type 2 diabetes are prescribed a GLP-1 RA. This narrative review addresses the complexity and cost issues surrounding incretin mimetics to support clinicians. METHODS: This narrative review summarizes key trials on the differing effects of incretin mimetics on glycosylated hemoglobin and weight, provides a table with rationale for how to interchange among agents, and summarizes the key factors that guide drug selection beyond guidance from the American Diabetes Association. To support proposed dose interchanges, we preferentially selected high-quality, prospective randomized controlled trials with direct comparisons of agents and doses when available. FINDINGS: Tirzepatide produces the greatest reductions in glycosylated hemoglobin and weight, but its impact on cardiovascular events is still under investigation. Subcutaneous semaglutide and liraglutide are approved for weight loss specifically and are effective in the secondary prevention of cardiovascular disease. Although producing less weight loss, only dulaglutide has effectiveness in the primary and secondary prevention of cardiovascular disease. Semaglutide is the only orally available incretin mimetic; however, the oral formulation produces less weight loss versus its subcutaneous alternative and did not have cardioprotection in its outcomes trial. Although effective in controlling type 2 diabetes, exenatide extended release has the least impact on glycosylated hemoglobin and weight among commonly used agents, while not having cardioprotection. However, exenatide extended release may be preferred on some restrictive insurance formularies. IMPLICATIONS: Although trials have not explicitly studied how to interchange among agents, interchanges can be guided by comparisons between agents' impact on glycosylated hemoglobin and weight. Efficient changes among agents can help clinicians optimize patient-centered care, particularly in the face of changing patient needs and preferences, insurance formularies, and drug shortages.

Leveraging Electronic Health Record Data for Timely Chronic Disease Surveillance: The Multi-State EHR-Based Network for Disease Surveillance.

CONTEXT: Electronic health record (EHR) data can potentially make chronic disease surveillance more timely, actionable, and sustainable. Although use of EHR data can address numerous limitations of traditional surveillance methods, timely surveillance data with broad population coverage require scalable systems. This report describes implementation, challenges, and lessons learned from the Multi-State EHR-Based Network for Disease Surveillance (MENDS) to help inform how others work with EHR data to develop distributed networks for surveillance. PROGRAM: Funded by the Centers for Disease Control and Prevention (CDC), MENDS is a data modernization demonstration project that aims to develop a timely national chronic disease sentinel surveillance system using EHR data. It facilitates partnerships between data contributors (health information exchanges, other data aggregators) and data users (state and local health departments). MENDS uses query and visualization software to track local emerging trends. The program also uses statistical and geospatial methods to generate prevalence estimates of chronic disease risk measures at the national and local levels. Resulting data products are designed to inform public health practice and improve the health of the population. IMPLEMENTATION: MENDS includes 5 partner sites that leverage EHR data from 91 health system and clinic partners and represents approximately 10 million patients across the United States. Key areas of implementation include governance, partnerships, technical infrastructure and support, chronic disease algorithms and validation, weighting and modeling, and workforce education for public health data users. DISCUSSION: MENDS presents a scalable distributed network model for implementing national chronic disease surveillance that leverages EHR data. Priorities as MENDS matures include producing prevalence estimates at various geographic and subpopulation levels, developing enhanced data sharing and interoperability capacity using international data standards, scaling the network to improve coverage nationally and among underrepresented geographic areas and subpopulations, and expanding surveillance of additional chronic disease measures and social determinants of health.

Representation Matters: Theorizing Health Communication from the Flesh.

This essay engages simultaneous stories that bridge the personal and the professional within the context of health communication focusing on how cultural, racialized identity politics reveal the shortfalls of scholarly literature as the overarching and exclusionary pulse of an academic conversation. Drawing upon a publication journey and personal Latinx knowledge about health treatment preferences, I describe the intertwined and inescapable embodied knowledge that enriches and guides scholarly endeavors. I assert several health communication sub-field calls to action.

Play and Mothers' Relationships With Children in the Context of Breast Cancer.

This interpretative phenomenological study explored play experiences between mothers who had completed, or were receiving treatment for, breast cancer and their young children and disease-related factors influencing those experiences. Six Puerto Rican mothers who had young children at the time of their primary treatment were interviewed. Interviews were recorded, transcribed, and analyzed through constant comparative method. Two themes emerged: (a) "changes and challenges," which contextualized disease-related factors affecting the maternal role; and (b) "play and relationships with children" described play moments and how treatment affected these. Participants emphasized the benefits of playing and relating with their children while in treatment. Play as a co-occupation and an effective means to connect mothers with their children must be considered in the practice of occupational therapy. Future studies with more diverse samples of mothers at different stages of the disease are warranted to expand this exploratory work.

Social connectedness, emotional regulation, and health behaviors as correlates of distress during lockdown for COVID-19: A diary study.

Mass lockdowns are a powerful infection-reduction strategy but are a significant stressor. This study aimed to explore whether various factors known to predict distress in normal contexts (e.g. social connectedness, emotional-regulation strategies, and health-related behaviors) are associated with daily distress under lockdown conditions. A time-based diary study evaluated how perceived social connectedness, health-promoting, and risk behaviors predicted within-person and between-person psychological distress. One hundred and nine adults completed surveys on these variables daily for 15 days while under stringent COVID-19 lockdown in Colombia. Emotional suppression and reappraisal were measured at the start of the study to explore whether they predicted distress. Distress was lower on the days that people experienced greater social connectedness (within-person analyses) but was not significantly predicted by between-participant differences in emotional regulation. Health-promoting behaviors such as exercising and meaningful activity were associated with lower distress, while watching COVID-19 news and eating high-calorie food were associated with higher distress. Looking at individual dynamics provides meaningful insights on daily behaviors associated with distress that might improve people's wellbeing during lockdown, such as social connectedness, meaningful activity, nutrition, exercise, and minimizing news exposure. Future research with alternative designs will enable causal conclusions to be drawn.

Diabetes insipidus in a patient with PCOS treated with Depo-Provera.

Summary: Depot medroxyprogesterone acetate, also known as Depo-Provera, is a progesterone-only contraceptive that is administered by injection to patients every three months. We describe the case of a 19-year-old female who was diagnosed with central diabetes insipidus following the administration of the contraceptive injection Depo-Provera. The patient was diagnosed with polycystic ovarian syndrome at age 16 and was originally prescribed oral contraceptives to restore menstrual regularity. Three years later, Depo-Provera was substituted for convenience, and symptoms of polyuria and polydipsia appeared one month after initiating the progesterone-only regimen. We are proposing that central diabetes insipidus may be a possible adverse effect of Depo-Provera in women with polycystic ovarian syndrome who receive the progesterone-only contraception, due to the interference of their arginine vasopressin mechanism through the alteration of estrogen levels. We review potential mechanisms through the presentation of previously completed research in polycystic ovarian syndrome. Learning points: We propose that although rare, the decrease in estrogen that is experienced during the administration of Depo-Provera can interfere with arginine vasopressin release in patients with polycystic ovarian syndrome (PCOS). Increased awareness of possible lasting adverse effects on fluid balance with unopposed progesterone administration in PCOS is important, as this case of the development of diabetes insipidus suggests. Discussion of such potential side effects is important when considering contraceptive options for the regulation of menses in patients with PCOS.

Scalability of an ACT-Based strategy for improving well-being in health care providers: A mix-method and preliminary evaluation of efficacy.

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Pharmacist-Physician Collaborative Practice to Improve Diabetes Care at Tampa General Medical Group.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a pharmacist-physician collaborative effort to reduce A1C and blood pressure and thereby lower risks for complications for people with diabetes being treated at a network of family care clinics in the Tampa, FL, area.

Using functional analytic psychotherapy strategies for supporting Latinas victims of interpersonal partner violence / Uso de estrategias de psicoterapia analítica funcional para apoyar a latinas víctimas de violencia interpersonal de pareja

Interpersonal partner violence (IPV) is a worldwide public health problem. As a result of IPV, victims report high rates of physical and behavioral disabilities. Help-seeking behaviors are key to obtaining support on facing and managing IPV. Cultural practices such as machismo, marianismo, and familismo are related to keeping quiet and remaining in an abusive relationship in Latinas. Difficulties in sharing emotions, setting interpersonal boundaries, and communicating needs are also behavioral barriers to seeking help in this population. All these factors are associated with social disconnection which reduces victims’ chances of obtaining support in risky situations. Although several programs have been developed for helping victims of IPV, more evidence on adaptions to particular cultural and interpersonal struggles faced by Latinas’ victims is needed. Functional Analytic Psychotherapy (FAP) proposes that therapeutic relationships based on intimacy can help victims of IPV to identify characteristics of those relationships that provide help when they need it. In this theoretical article, several FAP-based strategies aid therapists working with Latinas’ victims of IPV in strengthening clients’ interpersonal functioning and defeating cultural barriers when seeking help.(AU)

La violencia de pareja (IPV, por sus siglas en inglés) es un problema de salud pública mundial que genera altas tasas de discapacidades físicas y conductuales. Los comportamientos para buscar ayuda son claves para brindar soporte en el afrontamiento y el manejo de la violencia de género. El machismo, marianismo y familismo son prácticas culturales relacionadas con conductas de guardar silencio y permanecer en una relación abusiva en mujeres latinas. Asimismo, las dificultades para compartir emociones, establecer límites interpersonales y comunicar necesidades también son barreras para buscar ayuda. Estos factores están asociados a la desconexión social que reduce las posibilidades de que las víctimas sean apoyadas en situaciones de riesgo. Aunque se han desarrollado diversos programas psicológicos y sociales para ayudarlas, se necesita más evidencia sobre adaptaciones que respondan a los factores culturales e interpersonales propios de las mujeres Latinas víctimas de IPV. La Psicoterapia Analítica Funcional (FAP) propone que las relaciones terapéuticas basadas en la intimidad pueden ayudarlas a identificar características de relaciones que brindan ayuda cuando ellas la necesitan. En este artículo teórico se describen diferentes estrategias basadas en FAP con el fin de que los terapeutas que trabajan con Latinas víctimas de IPV puedan ayudarlas.(AU)

Coupling chemical oxidation processes and Leptosphaerulina sp. myco-remediation to enhance the removal of recalcitrant organic pollutants in aqueous systems.

This research evaluated for the first time, the coupling of chemical oxidation processes with Leptosphaerulina sp. (a Colombian fungus), to degrade a refractory pollutant. For such purpose, a model contaminant (crystal violet, CV) was considered. Initially, the pollutant, at high concentrations (i.e., 200 and 50 mg L-1), was submitted to the fungus action. However, the CV inhibited the growth and enzymatic production of the fungus. Then, three chemical oxidation processes: TiO2-photocatalysis, sonochemistry, or electrochemistry (with a Ti/IrO2 anode in sodium chloride) were used as treatments previous to the myco-remediation. These oxidative treatments led to the pollutant degradation (~100%) by the action of radicals or active chlorine species, but they showed low mineralization. Indeed, the total organic carbon removal (TOC) was 54, ~15, and 31% to TiO2-photocatalysis (after 12 h), sonochemistry (after 12 h), and electrochemistry (after 1.33 h), respectively. Thus, the resultant solutions from the chemical oxidations were submitted to the action of Leptosphaerulina sp. (this time effective fungus growth and enzymes production were observed). It was found that the TOC removals by the fungus were 87, 84, and 83% for solutions pre-treated by TiO2-photocatalysis (12 h), sonochemical (12 h), and electrochemical (1.33 h) treatments, respectively. Regarding the enzymatic production, TiO2-photocatalysis/Leptosphaerulina sp., ultrasonication/Leptosphaerulina sp., and electrochemical oxidation/Leptosphaerulina sp. combinations reached the highest activities of laccase (0.6 U mg-1, at day 15), manganese peroxidase (1.35 U mg-1, at day 7) and versatile peroxidase (1.72 U mg-1, at day 15), respectively. The results from this work evidence feasibility of the pre-treatment with chemical oxidation processes as a strategy to enhance Leptosphaerulina sp. action toward recalcitrant organic pollutants (as CV) in water.

CARD9 Is Required for Classical Macrophage Activation and the Induction of Protective Immunity against Pulmonary Cryptococcosis.

Caspase recruitment domain-containing protein 9 (CARD9) is a critical adaptor molecule triggered by the interaction of C-type lectin receptors (CLRs) with carbohydrate motifs found in fungi. Consequently, clinical and animal studies indicate that CARD9 is an important regulator of protective immunity against fungal pathogens. Previous studies suggest that CARD9 is important for the induction of protection against Cryptococcus neoformans, an opportunistic fungal pathogen that causes life-threatening infections of the central nervous system in immunocompromised patients. However, the effect of CARD9 deficiency on the induction of protective immune responses against C. neoformans is unknown. Immunization with a C. neoformans mutant that overexpresses the transcription factor zinc finger 2, denoted LW10, results in protection against an otherwise lethal challenge with wild-type (WT) C. neoformans Our results showed that CARD9 is essential for the induction of vaccine-mediated immunity against C. neoformans infection. We observed significant decreases in interleukin-17 (IL-17) production and significant increases in Th2-type cytokine (IL-4, IL-5, and IL-13) production in CARD9-deficient mice after inoculation with strain LW10. While leukocyte infiltration to the lungs of CARD9-deficient mice was similar in LW10 and WT C. neoformans-infected mice, macrophages derived from CARD9-deficient mice inherently skewed toward an M2 activation phenotype, were unable to contain the growth of LW10, and failed to produce nitric oxide in response to infection with LW10 or stimulation with lipopolysaccharide. These results suggest that CARD9-mediated signaling is required for M1 macrophage activation and fungicidal activity necessary for the induction of vaccine-mediated immunity against C. neoformansIMPORTANCECryptococcus neoformans is a fungal pathogen that is found throughout the environment and can cause life-threatening infections of the lung and central nervous system in severely immunocompromised individuals. Caspase recruitment domain-containing protein 9 (CARD9) is a critical molecule that is activated after interactions of C-type lectin receptors (CLRs) found on the surfaces of specific immune cells, with carbohydrate structures associated with fungi. Patients with defects in CARD9 are significantly more susceptible to a multitude of fungal infections. C. neoformans contains several carbohydrate structures that interact with CLRs on immune cells and activate CARD9. Consequently, these studies evaluated the necessity of CARD9 for the induction of protective immunity against C. neoformans infection. These results are important, as they advance our understanding of cryptococcal pathogenesis and host factors necessary for the induction of protective immunity against C. neoformans.

Enhancement of ligninolytic enzymes production and decolourising activity in Leptosphaerulina sp. by co-cultivation with Trichoderma viride and Aspergillus terreus.

This work investigated fungal co-culture as inducer of ligninolytic enzymes and decolourising activity in the Colombian strain Leptosphaerulina sp., an ascomycete white-rot fungus isolated from lignocellulosic material. Aspergillus niger, Aspergillus fumigatus, Aspergillus terreus, Trichoderma viride, Fusarium sp. and Penicillium chrysogenum were tested as Leptosphaerulina sp. inducers. The best fungal combinations in terms of enzyme production, fungal growth and decolourising activity were selected from solid media experiments. Response surface methodology (RSM) was utilised to optimise enzyme production and decolourising activity in liquid media. Solid media assays evidenced T. viride and A. terreus as the best Leptosphaerulina sp. inducers. The RSM identified a triple co-culture inoculated with T. viride (1000 µL) and A. terreus (1000 µL) into a 7-day culture of Leptosphaerulina sp. as the best treatment. This triple combination significantly improved ligninolytic enzymes production and Reactive Black 5 dye removal when compared to the Leptosphaerulina sp. monoculture and previously used chemical inducers. These results demonstrated the potential of fungal co-culture as an environmentally-friendly method to enhance Leptosphaerulina sp. enzymes production and decolourising activity.