Telementoring: a novel approach to reducing the osteoporosis treatment gap.

Bone Health ECHO telementors healthcare professionals to develop the clinical skills needed to provide advanced levels of care for patients with skeletal disorders. The goal of this mentorship model is to improve osteoporosis care in underserved areas, decrease the need for referral to specialty centers, and reduce the osteoporosis treatment gap. INTRODUCTION: The Project ECHO (Extension for Community Healthcare Outcomes) model of telementoring has been shown to improve the care individuals with chronic hepatitis C. ECHO has since been adapted to the address unmet needs in the care of other chronic complex diseases and recently applied to the care of osteoporosis and metabolic bone diseases. METHODS: Bone Health ECHO outcomes are assessed through an electronic data collector asking qualitative questions about self-efficacy. This is a progress report of Bone Health ECHO from its launch in October 2015 through May 2016. RESULTS: A total of 31 weekly Bone Health ECHO clinics were held over 8 months, with 43 individuals participating at least one clinic session. The number of clinics attended range from 1 to 30, with 13 learners attending more than 10 clinics and an average of 11 learners per clinic. Self-efficacy information provided by learners was diverse with many favorable anticipated changes in clinical practice. CONCLUSIONS: Bone Health ECHO telementors healthcare professionals in underserved areas to provide advanced levels of care for patients with skeletal disorders. The experience of Bone Health ECHO will guide the development of similar telementoring clinics in other locations. More data are needed to fully evaluate this novel approach to reducing the osteoporosis treatment gap.

Hafnia alvei. Respiratory tract isolates in a community hospital over a three-year period and a literature review.

In a retrospective review, a group of seven patients were found to have a sputum culture positive for Hafnia alvei. Hafnia alvei is a Gram-negative enteric and oropharyngeal bacillus and usually is nonpathogenic. All our patients had a chronic underlying illness and one of the patients was endotracheally intubated at the time of the isolation of this organism. Six of seven patients had other organisms isolated along with H alvei, and only one patient had a pure growth of H alvei confirmed by a culture obtained from a bronchoscopic protected brush specimen. All isolates displayed resistance to conventional antibiotics including cephalosporins and penicillins. Although rare, H alvei may be a potential pathogen in a patient with a chronic underlying illness.

Storage and distribution of trace metals and spheroidal carbonaceous particles (SCPs) from atmospheric deposition in the catchment peats of Lochnagar, Scotland.

Lochnagar is a remote mountain lake to the south-east of the Cairngorm region in Scotland. Its catchment receives anthropogenic trace metals solely from atmospheric deposition. Ten peat cores were taken from the catchment and analysis confirmed that they have been contaminated by trace metals. The peats have an high affinity for trace metals and this results in metal accumulation in the surface peat layers. The formation of trace metal sulphides may also reduce remobilisation. In this way, trace metals derived from atmospheric deposition have been scavenged and accumulated. In contaminated peat layers, 77.4% Hg, 89.6% Pb, 93.4% Cu, 72.4% Zn and 86.5% Cd of the total stored are from anthropogenic sources. The accumulated trace metals in the peats can potentially influence the lake system through erosion. Spheroidal carbonaceous particle (SCP) profiles were used to date the peat cores. By referring to the SCP profiles in the peats and comparing these with the trace metal profiles in the lake sediments, the mobility of trace metals in the catchment peats is confirmed.

Immunologic phenomena in the effusive form of feline infectious peritonitis.

The effusive form of feline infectious peritonitis (FIP) was reproduced by injecting 12- to 16-week-old kittens intraperitoneally with a cell-free inoculum derived from the tissues of infected cats. The kittens used for the study were either positive for FIP virus-reacting antibodies before inoculation or they were seronegative. Seropositive kittens were obtained from a cattery where the natural infection was enzootic, and seronegative kittens were obtained from a specific-pathogen-free cattery. Only about half the kittens that were seronegative before inoculation developed disease or serum antibodies to the tissue-derived virus. Seronegative kittens that developed disease showed no signs of illness until 8 to 10 days after inoculation, and they lived for 7 to 14 days after clinical signs appeared. The onset of clinical disease coincided with the appearance of serum antibodies. In contrast, all of the seropositive kittens became ill within 36 to 48 hours after inoculation, and died within 5 to 7 days. If seronegative kittens were treated with immune serum or immunoglobulin (Ig)G, they developed disease with the same frequency, acuteness, and severity as seropositive kittens. Foci of hepatitis and serositis in seropositive kittens contained viral antigen, IgG bound to antigen, and complement. Serum complement activity also decreased several days before death in seropositive kittens inoculated with tissue-derived FIP virus. The temporal relationship of clinical disease and the appearance of serum antibodies, the more acute and severe nature of the disease produced in seropositive kittens, and the presence of antibody and complement in the lesions indicated that effusive FIP is immunologically mediated.

Infection studies in kittens, using feline infectious peritonitis virus propagated in cell culture.

The propagation of feline infectious peritonitis virus (NW1-FIPV strain) in cell culture is described. Tissue culture-propagated virus was used to inoculate specific-pathogen-free kittens intraperitoneally, intratracheally, or orally. Intraperitoneal inoculation caused seroconversion and effusive peritonitis in 100% of the kittens. Intratracheal inoculation produced disease in 60% of the kittens, and oral inoculation in only 20%. Seroconversions without production of disease occurred in 10% of the kittens inoculated by either the intratracheal or the oral route. The remainder of the kittens inoculated by the intratracheal (30%) and oral (70%) routes did not develop serum antibodies or disease.

An enteric coronavirus infection of cats and its relationship to feline infectious peritonitis.

An enteric coronavirus that is antigenically closely related to feline infectious peritonitis virus (FIPV) is ubiquitous in the cat population. This virus has been designated feline enteric coronavirus to differentiate it from FIPV. The virus is shed in the feces by many seropositive cats; in catteries it is a cause of inapparent to mildly severe enteritis in kittens 6 to 12 weeks of age. The virus may produce a more severe enteritis in young specific-pathogen-free kittens. Feline enteric coronavirus selectively infects the apical columnar epithelium of the intestinal villi, from the caudal part of the duodenum to the cecum. In severe infections, there are sloughing of the tips of the villi and villous atrophy. Many cats recovering from the disease remain carriers of the virus. Recovered cats, observed for 3 to 24 months, remained healthy and did not develop peritonitis, pleuritis, or granulomatous disease. The relationship of feline enteric coronavirus and FIPV was studied. Although the viruses were antigenically similar, they were distinctly different in their pathogenicities. The enteric coronavirus did not cause feline infectious peritonitis in coronavirus antibody-negative cats inoculated orally or intraperitoneally nor in coronavirus antibody-positive cats inoculated intraperitoneally or intratracheally. Serologic tests, using FIPV, canine coronavirus, and transmissible gastroenteritis virus of swine as substrate antigens in fluorescent antibody procedures may not accurately identify FIPV infection. These tests do not appear to distinguish between FIPV and this feline enteric coronavirus.

RBRVS: still good news for physicians.

Lately, many physicians have been saying they've become disillusioned with the RBRVS. They don't believe the physician payment reform will bring gains for their undervalued evaluation and management services. They don't trust the federal government to live up to its end of the bargain. However, no one should write off the RBRVS. As can be seen from the text below, RBRVS will protect undervalued evaluation and management services in an era of medicare budget-cutting; it will introduce fairness and rationality into the Medicare payment system; it will provide a basis for arguing against unfair cuts in reimbursement (such as the recent ban on payment for most EKG interpretations) and it will bring the profession together to fight against any further cuts in the Medicare program.

Atmospheric deposition of phosphorus to land and freshwater.

We compiled published and newly-obtained data on the directly-measured atmospheric deposition of total phosphorus (TP), filtered total phosphorus (FTP), and inorganic phosphorus (PO4-P) to open land, lakes, and marine coasts. The resulting global data base includes data for c. 250 sites, covering the period 1954 to 2012. Most (82%) of the measurement locations are in Europe and North America, with 44 in Africa, Asia, Oceania, and South-Central America. The deposition rates are log-normally distributed, and for the whole data set the geometric mean deposition rates are 0.027, 0.019 and 0.14 g m(-2) a(-1) for TP, FTP and PO4-P respectively. At smaller scales there is little systematic spatial variation, except for high deposition rates at some sites in Germany, likely due to local agricultural sources. In cases for which PO4-P was determined as well as one of the other forms of P, strong parallels between logarithmic values were found. Based on the directly-measured deposition rates to land, and published estimates of P deposition to the oceans, we estimate a total annual transfer of P to and from the atmosphere of 3.7 Tg. However, much of the phosphorus in larger particles (principally primary biological aerosol particles) is probably redeposited near to its origin, so that long-range transport, important for tropical forests, large areas of peatland and the oceans, mainly involves fine dust from deserts and soils, as described by the simulations of Mahowald et al. (Global Biogeochemical Cycles 22, GB4026, 2008). We suggest that local release to the atmosphere and subsequent deposition bring about a pseudo-diffusive redistribution of P in the landscape, with P-poor ecosystems, for example ombrotrophic peatlands and oligotrophic lakes, gaining at the expense of P-rich ones. Simple calculations suggest that atmospheric transport could bring about significant local redistribution of P among terrestrial ecosystems. Although most atmospherically transported P is natural in origin, local transfers from fertilised farmland to P-poor ecosystems may be significant, and this requires further research.