Association of robotic approach with patient-reported outcomes after pancreatectomy: a prospective cohort study.

BACKGROUND: Robotic-assisted pancreatectomy continues to proliferate despite limited evidence supporting its benefits from the patient's perspective. We compared patient-reported outcomes (PROs) between patients undergoing robotic and open pancreatectomies. METHODS: PROs, measured with the FACT-Hep, FACT-G, and HCS, were assessed in the immediate postoperative (i.e., preoperative to discharge) and recovery (i.e., discharge to three months postoperative) periods. Linear mixed models estimated the association of operative approach on PROs. Minimally important differences (MIDs) were also considered. RESULTS: Among 139 patients, 105 (75.5%) underwent robotic pancreatectomies. Compared to those who underwent open operations, those who underwent robotic operations experienced worse FACT-Hep scores that were both statistically and clinically significant (mean difference [MD] 8.6 points, 95% CI 1.0-16.3). Declines in FACT-G (MD 4.3, 95% CI -1.0 to 9.6) and HCS (MD 4.3, 95% CI 0.8-7.9) scores appeared to contribute equally in both operative approaches to the decline in total FACT-Hep score. Patients who underwent robotic versus open operations both statistically and clinically significantly improved due to improvements in HCS (MD 6.1, 95% CI 2.3-9.9) but not in FACT-G (MD 1.2, 95% CI - 5.1-7.4). CONCLUSION: The robotic approach to pancreas surgery might offer, from the patient's perspective, greater improvement in symptoms over the open approach by three months postoperatively.

Locus coeruleus input to hippocampal CA3 drives single-trial learning of a novel context.

The memory for a new episode is formed immediately upon experience and can last up to a lifetime. It has been shown that the hippocampal network plays a fundamental role in the rapid acquisition of a memory of a one-time experience, in which the novelty component of the experience promotes the prompt formation of the memory. However, it remains unclear which neural circuits convey the novelty signal to the hippocampus for the single-trial learning. Here, we show that during encoding neuromodulatory input from locus coeruleus (LC) to CA3, but not CA1 or to the dentate gyrus, is necessary to facilitate novel contextual learning. Silencing LC activity during exposure to a novel context reduced subsequent reactivation of the engram cell ensembles in CA3 neurons and in downstream CA1 upon reexposure to the same context. Calcium imaging of the cells reactivated in both novel and familiar contexts revealed that suppression of LC inputs at the time of encoding resulted in more variable place fields in CA3 neurons. These results suggest that neuromodulatory input from LC to CA3 is crucial for the formation of a persistent memory in the hippocampus.

Silent memory engrams as the basis for retrograde amnesia.

Recent studies identified neuronal ensembles and circuits that hold specific memory information (memory engrams). Memory engrams are retained under protein synthesis inhibition-induced retrograde amnesia. These engram cells can be activated by optogenetic stimulation for full-fledged recall, but not by stimulation using natural recall cues (thus, amnesia). We call this state of engrams "silent engrams" and the cells bearing them "silent engram cells." The retention of memory information under amnesia suggests that the time-limited protein synthesis following learning is dispensable for memory storage, but may be necessary for effective memory retrieval processes. Here, we show that the full-fledged optogenetic recall persists at least 8 d after learning under protein synthesis inhibition-induced amnesia. This long-term retention of memory information correlates with equally persistent retention of functional engram cell-to-engram cell connectivity. Furthermore, inactivation of the connectivity of engram cell ensembles with its downstream counterparts, but not upstream ones, prevents optogenetic memory recall. Consistent with the previously reported lack of retention of augmented synaptic strength and reduced spine density in silent engram cells, optogenetic memory recall under amnesia is stimulation strength-dependent, with low-power stimulation eliciting only partial recall. Finally, the silent engram cells can be converted to active engram cells by overexpression of α-p-21-activated kinase 1, which increases spine density in engram cells. These results indicate that memory information is retained in a form of silent engram under protein synthesis inhibition-induced retrograde amnesia and support the hypothesis that memory is stored as the specific connectivity between engram cells.

Community Engagement Framework for Community Assessment and Improvement Planning.

As the emphasis on community-based public health expands, academics and practitioners are challenged to include the community throughout assessment and improvement planning activities. The volatility of community-based government programs and the emergence of new initiatives further complicate community involvement. Many communities have grown tired of being participants, of strategies focused on assessments that never reach implementation or goals, and of being abandoned when funding ends. A framework that melds lessons learned from previous programs and existing models with Web-based resources and new initiatives provides insights for sustainable and agile community-based solutions. Other implications include ways to align multiple assessment and planning requirements through one framework. This article describes the components and distinctions of a community engagement framework for assessment and planning conceptualized through the experiences of public health practice and academic partners in South Carolina.

Probuphine (Buprenorphine) Subdermal Implants for the Treatment Of Opioid-Dependent Patients.

Probuphine (buprenorphine) subdermal implants for the treatment of opioid-dependent patients.

Vaxchora: The First FDA-Approved Cholera Vaccination in the United States.

Vaxchora is the first vaccine approved by the Food and Drug Administration for the prophylaxis of cholera infection. Cholera, a potentially life-threatening bacterial infection that occurs in the intestines and causes severe diarrhea and dehydration, has a low incidence in the U.S., but a high incidence in Africa, Southeast Asia, and other locations around the world. These areas draw travelers from the U.S., so cholera can present in patients who return from visits to these regions. Previous means of prophylaxis included the use of doxycycline for the prevention of traveler's diarrhea, but doxycycline is not specific for cholera. With the approval of Vaxchora, a live attenuated, single-dose, oral suspension vaccine, travelers can now visit these areas with less chance of contracting the bacterium Vibrio cholerae, which causes cholera infections.

The New Face of Hyperlipidemia Management: Proprotein Convertase Subtilisin/Kexin Inhibitors (PCSK-9) and Their Emergent Role As An Alternative To Statin Therapy.

This review analyzes Proprotein Convertase Subtilisin/Kexin 9 inhibitors (PCSK-9), a new medication class that has arisen in the last year to combat hypercholesterolemia. They are targeted towards patients who are unable to achieve acceptable low density lipoprotein (LDL) levels despite maximum statin therapy, as well as those who are unable to tolerate maximum statin therapy due to side effects such as myopathy or myalgia. Two of these medications have been released in the last year: alirocumab (Praluent) and evolocumab (Repatha). This article will overview this medication class, describe their pathophysiology, and analyze the clinical data from the numerous studies and trials done on both of these medications for their efficacy and safety outcomes. Data compiled on this new class of medications support the research that PCSK-9 inhibitors are both a safe and effective means of lowering the LDL levels of resistant or otherwise currently unmanaged hypercholesterolemia patients.

Tiotropium Bromide/Olodaterol (Stiolto Respimat): Once-Daily Combination Therapy for the Maintenance of COPD.

Tiotropium bromide/olodaterol (Stiolto Respimat): once-daily combination therapy for the maintenance of COPD.

Quadracel: Vaccination Against Diphtheria, Tetanus, Pertussis, and Poliomyelitis in Children.

INTRODUCTION: Vaccinations in school-aged children are required by state and local law to maintain high vaccination coverage rates, as well as low rates of vaccine-preventable diseases. Diphtheria, tetanus, and pertussis are childhood diseases that can be life threatening; poliomyelitis, another childhood disease, can be disabling. In turn, vaccinations were developed to provide protection against these diseases. Today, several vaccinations are recommended for children, including but not limited to diphtheria, tetanus, and pertussis (DTaP) and poliomyelitis (IPV). DTaP requires five doses, and IPV requires four. Quadracel (diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine, Sanofi Pasteur Inc.) is a new vaccination developed to condense the last dose of both DTaP and IPV so they do not have to be given separately, thus reducing the total number of vaccinations required. DISCUSSION: The Quadracel vaccine is an option for use in children who are completing the DTaP and IPV series. In a randomized, controlled, phase 3, pivotal trial, Quadracel proved to be as efficacious and safe as Daptacel (diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed, Sanofi Pasteur Inc.) and IPOL (poliovirus vaccine inactivated, Sanofi Pasteur Inc.), given separately, to children between the ages of 4 and 6 years. CONCLUSION: Quadracel should be recommended to parents who have children between the ages of 4 and 6 years who meet the necessary administration criteria and need to finalize their DTaP and IPV series. Quadracel's administration in the vaccination series replaces one additional injection, which may benefit children who are afraid of receiving shots and parents who need to schedule one less doctor's appointment.

Dulaglutide (Trulicity): The Third Once-Weekly GLP-1 Agonist.

Dulaglutide (Trulicity): the third once-weekly GLP-1 agonist for type-2 diabetes.

Ceftazidime-Avibactam (Avycaz): For the Treatment of Complicated Intra-Abdominal and Urinary Tract Infections.

Ceftazidime-avibactam (Avycaz) for the treatment of complicated infections.

Sodium-Glucose Linked Transporter 2 (SGLT2) Inhibitors in the Management Of Type-2 Diabetes: A Drug Class Overview.

Sodium-glucose linked transporter 2 inhibitors limit the reabsorption of glucose from glomerular filtrate in the kidneys, reducing blood glucose levels in patients with type- 2 diabetes. This article is meant to evaluate this class of medications for clinicians.

A collaborative approach in workforce assessment: South Carolina's strategies for high response rates.

The South Carolina Public Health Training Center and South Carolina Department of Health and Environmental Control conducted a state public health workforce assessment using a collaborative methodology. A joint workforce assessment team used the 2010 Core Competencies for Public Health Professionals--developed by the Council on Linkages Between Academia and Public Health Practice--as the basis for the assessment and resulting continuing education programs. A 91% response rate (n = 1,375) was achieved among full-time regional employees, while an 81% response rate (n = 1,598) was achieved among all regional employee types. This unusually high response rate in a voluntary assessment was accomplished by involving key stakeholders in the planning, development, and implementation process and by communicating directly with leaders in South Carolina's eight health regions. In addition to boosting the response rate, the collaborative approach strengthened the partnership between the academic and practice partners. In this article, we discuss the workforce assessment methodology, strategies, results, and lessons learned.

Building a sustainable Academic Health Department: the South Carolina model.

Given the limited resources available to public health, it is critical that university programs complement the development needs of agencies. Unfortunately, academic and practice public health entities have long been challenged in building sustainable collaborations that support practice-based research, teaching, and service. The academic health department concept offers a promising solution. In South Carolina, the partners started their academic health department program with a small grant that expanded into a dynamic infrastructure that supports innovative professional exchange and development programs. This article provides a background and describes the key elements of the South Carolina model: joint leadership, a multicomponent memorandum of agreement, and a shared professional development mission. The combination of these elements allows the partners to leverage resources and deftly respond to challenges and opportunities, ultimately fostering the sustainability of the collaboration.

Disease progression and characteristics of HIV-infected women with and without a history of criminal justice involvement.

Early HIV diagnosis followed by prompt linkage to and consistent retention in HIV-related care is important to decrease morbidity and mortality. Progression to AIDS is of particular interest in HIV-positive women with a history of criminal justice-involvement due to their lack of access to care in the community and poor retention in HIV primary care. In this retrospective cohort study, we characterize the risk of developing AIDS among HIV-infected women with and without a history of criminal justice-involvement. Mean time to AIDS diagnosis was longer [123 ± 3.26 months] for women with no criminal justice-involvement when compared to women who were arrested or who went to prison. Women who were arrested (HR: 1.92, 95% CI: 1.43, 2.58) and women who went to prison (HR: 2.27, 95% CI: 1.52, 3.39) had an increased risk of developing AIDS when compared to women without criminal justice-involvement.

Restaurant industry preparedness against intentional food contamination: results of a South Carolina survey.

Food safety and food defense are both responsibilities of public health agencies. Food safety practices within restaurants are regulated by state and local public health laws based on the US Food and Drug Administration Model Food Code. However, little is known about preemptive practices against intentional food-borne outbreaks within restaurants. The researchers administered a survey to a 50 percent random sample of South Carolina's restaurants, a state that relies heavily on tourism and the restaurant industry for its economic well-being. The survey received a response rate of 15 percent. The food defense practice items fall under three functional categories: employee management and training practices; vendor and delivery-related practices; and physical facilities and operational security practices. This study presents the results, classified by geographic region. Findings indicate some key areas of vulnerability that need attention to protect the public from mass food outbreaks due to intentional contamination. Of concern, there is much variation in practices by geographic region. On the basis of the survey, recommendations are made to improve restaurant preparedness against food-borne outbreaks from terrorism and malevolent contamination.

Preventing intentional food contamination: a survey to assess restaurant preparedness.

In the age of preparedness, public health agencies are concerned with intentional acts of food contamination in restaurants, in addition to food safety. Food safety consists of applying standard norms of practice and infrastructure, which, if violated, cause food-borne illness. In contrast, food defense requires an institutionalized mindset of informed alertness to unusual variations from the norms, combined with preemptive practices best suited to each restaurant. Therefore, while food safety lends itself to regulation to ensure standard practices, food defense is best served by advisory guidelines for autonomous application, preserving the restaurant industry's core values of hospitality and customer service. To address this challenge, public health agencies need survey tools that can yield action-relevant data on the knowledge and practice gaps in food defense preparedness and on educational messages and support services to be developed for maximum impact potential. This article presents a mail survey instrument, developed using qualitative research to ensure content and face validity. Instrument development involved drafting the survey on the basis of expert consultations, validating its content by using focus groups (representing all restaurant categories and geographic regions), and ensuring face validity through cognitive interviews. The resulting survey remains sensitive to the hospitality industry while encompassing all vulnerable points.

Demonstrating excellence in the scholarship of practice-based service for public health.

Practice-based scholarship in public health addresses community health issues. The accredited schools of public health (SPHs) have played a significant role in defining and implementing the multidisciplinary, interprofessional, ecological approach to improving the health and safety of communities through academic public health practice. These schools have addressed the challenges raised by the Institute of Medicine for enhancing academic-practice linkages. The Association of Schools of Public Health (ASPH) established the Council of Public Health Practice Coordinators (Practice Council), whose members are delegates from each of the SPHs accredited by the Council on Education for Public Health (CEPH); there were 40 as of 2008. The Practice Council's priorities are to (1) promote greater commitment to scholarship in public health practice-based research, teaching, and service within SPHs, and (2) facilitate recognition and reward for practice-based scholarship in academic institutions. Extensive alignment of efforts by the Practice Council, SPHs, federal agencies, private institutions, and the practice sector have invigorated scholarship in academic public health practice.