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In this study, we investigated the role of glutamate delta 1 receptor (GluD1) in oligodendrocyte progenitor cell (OPC)-mediated myelination during basal (development) and pathophysiological (cuprizone-induced demyelination) conditions. Initially, we sought to determine the expression pattern of GluD1 in OPCs and found a significant colocalization of GluD1 puncta with neuron-glial antigen 2 (NG2, OPC marker) in the motor cortex and dorsal striatum. Importantly, we found that the ablation of GluD1 led to an increase in the number of myelin-associated glycoprotein (MAG+) cells in the corpus callosum and motor cortex at P40 without affecting the number of NG2+ OPCs, suggesting that GluD1 loss selectively facilitates OPC differentiation rather than proliferation. Further, deletion of GluD1 enhanced myelination in the corpus callosum and motor cortex, as indicated by increased myelin basic protein (MBP) staining at P40, suggesting that GluD1 may play an essential role in the developmental regulation of myelination during the critical window period. In contrast, in cuprizone-induced demyelination, we observed reduced MBP staining in the corpus callosum of GluD1 KO mice. Furthermore, cuprizone-fed GluD1 KO mice showed more robust motor deficits. Collectively, our results demonstrate that GluD1 plays a critical role in OPC regulation and myelination in normal and demyelinating conditions. [ABSTRACT FROM AUTHOR]

The article focuses on the significance of health equity in improving population health and reducing health disparities. It highlights the economic impact of health inequities and provides a framework for organizations to integrate health equity into their strategies across various domains. It authors emphasize that health equity is both a moral obligation and a business imperative, with examples of how organizations are taking steps to promote health equity.

ADP-ribosylation factors (ARF) GTPases are activated by guanine nucleotide exchange factors (GEFs) to support cellular homeostasis. Key to understanding spatio-temporal regulation of ARF signaling is the mechanism of GEF recruitment to membranes. Small GEFs are recruited through phosphoinositide (PIP) binding by a pleckstrin homology (PH) domain downstream from the catalytic Sec7 domain (Sec7d). The large GEFs lack PH domains, and their recruitment mechanisms are poorly understood. We probed Golgi recruitment of GBF1, a GEF catalyzing ARF activation required for Golgi homeostasis. We show that the homology downstream of Sec7d-1 (HDS1) regulates Golgi recruitment of GBF1. We document that GBF1 binds phosphoinositides, preferentially PI3P, PI4P and PI(4,5)P2, and that lipid binding requires the HDS1 domain. Mutations within HDS1 that reduce GBF1 binding to specific PIPs in vitro inhibit GBF1 targeting to Golgi membranes in cells. Our data imply that HDS1 and PH domains are functionally analogous in that each uses lipid-based membrane information to regulate GEF recruitment. Lipid-based recruitment of GBF1 extends the paradigm of lipid regulation to small and large GEFs and suggests that lipid-based mechanisms evolved early during GEF diversification. [ABSTRACT FROM AUTHOR]

Teesta river basin in Eastern Himalaya is being subjected to cascade hydropower development. To assess the impacts of this developmental activity on fish fauna of the basin, fish habitats of the four largest tributaries in the basin were selected for the present study. A total of 18 large hydroelectric projects are planned on these rivers. Here, a total of 11 EIAs and 2 carrying capacity studies in Teesta basin were reviewed. Our investigations show that after commissioning all the projects, 52–88% of the free-flowing river stretches will be diverted and 7.6–24% of the riverine ecosystems will be converted into semi lacustrine ecosystems in different rivers. The cascade hydropower development is likely to affect more than 100 fish species. All the EIA reports reviewed have investigated fish species richness, impacts on fish fauna and fishery management plans. EIA studies and management plans, however, do not adequately address important ecological and conservation issues due to various limitations. An integrated fish conservation plan for the upper Teesta basin is suggested in this contribution. [ABSTRACT FROM PUBLISHER]

In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors' collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health. These principles are meant to empower stakeholders-whether it is the planner or the practitioner, the decision maker or the dedicated caregiver-and inform the development of practical tools, research, and education. [ABSTRACT FROM AUTHOR]

The main objective of present study is to formulate and evaluate film forming gel of Bifonazole for local drug delivery. Tenia pedis is superficial skin fungal infection mainly occurs in athlete's foot. Bifonazole is a broad spectrum imidazole antifungal used in tenia pedis and possess high resistance towards fungus. It is an effective and well tolerated treatment for superficial fungal infections. In the treatment of skin fungal infections, the antifungal agent requires to be present at the site of infection for longer period of time. Thus the formulation which provides the prolonged drug delivery is needed. Film forming gel makes transparent film on the skin and provides the delivery of Bifonazole for prolonged period of time. So, such treatment reduces duration of therapy and improves the patient compliance. Eudragit RL(PO) as a film forming polymer, HPMC K100M as a gel forming agent and Triethyl citrate as a plasticizer were selected. It was concluded that drug was compatible with all excipients from FTIR study. A 32full factorial design was used in present study for optimization considering two factors Concentration of Eudragit RL(PO) and Concentration of Triethyl citrate.% Drug diffusion and Tensile strength were taken as dependent variable. The prepared film forming gel was evaluated for all parameters including mechanical properties and % drug diffusion. The optimized batch obtained from experimental design was prepared and evaluated for all parameters. Optimized formulation showed Tensile strength 0.875 N/m2 and % Drug diffusion 96.09 at 12 hour. Stability study of optimized formulation showed that formulation was stable at accelerated Condition. [ABSTRACT FROM AUTHOR]

The article presents a perspective on the role of U.S. health systems in preventing firearm injury in children and teenagers. Studies have revealed the increasing incidence of firearm injury and the death toll from it. A 2018 workshop sponsored by Kaiser Permanente and the American Hospital Association (AHA) identified ways to prevent firearm injury, including knowing the epidemiology and burden of firearm injury and investing in research on its risk factors.

Members of the large Sec7 domain- containing Arf guanine nucleotide exchange factor (GEF) family have been shown to dimerize through their NH2-terminal dimerization and cyclophilin binding (DCB) and homology upstream of Sec7 (HUS) domains. However, the importance of dimerization in GEF localization and function has not been assessed. We generated a GBF1 mutant (91/130) in which two residues required for oligomerization (K91 and E130 within the DCB domain) were replaced with A and assessed the effects of these mutations on GBF1 localization and cellular functions. We show that 91/130 is compromised in oligomerization but that it targets to the Golgi in a manner indistinguishable from wild-type GBF1 and that it rapidly exchanges between the cytosolic and membrane-bound pools. The 91/130 mutant appears active as it integrates within the functional network at the Golgi, supports Arf activation and COPI recruitment, and sustains Golgi homeostasis and cargo secretion when provided as a sole copy of functional GBF1 in cells. In addition, like wild-type GBF1, the 91/130 mutant supports poliovirus RNA replication, a process requiring GBF1 but believed to be independent of GBF1 catalytic activity. However, oligomerization appears to stabilize GBF1 in cells, and the 91/130 mutant is degraded faster than the wild-type GBF1. Our data support a model in which oligomerization is not a key regulator of GBF1 activity but impacts its function by regulating the cellular levels of GBF1. [ABSTRACT FROM AUTHOR]

Golden mahseer, Tor putitora Hamilton, one of the largest freshwater fish of the Indian sub-continent, inhabits mainly Himalayan rivers in the foothills. Among numerous freshwater fishes of the sub-continent, Golden mahseer is the most striking due to its large size, attractive golden colour, sustenance and sporting values. Tor putitora is known by various common names such as king mahseer, mighty mahseer and the tiger of water. Being a migratory fish, Golden mahseer undertakes periodic upstream migration during pre-monsoon and monsoon seasons from large rivers and higher order streams in the foothills to lower order streams for spawning. In recent years, conservationists, anglers and commercial fishermen have expressed concern over the declining populations of Golden mahseer due to indiscriminate fishing of brooders and juveniles besides the adverse effects of dams. Despite its ecological and economic importance, specific conservation measures by way of protective legal provisos are lacking for Golden mahseer in India. In view of its physical features, ecology and vulnerable conservation status, there is an exigent need to promote the Golden mahseer as a flagship conservation species of the Himalayan rivers. In view of the recent reports of unprecedented river regulation projects on the Himalayan rivers and need to draw global attention of conservationists, we review various aspects of ecology, life history, interesting features, traits and threats associated with the reduced chances of survival of Golden mahseer. [ABSTRACT FROM AUTHOR]

Objective This project was conducted to evaluate the loudness and acoustic parameters of toys designed for children. In addition, we investigated whether occluding the toys’ speaker with tape would result in a significant loudness reduction; thereby potentially reducing the risk of noise induced hearing loss. Methods Twenty-six toys were selected after an initial screening at two national retailers. Noise amplitudes at 0.25, 0.5, 1, 2, 4, and 8 kHz were measured using a digital sound level meter at a distance of 0 and 30 cm. The toys’ speakers were then occluded using adhesive tape and the same acoustic parameters were re-measured. Results Mean maximum noise amplitude of the toys at 0 cm and 30 cm was 104 dB A (range, 97–125 dB A) and 76 dB A (range, 67–86 dB A), respectively. Mean maximum noise amplitude after occlusion at 0 cm and 30 cm distances was 88 dB A (range, 73–110 dB A) and 66 dB A (range, 55–82 dB A), respectively, with a p -value <0.001. Conclusions Proper use of the loudest toys at a distant of 30 cm between the speaker and the child's ear will likely not pose a risk of noise-induced hearing loss. However, since most toys are used at closer distances, use of adhesive tape is recommended as an effective modification to decrease the risk of hearing loss. [ABSTRACT FROM AUTHOR]

Evidence suggests that the current growth in value-based payment models may unintentionally worsen health care disparities by disadvantaging hospitals caring for socially at-risk populations. To address this tension, value-based payment models should adopt a disparities-sensitive frame shift to integrate measures of equity into hospitals' financial calculus, incentivizing hospitals to tackle the disparities challenge without losing sight of quality. [ABSTRACT FROM AUTHOR]

Background: Studying diversity and distribution patterns of species along elevational gradients and understanding drivers behind these patterns is central to macroecology and conservation biology. A number of studies on biogeographic gradients are available for terrestrial ecosystems, but freshwater ecosystems remain largely neglected. In particular, we know very little about the species richness gradients and their drivers in the Himalaya, a global biodiversity hotspot. Methodology/Principal Findings: We collated taxonomic and distribution data of fish species from 16 freshwater Himalayan rivers and carried out empirical studies on environmental drivers and fish diversity and distribution in the Teesta river (Eastern Himalaya). We examined patterns of fish species richness along the Himalayan elevational gradients (50-3800 m) and sought to understand the drivers behind the emerging patterns. We used generalized linear models (GLM) and generalized additive models (GAM) to examine the richness patterns; GLM was used to investigate relationship between fish species richness and various environmental variables. Regression modelling involved stepwise procedures, including elimination of collinear variables, best model selection, based on the least Akaike's information criterion (AIC) and the highest percentage of deviance explained (D²). This maiden study on the Himalayan fishes revealed that total and non- endemic fish species richness monotonously decrease with increasing elevation, while endemics peaked around mid elevations (700-1500 m). The best explanatory model (synthetic model) indicated that water discharge is the best predictor of fish species richness patterns in the Himalayan rivers. Conclusions/Significance: This study, carried out along one of the longest bioclimatic elevation gradients of the world, lends support to Rapoport's elevational rule as opposed to mid domain effect hypothesis. We propose a species-discharge model and contradict species-area model in predicting fish species richness. We suggest that drivers of richness gradients in terrestrial and aquatic ecosystems are likely to be different. These studies are crucial in context of the impacts of unprecedented on-going river regulation on fish diversity and distribution in the Himalaya. [ABSTRACT FROM AUTHOR]

A macro-invertebrate based new biotic index is proposed to evaluate water quality in freshwater rivers. The new index is based on the data gathered and analysed from 21 sampling sites of eight rivers/streams of Sikkim in Eastern Himalaya. The sampling sites were chosen in such a manner to include the river stretches with disturbed, moderately disturbed and undisturbed catchment areas. The proposed index was calibrated against water quality index (WQI) of National Sanitation Foundation (NSF), USA and various other known biotic indices. The proposed index gives better results of the water quality of rivers compared to the existing abiotic and biotic indices, because: (i) it takes into account the abundance of taxa and reflects even the minor changes in abundance and community structure of the river ecosystem, (ii) it is flexible and gives freedom to select any pollution sensitivity score system based on family, generic or specific levels and (iii) it is universally applicable and is not affected by the geographic location of a river. [ABSTRACT FROM AUTHOR]

The Academic Database Assessment Tool (ADAT) from the Joint Information Systems Committee (JISC) enables users to compile and compare journal title lists from many different suppliers. The makers claim that this tool can help identify overlap of coverage among comparable databases and platforms. This article provides an overview of the tool's major features, including limitations, and how it can be used in academic libraries to make informed collection development and management decisions regarding electronic databases. [ABSTRACT FROM AUTHOR]

As information professionals, engineering librarians have the primary responsibilities of providing access to engineering information resources and giving instruction in how to use these resources. In the case of undergraduate engineering students, this extends to building their information literacy skills, an important component in helping them become lifelong learners; to be curious and independent, and to take greater responsibility for their own learning. The challenge in building information literacy in engineering students is to acquaint the students with the array of library resources available to them and to help them intelligently navigate the systems that contain the information. Too often, information literacy instruction is presented as a set of procedures for locating a hypothetical resource in the library. However, students are not interested in finding some resource randomly chosen as an example; they want to find resources that they perceive as being important and useful. During the 2005-2006 academic year, the engineering librarians at Drexel University took this into consideration and employed a new methodology for information literacy instruction: combining an online tutorial covering basic library skills with face-to-face consultations between student design teams and the engineering librarians. By utilizing varied instruction techniques aimed at different learning styles, with a strong active learning component delivered at the student's point of need - when they have a concrete, perceived information need - information literacy instruction can be improved so that engineering students retain more and develop lifelong learning skills. [ABSTRACT FROM AUTHOR]

The engineering library plays a critical role in initiating and maintaining the conduit between vendors of engineering information and the users of that information-faculty, students, and researchers. Likewise, vendors play a key role in supporting library, and faculty efforts, to promote science and engineering information resources, beyond just supplying content and interface. Science and engineering libraries, and vendors, can effectively work together to get the most from electronic resources for both large and small institutions. The case studies here show how Knovel Corporation, a sci-tech e-book vendor, has worked with librarians at large and small institutions, and with faculty members to promote awareness and usage of Knovel's interactive library of electronic books for science and engineering education. [ABSTRACT FROM AUTHOR]

Last year, researchers and librarians at both Drexel University and the University of Maryland initiated similar collaborative projects in their respective institutions to contribute to the development of life-long learning skills among the select participants. One joint finding was the importance of linking advances in knowledge, not just as hypothetical learning that benefits an elite few, but rather for the advancement of our society as a whole. [ABSTRACT FROM AUTHOR]

The article offers information on the efforts to prevent health care–associated infection (HAI). It mentions that the States Targeting Reduction in Infections via Engagement (STRIVE) program focuses on improving infection control practices and strengthening key stakeholder relationships to improve infection control efforts at the hospital and statewide levels.

Outreach, including patient navigation, has been shown to increase the uptake of colorectal cancer (CRC) screening in underserved populations. This analysis evaluates the cost-effectiveness of triennial multi-target stool DNA (mt-sDNA) versus outreach, with or without a mailed annual fecal immunochemical test (FIT), in a Medicaid population. A microsimulation model estimated the incremental cost-effectiveness ratio using quality-adjusted life years (QALY), direct costs, and clinical outcomes in a cohort of Medicaid beneficiaries aged 50–64 years, over a lifetime time horizon. The base case model explored scenarios of either 100% adherence or real-world reported adherence (51.3% for mt-sDNA, 21.1% for outreach with FIT and 12.3% for outreach without FIT) with or without real-world adherence for follow-up colonoscopy (66.7% for all). Costs and outcomes were discounted at 3.0%. At 100% adherence to both screening tests and follow-up colonoscopy, mt-sDNA costed more and was less effective compared with outreach with or without FIT. When real-world adherence rates were considered for screening strategies (with 100% adherence for follow-up colonoscopy), mt-sDNA resulted in the greatest reduction in incidence and mortality from CRC (41.5% and 45.8%, respectively) compared with outreach with or without FIT; mt-sDNA also was cost-effective versus outreach with and without FIT ($32,150/QALY and $22,707/QALY, respectively). mt-sDNA remained cost-effective versus FIT, with or without outreach, under real-world adherence rates for follow-up colonoscopy. Outreach or navigation interventions, with associated real-world adherence rates to screening tests, should be considered when evaluating the cost-effectiveness of CRC screening strategies in underserved populations. [ABSTRACT FROM AUTHOR]

Formation of transport vesicles requires the coordinate activity of the coating machinery that selects cargo into the nascent vesicle and the membrane bending machinery that imparts curvature to the forming bud. Vesicle coating at the trans -Golgi Network (TGN) involves AP1, GGA2 and clathrin, which are recruited to membranes by activated ARF GTPases. The ARF activation at the TGN is mediated by the BIG1 and BIG2 guanine nucleotide exchange factors (GEFs). Membrane deformation at the TGN has been shown to be mediated by lipid flippases, including ATP8A1, that moves phospholipids from the inner to the outer leaflet of the TGN membrane. We probed a possible coupling between the coating and deformation machineries by testing for an interaction between BIG1, BIG2 and ATP8A1, and by assessing whether such an interaction may influence coating efficiency. Herein, we document that BIG1 and BIG2 co-localize with ATP8A1 in both, static and highly mobile TGN elements, and that BIG1 and BIG2 bind ATP8A1. We show that the interaction involves the catalytic Sec7 domain of the GEFs and the cytosolic C -terminal tail of ATP8A1. Moreover, we report that the expression of ATP8A1, but not ATP8A1 lacking the GEF-binding cytosolic tail, increases the generation of activated ARFs at the TGN and increases the selective recruitment of AP1, GGA2 and clathrin to TGN membranes. This occurs without increasing BIG1 or BIG2 levels at the TGN, suggesting that the binding of the ATP8A1 flippase tail to the Sec7 domain of BIG1/BIG2 increases their catalytic activity. Our results support a model in which a flippase component of the deformation machinery impacts the activity of the GEF component of the coating machinery. [Display omitted] • The lipid flippase ATP8A1 interacts with the Guanine Nucleotide Exchange Factors BIG1/BIG2 at the trans-Golgi network (TGN) in mammalian cells. • ATP8A1 and BIG1/BIG2 interaction stimulates activated ARFs at the TGN, recruiting AP1, GGA2, and clathrin. • ATP8A1 co-localizes with BIG1/BIG2 in static and mobile TGN elements, linking membrane deformation with coating processes. [ABSTRACT FROM AUTHOR]

This article discusses the importance of promoting health equity in the U.S. workforce, particularly in relation to COVID-19 and cardiovascular disease. It highlights the economic and social costs of health inequities and introduces the Health Equity in the Workforce initiative led by the American Heart Association. The initiative aims to improve health outcomes for 10 million U.S. workers by 2025 through strategic relationships, empowering employers, embedding in communities, measuring impact, and recognizing achievement. The article also discusses the efforts of the American Heart Association, Deloitte Health Equity Institute, and the SHRM Foundation in addressing health disparities and promoting diversity and inclusion. These organizations provide actionable strategies for employers to prioritize health equity in the workplace and believe that it is essential for creating a healthier and more equitable future for all. [Extracted from the article]

Rethinking Community Benefit Programs - A New Vision for Hospital Investment in Community Health Over the past decade, hospitals have been tasked with a growing responsibility to address the social determinants of health. This requires (1) policy reforms that incentivize investments in community health, (2)hospital-community partnerships, and (3) a renewed focus on the "investment" in community investment. [Extracted from the article]

In this article the authors discuss a comprehensive public health agenda which was established in Chicago, Illinois by Chicago's Mayor, Rahm Emanuel, and the Chicago Department of Public Health and a health model in the city called Presence Health which aims to find resources for local health departments. In the article they offer their opinions on the agenda and model and on the need for public health collaboration that improves public health systems and policy making.

OBJECTIVES: Hospitals must strategically build organizational capacities to succeed in bundled payment arrangements. Given differences between Medicare and commercial arrangements, capacities may vary between hospitals in Medicare vs both Medicare and commercial bundled payment programs. This study compared organizational capacities between these 2 hospital groups. STUDY DESIGN: National survey of American Hospital Association (AHA) member hospitals with experience in bundled payment programs. METHODS: We analyzed data from October 31, 2017, to April 30, 2018, collected from AHA member hospitals with bundled payment experience in only Medicare (Medicareonly hospitals) or in both Medicare and commercial insurers (multipayer hospitals). Survey questions examined capacity in 4 areas: (1) physician performance feedback, (2) care management, (3) postacute care provider utilization, and (4) health information technology. RESULTS: Our sample included 114 hospitals reporting experience in Medicare or commercial bundled payment programs. Both Medicare-only and multipayer hospitals reported high organizational capacities in performance measurement of physician-level quality and cost feedback and in incorporation of health information technology. More multipayer hospitals reported high capacity for coordinating hospital to postacute care settings (88% vs 52%). Although nearly all hospitals in both groups reported formalized relationships with skilled nursing facilities (98%), fewer hospitals reported such relationships with long-term acute care hospitals (83%) and inpatient rehabilitation facilities (80%). CONCLUSIONS: Although they have similar capacity in a number of areas, Medicare-only and multipayer hospitals differed with respect to other aspects of organizational capacity. [ABSTRACT FROM AUTHOR]

The glutamate delta family of receptors is composed of GluD1 and GluD2 and serve as synaptic organizers. We have previously demonstrated several autism-like molecular and behavioral phenotypes including an increase in dendritic spines in GluD1 knockout mice. Based on previous reports we evaluated whether disruption of autophagy mechanisms may account for these phenotypes. Mouse model with conditional deletion of GluD1 from excitatory neurons in the corticolimbic regions was utilized. GluD1 loss led to overactive Akt-mTOR pathway, higher p62 and a lower LC3-II/LC3-I ratio in the somatosensory cortex suggesting reduced autophagy. Excitatory elements were increased in number but had immature phenotype based on puncta size, lower AMPA subunit GluA1 expression and impaired development switch from predominantly GluN2B to mixed GluN2A/GluN2B subunit expression. Overactive Akt-mTOR signaling and impaired autophagy was also observed in dorsal striatum upon conditional ablation of GluD1 and in the prefrontal cortex and hippocampus in constitutive knockout. Finally, cognitive deficits in novel object recognition test and fear conditioning were observed in mice with conditional ablation of GluD1 from the corticolimbic regions. Together, these results demonstrate a novel function of GluD1 in the regulation of autophagy pathway which may underlie autism phenotypes and is relevant to the genetic association of GluD1 coding, GRID1 gene with autism and other developmental disorders. [Display omitted] [ABSTRACT FROM AUTHOR]

Quantum key distribution (QKD) is a revolutionary communication technology that promises ultimate security assurance by exploiting the fundamental principles of quantum mechanics. In this work, we report design and development of a fully automated inter-building QKD framework for generation and distribution of cryptographic keys, securely and seamlessly, by executing weak coherent pulse based BB84 protocol. This framework is experimentally validated by establishing a quantum communication link between two buildings separated by ∼ 300 m of free-space atmospheric channel. A novel synchronization technique enabled with indigenous NavIC (IRNSS) constellation is developed and implemented. This QKD system demonstrates generation of secure key rate as high as 300 Kbps with QBER < 3% for mean photon no. per pulse (μ) of 0.15. The intercept–resend eavesdropping attack has been emulated within the system and evaluated during experiment. A novel quantum secured end-to-end encrypted video calling app (QuViC) is also developed and integrated with QKD framework to demonstrate unconditionally secure two-way communication over Ethernet, functioning alongside with quantum communication. [ABSTRACT FROM AUTHOR]

The indications for postoperative admission after tonsillectomy in children >3 years of age are less well defined than for children <3 years old, and typically include severe obstructive sleep apnea (OSA), obesity, comorbidities, or behavioral factors. Inpatient care after tonsillectomy typically consists of respiratory monitoring and support, as respiratory compromise is the most common complication after pediatric tonsillectomy. We aim to evaluate risk factors associated with postoperative oxygen supplementation and to identify high risk populations within the admitted population who use additional resources or require additional interventions. Retrospective chart review of patients between the ages of 3 and 18 years old who underwent tonsillectomy by four surgeons at a tertiary care children's hospital was performed. Data including demographics, comorbidities, surgical intervention, pre- and postoperative AHI, admission, postoperative oxygen requirement, and postoperative complications was collected and analyzed. There were 401 patients included in the analysis. Of the patients in this study, 65.59% were male, 43.39% were Latino, and 53.87% were ages 3 to 7. Of the 397 patients with a record for supplemental oxygen, 36 (9.07%) received supplemental oxygen. The LASSO regression odds ratios (OR) found to be important for modeling supplemental oxygen use (in decreasing order of magnitude) are BMI ≥35 (OR = 2.30), pre-op AHI >30 (OR = 2.28), gastrointestinal comorbidities (OR = 2.20), musculoskeletal comorbidities (OR = 1.91), cardiac comorbidities (OR = 1.20), pulmonary comorbidities (OR = 1.14), and BMI 30 to <35 (OR = 1.07). Female gender was found to be negatively associated with risk of supplemental oxygen use (OR = 0.84). Age, race, AHI ≥15–30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement. BMI ≥30, pre-op AHI >30, male gender, and gastrointestinal, musculoskeletal, cardiac, and pulmonary comorbidities are all associated with postoperative supplemental oxygen use. Age, race, AHI ≥15–30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement. [ABSTRACT FROM AUTHOR]

Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts. To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics. A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0–19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses. From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005–2010 and 2011–2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians. Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0–4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities. • Rate of nonfatal choking injuries increased after the AAP recommendations in 2010. • Rate of choking fatalities in all children decreased after 2010. • Rate of choking fatalities in 0–4 year olds did not change after 2010. • Racial gaps exist with highest rates of nonfatal and fatal injury in Black children. [ABSTRACT FROM AUTHOR]

Background and Aims: Opioid substitution treatment is used in many countries as an effective harm minimization strategy. There is a need for more information about patient safety incidents and the resulting harm relating to this treatment. We aimed to characterize patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community‐based care by: (i) identifying the sources and nature of harm and (ii) describing and interpreting themes to identify priorities to focus future improvement work. Design Mixed‐methods study examining patient safety incident reports involving opioid substitution treatment with either methadone or buprenorphine in community‐based care. Setting: Data submitted between 2005 and 2015 from the National Reporting and Learning System (NRLS), a national repository of patient safety incident reports from across England and Wales. Participants: A total of 2284 reports were identified involving patients receiving community‐based opioid substitution treatment. Measurements Incident type, contributory factors, incident outcome and severity of harm. Analysis involved data coding, processing and iterative generation of data summaries using descriptive statistical and thematic analysis. Findings Most risks of harm from opioid substitution treatment came from failure in one of four processes of care delivery: prescribing opioid substitution (n = 151); supervised dispensing (n = 248); non‐supervised dispensing (n = 318); and monitoring and communication (n = 1544). Most incidents resulting in harm involved supervised or non‐supervised dispensing (n = 91 of 127, 72%). Staff‐ (e.g. slips during task execution, not following protocols) and organization‐related (e.g. poor working conditions or poor continuity of care between services) contributory factors were identified for more than half of incidents. Conclusions: Risks of harm in delivering opioid substitute treatment in England and Wales appear to arise out of failures in four processes: prescribing opioid substitution, supervised dispensing, non‐supervised dispensing and monitoring and communication. [ABSTRACT FROM AUTHOR]

The article offers information on the development of the tiered approach to prioritize Catheter-Associated Urinary Tract Infection (CAUTI) interventions. It mentions that the application of the Grading of Recommendations Assessment, Development and Evaluation system approach for evaluating quality of evidence and determining strength of recommendations.

Purpose: Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer 'all femtosecond laser' surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK.Methods: Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable.Results: The study population consisted of 21 males and 16 females. The mean±standard deviation age was 33±8years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent.Conclusions: This early data from surgeons' first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article {Population Health, Public Health, and Accountable Care: Emerging Roles and Relationships" by Richard C. Ingram, Julia F. Costich, and F. Douglas Scutchfield, along with a response from the authors.

This study explores the use of mobile health applications (mHealth apps) on smartphones or tablets for health-seeking behavior among US adults. Data was obtained from cycle 4 of the 4th edition of the Health Information National Trends Survey (HINTS 4). Weighted multivariate logistic regression models examined predictors of 1) having mHealth apps, 2) usefulness of mHealth apps in achieving health behavior goals, 3) helpfulness in medical care decision-making, and 4) asking a physician new questions or seeking a second opinion. Using the Andersen Model of health services utilization, independent variables of interest were grouped under predisposing factors (age, gender, race, ethnicity, and marital status), enabling factors (education, employment, income, regular provider, health insurance, and rural/urban location of residence), and need factors (general health, confidence in their ability to take care of health, Body Mass Index, smoking status, and number of comorbidities). In a national sample of adults who had smartphones or tablets, 36 % had mHealth apps on their devices. Among those with apps, 60 % reported the usefulness of mHealth apps in achieving health behavior goals, 35 % reported their helpfulness for medical care decision-making, and 38 % reported their usefulness in asking their physicians new questions or seeking a second opinion. The multivariate models revealed that respondents were more likely to have mHealth apps if they had more education, health insurance, were confident in their ability to take good care of themselves, or had comorbidities, and were less likely to have them if they were older, had higher income, or lived in rural areas. In terms of usefulness of mHealth apps, those who were older and had higher income were less likely to report their usefulness in achieving health behavior goals. Those who were older, African American, and had confidence in their ability to take care of their health were more likely to respond that the mHealth apps were helpful in making a medical care decision and asking their physicians new questions or for a second opinion. Potentially, mHealth apps may reduce the burden on primary care, reduce costs, and improve the quality of care. However, several personal-level factors were associated with having mHealth apps and their perceived helpfulness among their users, indicating a multidimensional digital divide in the population of US adults. [ABSTRACT FROM AUTHOR]

The article deals with FoodBorne Chicago, launched by Chicago Department of Public Health (CDPH) and civic partners on March 23, 2013, tasked to promote food safety improvement in Chicago, Illinois by identifying and responding to complaints on possible foodborne illnesses on online social networking Twitter. Topics discussed include submission of 193 complaints of possible foodborne illness, inspection of 133 restaurants, and Twitter messages tracked through supervised learning algorithm.

Glutamate delta-1 (GluD1) receptors are expressed throughout the forebrain during development with high levels in the hippocampus during adulthood. We have recently shown that deletion of GluD1 receptor results in aberrant emotional and social behaviors such as hyperaggression and depression-like behaviors and social interaction deficits. Additionally, abnormal expression of synaptic proteins was observed in amygdala and prefrontal cortex of GluD1 knockout mice (GluD1 KO). However the role of GluD1 in learning and memory paradigms remains unknown. In the present study we evaluated GluD1 KO in learning and memory tests. In the eight-arm radial maze GluD1 KO mice committed fewer working memory errors compared to wildtype mice but had normal reference memory. Enhanced working memory in GluD1 KO was also evident by greater percent alternation in the spontaneous Y-maze test. No difference was observed in object recognition memory in the GluD1 KO mice. In the Morris water maze test GluD1 KO mice showed no difference in acquisition but had longer latency to find the platform in the reversal learning task. GluD1 KO mice showed a deficit in contextual and cue fear conditioning but had normal latent inhibition. The deficit in contextual fear conditioning was reversed by D-Cycloserine (DCS) treatment. GluD1 KO mice were also found to be more sensitive to foot-shock compared to wildtype. We further studied molecular changes in the hippocampus, where we found lower levels of GluA1, GluA2 and GluK2 subunits while a contrasting higher level of GluN2B in GluD1 KO. Additionally, we found higher postsynaptic density protein 95 (PSD95) and lower glutamate decarboxylase 67 (GAD67) expression in GluD1 KO. We propose that GluD1 is crucial for normal functioning of synapses and absence of GluD1 leads to specific abnormalities in learning and memory. These findings provide novel insights into the role of GluD1 receptors in the central nervous system. [ABSTRACT FROM AUTHOR]

The delta family of ionotropic glutamate receptors consists of glutamate d1 (GluD1) and glutamate d2 (GluD2) receptors. While the role of GluD2 in the regulation of cerebellar physiology is well understood, the function of GluD1 in the central nervous system remains elusive. We demonstrate for the first time that deletion of GluD1 leads to abnormal emotional and social behaviors. We found that GluD1 knockout mice (GluD1 KO) were hyperactive, manifested lower anxiety-like behavior, depression-like behavior in a forced swim test and robust aggression in the resident-intruder test. Chronic lithium rescued the depression-like behavior in GluD1 KO. GluD1 KO mice also manifested deficits in social interaction. In the sociability test, GluD1 KO mice spent more time interacting with an inanimate object compared to a conspecific mouse. D-Cycloserine (DCS) administration was able to rescue social interaction deficits observed in GluD1 KO mice. At a molecular level synaptoneurosome preparations revealed lower GluA1 and GluA2 subunit expression in the prefrontal cortex and higher GluA1, GluK2 and PSD95 expression in the amygdala of GluD1 KO. Moreover, DCS normalized the lower GluA1 expression in prefrontal cortex of GluD1 KO. We propose that deletion of GluD1 leads to aberrant circuitry in prefrontal cortex and amygdala owing to its potential role in presynaptic differentiation and synapse formation. Furthermore, these findings are in agreement with the human genetic studies suggesting a strong association of GRID1 gene with several neuropsychiatric disorders including schizophrenia, bipolar disorder, autism spectrum disorders and major depressive disorder. [ABSTRACT FROM AUTHOR]

Being the most delicate organ of the body, the brain is protected against potentially toxic substances by the blood-brain barrier (BBB), which restricts the entry of most pharmaceuticals into the brain. The developmental process for new drugs for the treatment of CNS disorders has not kept pace with progress in molecular neurosciences because most of the new drugs discovered are unable to cross the BBB. The clinical failure of CNS drug delivery may be attributed largely to a lack of appropriate drug delivery systems. Localized and controlled delivery of drugs at their desired site of action is preferred because it reduces toxicity and increases treatment efficiency. The present review provides an insight into some of the recent advances made in the field of brain drug delivery.The various strategies that have been explored to increase drug delivery into the brain include (i) chemical delivery systems, such as lipid-mediated transport, the prodrug approach and the lock-in system; (ii) biological delivery systems, in which pharmaceuticals are re-engineered to cross the BBB via specific endogenous transporters localized within the brain capillary endothelium; (iii) disruption of the BBB, for example by modification of tight junctions, which causes a controlled and transient increase in the permeability of brain capillaries; (iv) the use of molecular Trojan horses, such as peptidomimetic monoclonal antibodies to transport large molecules (e.g. antibodies, recombinant proteins, nonviral gene medicines or RNA interference drugs) across the BBB; and (v) particulate drug carrier systems. Receptor-mediated transport systems exist for certain endogenous peptides, such as insulin and transferrin, enabling these molecules to cross the BBB in vivo.The use of polymers for local drug delivery has greatly expanded the spectrum of drugs available for the treatment of brain diseases, such as malignant tumours and Alzheimer's disease. In addition, various drug delivery systems (e.g. liposomes, microspheres, nanoparticles, nanogels and bionanocapsules) have been used to enhance drug delivery to the brain. Recently, microchips and biodegradable polymers have become important in brain tumour therapy.The intense search for alternative routes of drug delivery (e.g. intranasal drug delivery, convection-enhanced diffusion and intrathecal/intraventricular drug delivery systems) has been driven by the need to overcome the physiological barriers of the brain and to achieve high drug concentrations within the brain. For more than 30 years, considerable efforts have been made to enhance the delivery of therapeutic molecules across the vascular barriers of the CNS. The current challenge is to develop drug delivery strategies that will allow the passage of drug molecules through the BBB in a safe and effective manner. [ABSTRACT FROM AUTHOR]

A variety of 4,4'-disubstituted phenyl benzoates having a terminal chain containing multifluorine atoms, attached directly to the benzene ring or through an ester group, have been synthesized and their mesomorphic properties determined by hot stage polarizing optical microscopy. These properties were compared to those of the corresponding hydrogenated esters and to other esters containing rigid terminal chains. Usually transition temperatures were higher and mesophase ranges wider than those observed for the parent compounds but no nematic phases were found. Any mesophase seen was usually a smectic A phase sometimes accompanied by a smectic C phase. Crystal E phases were found along with the smectic A phase in alkyl or alkoxy esters having a C9F19CO2 chain on the acid side. A first order smectic A–smectic C transition was observed in the ester with CN on the acid side and O2CC7F15 on the phenol side. A comparison of the effect of a terminal fluorinated chain and a lateral fluorine group on one set of esters is also included. [ABSTRACT FROM AUTHOR]