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Metabolic syndrome (MetS), which includes obesity, diabetes, hypertension, hyperlipidemia, and fatty-liver disease, affects more than two-thirds of the U.S. population. Surgical weight loss has been popularized in the last several decades as a means to produce significant weight loss and improvements in the comorbidities of MetS. Women are by far the most common recipients of these surgeries (more than 85%). Women of childbearing age are very likely to pursue surgical weight loss to improve their reproductive function and fertility for childbearing purposes. Significant research using pre-clinical models from our laboratory and clinical data from around the world suggest that surgical weight loss before pregnancy may have negative consequences for offspring. The present study investigates the metabolic endpoints in female-rodent offspring born to dams who had previously received vertical sleeve gastrectomy (VSG) before pregnancy. Comparisons were made to offspring from lean and obese dams. In the adult offspring of either maternal VSG or sham surgery, no differences in body weight, body fat, or lean body mass between groups were identified. The blood pressure measured in a subset of female offspring showed no differences between the VSG and the sham groups. Estrus cyclicity measured by lavage on serial days showed altered cycles in the VSG offspring compared to the controls. For animals that had previously only been exposed to chow, rats were fasted overnight and then given a 1 g meal of either chow or a novel high-fat diet (HFD). The animals were euthanized and paraformaldehyde (PFA)-perfused to perform brain immunohistochemistry for c-Fos, an immediate–early gene activated by novel stimuli. In the VSG rats exposed to either the chow or the HFD meal, the c-Fos-activated cells were significantly blunted in the nucleus of the solitary tract (p < 0.05), the paraventricular nucleus of the hypothalamus (PVN) (p < 0.05), and the dorsal medial nucleus of the hypothalamus (DMH) (p < 0.05) in comparison to the sham controls. These data suggest that the hypothalamic wiring within the brain that controls the response to nutrients and reproductive function was significantly altered in the VSG offspring compared to the offspring of the dams that did not receive weight-loss surgery. [ABSTRACT FROM AUTHOR]

Introduction: Rapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB); however, pediatric data are limited. Objectives: The primary objective of this study was to assess the clinical impact of concomitant implementation of an ASP and RDT in children with SAB. Methods: This pre‐post quasi‐experimental study compared time to optimal antibiotic in children with SAB in 2015/2016 (pre‐intervention [PRE]) and 2017/2018 (post‐intervention [POST]). During the PRE period there was no RDT or ASP available. However, in the POST period, RDT was performed on all positive blood cultures, followed by feedback from an ASP. Secondary outcomes included time to effective antibiotic, antibiotic exposure, duration of bacteremia, hospital length of stay (LOS), transfer to the intensive care unit (ICU), SAB recurrence, and inpatient mortality. Results: Sixty‐eight patients were included in the study (PRE: n = 32, POST: n = 36). Median time to optimal antibiotic therapy decreased by 23 hours (PRE: 44.3 hours vs POST: 21.3 hours; P =.008). Duration of bacteremia (PRE: 65 hours vs POST: 40.9 hours; P =.03) and inpatient mortality (PRE: 12.5% vs POST: 0%; P =.04) were also reduced. However, further review revealed that only one death was related to SAB. Differences in time to effective therapy, antibiotic exposure, and hospital LOS were not significantly different between the groups. There were similar rates of infectious disease (ID) consultation (PRE: 78% vs POST: 89%, P =.23), but a shorter time to central line removal in the POST group (PRE: 68.2 hours vs POST: 19.8 hours; P =.04). Throughout the study period, recurrence of SAB only occurred in one patient (PRE). Conclusion: ASP interventions, facilitated by RDT, resulted in a shorter time to optimal antibiotic therapy in children with SAB. Although these interventions may have led to improved overall SAB management, further studies are needed to confirm clinical benefits. [ABSTRACT FROM AUTHOR]

The American White Ibis (Eudocimus albus) is a nomadic wading bird common to wetland habitats in the southeastern US. In south Florida, US, habitat depletion has driven many ibis to become highly urbanized. Although they forage in neighborhood parks, artificial wetlands, backyards, and golf courses, the majority continue to nest in natural wetlands, often in dense, mixed species colonies. Adults and juveniles commonly disperse thousands of kilometers to other breeding colonies along the Gulf and southeast Atlantic coasts, presenting the potential for close contact with humans, domestic animals, and other wild bird species. Historically, wading birds were not considered to be significant hosts for influenza A virus (IAV), yet as ibis regularly move among various human, domestic animal, and wildlife interfaces, their potential to be exposed to or infected with IAV deserves attention. We experimentally challenged wild-caught, captive-reared White Ibis (n=20) with IAV, tested wild White Ibis for IAV, and serologically tested wild White Ibis for antibodies to IAV. White Ibis were highly susceptible to experimental challenge with H6N1 and H11N9 IAVs, with cloacal shedding lasting an average of 6 d. All 13 infected birds seroconverted by 14 d postinfection as determined by microneutralization. In contrast, no birds challenged with H3N8 were infected. We tested 118 swabs and 578 serum samples from White Ibis captured in southeastern Florida for IAV infection and antibodies to IAV, respectively. Although no IAVs were isolated, 70.4% serum samples were antibody positive by blocking enzyme-linked immunosorbent assay (bELISA). Neutralizing antibodies to H1–H12 were detected in 96.0% of a subset of bELISA positive birds (n=196) and 81.0% tested antibody positive to two or more hemagglutinin subtypes, indicating that exposure to multiple IAVs is common. These results provide evidence that White Ibis are susceptible and naturally infected with IAV and may represent a component of the IAV natural reservoir system. [ABSTRACT FROM AUTHOR]

The American White Ibis (Eudocimus albus) is a nomadic wading bird that is increasing the amount of time spent foraging in urban areas, relying on artificial wetlands and other anthropogenic resources year-round. In this study, we explore whether and how American White Ibis association with urban environments is predictive of variation in the timing and length of behavioral seasons. Other urbanized species exhibit altered annual cycles such as loss of migratory behavior and year-round breeding related to consistent resource abundance, often related to intentional and unintentional provisioning. To determine if these same patterns of behavior were also present in White Ibis, we used behavioral change point analysis to segment the tracks of 41 ibis equipped with GPS backpacks to identify the initiation and duration of four behavioral seasons (non-breeding, pre-breeding, breeding, post-breeding) the degree of urban association. We found that intraspecific variation in urban habitat use had strong carryover effects on the timing and duration of behavioral seasons. This study revealed ibis with higher use of urban habitats in non-breeding seasons had longer non-breeding seasons and shorter breeding seasons that began earlier in the year compared to ibis that primarily use wetland habitats. The timing and duration of seasons also varied with ibis age, such that ibis spent more time engaged in breeding-related seasons as they aged. Juvenile and subadult ibis, though considered to be reproductively immature, also exhibit behavioral shifts in relation to breeding seasons. The behavioral patterns found in this study provide evidence that ibis are adapting their annual cycles and seasonal behaviors to exploit urban resources. Future research is needed to identify the effect of interactions between ibis urban association and age on behavioral season expression. [ABSTRACT FROM AUTHOR]

Microbial communities in the gastrointestinal tract influence many aspects of host health, including metabolism and susceptibility to pathogen colonization. These relationships and the environmental and individual factors that drive them are relatively unexplored for free-living wildlife. We quantified the relationships between urban habitat use, diet, and age with microbiome composition and diversity for 82 American white ibises (Eudocimus albus) captured along an urban gradient in south Florida and tested whether gut microbial diversity was associated with Salmonella enterica prevalence. Shifts in community composition were significantly associated with urban land cover and, to a lesser extent, diets higher in provisioned food. The diversity of genera was negatively associated with community composition associated with urban land cover, positively associated with age class, and negatively associated with Salmonella shedding. Our results suggest that shifts in both habitat use and diet for urban birds significantly alter gut microbial composition and diversity in ways that may influence health and pathogen susceptibility as species adapt to urban habitats. [ABSTRACT FROM AUTHOR]

Newcastle disease (ND) is a major constraint to Kenya's poultry production, which is comprised of approximately 80% indigenous chickens (ICs; caged and free-range system) and 20% exotic chickens (intensive system). This study analyzed cases reported as suspected ND in Kenya between 2005 and 2015. Of the suspected 332 ND reported cases from the three production systems in 27 locations within six Kenyan Agro-Ecological Zones (AEZs), 140 diagnosed as infected with avian orthoavulavirus 1 (AOaV-1; formerly Newcastle disease virus) were present in every year in all AEZs. The numbers of AOaV-1-positive cases differed significantly (p < 0.05) between the production systems across the years depending on the season, climate, and location. In the free-range system, both ambient temperatures and season associated significantly (p = 0.001 and 0.02, respectively) with the number of cases, while in the intensive and caged systems, the positive cases correlated significantly with season and relative humidity, respectively (p = 0.05). Regardless of the production systems, the numbers of clinically sick birds positively correlated with the ambient temperatures (r = 0.6; p < 0.05). Failure to detect AOaV-1 in 58% of the ND cases reported, and mortalities exceeding the observed numbers of clinically sick birds suggest deficiencies in the current ND reporting and diagnostic system. Intensive farmers were the slowest in reporting the cases and diagnostic deficiencies were most evident by failure to test the exposure of ICs to natural infection with AOaV-1 and for the AOaV-1-negative cases lack of testing for other pathogens and/or AOaV-1 variants. This study indicates a need for improved surveillance and diagnostics in Kenyan domestic poultry. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe an approach to developing a makerspace assessment plan. This approach focuses on connecting organizational and service point mission statements with outcome-based assessment plan goals, strategies, methods, and success measures.Design/methodology/approach This paper will outline the steps taken by an academic research library to design an outcomes-based assessment plan that monitors the human ecology of a makerspace. The paper includes a history of the space, the role of the library within the campus makerspace environment, the connection between mission statements and assessment plans, and how that connection can facilitate and drive space and service design.Findings Designing assessment plans that are centered on a makerspace mission statement can ensure that progress toward fulfilling the mission, values, and goals of the space is constantly monitored.Originality/value Academic library makerspace assessment literature is still in its infancy. This paper seeks to contribute to the literature on academic library makerspace management and stewardship. [ABSTRACT FROM AUTHOR]

Worldwide, Salmonella spp. is a significant cause of disease for both humans and wildlife, with wild birds adapted to urban environments having different opportunities for pathogen exposure, infection, and transmission compared to their natural conspecifics. Food provisioning by people may influence these factors, especially when high-density mixed species flocks aggregate. White Ibises (Eudocimus albus), an iconic Everglades species in decline in Florida, are becoming increasingly common in urbanized areas of south Florida where most are hand-fed. We examined the prevalence of Salmonella shedding by ibises to determine the role of landscape characteristics where ibis forage and their behavior, on shedding rates. We also compared Salmonella isolated from ibises to human isolates to better understand non-foodborne human salmonellosis. From 2010–2013, 13% (n = 261) adult/subadult ibises and 35% (n = 72) nestlings sampled were shedding Salmonella. The prevalence of Salmonella shedding by ibises significantly decreased as the percent of Palustrine emergent wetlands and herbaceous grasslands increased, and increased as the proportion of open-developed land types (e.g. parks, lawns, golf courses) increased, suggesting that natural ecosystem land cover types supported birds with a lower prevalence of infection. A high diversity of Salmonella serotypes (n = 24) and strain types (43 PFGE types) were shed by ibises, of which 33% of the serotypes ranked in the top 20 of high significance for people in the years of the study. Importantly, 44% of the Salmonella Pulsed-Field Gel Electrophoresis patterns for ibis isolates (n = 43) matched profiles in the CDC PulseNet USA database. Of these, 20% came from Florida in the same three years we sampled ibis. Importantly, there was a negative relationship between the amount of Palustrine emergent wetland and the number of Salmonella isolates from ibises that matched human cases in the PulseNet database (p = 0.056). Together, our results indicate that ibises are good indicators of salmonellae strains circulating in their environment and they have both the potential and opportunity to transmit salmonellae to people. Finally, they may act as salmonellae carriers to natural environments where other more highly-susceptible groups (nestlings) may be detrimentally affected. [ABSTRACT FROM AUTHOR]

The article reflects on ethical issues related to organ transplantation and donation of organs by living person for patients with alcoholic liver disease; and discusses social stigma of the patient with the disease.

Geographic patterns in body size are often associated with latitude, elevation, or environmental and climatic variables. This study investigated patterns of body size and cell size of the green anole lizard, Anolis carolinensis, and potential associations with geography or climatic variables. Lizards were sampled from 19 populations across the native range, and body size, red blood cell size and size and number of muscle cells were measured. Climatic data from local weather stations and latitude and longitude were entered into model selection with Akaike's information criterion to explain patterns in cell and body sizes. Climatic variables did not drive any major patterns in cell size or body size; rather, latitude and longitude were the best predictors of cell and body size. In general, smaller body and cell sizes in Florida anoles drove geographic patterns in A. carolinensis. Small size in Florida may be attributable to the geological history of the peninsular state or the unique ecological factors in this area, including a recently introduced congener. In contrast to previous studies, we found that A. carolinensis does not follow Bergmann's rule when the influence of Florida is excluded. Rather, the opposite pattern of larger lizards in southern populations is evident in the absence of Florida populations, and mirrors the general pattern in squamates. Muscle cell size was negatively related to latitude and red blood cell size showed no latitudinal trend outside of Florida. Different patterns in the sizes of the 2 cell types confirm the importance of examining multiple cell types when studying geographic variation in cell size. [ABSTRACT FROM AUTHOR]

Purpose: Determine if raising the pH of 2% lidocaine with epinephrine 1:100 000 to a physiologic level decreases pain perception during periocular, subcutaneous anesthesia. Design: Double-blind, prospective, randomized study. Simultaneous unilateral injections of buffered and unbuffered lidocaine solutions were given before surgery to patients having bilateral, periocular surgery. Participants: Fifty-four consecutive patients (27 male and 27 female; mean age, 68 years; standard deviation, 11 years). Intervention: Patients were given simultaneous injections of buffered and unbuffered 2% lidocaine with epinephrine 1:100 000. The needles were inserted simultaneously and the anesthesia was injected for a 20-second count for a total volume of 1.0 ml per injected side. Main Outcome Measures: After the simultaneous injections, the patients were asked to rate the pain on each side on a Likert-type visual analog scale of 0 to 10. Results: Sixty-five percent of patients preferred the buffered lidocaine with a scaled pain reduction of 0.9 (P = 0.0005). Additionally, for the patients who believed that the buffered solution was less painful, the mean decrease in scaled pain rating was 2, for a 51% reduction in pain level (P = 0.001). No gender differences were noted. Conclusions: Buffering 2% lidocaine with epinephrine 1:100 000 with sodium bicarbonate 8.4% offers a clinically and statistically significant reduction in pain experienced by two-thirds of patients receiving periocular subcutaneous anesthesia. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

The article describes the case of a female patient who presented with a Purtscherlike retinopathy and her subsequent diagnosis of primary hypereosinophilic syndrome. The patient's presentation with a ten-day history of blurry vision and urticarial skin rash is addressed. Bilateral cotton wool spots in the posterior pole, intraretinal hemorrhages, and Purtscher flecken were demonstrated via retinoscopic examination.

At present, we do not know what causes sporadic breast cancer. Environmental factors,particularly diet, appear to explain at least 70% of newly diagnosed breast cancers, but it is not clear what these factors are. We propose that the lack of progress in this area is due to a lack of considering the effect of timing of environmental and dietary exposures on the breast. The evidence provided above suggests that an in utero exposure to an estrogenic environment-including that caused by diet [high (n-6) PUFA or genistein]-increases breast cancer risk. This increase may be mediated by an increased presence of TEB in the mammary epithelial tree and increased ER-alpha levels, reduced ER-beta levels or both. Prepubertal estrogenic exposure, in contrast, reduces later risk of developing breast cancer. The protective effect of estrogens may be mediated by early epithelial differentiation, reduced presence of ER-alpha and increased levels of ER-beta in the mammary gland. The challenge we are now facing is to determine whether the data obtained mainly through the use of animal models is relevant to women and if so, how we might be able to modulate pregnancy and childhood estrogenic exposure by appropriate dietary modifications to reduce breast cancer risk in women. [ABSTRACT FROM AUTHOR]

Reports that nitric oxide serves as an endothelium-dependent vasodilator and an antithrombotic agent in the vasculature. How nitric oxide is formed; What role nitric oxide plays in helping ameliorate vascular injury by homocysteine; S-nitrosothiols (RSNO) effect on vascular tone, platelet aggregation and adhesion; RSNO effect on endothelial function and dysfunction.

Discusses the association of elevated plasma homocysteine concentrations with vascular disease. Metabolism for homocysteine; Influences on homocysteine levels; How prothrombotic effect of homocysteine be a result of endothelial injury or dysfunction; Therapeutic implications of having elevated homocysteine.

The article presents a study to analyze the effects of cyclic strain or load in the presence or absence of a nitric oxide (NO) agonist on endothelial cell proliferation. The results show that endogenous NO production by human microvascular endothelial cells regulates their growth response to cyclic strain.

Nitric oxide (NO) is a simple heterodiatomic molecule with a broad range of biologic actions. In the cardiovascular system NO serves as an endothelium-dependent vasodilator, an antithrombotic agent, an antiproliferative molecule, and a regulator of cardiac contractility. Owing to its reactivity under physiologic conditions, accumulating data suggest that NO forms derivatives with several classes of biologic compounds. One group of biochemical functionalities that serves this role is that of thiols, which can form thionitrites or S-nitrosothiols with NO. In this paper we will examine the effects of the biologically known and the chemically produced S-nitrosothiols on the cardiovascular system in order to understand better what role these compounds may play in physiologic and pathologic states. [ABSTRACT FROM PUBLISHER]

Kenyan poultry consists of ~80% free-range indigenous chickens kept in small flocks (~30 birds) on backyard poultry farms (BPFs) and they are traded via live bird markets (LBMs). Newcastle disease virus (NDV) was detected in samples collected from chickens, wild farm birds, and other domestic poultry species during a 2017–2018 survey conducted at 66 BPFs and 21 LBMs in nine Kenyan counties. NDV nucleic acids were detected by rRT-PCR L-test in 39.5% (641/1621) of 1621 analyzed samples, of which 9.67% (62/641) were NDV-positive by both the L-test and a fusion-test designed to identify the virulent virus, with a majority being at LBMs (64.5%; 40/62) compared to BPFs (25.5%; 22/62). Virus isolation and next-generation sequencing (NGS) on a subset of samples resulted in 32 complete NDV genome sequences with 95.8–100% nucleotide identities amongst themselves and 95.7-98.2% identity with other east African isolates from 2010-2016. These isolates were classified as a new sub-genotype, V.3, and shared 86.5–88.9% and 88.5–91.8% nucleotide identities with subgenotypes V.1 and V.2 viruses, respectively. The putative fusion protein cleavage site (113R-Q-K-R↓F 117) in all 32 isolates, and a 1.86 ICPI score of an isolate from a BPF chicken that had clinical signs consistent with Newcastle disease, confirmed the high virulence of the NDVs. Compared to genotypes V and VI viruses, the attachment (HN) protein of 18 of the 32 vNDVs had amino acid substitutions in the antigenic sites. A time-scaled phylogeographic analysis suggests a west-to-east dispersal of the NDVs via the live chicken trade, but the virus origins remain unconfirmed due to scarcity of continuous and systematic surveillance data. This study reveals the widespread prevalence of vNDVs in Kenyan backyard poultry, the central role of LBMs in the dispersal and possibly generation of new virus variants, and the need for robust molecular epidemiological surveillance in poultry and non-poultry avian species. [ABSTRACT FROM AUTHOR]

Poultry production plays an important role in the economy and livelihoods of rural households in Kenya. As part of a surveillance program, avian influenza virus (AIV)-specific real-time RT-PCR (RRT-PCR) was used to screen 282 oropharyngeal swabs collected from chickens at six live bird markets (LBMs) and 33 backyard poultry farms in Kenya and 8 positive samples were detected. Virus was isolated in eggs from five samples, sequenced, and identified as H9N2 low pathogenic AIV (LPAIV) G1 lineage, with highest nucleotide sequence identity (98.6–99.9%) to a 2017 Ugandan H9N2 isolate. The H9N2 contained molecular markers for mammalian receptor specificity, implying their zoonotic potential. Virus pathogenesis and transmissibility was assessed by inoculating low and medium virus doses of a representative Kenyan H9N2 LPAIV isolate into experimental chickens and exposing them to naïve uninfected chickens at 2 -days post inoculation (dpi). Virus shedding was determined at 2/4/7 dpi and 2/5 days post placement (dpp), and seroconversion determined at 14 dpi/12 dpp. None of the directly-inoculated or contact birds exhibited any mortality or clinical disease signs. All directly-inoculated birds in the low dose group shed virus during the experiment, while only one contact bird shed virus at 2 dpp. Only two directly-inoculated birds that shed high virus titers seroconverted in that group. All birds in the medium dose group shed virus at 4/7 dpi and at 5 dpp, and they all seroconverted at 12/14 dpp. This is the first reported detection of H9N2 LPAIV from Kenya and it was shown to be infectious and transmissible in chickens by direct contact and represents a new disease threat to poultry and potentially to people. • First detection and characterization of avian influenza virus (AIV) in Kenya. • Viruses were characterized as H9N2 low pathogenic AIV (LPAIV) from G1 lineage. • Kenyan H9N2 LPAIV contain markers for virulence and adaptation in mammalian hosts. • Kenyan H9N2 LPAIV is infectious and transmissible by direct contact in chickens. [ABSTRACT FROM AUTHOR]

Background Rapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB). Data in children are lacking. In January 2017, Atrium Health implemented a pediatric ASP with blood culture RDT. The objective of this study was to determine the impact of those interventions. Methods This was a retrospective, multicenter, quasi-experimental study of children ≤18 years with monomicrobial SAB from March 2015 to August 2016 (pre-intervention; PRE) and March 2017 to August 2018 (post-intervention; POST). The primary outcome was time to an optimal antibiotic. Secondary outcomes included time to effective antibiotic, total antibiotic exposure in the first 5 days, duration of bacteremia, infectious diseases (ID) consultation, time to central line removal, hospital and pediatric ICU length of stay (LOS), need for vasopressors or intubation, recurrence of SAB within 90 days, and inpatient mortality. Results Of 101 patients with SAB, 32 and 36 met inclusion criteria for the PRE and POST groups, respectively. The median time to optimal antimicrobial therapy decreased by 23 hours (PRE 44.3 hours vs. POST 21.3 hours; P = 0.008). Duration of bacteremia (65h vs. 40.9 hours; P = 0.028) and mortality (12.5% vs. 0%; P = 0.044) was also significantly reduced. Differences in median time to effective therapy (7 hours vs. 5.1 hours; P = 0.74), total antibiotic exposure in the first 5 days (160.4 hours vs. 152 hours; P = 0.4), hospital LOS (9.9 vs. 8.5 days; P = 0.25), and pediatric ICU LOS (7 vs. 4 days; P = 0.11) did not meet statistical significance, but trended downward. The POST group had more patients with ID consultation (78% vs. 89%, P = 0.23) and shorter time to central line removal (68 hours vs. 20 hours; P = 0.037). There was no difference in the need for vasopressors (3 vs. 3 patients; P = 0.99) or intubation (2 vs. 4 patients; P = 0.68). Throughout the study period, recurrence of SAB only occurred in one patient (PRE). Conclusion Concurrent implementation of RDT and an ASP in pediatric patients with SAB decreased time to optimal antimicrobial therapy, duration of bacteremia, and mortality. RDT coupled with timely feedback from an ASP contributed to improved SAB management and clinical outcomes in children. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]