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Behavioral changes due to digitalization, such as telework, shifted energy demand, especially during COVID-19. Behavioral changes are often overlooked in macro-demand forecasts. This study forecasts macro-energy use to 2030 using American Time Use Survey and national energy data from 2003-2019. It examines and explains residential, non-residential, and transportation sectors through efficiency, technology characteristics (e.g., home floor area), and usage (time-use). Results showed that improved efficiency had the largest effect on energy demand per capita in all sectors from 2003-2019. The time-use (behavior) effect was strongest in non-residential buildings, resulting in a net energy reduction of -9%, decomposed into increased in floor area (+24%), improved efficiency (-26%), and reduced time-use (-7%). In forecasting, two potential effects of telework on energy use in 2030 were explored: (1) temporary shift in telework due to COVID-19 (14% teleworking in 2030) and (2) permanent shift in telework that increases with historical trends (34%). The permanent shift resulted in 3.6% less energy demand per capita in 2030. Reduced time-use of non-residential buildings had the largest effect on decreasing energy demand, -29%, with +8.5% from residential energy use, -7.5% from transportation, yielding a net -28% energy use per teleworker. Alternate perspectives are needed to corroborate results.

Two field experiments were conducted in two agro-ecological zones of Ghana (Forest and Coastal Savannah) to assess the efficacy of preemergence herbicides Oxadiargyl and Pendimethalin on weed incidence, growth and yield of pepper. The experiment was factorial arranged in a randomized complete block design. The treatments were Oxadiargyl at 0.4, 0.5, 0.6 L/ha, Pendimethalin at 1.5, 2.0, 2.5 L/ha and hand weeding at intervals of 3, 6 and 9 weeks as control. Data was collected on weed type and abundance, number of days to weed emergence, type of re-emerging weeds and percentage weed cover. Data on plant height, number of branches per plant, yield and yield components of pepper plants were also collected. Results indicated that application of Pendimethalin led to a significantly (p

Health care organizations are building, deploying, and self-governing digital health technologies (DHTs), including artificial intelligence, at an increasing rate. This scope necessitates expertise and quality infrastructure to ensure that the technology impacting patient care is safe, effective, and ethical throughout its lifecycle. The objective of this article is to describe Mayo Clinic’s approach for embedding internal accountability as a case study for other health care institutions seeking modalities for responsible implementation of artificial intelligence–enabled DHTs. Mayo Clinic aims to enable and empower innovators by (1) building internal skills and expertise, (2) establishing a centralized review board, and (3) aligning development and deployment processes with regulations, standards, and best practices. In 2022, Mayo Clinic established the Software as a Medical Device Review Board (The Board), an independent body of physicians and domain experts to represent the organization in providing innovators regulatory and risk mitigation recommendations for DHTs. Hundreds of digital health product teams have since benefited from this function, intended to enable responsible innovation in alignment with regulation and state-of-the-art quality management practices. Other health care institutions can adopt similar internal accountability bodies using this framework. Opportunity remains to iterate on Mayo Clinic’s approach in alignment with advancing best practices and enhance representation on The Board as part of standard continuous improvement practices.

Purpose: Electrocardiogram-gated computed tomography with coronary angiography can be used for cardiac substructure sparing (CSS) optimization, which identifies and improves avoidance of cardiac substructures when treating with intensity modulated radiotherapy (IMRT). We investigated whether intensity modulated proton therapy (IMPT) would further reduce dose to cardiac substructures for patients with mediastinal lymphoma. Patients and Methods: Twenty-one patients with mediastinal lymphoma were enrolled and underwent electrocardiogram-gated computed tomography angiography during or shortly after simulation for radiotherapy planning. Thirteen patients with delineated cardiac substructures underwent comparative planning with both IMPT and IMRT. Plans were normalized for equivalent (95%) target volume coverage for treatment comparison. Results: Thirteen patients met criteria for this study. The median size of the mediastinal lymphadenopathy was 7.9 cm at the greatest diameter. Compared with IMRT-CSS, IMPT-CSS significantly reduced mean dose to all cardiac substructures, including 3 coronary arteries and 4 cardiac valves. Use of IMPT significantly reduced average whole-heart dose from 9.6 to 4.9 Gy (P < .0001), and average mean lung dose was 9.7 vs 5.8 Gy (P < .0001). Prospectively defined clinically meaningful improvement was observed in at least 1 coronary artery in 9 patients (69%), at least 1 cardiac valve in 10 patients (77%), and whole heart in all 13 patients. Conclusions: For patients with mediastinal lymphoma, IMPT-CSS treatment planning significantly reduced radiation dose to cardiac substructures. The significant improvements outlined in this study for proton therapy suggest possible clinical improvement in alignment with previous analyses of CSS optimization.

Summary: The TAM receptor, Axl, has been implicated as a candidate entry receptor for Zika virus (ZIKV) infection but has been shown as inessential for virus infection in mice. To probe the role of Axl in murine ZIKV infection, we developed a mouse model lacking the Axl receptor and the interferon alpha/beta receptor (Ifnar−/−Axl−/−), conferring susceptibility to ZIKV. This model validated that Axl is not required for murine ZIKV infection and that mice lacking Axl are resistant to ZIKV pathogenesis. This resistance correlates to lower pro-interleukin-1β production and less apoptosis in microglia of ZIKV-infected mice. This apoptosis occurs through both intrinsic (caspase 9) and extrinsic (caspase 8) manners, and is age dependent, as younger Axl-deficient mice are susceptible to ZIKV pathogenesis. These findings suggest that Axl plays an important role in pathogenesis in the brain during ZIKV infection and indicates a potential role for Axl inhibitors as therapeutics during viral infection. : Biological Sciences; Neurotoxicology; Virology Subject Areas: Biological Sciences, Neurotoxicology, Virology

Abstract: Domestic and wild animal intrusions are identified as a food safety risk during fresh produce production. The purpose of this study was to evaluate the survival of Shiga toxin-producing Escherichia coli (STEC) in cattle, feral pig, waterfowl, deer, and raccoon feces from sources in California, Delaware, Florida, and Ohio. Fecal samples were inoculated with a cocktail of rifampin-resistant STEC serotypes (O103, O104, O111, O145, and O157) (104 to 106 CFU/g of feces). Inoculated feces were held at ambient temperature. Populations of surviving cells were monitored throughout 1 year (364 days), with viable populations being enumerated by spread plating and enrichment when the bacteria were no longer detected by plating. Representative colonies were collected at various time intervals based on availability from different locations to determine the persistence of surviving STEC serotypes. Over the 364-day storage period, similar survival trends were observed for each type of animal feces from all states except for cattle and deer feces from Ohio. STEC populations remained the highest in cattle and deer feces from all states between days 28 and 364, except for those from Ohio. Feral pig, waterfowl, and raccoon feces had populations of STEC of <1.0 log CFU/g starting from day 112 in feces from all states. E. coli O103 and O104 were the predominant serotypes throughout the entire storage period in feces from all animals and from all states. The survival of both O157 and non-O157 STEC strains in domesticated and wild animal feces indicates a potential risk of contamination from animal intrusion., (Copyright ©, International Association for Food Protection.)

Abstract: Heightened concerns about wildlife on produce farms and possible introduction of pathogens to the food supply have resulted in required actions following intrusion events. The purpose of this study was to evaluate the survival of Salmonella in feces from cattle and various wild animals (feral pigs, waterfowl, deer, and raccoons) in California, Delaware, Florida, and Ohio. Feces were inoculated with rifampin-resistant Salmonella enterica cocktails that included six serotypes: Typhimurium, Montevideo, Anatum, Javiana, Braenderup, and Newport (104 to 106 CFU/g). Fecal samples were stored at ambient temperature. Populations were enumerated for up to 1 year (364 days) by spread plating onto tryptic soy agar supplemented with rifampin. When no colonies were detected, samples were enriched. Colonies were banked on various sampling days based on availability of serotyping in each state. During the 364-day storage period, Salmonella populations decreased to ≤2.0 log CFU/g by day 84 in pig, waterfowl, and raccoon feces from all states. Salmonella populations in cattle and deer feces were 3.3 to 6.1 log CFU/g on day 336 or 364; however, in Ohio Salmonella was not detected after 120 days. Salmonella serotypes Anatum, Braenderup, and Javiana were the predominant serotypes throughout the storage period in all animal feces and states. Determination of appropriate risk mitigation strategies following animal intrusions can improve our understanding of pathogen survival in animal feces., (Copyright ©, International Association for Food Protection.)

Objective: To determine paediatrician's knowledge and attitudes about oral health in Trinidad and Tobago., Design and Method: A pre-tested questionnaire was sent out via survey monkey to 70 out of 75 paediatricians registered with the Medical Board of Trinidad and for whom email addresses were available. Hard copies of the questionnaires were delivered to the paediatric departments of the Eric Williams Medical Sciences complex. Paediatricians that were unable to complete the questionnaire online were asked to complete hard copies., Results: Forty-nine paediatricians responded, yielding a response rate of 70%. Most (95.9%) of the participants had positive views about routine dental visits, but yet only 28.6% advised a first dental visit between the ages 6 months and 1 year. Although the majority (91.8%) had positive views on fluoride supplementation, knowledge of appropriate fluoride dosages was not in keeping with current guidelines. Mixed views on the role of breastfeeding as a risk factor for developing decay were seen among respondents; 63.3% of the paediatricians indicated that they did not receive any education on the oral health of young children during their specialty training, and most felt they required additional training in this area., Conclusions: Paediatricians in Trinidad and Tobago demonstrated positive attitudes toward oral health. However, their knowledge with respect to oral disease prevention including the use of fluoride, and timing of the first dental visit appear to be lacking. Paediatricians may benefit from continuing education with regards to the oral health of children., (© 2018 FDI World Dental Federation.)

Background and Purpose: Blended learning (BL) integrates face-to-face and online instructional methods, with applications in pharmacy education. This study aimed to assess pharmacy students' perceptions of BL in a pharmacy seminar course at The University of the West Indies, St. Augustine campus, Trinidad and Tobago., Educational Activity and Setting: Topics based on the use of medicines and public health were presented by student groups during live seminars, supplemented with online activities. An online survey of students' perceptions was administered at the end of the course. The usefulness of learning resources and course activities were assessed using 5-point Likert-like scales (1 = not helpful to 5 = very helpful). The effectiveness of the instructor, blended delivery, time value, and development of critical-thinking were rated on a 5-point Likert scale for agreement (1 = strongly disagree to 5 = strongly agree). Topics that were most instructive and additional topics of interest were also identified., Findings: Approximately 51% of students (37/72) completed the questionnaire; 73% were female and mean age was 24 years. The learning resources and most course activities were generally helpful (median = 4) in facilitating learning. There was strong agreement (median = 5) on the ease of navigating the online platform, and instructor encouraging interest in pharmacy issues. Students agreed (median = 4) that the course facilitated critical thinking, the BL approach was effective, and the time spent was worthwhile. The most instructive topics included medication errors, antibiotic resistance, and medicines in children and the elderly., Summary: BL in pharmacy seminars is a valuable approach to engage students learning about pharmacy and public health., (Copyright © 2017 Elsevier Inc. All rights reserved.)

A five-year old mixed breed bitch was presented to the veterinary clinic in lateral recumbency with a history of anorexia and muscle hyperaesthesia. Examination of the blood smear of this animal revealed the presence of Hepatozoon spp. gamonts in the neutrophils and monocytes with a parasitaemia level of approximately 2%. Complete blood count (CBC) revealed a neutrophilia, and a normocytic normochromic non-regenerative anaemia which were consistent with Hepatozoon spp. infections. Diagnosis was confirmed by polymerase chain reaction (PCR) amplification of the 18S rRNA gene followed by DNA sequencing of the amplicon. Although the other dog in the household appeared asymptomatic, Hepatozoon canis infection was confirmed by both microscopic examination of blood smear and PCR. Both dogs were infested with Rhipicephalus sanguineus ticks. Phylogenetic analysis revealed that the H. canis sequences from these two dogs were similar to those from Venezuela and St Kitts but not Brazil. This is the first reported case of Hepatozoon canis infections in dogs in Trinidad that were confirmed by molecular techniques., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Spindle cell carcinoma, a rare variant of squamous cell carcinoma, has propensity to occur in the upper aero digestive tract, including the oral mucosa. In this oral pathology communication, we report the occurrence of this neoplasm in the left mandible as a large fleshy growth with destruction of bone in a 73-year-old Afro-Trinidadian female. The distinction of this tumor from other malignant spindle cell mesenchymal tumors is important. Selective sampling of this specimen for possible transitional areas of squamous and spindle cell appearance, immunohistochemical staining for cytokeratin, vimentin, and S-100 protein are helpful in establishing the diagnosis. According to the patient's insistence, debulking of the tumor was performed under general anesthesia. Eight months later the patient succumbed to the disease.

Aims: Increased platelet aggregation plays an important role in the etiology of cardiovascular disease. Garlic inhibits platelet aggregation; however, the mechanisms involved have not clearly been defined. This study was undertaken to investigate the mechanisms by which an aged garlic extract (AGE) inhibits both the activation and aggregation of human platelets., Main Methods: Isolated human platelets were stimulated with ADP and their adhesion to fibrinogen was assessed using Rose Bengal or (51)Cr uptake. Activation of platelets was assessed using fluorescence activated cell sorting (FACS) analysis along with measurement of intracellular cAMP., Key Findings: AGE at concentrations in the range of 3.12 to 12.5% (v/v) inhibited the binding of platelets to fibrinogen by approximately 40% when compared to control values in the Rose Bengal assay (P<0.05). In the (51)Cr experiments AGE significantly inhibited the binding of ADP-activated platelets to immobilized fibrinogen by 61.5% at 1.56% and 6.25% (v/v) of AGE respectively. At a concentration of 12.5% (v/v) the inhibition was 70.4% and at 25% (v/v) it was 64.5% respectively (P<0.05). In the fluorescence activated cell sorting (FACS) analysis, AGE significantly decreased the amount of PAC-1 binding to GPIIb/IIIa by approximately 72% compared with PBS control. In conjunction to these observations, AGE also increased platelet cAMP (P<0.01) levels., Significance: These findings suggest that AGE inhibits platelet aggregation via inhibition of the GPIIb/IIIa receptor and an increase in cAMP., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Background: Breast cancer is the most frequently diagnosed cancer among women worldwide. This study examines the breast cancer mortality patterns and trends in the Caribbean island state, Trinidad and Tobago for the 35-year period, 1970-2004., Methods: A retrospective analysis of the trends in breast cancer mortality from 1970 to 2004 was conducted. Crude mortality per 100,000 women, age-standardized mortality using World Standard population and age-stratified mortality were calculated and comparison was made between age groups above and below 50 years., Results: A general pattern of increase was observed in both crude and age-standardized mortality. The overall average crude mortality was 15.6 per 100,000 women (95% confidence interval (CI) 13.9-17.1) and the average age-standardized mortality was 18.0 per 100,000 women (95% CI 16.7-19.2). There was a pattern of increase in mortality with increasing age. The mortality rate was considerably higher for the age groups above 50 years than those less than 50 years of age both showing an upward trend over the 35-year period., Conclusions: Breast cancer mortality continued to increase over the 35-year period in Trinidad and Tobago. This study did not identify the exact reasons for this increasing trend. However, it is known that Trinidad and Tobago is becoming much more industrialized. It may be speculated that decrease in fertility rates, increase in the incidence of obesity and hormone utilization could have influenced this trend.

A two-year prospective study of 554 Pseudomonas aeruginosa isolates was recovered from various clinical sources throughout Trinidad, and their resistance patterns to antipseudomonal antimicrobial agents were determined. Of the 554 P. aeruginosa isolates, 20.6% (114/554) were community isolates, 17.3% (96/554) from the intensive care unit (ICU), 10.1% (56/554) from the nursery, and the remaining 52% (288/554) were from other hospital inpatient services. Respiratory tract infections were the predominant source of P. aeruginosa isolates from the ICU--46.9% (45/96)--and nursery--21.4% (12/56), whereas wounds were the principal source of P. aeruginosa from the surgical services--77.0% (141/183). Community isolates of P. aeruginosa were predominantly from ear--100% (51/51)--and urinary tract infections--35.5%, (33/93). The overall prevalence of resistance was low for both hospital isolates (13.9%) and community isolates (3.8%). All community isolates were fully sensitive to four of the nine antimicrobials tested. Resistance rates among community strains ranged from 2.6% (ciprofloxacin and ceftazidime) to 12.3% for piperacillin. All isolates from hospital were fully sensitive to imipenem, but resistance rates for the other drugs ranged between 2.5% and 27.3%. The study showed that the overall resistance pattern of P. aeruginosa was relatively low. This is an encouraging observation but invites caution since resistance to the newly introduced drug, cefepime, has now emerged within the hospital environment and may present serious therapeutic problems within the near future. Policies governing the use of antimicrobials in many institutions are lacking. Such policies must be instituted in order to limit the spread of resistance and also to reduce the emergence of resistance to newly commissioned drugs within the country.

The prevalence of antimicrobial resistance among urinary pathogens has been increasing worldwide. Laboratory diagnosed urinary tract infections were retrospectively evaluated for the years 1996 through 1999, to document the common pathogens and their changing antimicrobial profiles. From 14,853 hospital specimens, an isolation rate of 6.1% was found; and from 5330 community specimens, the isolation rate was 27.9%. E. coli was the predominant cause of urinary tract infections in both hospital and community practices. The rate of isolation of the other pathogens was relatively stable except for citrobacter species, which increased from 1.3% in 1996 to 20.1% in 1999 (p < 0.001) among community isolates. Significant changes in the susceptibility patterns of uropathogens also were observed. E. coli strains from hospitals were significantly more resistant to cefuroxime than community strains (p < 0.001), while resistance to ampicillin and nalidixic acid was high in both practices. No substantial changes in susceptibility to gentamicin and tetracycline were noticed during the four-year period compared to the 99% resistance to tetracycline in 1995. In relation to nitrofurantoin, no significant changes were noted in both practices where resistant rates remained low, but susceptibility to augmentin showed much improvement among all isolates, including E. coli. Urinary isolates were more commonly recovered from the paediatric age group (1-10 years) and those older than 50 years of age, and males were the predominant gender in both age groups. The study showed that the antibiotics useful in the treatment of UTI in decreasing order of effectiveness in community practice were gentamicin, norfloxacin, nitrofurantoin and cefuroxime. For nosocomial UTI, the drugs most effective include norfloxacin, nitrofurantoin, gentamicin, co-trimoxazole and amoxicillin-clavulanic acid.

Purpose: To assess perceived sexually transmitted disease (STD) (gonorrhea and chlamdydia) screening behaviors among young women at risk for STDs by evaluating readiness, pros and cons, and self-efficacy to seek STD screening in the absence of symptoms., Methods: Two hundred forty young urban women (mean 18.8 years +/-1.59) consecutively attending an urban reproductive clinic voluntarily completed a 67-item questionnaire on STD screening behaviors that included the stages of change (SOCs), decisional balance, and self-efficacy as well as sexual practices and partner relationships. The data were analyzed using descriptive statistics, multivariate analyses of variance, Chi-square tests, and Wilcoxon signed rank test., Results: Ninety-five percent of the participants would be willing to obtain STD screening for early disease detection. Participants were further along the SOCs for STD screening following unprotected sex with a change in partner than main partner, (p <.001). Pros and cons of STD screening varied according to the SOCs for STD screening with a change in partner and main partner. Self-efficacy increased linearly along the SOCs for STD screening (p <.001)., Conclusions: Most young women recognize the importance of STD screening but are not currently being tested when at risk for STDs. STD screening behaviors varied according to the partner relationship, which highlights the importance of stage- and partner-matched counseling to promote STD screening particularly when at risk for STDs.

Objective: To describe the working practices and level of job satisfaction of dental nurses in Trinidad and Tobago., Design: Postal survey., Participants: Fifty enrolled and practising dental nurses in Trinidad and Tobago were surveyed, 38 replied (76%)., Outcomes Measures: Current working practice, career breaks, continuing education, job satisfaction., Results: All dental nurses were employed by the Ministry of Health or Regional Health Authorities. Most performed a wide range of clinical and administrative duties along with delivering dental health education. Forty five per cent of respondents had taken a career break since qualifying with maternity and child rearing being the most common reason (94%). Sixty six per cent had attended a continuing education course in the previous year, with this most frequently being a dental refresher course. Satisfaction with pre-qualification training was high but current job satisfaction was low. Concerns with working conditions and career paths were identified., Conclusion: Dental nurses in Trinidad and Tobago expressed confidence in their ability to perform their current duties and showed interest in continuing education. Job satisfaction was low.

Metastatic tumours to the oral region are rare but more often involve the jaws rather than the oral soft tissues. In this report, an infiltrative ductal carcinoma of the breast that metastasised to the mandibular gingiva is presented. The patient consulted her dentist for what she thought was a dental abscess in the bicuspid region of the lower left jaw. However, her dentist referred her for a specialist opinion of the lesion. The patient's medical history revealed that she had undergone a breast 'lumpectomy' 1 year previously. A provisional diagnosis of primary or metastatic malignancy was made, and a biopsy was performed. Microscopically, the lesion showed features of a poorly differentiated infiltrative ductal carcinoma. Subsequent microscopic review of the primary lesion also showed a poorly differentiated infiltrating ductal carcinoma of the breast identical to the features observed in the metastatic lesion.

The sensitivity of Staphylococcus aureus strains isolated from Nigerian foods to phages in the international phage sets for typing human and bovine strains of staphylococci was determined. The enterotoxigenicity of the strains was also determined using the avidin-biotin enzyme-linked immunosorbent assay and the reversed passive latex agglutination test (for staphylococcal enterotoxin D only). One hundred and five (67.7%) of 155 strains tested were susceptible to phages in both typing sets. Phages for staphylococci of human origin lysed all 105 typeable strains while those for staphylococci of bovine origin were responsible for the lysis of 92 strains. Phages in the different phage groups (mixed) were most frequently responsible for lysis, 29 (27.6%), followed by group III phages with 26 (24.8%) strains susceptible. Of the 155 strains tested, 122 (78.7%) were enterotoxigenic producing staphylococcal enterotoxins A, B, C, D, or a combination. Dried beef isolates were most enterotoxigenic (100.0%) and those from fermented milk least (68.8%). Staphylococcal enterotoxins C, B, and A were elaborated either singly or in combination by 71 (58.2%), 69 (56.6%), and 62 (50.8%) strains, respectively. It was concluded that a majority of staphylococcal strains isolated from Nigerian foods originated from humans and their high enterotoxigenicity could be a health risk to consumers.