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Purpose: Children may be exposed to numerous in-home environmental exposures (IHEE) that trigger asthma exacerbations. Spatially linking social and environmental exposures to electronic health records (EHR) can aid exposure assessment, epidemiology, and clinical treatment, but EHR data on exposures are missing for many children with asthma. To address the issue, we predicted presence of indoor asthma trigger allergens, and estimated effects of their key geospatial predictors.Methods: Our study samples were comprised of children with asthma who provided self-reported IHEE data in EHR at a safety-net hospital in New England during 2004-2015. We used an ensemble machine learning algorithm and 86 multilevel features (e.g., individual, housing, neighborhood) to predict presence of cockroaches, rodents (mice or rats), mold, and bedroom carpeting/rugs in homes. We reduced dimensionality via elastic net regression and estimated effects by the G-computation causal inference method.Results: Our models reasonably predicted presence of cockroaches (area under receiver operating curves [AUC] = 0.65), rodents (AUC = 0.64), and bedroom carpeting/rugs (AUC = 0.64), but not mold (AUC = 0.54). In models adjusted for confounders, higher average household sizes in census tracts were associated with more reports of pests (cockroaches and rodents). Tax-exempt parcels were associated with more reports of cockroaches in homes. Living in a White-segregated neighborhood was linked with lower reported rodent presence, and mixed residential/commercial housing and newer buildings were associated with more reports of bedroom carpeting/rugs in bedrooms.Conclusions: We innovatively applied a machine learning and causal inference mixture methodology to detail IHEE among children with asthma using EHR and geospatial data, which could have wide applicability and utility. [ABSTRACT FROM AUTHOR]

Background: Despite increased use of arterial grafts, the long saphenous vein (LSV) is often utilised as conduit for coronary artery bypass graft (CABG). Preoperative ultrasound (U/S) vein assessment is limited to patients with varicosities, clinical signs suggestive of poor vein conduits and a history of cardiac or vascular surgery. The aim of this study was to evaluate the usefulness and logistics of the surgeon incorporating intraoperative U/S assessment of the LSV into their regular practice.Methods: All patients undergoing coronary artery revascularisation and open vein harvest in our institution were recruited from July 2016 to February 2017. Demographics, including known risk factors for wound complications were documented, in addition to surgical details such as harvest time, vein length and surgical repairs of the conduit. Focussed U/S assessment was performed intraoperatively by the surgical registrar before beginning the procedure. The diameter of the leg pre and postoperatively, as well as the incidence, type and severity of wound complications were documented for further statistical analysis.Results: A total of 103 patients were included in this study. Two patients died perioperatively and were excluded from the study. The remaining 101 patients were separated in two cohorts-U/S group (n=32) and blind technique group (n=69). Demographics were similar between the groups, whilst other risk factors for harvest complications, such as presence of superficial varicosities on clinical examination and renal failure were significantly more frequent in the U/S group. The median harvest time was significantly lower within the U/S group (25 mins versus 40 mins; p=0.001), as was the rate of overall wound complications (6.2% vs 23.2%; p=0.04).Conclusions: Ultrasound assessment of the LSV by the surgical team intraoperatively is feasible, easy to learn and does not demand extra costs or delays. It significantly reduces surgical harvest time and it is associated with a reduced incidence of wound complications, swelling and postoperative mobility impairment. [ABSTRACT FROM AUTHOR]

• Indoor CO 2 exceeded 1000 ppm 33% of the time and ventilation rates were below 7 L/s. • Increasing ventilation increased CO 2 emissions, energy, and costs between 1 and 4%. • Rooftop gardens always counterbalanced increased CO 2 emissions, energy, and costs. • Enhancing plant growth increases CO 2 emissions benefits by an additional 23%. Building energy use contributes to urban carbon dioxide (CO 2) emissions while inadequate ventilation can yield indoor CO 2 build up from human respiration. However, increasing ventilation rates can add to energy costs and climate burdens. Our objective was to quantify changes in emissions, energy, and financial cost when rooftop garden and ventilation upgrades are done simultaneously, with an opportunity to enhance plant growth from exhausted CO 2. We measured indoor CO 2 concentrations, calculated ventilation rates, and modeled five scenarios to assess these impacts. The indoor CO 2 concentration maximum was 2210 ppm, median was 840 ppm, and 33% of the daytime was spent above 1000 ppm. The estimated ventilation rate was 4 L/s. Our model calculations show that increasing ventilation to recommended levels (7 L/s) would increase total CO 2 emissions, energy use, and cost (1–4%), but this could be counterbalanced by rooftop garden installation benefits, which yielded a net decrease of 23–46% in CO 2 emissions, 12–13% in energy use, and 12–16% in cost. This novel integration of data collection and modeling provides support for the co-benefits of simultaneous improved installation ventilation systems and indoor CO 2 -enhanced rooftop gardens. [ABSTRACT FROM AUTHOR]

Introduction Suspected thyroid malignancies are usually assumed to be primary in origin. Rarely, in 1–3% of cases, the tumour arises from a secondary source such as a melanoma or breast carcinoma. There is a growing body of research concerning metastatic spread of renal cell carcinoma to the thyroid gland. Presentation of case This case report describes the presentation and diagnostic work-up of an 84yr male presenting with a goitre and hoarse voice. Histopathological examination of the excised 95 × 65 × 55 mm tissue mass revealed metastatic clear cell renal cell carcinoma. Discussion This disease pattern has become increasingly apparent in recent literature. A literature review of 150 documented cases worldwide showed that the mean interval for this spread to occur is 9 years. Conclusion There is a need for further investigation into the underlying pathophysiology of this phenomenon and increased awareness from clinicians of its existence. [ABSTRACT FROM AUTHOR]

Abstract: The contribution of the left inferior prefrontal cortex in semantic processing has been widely investigated in the last decade. Converging evidence from functional imaging studies shows that this region is involved in the “executive” or “controlled” aspects of semantic processing. In this study, we report a single case study of a patient, PW, with damage to the right prefrontal and temporal cortices following stroke. PW showed a problem in executive control of semantic processing, where he could not easily override automatic but irrelevant semantic processing. This case, thus, shows the necessary role of the right inferior prefrontal cortex in executive semantic processing. Compared to tasks previously used in the literature, our tasks placed higher demands on executive semantic processing. We suggest that the right inferior prefrontal cortex is recruited when the demands on executive semantic processing are particularly high. [Copyright &y& Elsevier]

Analyzes the difference between single perpetrator and multiple parties in domestic violence situations and arrest in the United States. Notion on arrest decisions of responding police officers; Comparison between men and women's use of violence; List of arrest factors; Significance of arrest factors in single perpetrator and multiple party incidents.

Background. The pathogenetic mechanisms by which individuals with chronic hepatitis B virus (HBV) infection develop membranous nephropathy (MN) are probably dependent on interactions between viral, host and environmental factors; some evidence suggests a genetic predisposition. HBVMN constitutes a major etiological group in black children with nephrotic syndrome. We therefore explored the HLA associations in black children with HBVMN. Method. Thirty black children, age range 2 to 16 years, with biopsy-proven HBVMN, were the subjects of the study. HBV status was determined using third generation ELISA. HLA A, B and C antigens were determined using a two-stage lymphocytotoxic test. HLA DRB1* and DQB1* typing was done using sequence-specific primers. HLA class 1 and II antigen frequencies of the study subjects were compared to controls that were randomly chosen healthy blood donors from the same population. Results. HLA DQB1*0603 was increased in patients with HBVMN compared to controls (χ² = 13.65, RR = 4.3). DRB1*07 and DQB1*02 were increased in frequency in the study subjects but failed to reach statistical significance. There was no significant difference in the frequencies of class 1 antigens in the study group compared to controls. Conclusion. To our knowledge, this is the first report of HLA associations in black patients with HBVMN in whom Class 1 and 11 antigens were determined using molecular methodology. There was a high frequency of DQB1*0603 in subjects compared to controls, suggesting a possible genetic predisposition to the development of HBVMN. [ABSTRACT FROM AUTHOR]

HBV and proteinuria in relatives and contacts of children with hepatitis B virus-associated membranous nephropathy. Background. Hepatitis B virus (HBV)-associated membranous nephropathy (HBVMN) is an important cause of childhood nephrotic syndrome in regions endemic for the virus, but little is understood of the biosocial context in which the disease develops. We evaluated HBV status and proteinuria in family members and household contacts of index children with HBVMN to test the hypothesis that HBV carriage and asymptomatic proteinuria are closely linked and may be causally associated. Methods. Thirty-one black children with biopsy-proven HBVMN were the index cases. One hundred and fifty-two family members and 43 black household contacts were the subjects of the study. We assessed HBV carrier status by testing for HBV antigens and antibodies using enzyme-linked immunosorbent assays (ELISA) and for HBV DNA by using slot-blot hybridization and the polymerase chain reaction. Sequencing of the precore region of HBV was done in a subset of both index cases and subjects. Proteinuria was assessed by measuring the urinary protein/creatinine ratio. Results. Seventy-two (37%) of the 195 family members and household contacts were HBV carriers, and 53 (27%) had a protein/creatinine ratio greater than the physiological limit. The frequency of abnormal proteinuria was not significantly different in those with [22 out of 72 (30.5%)] or without [33 out of 104 (32%)] HBV carriage. This lack of association remained when carriers were classified into those who were HBsAg positive only and those with active viral replication (HBsAg and/or HBeAg and/or HBV DNA; P = 0.01). Family members were more predisposed to HBV carriage than household contacts, but abnormal proteinuria was present with equal frequency (P = 0.48). Age had a significant impact on proteinuria, with children less than five years being more likely to have abnormal proteinuria (P = 0.008). The prevalence of abnormal... [ABSTRACT FROM AUTHOR]