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Objective : Catholic Religious and Ethical Directives restrict access to contraception, yet offering contraception during a delivery hospitalization facilitates birth spacing and is a convenient option for patients during the postpartum period. We assessed patient and provider experiences with hospital transparency around postpartum contraceptive care in Illinois Catholic hospitals. Study Design : We interviewed 44 participants with experience in Illinois Catholic hospitals: 21 patients, and 23 providers, including clinicians, nurses, doulas, and postpartum program staff. We used an open-ended interview approach, with a semi-structured guide focused on postpartum contraceptive care. We conducted interviews by phone between November 2019 and June 2020. We audio-recorded interviews, transcribed them verbatim, and coded transcripts in Dedoose. We developed narrative memos for each code, identifying themes and sub-themes. We organized these in a matrix for analysis and present here themes regarding hospital transparency that emerged across interviews. Results : Many patients knew they were delivering in a Catholic hospital; however, few were aware that Catholic policies limited their healthcare options. Patients expressed a desire for hospitals to be transparent, even “very vocal,” about religious restrictions and described consequences of restrictions on patient care. Patients lacked information to make contraceptive decisions, experienced limits on or delays in care, and some lost continuity with trusted providers. Consequences for providers included moral distress in trying to provide care using workarounds such as documenting false medical diagnoses. Conclusions : Religious restrictions on postpartum contraception restrict access, cause unnecessary delays in care, and lead to misdiagnosis and marginalization of contraceptive care. Restrictions also cause moral distress to providers who balance career repercussions and professional integrity with patient needs. Implications : To protect patient autonomy, especially during the vulnerable postpartum period, Catholic hospitals should increase transparency regarding limitations on reproductive health care. Insurers and policy-makers should guarantee that patients have the option to receive care at hospitals without these limitations and facilitate public education about what to expect at Catholic facilities.

Antimicrobial seed treatments recommended by Canadian guidance for sprouted vegetable production (2,000 ppm of hypochlorite for 15 to 20 min or 6 to 10% hydrogen peroxide for 10 min at room temperature) are not fully compliant with organic production principles. We investigated the effect of a sequential treatment consisting of a 10-min soak at 50°C in water followed by exposure to a 2.0% H2O2 plus 0.1% AcOH sanitizing solution against Escherichia coli O157:H7, Listeria monocytogenes, and Salmonella enterica inoculated onto alfalfa and radish seed. The sequential treatment was as effective as the recommended treatments and could reduce populations of all three species by a minimum of 3 log CFU/g using a reduced (1:2) ratio of seed to sanitizing solution and low concentrations of sanitizers approved for use in organic food production. However, the efficacy of all the treatments examined in this work was considerably reduced by storage of the seed for 4 weeks at either 11 or 75% relative humidity prior to treatment and assessment. None of the treatments could eradicate the target pathogens from seed, irrespective of time elapsed since inoculation. The results of this work suggest that the effect of storage should be considered in the assessment of antimicrobial treatments for sprouting vegetable seed. HIGHLIGHTS

PURPOSE: We studied effects of age and horizontal duction on deformation of the optic nerve (ON) head and peripapillary retina as reflected by displacement of vascular landmarks to explore the influence of adduction tethering. DESIGN: Cross-sectional study. METHODS: Setting: University. Study Population: Single eyes of 20 healthy young adults (average age 23.9±3.9 SD) years were compared to 20 older subjects (average age 61.4±9.3) years. Observational Procedure: The disc and peripapillary retina were imaged by scanning laser ophthalmoscopy in central gaze, and 35° abd- and adduction. Main Outcome Measure: Deformations of the disc and adjacent PPR were measured by comparing positions of epipapillary and epiretinal blood vessels. RESULTS: Vessels within the ONH of younger subjects shifted temporally during adduction and nasally during abduction. Displacement of the nasal hemi-disc in adduction was greater at 38.5±1.7μm (SEM) than the temporal half at 4.1±2.1μm (P

Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09-7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2-3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors.

PURPOSE: Gray crescents characterized by darkly pigmented regions on the optic nerve head (ONH) could make assessment of cupping difficult by obscuring the true anatomic disc border. On slit lamp examination, two morphologically distinct types of gray crescents at the curved disc boundary exist. The in vivo histological characteristics differentiating these two types are described using spectral domain optical coherence tomography (SD-OCT). METHODS: A prospective interventional case series in a single tertiary referral center. Sixteen eyes of 10 patients with gray crescents determined through clinical exam and fundus photography underwent cross-sectional optic nerve head and parapapillary imaging using high resolution SD-OCT. In vivo histology of gray crescents was characterized. RESULTS: In SD-OCT images across the areas of gray crescent, type A gray crescents represent regions where the retinal pigmented epithelium (RPE)-Bruch’s membrane complex is absent and the dark underlying choroid is directly visible. In contrast, Type B gray crescents represent regions of the retina where the RPE is clumped or thickened, typically appearing to be folded upon itself, revealing the embryonic continuity of the RPE and neuro-retina. CONCLUSION: Shields Type A and B gray crescents appear different clinically because histologically they represent differences in RPE. Type A grey crescents lack RPE, whereas Type B crescents have thickened, folded RPE. Gray crescents can obscure the true disc border and result in pseudo-cupping of the ONH. Identification of gray crescents is clinically important since failure to recognize pseudo-cupping can contribute to over diagnosis of glaucoma.

Objective Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). Methods National clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score ≥ 5) between 10/1/09–5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking ≤ 14 days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit ≤ 365 days after positive screening), pharmacotherapy for AUD (filled prescription ≤ 365 days after positive screening), and mental health care ≤ 14 days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. Results Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03–1.05) for brief interventions, 1.06 (1.05–1.08) for specialty AUD treatment, 1.35 (1.31–1.39) for AUD pharmacotherapy, and 1.82 (1.80–1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18–29 years) and older veterans (65 + years) and weaker or non-significant for middle-aged veterans (30–44 and 45–64 years). Conclusions In this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use.

In recent years, the implementation of trauma-focused treatments has expanded across settings that vary widely in the availability of resources, infrastructure, and personnel. The present review aims to inform researchers, policy makers, trainers, and administrators about this diverse range of research. Taking a global health perspective, this review of effectiveness trials and implementation studies compares strategies used in high-income countries to those in low- and medium-income countries. A primary difference between studies in high-income and low- and medium-income countries is the relative emphasis placed on fidelity or adaptation. Adaptations used in low- and medium-income countries might offer useful ideas for increasing the portability, impact, and accessibility of evidence-based interventions in high-income countries.

Background: This study determined current status of laboratory biosafety in Nigerian veterinary research facilities. Methods: A questionnaire was developed to obtain information from researchers across Nigeria from July 2014 to July 2015. Information regarding demographics, knowledge of laboratory biosafety, availability and proper use of personal protective equipment (PPE), any priority pathogens researched, attitude on and use of standard laboratory practices, and biosafety awareness was obtained using a numeric scoring system. Data were analyzed with descriptive statistics, and univariate and multivariate logistic regression. Results: A total of 74 participants from 19 facilities completed the questionnaire. General knowledge scores ranged from 3 to 28 (out of 28 possible points), with 94.6% of respondents receiving low scores (scores mean + 1 standard deviation). Only 16.2% of respondents (from four facilities) reported having biosafety officers. Rabies virus was the most researched pathogen (31.1% of respondents). The majority (71.6%) were unaware of laws guiding biosafety. Researchers [odds ratio (OR) = 18.0; 95% confidence interval (CI): 1.63, 198.5; p = 0.023], especially in BSL-2 (OR = 258.5; 95% CI: 12.71, 5256; p

Intracellular calcium release is essential for regulating almost all cellular functions. Specific spatio-temporal patterns of cytosolic calcium elevations are critical determinants of cell fate in response to pro-apoptotic cellular stressors. As the apoptotic program can take hours or days, measurement of long-term calcium dynamics are essential for understanding the mechanistic role of calcium in apoptotic cell death. Due to the technical limitations of using calcium-sensitive dyes to measure cytosolic calcium little is known about long-term calcium dynamics in living cells after treatment with apoptosis-inducing drugs. Genetically encoded calcium indicators could potentially overcome some of the limitations of calcium-sensitive dyes. Here, we compared the performance of the genetically encoded calcium indicators GCaMP6s and GCaMP6f with the ratiometric dye Fura-2. GCaMP6s performed as well or better than Fura-2 in detecting agonist-induced calcium transients. We then examined the utility of GCaMP6s for continuously measuring apoptotic calcium release over the course of ten hours after treatment with staurosporine. We found that GCaMP6s was suitable for measuring apoptotic calcium release over long time courses and revealed significant heterogeneity in calcium release dynamics in individual cells challenged with staurosporine. Our results suggest GCaMP6s is an excellent indicator for monitoring long-term changes cytosolic calcium during apoptosis.

When compared to common bacterial agents associated with foodborne disease, Listeria monocytogenes is an infrequent but pernicious pathogen linked to disproportionally high levels of morbidity and mortality in susceptible individuals. To improve clinical outcomes, invasive infections require prudent administration of antimicrobial agents. While L. monocytogenes has historically been susceptible to antimicrobials effective against Gram positive bacteria, there have been reports of antimicrobial resistance (AMR) in this organism, including in isolates originating from food-producing animals, food processing environments (FPE), and food (i.e. the food chain). Considering human listeriosis is acquired predominantly through foodborne transmission, this is concerning. In particular, food chain factors may influence L. monocytogenes AMR through i. horizontal exchange of AMR genes, ii. induction of AMR-related stress responses through sub-lethal exposure to factors controlling microbial growth in food, and iii. recurring exposure to disinfectants in the FPE. In light of the significant technical challenges of fully understanding the influence of the food chain on AMR, this review examines how environments and conditions spanning the food continuum may influence current AMR trends through genetic, physiological, and selection pressure-based perspectives. When combined with effective surveillance, such knowledge will be useful in prolonging the efficacy of the currently available repertoire of therapeutic treatment options.

Objective Brief intervention (BI) for unhealthy alcohol use is a top prevention priority for adults in the U.S, but rates of BI receipt vary across patients. We examine BI receipt across race/ethnicity and gender in a national cohort of patients from the Department of Veterans Affairs (VA)—the largest U.S. integrated healthcare system and a leader in implementing preventive care for unhealthy alcohol use. Methods Among 779,041 VA patients with documented race/ethnicity and gender who screened positive for unhealthy alcohol use (AUDIT-C score ≥ 5) between 10/1/09 and 5/30/13, we fit Poisson regression models to estimate the predicted prevalence of BI (EHR-documented advice to reduce or abstain from drinking) across race/ethnicity and gender. Results Rates of BI were lowest among Black women (67%), Black men (68%), and Asian/Pacific Islander women (68%), and highest among white men (75%), Hispanic men (75%), and Asian/Pacific Islander men (75%). A significant race/ethnicity by gender interaction indicated that the associations between race/ethnicity and gender with BI depended on the other factor. Gender differences were largest among Asian/Pacific Islander patients and were nonsignificant among American Indian/Alaska Native patients. Adjustment for covariates not expected to be on the causal pathway (e.g., age, year of AUDIT-C screen) slightly attenuated but did not change the direction of results. Conclusions Receipt of BI for unhealthy alcohol use varied by race/ethnicity and gender, and the impact of one factor depended on the other. Black women, Black men, and Asian/Pacific Islander women had the lowest rates of receiving recommended alcohol-related care. We found these disparities in a healthcare system that has implemented universal alcohol screening and incentivized BI for all patients with unhealthy alcohol use, suggesting that reducing disparities in alcohol-related care may require targeted interventions.

The Caenorhabditis elegans germline is a well-studied model system for investigating the control of cell fate by signaling pathways. Cell signals at the distal tip of the germline promote cell proliferation; just before the loop, signals couple cell maturation to organism-level nutrient status; at the proximal end of the germline, signals coordinate oocyte maturation and fertilization in the presence of sperm. The latter two events require dual phosphorylation and activation of ERK, the effector molecule of the Ras/MAPK cascade. In C. elegans, ERK is known as MPK-1. At this point, none of today’s methods for real-time monitoring of dually phosphorylated MPK-1 are working in the germline. Consequently, quantitative understanding of the MPK-1-dependent processes during germline development is limited. Here, we make a step toward advancing this understanding using a model-based framework that reconstructs the time course of MPK-1 activation from a snapshot of a fixed germline. Our approach builds on a number of recent studies for estimating temporal dynamics from fixed organisms, but takes advantage of the anatomy of the germline to simplify the analysis. Our model predicts that the MPK-1 signal turns on ∼30 h into germ cell progression and peaks ∼7 h later.

Increased consumer demand for fresh leafy produce has been paralleled by an increase in outbreaks and illness associated with these foods. Presently, data on the microbiological quality and safety of produce harvested in the Lower Mainland of British Columbia is lacking. Therefore, fresh green, red, and romaine lettuce samples (n = 68) were obtained from five regional farmers' markets in late summer of 2012 and subsequently analyzed to determine total numbers of aerobic bacteria, coliforms, and Escherichia coli. Additionally, enrichment procedures were used to detect low concentrations of E. coli. Obtained E. coli isolates were subjected to multiplex PCRs to determine phylogenetic groupings and the presence of virulence genes (eaeA, hlyA, stx1, and stx2). All E. coli were tested for resistance to 15 antibiotics using a disk diffusion assay. Lettuce samples yielded mean aerobic colony counts of 6.3 log CFU/g. Coliforms were detected in 72% of samples, with a median concentration of 1.9 log CFU/g. Of samples, 13% were found to harbor E. coli, with a median level of 0.7 log CFU/g. Antibiogram typing of all E. coli (n = 33) revealed that 97% possessed resistance to one or more antimicrobials, with resistance to amikacin (58%), trimethoprim (48%), and trimethoprim-sulfamethoxazole (45%) being the most common. Phylogroup typing showed that 79% of these isolates belonged to group B1, with the remaining assigned to groups A (9%) or D (12%); no virulence genes were detected. Considering that phylogroup indicators suggestive of fecal contamination (groups A and D E. coli) were recovered in lettuce samples presented at retail, further work is required to explore at what point along the food chain contamination occurs. Also, this study shows the presence of multidrug-resistant E. coli in fresh vegetables. Summed, these data provide important information on the microbiological quality of leafy vegetables grown in British Columbia through the detection and characterization of frequently used indicator organisms.

The first synthesis of bivalent ligands of β-carboline-3-carboxylates has been achieved from β-carboline-3-carboxylate tert -butyl ester (βCCt) via Sonogashira and palladium-catalyzed homocoupling processes. The Boc protected intermediate, an iodo-β-carboline-3-carboxylate, was employed to provide a general entry into a series of bivalent ligands structurally similar to βCCt.

We report the case of a 33-year-old woman with sensory exotropia who developed diplopia following implantation of a Boston K-pro keratoprosthesis. She underwent uneventful, successful strabismus surgery with recovery of stereopsis. To the best of our knowledge, surgical treatment of diplopia related to sensory exotropia in a K-pro patient has not been previously reported.