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Background Dolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD. Methods Retrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers. Results The groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007). Conclusions Patients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group. [ABSTRACT FROM AUTHOR]

Centarea maculosa Lam. (spotted knapweed) is one of the most destructive invasive weeds in the western United States, particularly in pastures and rangelands. One of the components that may contribute to its invasiveness is the naturally produced, root-secreted allelochemical (-)-catechin. This compound has been shown to have broad-spectrum phytotoxic activity, possibly assisting C. maculosa in displacing native plant communities. As a recently characterized phytochemical, little is known about the specific effect of (-)-catechin on either C. inaculosa or other plant species. We have found that, in vitro, C. maculosa begins to secrete phytotoxic levels of (-)-catechin within 2-3 weeks of seedling emergence. Furthermore, (-)-catechin concentrations consistent with those naturally secreted by C. maculosa were sufficient to inhibit germination in all species tested, including C. maculosa. These concentrations were also often either phytotoxic or growth inhibitory to seedlings in a range of plant species, while having no negative effects on the growth of C. maculosa seedlings. However, our results also indicate that different levels of resistance and susceptibility to (-)-catechin exist in plant populations, suggesting that the capability of C. inaculosa to invade an area through allelochemistry may be dependent on the age and species composition of plants in that area. [ABSTRACT FROM AUTHOR]

Human health and economic prosperity are vulnerable to freshwater shortage in many parts of the world. Despite a growing literature that examines the freshwater vulnerability in various spatiotemporal contexts, existing knowledge has been conventionally constrained by a territorial perspective. On the basis of spatial analyses of monthly water and electricity flows across 2110 watersheds and three interconnected power systems, this study investigates the water-electricity nexus (WEN)'s transboundary effects on freshwater vulnerability in the continental United States in 2014. The effects are shown to be considerable and heterogeneous across time and space. For at least one month a year, 58 million people living in water-abundant watersheds were exposed to additional freshwater vulnerability by relying on electricity generated by freshwater-cooled thermal energy conversion cycles in highly stressed watersheds; for 72 million people living in highly stressed watersheds, their freshwater vulnerability was mitigated by using imported electricity generated in water-abundant watersheds or power plants running dry cooling or using nonfreshwater for cooling purposes. On the country scale, the mitigation effects were the most significant during September and October, while the additional freshwater vulnerability was more significant in February, March, and December. Due to the WEN's transboundary effects, overall, the freshwater vulnerability was slightly worsened within the Eastern Interconnection, substantially improved within the Western Interconnection, and least affected within the ERCOT Interconnection. [ABSTRACT FROM AUTHOR]

Context: Existing research on refugee healthcare access is focused on psychological, emotional and cultural barriers to care. Our research shows that before we can address these internal barriers we must focus interventions on basic structural barriers in a way that specifically targets the needs of individuals from different countries. To impact health seeking behavior, basic structural needs such as communication, financing, and transportation must be met. This needs assessment looked at the differences in barriers to healthcare access faced by refugees from different countries of origin, ft also specifies structural barriers that are common among all refugee groups. Design: Cross-sectional survey Setting: San Antonio, Texas Patients/Participants: Over age 18, self-identify as refugee, arrived in US between January 2008 through December 2010. Subjects (n=49) recruited in two subgroups: a) San Antonio Refugee Health Clinic (SARHC) (n=6), b) randomized door-to-door sampling at apartment complexes identified as housing for resettled refugees (n=43). Intervention/lnstrument: 64 question survey tool assessing demographics, financial payment systems, transportation, technology, English fluency, translation services, confidence in healthcare providers, finances, ability to seek healthcare, and impressions of discrimination. Survey sessions conducted in seven languages. Results: Refugees have trouble accessing healthcare as shown by the fact that 53.2% of refugees do not feel confident scheduling a doctor's appointment and 41.3% report visiting the ER when they get sick. 24.5% of refugees reported having one or more chronic illnesses, but only 16.7% of those who reported having a chronic illness also reported going to a doctor for check-ups. The major structural barriers to accessing healthcare in this population include language, transportation, and financing. Inadequate English language skill is a major barrier as evidenced by that fact that confidence in scheduling a doctor's appointment is significantly associated with confidence in speaking and reading English (p= 0.001). In this population, 65.3% of refugees reported that they require a translator, while 30.6% use a family member as a translator. Only 34.7% have access to a private motor vehicle and only those without access to a private motor vehicle are more likely to list transportation as a major barrier (p=0.042). Barriers differ by country of origin and age groups within this population. While language is a major barrier for all groups, refugees from Nepal, Bhutan and Burma identified language more than other groups (p=0.026), while adults over the age of 40 were more likely to list language as a major barrier than younger people (p=0.009). Bhutanese and Nepalese refugees were more likely to feel that the quality of their healthcare would improve if they had more money than Burmese refugees (p=0.001). Conclusion: In order to improve the health of the refugee population in San Antonio, we first must address the major structural barriers to accessing healthcare; language, transportation and financing. Because there are significant differences in experiences within this population, a "one size fits all" approach is not the most effective means to intervene. We believe that an accompaniment program that pairs healthcare professionals and students with refugee families will contextualize the message and learning, while simultaneously addressing both structural and internal barriers to accessing healthcare services in this population. [ABSTRACT FROM AUTHOR]

We performed an epidemiological study on Salmonella isolated from raw plant-based feed in Spanish mills. Overall, 32 different Salmonella serovars were detected. Despite its rare occurrence in humans and animals, Salmonella enterica serovar California was found to be the predominant serovar in Spanish feed mills. Different typing techniques showed that isolates of this serovar were genetically closely related, and comparative genomic hybridization using microarray technology revealed 23 S. enterica serovar Typhimurium LT2 gene clusters that are absent from serovar California. [ABSTRACT FROM AUTHOR]