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BACKGROUNDOne of the most important consequences of climate change is the increased spread of dengue from tropical and subtropical regions to temperate areas around the world. Climate variables such as temperature and precipitation influence the dengue vector’s biology, physiology, abundance, and life cycle. Thus, an analysis is needed of climate changes and their possible links with the growing occurrence of epidemics recorded in recent decades.OBJECTIVESTo assess the increasing incidence of dengue driven by climate change at the southern limits of dengue virus transmission in South America.METHODSWe analyze the evolution of climate, epidemiological, and biological variables, comparing a period without the presence of dengue cases to a more recent period with the occurrence of cases and, consequently, of important epidemics. Temperature and precipitation are the climate variables evaluated, the total number of cases and incidence of dengue are the epidemiological variables, and finally, the optimal temperature ranges for transmission of the dengue vector is the biological variable.RESULTSThe presence of dengue cases and epidemic outbreaks are observed to be consistent with positive temperature trends and anomalies. Dengue cases do not seem to be associated with precipitation trends and anomalies. The number of days with optimal temperatures for dengue transmission increased from the period without dengue cases to the period with the presence of dengue cases. However, the number of months with optimal transmission temperatures was the same in both periods.CONCLUSIONSThe higher incidence of dengue virus (DENV) and its expansion to different regions of Argentina seem to be associated with temperature increases in the country during the past decades. The active surveillance of both the vector and associated arboviruses will make it possible to assess and predict the occurrence of epidemics, based on the accelerated changes in climate. Such surveillance should go hand in hand with efforts to improve the understanding of the mechanisms driving the geographic expansion of dengue and other arboviruses beyond the current limits.

© 2017 The International Society of Protistologists.Recent advances in molecular technology have revolutionized research on all aspects of the biology of organisms, including ciliates, and created unprecedented opportunities for pursuing a more integrative approach to investigations of biodiversity. However, this goal is complicated by large gaps and inconsistencies that still exist in the foundation of basic information about biodiversity of ciliates. The present paper reviews issues relating to the taxonomy of ciliates and presents specific recommendations for best practice in the observation and documentation of their biodiversity. This effort stems from a workshop that explored ways to implement six Grand Challenges proposed by the International Research Coordination Network for Biodiversity of Ciliates (IRCN-BC). As part of its commitment to strengthening the knowledge base that supports research on biodiversity of ciliates, the IRCN-BC proposes to populate The Ciliate Guide, an online database, with biodiversity-related data and metadata to create a resource that will facilitate accurate taxonomic identifications and promote sharing of data.

BACKGROUND The incidence of metachronous colorectal cancer (MCRC) among colorectal cancer (CRC) survivors varies significantly, and the optimal colonoscopy surveillance practice for mitigating MCRC incidence is unknown. METHODS A cost-effectiveness analysis was used to compare the performances of the US Multi-Society Task Force guideline and all clinically reasonable colonoscopy surveillance strategies for 50- to 79-year-old posttreatment CRC patients with a computer simulation model. RESULTS The US guideline [(1,3,5)] recommends the first colonoscopy 1 year after treatment, whereas the second and third colonoscopies are to be repeated at 3- and 5-year intervals. Some promising alternative cost-effective strategies were identified. In comparison with the US guideline, under various scenarios for a 20-year period, 1) reducing the surveillance interval of the guideline after the first colonoscopy by 1 year [(1,2,5)] would save up to 78 discounted life-years (LYs) and prevent 23 MCRCs per 1000 patients (incremental cost-effectiveness ratio [ICER] ≤ $23,270/LY), 2) reducing the intervals after the first and second negative colonoscopies by 1 year [(1,2,4)] would save/prevent up to 109 discounted LYs and 36 MCRCs (ICER ≤ $52,155/LY), and 3) reducing the surveillance intervals after the first and second negative colonoscopy by 1 and 2 years [(1,2,3)] would save/prevent up to 141 discounted LYs and 50 MCRCs (ICER ≤ $63,822/LY). These strategies would require up to 1100 additional colonoscopies per 1000 patients. Although the US guideline might not be cost-effective in comparison with a less intensive oncology guideline [(3,3,5); the ICER could be as high as $140,000/LY], the promising strategies would be cost-effective in comparison with such less intensive guidelines unless the cumulative MCRC incidence were very low. CONCLUSIONS The US guideline might be improved by a slight increase in the surveillance intensity at the expense of moderately increased cost. More research is warranted to explore the benefits/harms of such practices. Cancer 2016. © 2016 American Cancer Society.

We conducted a preliminary study of the 4 session Community-Friendly Health Recovery Program for HIV-infected drug users (CHRP+) which was adapted from a 12 session evidence-based risk reduction and antiretroviral adherence intervention. Improvements were found in the behavioral skills required to properly adhere to HIV medication regimens. Enhancements were found in all measured aspects of sex-risk reduction outcomes including HIV knowledge, motivation to reduce sex-risk behavior, behavioral skills related to engaging in reduced sexual risk, and reduced risk behavior. Improvements in drug use outcomes included enhancements in risk reduction skills as well as reduced heroin and cocaine use. Intervention effects also showed durability from Post-intervention to the Follow-up assessment point. Females responded particularly well in terms of improvements in risk reduction skills and risk behavior. This study suggests that an evidence-based behavioral intervention may be successfully adapted for use in community-based clinical settings where HIV-infected drug users can be more efficiently reached.

Background: Laparoscopic (LAP) surgery is increasingly performed for primary ileocolic Crohn's disease (CD), but its application in patients with recurrent ileocolic CD is less well described. Our aim was to assess whether or not a laparoscopic approach was safe, feasible, and conferred meaningful short-term benefits in this patient population. Methods: Patients undergoing LAP surgery for recurrent ileocolic CD at our institution from 1998–2008 were identified using a prospectively maintained database. Potential risk factors for conversion to open surgery and overall patient outcomes were assessed with univariate analysis. Results: Forty patients were identified, of which 30 (75%) were LAP-completed and 10 (25%) were LAP-converted. The groups did not differ with respect to clinicopathological features. LAP-converted patients were significantly more likely to require adhesiolysis than LAP-completed patients (100% versus 67%, P = 0.04). There was 1 intraoperative complication in a converted patient. LAP-converted patients had longer times to soft diet (4 versus 3 days, P = 0.03) and longer length of stay (7 versus 4 days, P = 0.003). The groups did not differ with respect to incidence of postoperative complications or frequency of readmission within 30 days. There was no mortality. Concusions: In up to 20% of patients with recurrent ileocolic, successful laparoscopic re-resection may be prevented by adhesions. Conversion increased the length of stay without increasing morbidity. We conclude that LAP surgery can be safely performed in selected patients with recurrent ileocolic CD and leads to short-term benefits. (Inflamm Bowel Dis 2010)

Background: Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBD patients with complex and medically refractory ECF. Methods: After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 ± 118 days). Results: Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (±7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. Conclusions: Our results indicate that in a high-risk IBD patient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option. (Inflamm Bowel Dis 2009)

A large part of the Web is comprised of databases that only reveal their information if you are sitting on their doorstep, requesting it directly. General-purpose search engines do not find this dynamically-generated information, nor do they easily locate the many different file formats loaded on the Web. Tried-and-true methods searchers can use to obtain access to this hidden Web content, as well as recent developments in search technologies, are described and explained.

Objectives: To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol-lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines. Methods: A cross-sectional study design utilizing a convenience sample of patients from a high-volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point-of-care testing with a cutoff of 190 mg/dL. Those who tested positive had four-hour fasting complete lipid profiles performed by the central laboratory. Results: There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four-hour fasting total cholesterol level of 224 mg/dL, a low-density lipoprotein (LDL) level of 138 mg/dL, a high-density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol-lowering medications and 91.7% of these patients reported an interest in initiating therapy. Conclusions: In this study, approximately 25% of inner-city CPOU patients are possible candidates for cholesterol-lowering interventions. Benefits of initiating therapy during this potential “teachable moment” in a CPOU should be investigated in a subsequent multicenter randomized trial.

Careful study of the pathomechanics and epidemiology of sports-related spine injuries brings to light many common features. The incidence increases as the sport becomes increasingly violent and aggressive. Improperly conditioned neck muscles and lack of knowledge of the proper techniques of the sport put the athlete who sustains a blow to the head at significant risk for head and/or spine injury. Improper helmet fit and the use of the head as an offensive weapon are also common features. Although recognition of these features has resulted in a dramatic reduction in catastrophic athletic spine injury, the athlete remains at risk for less severe head and spine injury.

In today's highly competitive world, higher education needs to look more closely at improving customer service on campus. As the consumers of education become more aware of their rights, they will be demanding the same service of educational institutions as they do commercial businesses. Higher education needs to investigate what busienss has been doing in the area of customer service and apply it in the education environment. This paper will explore the relationship between quality customer service and student retention, and will present a customer service model that could be used to initiate a comprehensive customer service program on campus.

The effect of early myocardial reperfusion on patterns of death after acute myocardial infarction (AMI) is unknown. Thus, the mechanism and timing of in-hospital and late deaths among a group of 614 patients treated with coronary angioplasty without antecedent thrombolytic therapy for AMI were determined. Death occurred in 49 patients (8%) before hospital discharge. Four patients died in the catheterization laboratory. Death was due to cardiogenic shock in 22 patients, acute vessel reclosure in 5 patients, was sudden in 8 patients and followed elective coronary artery bypass surgery in 8 patients. Cardiac rupture was observed in only 2 patients after failed infarct angioplasty, and did not occur among the 574 patients with successful infarct reperfusion. Intracranial hemorrhage did not occur. Multivariate predictors of in-hospital death included failed infarct angioplasty, cardiogenic shock, 3-vessel coronary artery disease and age ≥70 years. During a follow-up period of 32 ± 21 months (range 1 to 87), 55 patients died. The cause of death was cardiac in 36 patients, including an arrhythmic death in 23 patients and was due to circulatory failure in 13 others. One patient died of reinfarction due to late reclosure of the infarct artery. Actuarial survival curves demonstrated overall survival after hospital discharge of 95 and 87% at 1 and 4 years, respectively. Freedom from cardiac death at 1 and 4 years was 96 and 92%. Multivariate predictors of late death included 3-vessel disease, a baseline ejection fraction of ≤40%, age >70 years and female gender. Thus, death after coronary angioplasty for AMI is related to the status of the left ventricle and the extent of coronary artery disease. Coronary angioplasty during AMI may reduce the incidence of cardiac rupture.

Single-walled carbon nanotubes (SWNTs) provide an alternative to multi-quantum well (MQW) based saturable absorbers at optical communication wavelengths. This work is aimed at measuring the nonlinear absorption coefficient of SWNTs at 1550 nm and to compare the performance of SWNT based saturable absorbers with MQW based saturable absorbers. In this work, saturable absorption and optical bleaching in a SWNT sample at 1550 nm were observed by the Power-scan and the two-color pump-probe measurement methods. A measurement system capable of performing Z-scan, P-scan, and pump-probe measurements was developed. The filtration method was used to fabricate a thin film of SWNTs grown by the HiPco process onto a sapphire substrate. The experimental results obtained from the P-scan measurements were analyzed to estimate the nonlinear absorption coefficient of the SWNT sample. The estimated values are large compared to those of other nonlinear optical materials. Optical bleaching was observed in the pump-probe measurement. A figure of merit to compare the performance of saturable absorbers based on their modulation depth, saturation intensity, and recovery time is proposed. Using it, the figures of merit of the SWNT sample used in this work, those of several SWNT based saturable absorbers reported in the literature, and those of several MQW based saturable absorbers, also reported in the literature, were calculated. The calculations showed that the performance of SWNT based saturable absorbers is comparable to MQW based saturable absorbers. The optical properties of SWNTs, combined with the low cost of fabrication, demonstrate the potential of SWNT based devices to find a large number of optical applications.

In a survey of the 106 California Community Colleges, it was found that over 75% operated formal programs for the learning disabled, while an additional 12% provided informal services for their LD student population. Though diversity existed among the college LD programs surveyed, a consistency of process and practice was evident. Most colleges provided similar means for the identification and diagnosis of potential LD students and in the support services delivered. More specifically, LD programming similarities were demonstrated in intake interviewing, referral procedure and agencies, assessment tools, personnel, counseling and availability of a learning center. Based on the model provided by the California Community Colleges, these recommendations are made for adoption by others who wish to implement LD programming at the post-secondary level: (a) a defined identification and assessment approach, IEP development, and delivery system; (b) collection of assessment data on all students that measures discrepancy; (c) appropriate, valid, and reliable assessment instruments; (d) IEPs that indicate assessment data, discrepancy, needs, goals, and programming methodology; (e) a multidisciplinary team approach to assessment, IEP development, and delivery systems; (f) consistent data reporting methods securely maintained; (g) confidentiality of material; and (h) in-service programming.