Abstract only
Prior to 2003, the number of annual cases of Rocky Mountain spotted fever (RMSF) reported in Arizona was reliably close to zero. However, since an initial RMSF outbreak in 2003, case ...rates have rapidly increased in Arizona and continue to rise. This outbreak has been tied to a novel vector,
Rhipicephalus sanguineus
, the brown dog tick. Since then, the vectoring capacity of the brown dog tick is seemingly spreading as Northern Mexico across the border from Arizona has had over 4000 reported cases since 2008, with mortality rates as high as 38%. This discovery was somewhat unsettling considering the continental‐wide distribution of these ticks. Given this is a zoonotic disease, canines act as an amplifier for the bacterial agent
Rickettsii rickettsii
and then brown dog ticks pass it on to humans as an incidental host. Therefore, the need to understand the canine‐based factors that drive the spread of RMSF in this region has become more urgent.
Previously, we have identified three distinct lineages of
R. sanguineus
within the region with variation in rickettsial infection rates between clades. This could lead to the distribution of ticks on a canine patient, the tick infection rate, and canine seroprevalence driving the human case rate that we see across Arizona and New Mexico. To test this hypothesis, we have focused on the canine as the unit of interest in our epidemiological approach. To this end, we collected all of the ticks and serum from a series of canine patients from five locations across distributed across Arizona and New Mexico. These ticks were phylogenetically categorized based on sequencing of mitochondrial genes and tested for the presence of rickettsial DNA. The serum was tested for rickettsial antibodies using immuno‐fluorescence assay.
The results of this study show that the population of ticks found on an individual dog tend to be monophyletic belonging to a single clade, meaning ticks taken off the same canine are more closely related to one another than to ticks taken off other canines. This implies that the distribution of tick clades across the region plays a fundamental role in the transmission of RMSF. Moreover, while the rickettsial prevalence differs between these different tick lineages, we have found that the likelihood of one tick being infected on a canine is directly correlated to the number of other ticks infected on the canine. Therefore, transmission among feeding groups and co‐localized ticks is a major determinant of canine infection rates. Given these two factors drive the canine infection rate, it is likely they drive the human rate as well. These data were then used to evaluate the feasibility of a canine‐based vaccine by calculating the basic reproduction rate among other variables, which allows us to assess the plausibility of achieving herd immunity through vaccination campaigns. These methods will help to control the spread of RMSF to humans as well as prevent future outbreaks.
Support or Funding Information
MWU One Health Award to JVB, MWU REAP Award to JVB, MWU Kenneth A. Suarez Award to SM, MWU CGS Funding to AO
Abstract only
Rocky Mountain spotted fever (RMSF) is a rapidly‐progressing, tick‐borne, zoonotic disease caused by the bacterium
Rickettsia rickettsii
. Most of the symptoms of RMSF are flu‐like in ...nature; including fever, nausea, fatigue, and muscle weakness. The one non‐specific symptom is the presence of petechiae, but by the time they appear it is often too late. Even with treatment, RMSF can have a fatality rate of up to 35% and if left untreated it can rise to as high as 80%. In 2003, a new vector for RMSF was identified;
Rhipicephalus sanguineus
, or the brown dog tick. Unlike its Dermacentor counterparts,
R. sanguineus
is found nationally, yet is only known to act as a vector in the Arizona region. The number of cases in Arizona has been on the rise year over year and, perhaps more troubling, just south of the Arizona border, the number of cases in Mexico has surpassed 4000 in the last three years, with an annual fatality rate as high as 47%. Recently, the brown dog tick was indicated as the vector for this outbreak in Mexico. Therefore, understanding why
R. sanguineus
can act as a vector for RMSF in the Arizona region, but not elsewhere has become more urgent.
We propose three hypotheses for the recent emergence of
R. sanguineus
as a vector for RMSF: (1) there exists a distinct sub‐population of
R. sanguineus
which better transmits
R. rickettsii
, (2) a distinct strain of
R. rickettsii
maintains more favorably in the
R. sanguineus
populations in this region, and (3) changing environmental factors and dog‐keeping practices in the Arizona region have contributed to the spread of RMSF.
To test these hypotheses, we have partnered with the Midwestern Veterinary Mobile Clinic as well as the Arizona Animal Welfare League to collect brown dog tick and serum samples from 16 locations spanning Arizona, New Mexico, and Mexico. We isolated and sequenced
12S
,
16S
, and
COX‐1
tick mitochondrial genes and used a maximum likelihood phylogenetic method on the concatenated sequences. To determine rickettsial prevalence, we tested for the rickettsial‐specific,
rOmpA
gene and sequenced it. Furthermore, immunofluorescence assay (IFA) was conducted on canine serum samples to evaluate canine anti‐rickettsial antibody seroprevalence in these locations. Finally, all these data were mapped on a geographic climate model. Results indicate variation in tick phylogeographic distribution, rickettsial prevalence rates ranging from 18% to 64% among sub‐populations of
R. sanguineus
, and seroprevalence rates as high as 33%, indicating areas with endemic levels of RMSF (>15%). These data indicate that no single factor, but rather a confluence of factors drive the spread of RMSF in the region. With this data we can begin to predict and prevent future outbreaks of RMSF and improve canine and human health.
Support or Funding Information
MWU One Health Award to JVB, MWU REAP Award to JVB, MWU CGS Funding to AO, Kenneth A. Suarez Award to SM
Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit ...EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) holds promise for increasing the use of EBPs such as prolonged exposure therapy (PE) in military treatment facilities. TACTICS combines a needs assessment, a rubric for selecting implementation strategies based on local barriers, an implementation toolkit, and external facilitation to support local champions and their implementation teams in enacting changes. This paper describes the rationale for and design of a study that will evaluate whether TACTICS can increase implementation of PE for PTSD and improve patient outcomes in military BH clinics relative to provider training in PE alone.
The study is a multi-site, cluster randomized, stepped-wedge trial, with the military treatment facility as the unit of analysis. Eight facilities undergo a provider-training phase, followed by 5 months of TACTICS implementation. The timing of TACTICS at each facility is randomly assigned to begin 9, 14, or 19 months after beginning the provider-training phase. Primary analyses will compare the proportion of PTSD patients receiving PE and patients' mean improvement in PTSD symptoms before and after the onset of TACTICS.
TACTICS endeavors to balance standardization of empirically-supported implementation strategies with the flexibility of application necessary for success across varied clinical settings. If successful, TACTICS may represent a systematic and scalable method of promoting and supporting EBP implementation.
Clinicaltrials.gov Identifier: NCT03663452
Glenoid bone loss in anatomic total shoulder arthroplasty (aTSA) remains a controversial and challenging clinical problem. Previous studies have shown high rates of glenoid loosening for aTSA in ...shoulders with retroversion, posterior bone loss, and posterior humeral head subluxation. This study is the first to present minimum 2-year follow-up data of an all-polyethylene, biconvex augmented anatomic glenoid component for correction of glenoid retroversion and posterior humeral head subluxation.
This study is a multicenter, retrospective review of prospectively collected data on consecutive patients from 7 global clinical sites. All patients underwent aTSA using the biconvex posterior augmented glenoid (PAG). Inclusion criteria were preoperative computed tomographic (CT) scan, minimum 2 years since surgery, preoperative and minimum 2-year postoperative range of motion examination, and patient-reported outcome measures (PROMs). Glenoid classification, glenoid retroversion, and posterior humeral head subluxation were measured from preoperative CT and radiography and postoperative radiography. Statistical comparisons between pre- and postoperative values were performed with a paired t test.
Eighty-six of 110 consecutive patients during the study period (78% follow-up) met the inclusion criteria and were included in our analysis. Mean follow-up was 35 ± 10 months, with a mean age of 68 ± 8 years (range 48-85). Range of motion statistically improved in all planes from pre- to postoperation. Mean visual analog scale score improved from 5.2 preoperation to 0.7 postoperation, Single Assessment Numeric Evaluation score from 43.2 to 89.5, Constant score from 41.8 to 76.9, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score from 49.8 to 86.7 (all P < .0001). Mean glenoid retroversion improved from 19.3° to 7.4° (P < .0001). Posterior subluxation improved from 69.1% to 53.5% and posterior decentering improved from 5.8% to –3.0% (P < .0001). There was 1 patient with both a prosthetic joint infection and radiographic glenoid loosening that required revision. Seventy-nine of 86 patients had a Lazarus score of 0 (no radiolucency seen about peg or keel) at final follow-up.
This study shows that at minimum 2-year follow-up, a posterior-augmented all-polyethylene glenoid can correct glenoid retroversion and posterior humeral head subluxation. Clinically, there was significant improvement in both range of motion and PROMs.
This study sought to compare outcomes of patients enrolled in the NCSI (National Cardiogenic Shock Initiative) trial who were treated using a revascularization strategy of percutaneous coronary ...intervention (PCI) of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI).
In patients with multivessel disease who present with acute myocardial infarction and cardiogenic shock (AMICS), intervening on the nonculprit vessel is controversial. There are conflicting published reports and lack of evidence, particularly in patients treated with early mechanical circulatory support (MCS).
From July 2016 to December 2019, patients who presented with AMICS to 57 participating hospitals were included in this analysis. All patients were treated using a standard shock protocol emphasizing early MCS, revascularization, and invasive hemodynamic monitoring. Patients with multivessel coronary artery disease (MVCAD) were analyzed according to whether CV-PCI or MV-PCI was undertaken during the index procedure.
Of 198 patients with MVCAD, 126 underwent MV-PCI (64%) and 72 underwent CV-PCI (36%). Demographics between the cohorts were similar with respect to age, sex, history of diabetes, prior PCI or coronary artery bypass grafting, and prior history of myocardial infarction. Patients who underwent MV-PCI had a trend toward more severe impairment of cardiac output and worse lactate clearance on presentation, and cardiac performance was significantly worse at 12 h. However, 24 h from PCI, the hemometabolic derangements were similar. Survival and rates of acute kidney injury were not significantly different between groups (69.8% MV-PCI vs. 65.3% CV-PCI; p = 0.51; and 29.9% vs. 34.2%; p = 0.64, respectively).
In patients with MVCAD presenting with AMICS treated with early MCS, revascularization of nonculprit lesions was associated with similar hospital survival and acute kidney injury when compared with culprit-only PCI. Selective nonculprit PCI can be safety performed in AMICS in patients supported with mechanical circulatory support.
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Beans, an excellent source of dietary fiber and protein, have potential for lowering glycemic load. Prepared meals with high dietary fiber and low glycemic load were rare in a market survey in Baton ...Rouge, LA. The purpose of this research was to increase fiber and decrease glycemic load in ravioli through substitution with bean flour from pinto, navy, or black beans mixed with wheat flour. Navy bean flour mixed with wheat flour resulted in similar texture to wheat flour at up to 50% substitution level. Calculated proximate analysis of raviolis with 50% and 75% navy bean flour predicted a 14% to 21% DV increase in dietary fiber and a 7- to 10-gram decrease in glycemic load. Sensory evaluation found that the color, texture, aroma, appearance, and liking preferences were not significantly changed by 50% substitution of navy bean flour. An acceptable higher fiber, lower glycemic index ravioli was produced.
The ideal contrast agents for ventilation SPECT and MRI are Technegas and
Xe gas, respectively. Despite increasing interest in the clinical utility of ventilation imaging, these modalities have not ...been directly compared. Therefore, our objective was to compare the ventilation defect percent (VDP) assessed by Technegas SPECT and hyperpolarized
Xe MRI in patients scheduled to undergo lung cancer resection with and without pre-existing obstructive lung disease.
Forty-one adults scheduled to undergo lung cancer resection performed same-day Technegas SPECT, hyperpolarized
Xe MRI, spirometry, and diffusing capacity of the lung for carbon monoxide (DL
). Ventilation abnormalities were quantified as the VDP using two different methods: adaptive thresholding (VDP
) and k-means clustering (VDP
). Correlation and agreement between VDP quantified by Technegas SPECT and
Xe MRI were determined by Spearman correlation and Bland-Altman analysis, respectively.
VDP measured by Technegas SPECT and
Xe MRI were correlated (VDP
: r = 0.48,
= 0.001; VDP
: r = 0.63,
< 0.0001). A 2.0% and 1.6% bias towards higher Technegas SPECT VDP was measured using the adaptive threshold method (VDP
: 23.0% ± 14.0% vs. 21.0% ± 5.2%,
= 0.81) and k-means method (VDP
: 9.4% ± 9.4% vs. 7.8% ± 10.0%,
= 0.02), respectively. For both modalities, higher VDP was correlated with lower FEV
/FVC (SPECT VDP
: r = -0.38,
= 0.01; MRI VDP
: r = -0.46,
= 0.002) and DL
(SPECT VDP
: r = -0.61,
< 0.0001; MRI VDP
: r = -0.68,
< 0.0001). Subgroup analysis revealed that VDP measured by both modalities was significantly higher for participants with COPD (n = 13) than those with asthma (n = 6; SPECT VDP
:
= 0.007, MRI VDP
:
= 0.006) and those with no history of obstructive lung disease (n = 21; SPECT VDP
:
= 0.0003, MRI VDP
:
= 0.0003).
The burden of ventilation defects quantified by Technegas SPECT and
Xe MRI VDP was correlated and greater in participants with COPD when compared to those without. Our observations indicate that, despite substantial differences between the imaging modalities, quantitative assessment of ventilation defects by Technegas SPECT and
Xe MRI is comparable.
Availability of prepared foods in today's market that provide healthy diets for consumers 65 and older is lacking. A general market survey, covering nine grocery stores and approximately 400 items in ...the greater Baton Rouge area, was conducted on snack foods, frozen meals, and dry products. Two other surveys included a survey of pasta items and a blind consumer survey targeting consumers ages 65 and older. In each survey, products were categorized as high, medium, or low in fiber and low, medium, or high glycemic load. Prepared meals with high levels of dietary fiber and low glycemic loads were found to be rare. Results from the blind consumer survey found that key unsatisfactory characteristics in commercial products were texture and color. Our research suggests that there is a need for the development of healthier prepared meals in the grocery store market.
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