Association of a sepsis initiative on broad spectrum antibiotic use and outcomes in an ED population.

Introduction: Sepsis identification and treatment is a priority for emergency department (ED) providers and payors alike. However, aggressive metrics aimed at improving sepsis care could have unintended consequences for patients who do not have sepsis.

Methods: All ED patient visits for a one month period before and after a quality initiative to increase early antibiotic use in septic patients were included.

Humoral immune responses associated with control of SARS-CoV-2 breakthrough infections in a vaccinated US military population.

Background: COVID-19 vaccines have been critical for protection against severe disease following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but gaps remain in our understanding of the immune responses that contribute to controlling subclinical and mild infections.

Methods: Vaccinated, active-duty US military service members were enrolled in a non-interventional, minimal-risk, observational study starting in May, 2021. Clinical data, serum, and saliva samples were collected from study participants and were used to characterise the humoral immune responses to vaccination and to assess its impact on clinical and subclinical infections, as well as virologic outcomes of breakthrough infections (BTI) including viral load and infection duration.

Development and implementation of a patient assistance fund: a descriptive study.

Background: The purpose of this descriptive study is to outline the Roseman University of Health Sciences (RUHS) College of Dental Medicines' Patient Assistance Fund development, organization and outcomes. The description and reported results provide insight to others considering similar health professions programs.

Methods: The Patient Assistance Fund (PAF) affords dental students an opportunity to petition for and obtain financial assistance for their most disadvantaged patients.

Cell invasion, RAGE expression, and inflammation in oral squamous cell carcinoma (OSCC) cells exposed to e-cigarette flavoring.

Objective: Electronic cigarettes have given rise to a new, largely unregulated market within the smoking industry. While generally supposed to be less harmful than traditional tobacco smoke, awareness of the biological effects of electronic cigarette liquid is still scarce. Our objective was to determine the impact of electronic cigarette flavoring and nicotine on gingival squamous cell carcinoma invasion, RAGE expression, and the elaboration of pro-inflammatory molecules.

The Impact of Using Documented but Uncharged Offense Data on JSORRAT-II Predictive Validity.

Following the implementation of sexual offender notification laws, researchers have found a drop in the rate of prosecutions and an increase in plea bargains for sexual offenses committed by male juveniles. This type of prosecutorial hesitation has implications for the predictive validity of sexual recidivism risk assessments, such as the Juvenile Sexual Offender Recidivism Risk Assessment Tool-II (JSORRAT-II), that require data from officially adjudicated offenses in the scoring of several items. The present study sought to test the impact of including data from documented but uncharged (DBU) sexual offenses in the scoring of the JSORRAT-II on its predictive validity using an exhaustive sample of 1,095 juveniles who offended sexually from the states of Iowa and Utah.

Cross-Validation of the JSORRAT-II in Iowa.

The predictive validity of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (JSORRAT-II) was evaluated using an exhaustive sample of 11- to 17-year-old male juveniles who offended sexually (JSOs) between 2000 and 2006 in Iowa (n = 529). The validity of the tool in predicting juvenile sexual recidivism was significant (area under the receiver operating characteristic curve [AUC] = .70, 99% confidence interval [CI] = [.

Development and Validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II.

This article describes the development and initial validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (JSORRAT-II). Potential predictor variables were extracted from case file information for an exhaustive sample of 636 juveniles in Utah who sexually offended between 1990 and 1992. Simultaneous and hierarchical logistic regression analyses were used to identify the group of variables that was most predictive of subsequent juvenile sexual recidivism.

Predictive validity of adult risk assessment tools with juveniles who offended sexually.

An often-held assumption in the area of sexual recidivism risk assessment is that different tools should be used for adults and juveniles. This assumption is driven either by the observation that adolescents tend to be in a constant state of flux in the areas of development, education, and social structure or by the fact that the judicial system recognizes that juveniles and adults are different. Though the assumption is plausible, it is largely untested.

Standardizing protected species observer requirements in the United States.

Currently, there is considerable geographic variation in the data-collection requirements and procedures for US-permitted seismic surveys conducted for energy and research purposes. The development of standards to train PSOs, standardization of data collection, submission standards, and development of quality assurance and quality control standards will make data analysis more efficient and robust. The implementation of national standards for the Seismic Survey PSO Programs will increase the integrity of data collected and reported for more effective protected species management.

United States Bureau of Ocean Energy Management, Regulation and Enforcement: filling data gaps to better understand the effects of anthropogenic noise on marine life.

Protecting the environment while ensuring the safe development of our Nation's offshore energy(from both renewable and traditional sources) and marine mineral resources is a critical part of the mission of the BOEMRE. The BOEMRE, as with all federal agencies, must consider the potential environmental impacts for every decision made. This includes understanding the potential for and degree of adverse effects that may result from the introduction of anthropogenic noise into the marine environment from BOEMRE-regulated industry sources.

Healthy individuals have T-cell and antibody responses to the tumor antigen cyclin B1 that when elicited in mice protect from cancer.

We previously identified the aberrantly expressed cell cycle regulator cyclin B1 as a tumor antigen recognized by antibodies and T cells from patients with breast, lung, and head and neck cancers. Ordinarily expressed only transiently in the G2/M stage of the cell cycle in normal cells, cyclin B1 is constitutively expressed at high levels in the cytoplasm of these and many other tumor types, leading to its recognition by the cancer patient's immune system. We report here an unexpected observation that cyclin B1-specific antibody and memory CD4 and CD8 T cells are also found in many healthy individuals who have no history of cancer.

Derivation of new emission factors for quantification of mass emissions when using optical gas imaging for detecting leaks.

This paper describes the development of new "leak/no-leak" emission factors that are suitable for estimating facilities' fugitive emissions when using an alternative work practice (AWP) that is based on optical gas imaging technology for detecting leaking piping system components. These emission factors were derived for valves, pumps, and connectors/flanges for instrument leak detection thresholds ranging from 3 to 60 g/hr using a combination of field data and Monte Carlo statistical simulation techniques. These newly derived leak/no-leak emission factors are designed to replace the U.

Equivalent leak definitions for Smart LDAR (leak detection and repair) when using optical imaging technology.

Controlling fugitive emissions from leaks in petrochemical industry process equipment now requires periodic monitoring of valves, flanges, pumps etc., typically on a quarterly basis. Previous studies have shown that over 90% of the reducible emissions come from approximately 0.

GM1 binding-deficient exotoxin is a potent noninflammatory broad spectrum intradermal immunoadjuvant.

Intradermal (i.d.) immunization is a promising route of vaccine administration.

Early reconstitution of the T-cell repertoire after non-myeloablative peripheral blood stem cell transplantation is from post-thymic T-cell expansion and is unaffected by graft-versus-host disease or mixed chimaerism.

To study immune recovery after non-myeloablative, reduced-intensity stem cell allografts (NST) and T-cell-depleted myeloablative transplants (TCD), we measured T-cell subset recovery by flow cytometry, T-cell repertoire by spectratyping and thymic T-cell output using a T-cell receptor excision circle (TREC) assay. We found a rapid and comparable increase in lymphocyte numbers in both NST and TCD, supporting the presence of a powerful drive for lymphocyte recovery after transplant. Spectratyping on d 45 and 100 revealed almost complete normalization of the T-cell repertoire in NST patients by d 45, whereas TCD patients demonstrated marked skewing of the repertoire, persisting to d 100.

Immunostimulant patch containing heat-labile enterotoxin from Escherichia coli enhances immune responses to injected influenza virus vaccine through activation of skin dendritic cells.

Vaccine strategies, such as influenza virus vaccination of the elderly, are highly effective at preventing disease but provide protection for only the responding portion of the vaccinees. Adjuvants improve the magnitude and rates of responses, but their potency must be attenuated to minimize side effects. Topical delivery of strong adjuvants such as heat-labile enterotoxin from Escherichia coli (LT) induces potent immune responses.

Oligoclonal T cell expansion in myelodysplastic syndrome: evidence for an autoimmune process.

There is accumulating evidence that the marrow-failure of myelodysplastic syndrome (MDS) is immune-mediated. We studied patients with MDS to look for oligoclonal or clonal expansion in T cells indicative of an autoimmune process. We used a PCR-based technique (spectratyping) to characterize the T cell repertoire in MDS (n=15; 9 RA, 4 RARS, 2 RAEB) and compared results with age-matched healthy donors (n=20) and transfusion-dependent (TD) patients with hemoglobinopathy (n=5).

In vitro T-cell receptor V beta repertoire analysis may identify which T-cell V beta families mediate graft-versus-leukaemia and graft-versus-host responses after human leucocyte antigen-matched sibling stem cell transplantation.

We studied oligoclonal T-cell expansions of 24 T-cell receptor (TCR) V beta families in normal donor lymphocytes stimulated with patient's cells and in recipient blood after transplant, using a polymerase chain reaction-based assay (spectratyping). T cells from donor blood were incubated with separated myeloid leukaemia cells or T cells from the HLA-identical sibling recipient. In five of the six patients tested, the T-cell V beta skewing pattern observed in vitro was seen in vivo after transplant.

Molecular remission of chronic myeloid leukaemia following a non-myeloablative allogeneic peripheral blood stem cell transplant: in vivo and in vitro evidence for a graft-versus-leukaemia effect.

Two patients with chronic myeloid leukaemia (CML) received a non-myeloablative preparative regimen of cyclophosphamide and fludarabine, followed by an unmanipulated, G-CSF-mobilized, peripheral blood stem cell transplant from an HLA-identical sibling. Chimaerism, evaluated in myeloid and T-lymphoid lineages by PCR of minisatellite variable regions, showed day 14 post-transplant haemopoietic recovery to be 90% autologous in both patients. On day 30 the bone marrow showed only 1/20 and 2/18 donor metaphases.

Dermal microvascular injury in the human peripheral blood lymphocyte reconstituted-severe combined immunodeficient (HuPBL-SCID) mouse/skin allograft model is T cell mediated and inhibited by a combination of cyclosporine and rapamycin.

We have analyzed the mechanism of human endothelial injury in a human peripheral blood lymphocyte-severe combined immunodeficient (huPBL-SCID) mouse/human skin graft model of allograft injury and examined the effect of immunosuppressive drugs on this process. In this model, split-thickness human skin containing the superficial dermal microvessels was grafted onto immunodeficient C.B-17 SCID or SCID/beige mice and allowed to heal.

Alloreactive cytotoxic T-lymphocyte-defined HLA-B7 subtypes differ in peptide antigen presentation.

We investigated T-cell-defined HLA-B7 subtypes using cDNA sequencing, analysis of bound peptides, and reactivity with a panel of alloreactive cytotoxic T-lymphocyte (CTL) clones. Three subtypes (HLA-B*0702, HLA-B*0703, and HLA-B*0705) differ in nucleotide and predicted amino acid sequence. CTL reactivity and pooled peptide sequencing show that these three HLA-B7 subtypes bind distinct but overlapping sets of peptides.

Antigen-presenting function of human endothelial cells. Direct activation of resting CD8 T cells.

We characterized the response of resting human CD8 T cells to allogeneic endothelial cells (EC). Both resting and IFN-gamma-pretreated EC stimulate similar CD8 T cell proliferative responses (peak, day 5 to 6), whereas only IFN-gamma-pretreated EC stimulate CD4 T cells. The response increases with increasing numbers of CD8 T cells from 25,000 to 400,000/well.

Perpetrator gender and type of child maltreatment: overcoming limited conceptualizations and obtaining representative samples.

A lack of sensitive differentiation across the types of child maltreatment and lack of attention to differences due to perpetrator gender are serious shortcomings in child maltreatment perpetration research. Findings about perpetration may be confounded and of questionable validity as a result. Certain conceptual and methodological difficulties lie at the root of this lack of sensitivity and lead to inadequate research designs and sampling procedures.