Racial and Socioeconomic Equity of Tecovirimat Treatment during the 2022 Mpox Emergency, New York, New York, USA

We assessed tecovirimat treatment equity for 3,740 mpox patients in New York, New York, USA, during the 2022 mpox emergency; 32.4% received tecovirimat. Treatment rates by race/ethnicity were 38.8% (White), 31.3% (Black/African American), 31.0% (Hispanic/Latino), and 30.1% (Asian/Pacific Islander/other). Future public health emergency responses must prioritize institutional and structural racism mitigation.

Adeno-associated viral serotypes differentially transduce inhibitory neurons within the rat amygdala

Recombinant adeno-associated viruses (AAV) are frequently used to make localized genetic manipulations within the rodent brain. It is accepted that the different viral serotypes possess differing affinities for particular cell types, but it is not clear how these properties affect their ability to transduce specific neuronal cell sub-types. Here, we examined ten AAV serotypes for their ability to transduce neurons within the rat basal and lateral nuclei of the amygdala (BLA) and the central nucleus of the amygdala (CeA). AAV2 based viral genomes designed to express either green fluorescent protein (GFP) from a glutamate decarboxylase (GAD65) promoter or the far-red fluorescent protein (E2-Crimson) from a phosphate-activated glutaminase (PAG) promoter were created and pseudotyped as AAV2/1, AAV2/4, AAV2/5, AAV2/6, AAV2/7, AAV 2/8, AAV2/9, AAV2/rh10, AAV2/DJ and AAV2/DJ8. These viruses were infused into the BLA and CeA at equal titers and twenty-one days later tissue within the amygdala was examined for viral transduction efficiency. These serotypes transduced neurons with similar efficiency, except for AAV4 and AAV5, which exhibited significantly less efficient neuronal transduction. Notably, AAV4 and AAV5 possess the most divergent capsid protein sequences compared to the other commonly available serotypes. We found that the Gad65-GFP virus did not exclusively express GFP within inhibitory neurons, as assessed by fluorescent in situ hybridization (FISH), but when this virus was used to transduce CeA neurons, the majority of the neurons that expressed GFP were in fact inhibitory neurons and this was likely due to the fact that this nucleus contains a very high percentage of inhibitory neurons.

Surveillance and preparedness for Ebola virus disease -- New York City, 2014

In July 2014, as the Ebola virus disease (Ebola) epidemic expanded in Guinea, Liberia, and Sierra Leone, an air traveler brought Ebola to Nigeria and two American health care workers in West Africa were diagnosed with Ebola and later medically evacuated to a U.S. hospital. New York City (NYC) is a frequent port of entry for travelers from West Africa, a home to communities of West African immigrants who travel back to their home countries, and a home to health care workers who travel to West Africa to treat Ebola patients. Ongoing transmission of Ebolavirus in West Africa could result in an infected person arriving in NYC. The announcement on September 30 of an Ebola case diagnosed in Texas in a person who had recently arrived from an Ebola-affected country further reinforced the need in NYC for local preparedness for Ebola.

Shared decision-making in back pain consultations: an illusion or reality?

PURPOSE

Amid a political agenda for patient-centred healthcare, shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that shared decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of shared decision-making in clinical encounters involving physiotherapists and patients with back pain.

METHOD

Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the shared decision-making competency of the clinicians.

RESULTS

The mean OPTION score was 24.0% (range 10.4-43.8%).

CONCLUSION

Shared decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to shared decision-making and further work should focus on when and how it can be implemented.

Accumulation and effects of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) exposure in the green anole (Anolis carolinensis)

Environmental contamination by energetic compounds is an increasing international concern, although little is known of their accumulation in and affect on wildlife. Reptiles are often good models for contaminants studies due to natural history traits that increase their potential for exposure. We report a study to assess accumulation and effects of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX, High Melting Explosive) in green anoles (Anolis carolinensis). Acute oral toxicity (LD(50)) was estimated to exceed 2000 mg/kg body weight in adult male and female anoles using a standard up-and-down method. Accumulation of HMX was assessed in adult females via dietary exposure and into eggs by two routes (directly from the soil and via maternal transfer). HMX readily accumulated into adult females in a dose-dependent manner and into eggs following both exposure pathways. However, total HMX in soil-exposed eggs was up to 40-times greater than those exposed via maternal transfer. Although there was a suggestion of an HMX-induced reduction in body weight in adult females, overall there were no effects observed over the 12 week exposure period. The only significant effect on eggs was a 50% reduction in hatching success for eggs exposed to 2000 mg/kg HMX in the soil during incubation. Growth and survival of hatchlings was not affected by HMX exposure. Our results demonstrate that HMX accumulates through the food chain and into eggs from the soil, but likely poses minimal threat to lizards except to hatching success in eggs incubated in soils with HMX levels near maximum environmental concentrations.

Screening of nonfilamentous bacteria for production of cutin-degrading enzymes

Two hundred thirty-two nonfilamentous bacterial strains, including saprophytes, plant pathogens, and opportunistic plant and human pathogens, were screened for the ability to produce cutinases (cutin-degrading esterases). Initially, esterase activity of culture filtrates of strains grown in nutrient broth-yeast extract medium supplemented with 0.4% apple or tomato cutin was determined by a spectrophotometric assay utilizing the model substrate p-nitrophenyl butyrate. The culture filtrates of the 10 Pseudomonas aeruginosa strains tested exhibited the highest esterase activity, with values of >500 nmol/min/ml. Of these 10 strains, 3 (K799, 1499A, and DAR41352) demonstrated significant induction (10-fold or above) of esterase activity by addition of cutin to nutrient broth-yeast extract medium. The ability of culture filtrates of the three strains to cause release of apple cutin monomers was confirmed by a novel high-performance liquid chromatography technique. Monomer identification was confirmed by gas chromatography-mass spectroscopy analyses. Addition of the nonionic detergent n-octylglucoside stimulated cutinase activity of culture filtrates from strains K799 and DAR41352, but not that of filtrates from strain 1499A. Time course studies in nutrient broth-yeast extract medium supplemented with apple cutin indicated maximal levels of cutinase in the culture fluids after cultures entered stationary phase. Incubation temperatures below the optimal temperature for growth (37 degrees C) led to maximal production of cutinase.

AIDS-defining opportunistic illnesses in the HAART era in New York City

Despite widespread availability of HAART, opportunistic illnesses (OIs) still occur and result in an increased risk of mortality among persons with AIDS. We estimated the incidence of OIs among all new adult AIDS cases in New York City in 2000 overall and in demographic and clinical subgroups and identified factors associated with occurrence of an AIDS-defining OI versus AIDS diagnosis based on low CD4+ values only. In 2000, 5,451 new AIDS cases were reported to the New York City Department of Health and Mental Hygiene. Of these 27.4% (95% CI: 22.8-32.6) had at least one OI, most frequent being Pneumocystis jiroveci pneumonia (12.2%) and M. tuberculosis (5.3%); 47.1% (41.7-52.5) had a late HIV diagnosis (i.e.< or =6 months before AIDS diagnosis). Persons with a late HIV diagnosis not in recent care had a 3.5-fold increased odds (1.29-9.63) of an OI, compared to non-late testers in care. Other predictors of an OI were injection drug use and older age. We conclude that OIs remain prevalent in the HAART era and late testers not in care are especially likely to develop an OI. Our results support comprehensive HIV programs promoting early HIV testing and linkage to care to prevent OI-related morbidity and mortality.

Management of the multiple limb amputee

ISSUE

Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization.

METHOD

A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation.

CONCLUSION

Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.

Inter-observer reliability of clinical outcome measures in a lower limb amputee population

PURPOSE

In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood-Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper.

METHODS

An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months.

RESULTS

The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes.

CONCLUSIONS

This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.

Save that arm: a study of problems in the remaining arm of unilateral upper limb amputees

A study has been made by questionnaire, personal examination and telephone interview of unilateral upper limb amputees seen at the Prince Henry Hospital, Australia between 1994 and 1997. There were 60 questionnaires posted. Replies were received from 46. Problems were noted in the remaining arm of 23 (50%). The respondents' problems not only consisted of overuse symptoms, but also of an exacerbation of pre-existing arthritis and injury due to trauma to the remaining arm during the accident. Case histories are given in 3 typical cases. Treating professionals are warned about the hazards that one arm amputations present to the remaining arm.

Allegations of sexual misconduct: a risk management perspective

Increasingly, patients are making complaints to state licensing boards and filing lawsuits against healthcare providers alleging sexual misconduct. This article addresses the risk management implications of patient allegations of sexual misconduct involving inappropriate touching by healthcare providers during an examination or treatment. From a risk management standpoint, techniques can be implemented before and after these incidents that can help reduce the facility's exposure.

Painful neuromata following upper limb amputation

Painful neuromata occurring after upper limb amputation are a significant cause of stump pain and limit the success of prosthetic training and use. There is little information in the literature regarding incidence, consequences or outcomes of painful neuromata subsequent to upper limb amputation. This article reports an analysis of thirty-two consecutive upper limb amputees. Of these 25% had moderate-to-severe stump pain and clinical signs suggestive of neuromata. All patients with neuromata were limited in their ability to use a prosthesis prior to surgery and following failure of conservative measures, were referred for surgical opinion. Six patients have undergone surgical management. The results of surgery, with respect to pain and prosthetic usage, are discussed.

The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia

A follow-up study by questionnaire or interview has been made of the 27 respondents of 41 upper limb amputees (66%) treated at the Royal South Sydney Hospital between 1981 and 1990. Prosthetic use of 8 h/day or more was 37% and occasional use was 18.5%. The prosthetic users were more likely to be distal amputees. The reason for the low level of prosthetic use is not known. The majority of non-users discarded prostheses after leaving their rehabilitation programme. Occupational changes were made by 72% of the amputees. The unemployment rate at follow-up was similar to the rest of the community, which is a better outcome than 25 years ago. Activities of daily living had been affected in all patients, but to a lesser extent in prosthetic users. Leisure pursuits were changed in 70% of patients, with these activities being more sedentary and indoor in nature. Of the 18 car drivers, 15 drove automatic cars with modifications. Phantom pain was experienced by 16 of the respondents (59%) and stump pain was experienced by seven. Only 26% used medication or alcohol for the pain. Pain did not affect prosthetic use or functional ability.

Rehabilitation after a letter-bomb attack causing bilateral hand loss and other injuries: case report

The rehabilitation of patients after terrorist attacks has received scant attention in the literature. A case is reported of a patient injured in a letter-bomb explosion; his injuries were bilateral hand loss, loss of one eye, and perforated ear-drums. The successful rehabilitation of this patient to normal work in 8 months is described. A rehabilitation plan for management of similar patients is given.

The care of the limb deficient child in Australia

The incidence of limb deficiency is given as is the prevalence of prosthetic use in Australia. The organisation of clinics and the Free Limb Scheme is described and its effects discussed.

Lower limb amputation in three Australian states

A study has been made of lower limb amputation statistics from morbidity data from the State Health Departments in New South Wales, Queensland, and Western Australia. The incidence of lower limb amputation in these three States was 22.6 in 1981, 22.5 in 1983, and 23.6 in 1984. Incidence was lowest in New South Wales and highest in Western Australia. Below-knee amputation was more common than above-knee except in Western Australia in the years 1981 and 1983. Males had slightly more amputations than females. Incidence increased steadily with age, rising rapidly after 55 years. Vascular disease was the most common cause of major amputation. Of malignancies, skin cancers, both malignant melanoma and other forms, were causes of major and minor amputations in addition to bone malignancies. These three Australian States have a lower incidence of amputation than the United Kingdom or Finland.

The Structure of Affect and Trait Judgments of Political Figures

The roles of affective and cognitive processes in judgment have been the focus of much recent research and theoretical debate. This study was designed to investigate the structure of voters' affective reactions and trait attributions to national political figures. Three-mode factor analysis was used to determine the structure of the affect and trait scales. Politician factors and subject types were also derived, as were the interrelationships among these modes. Positive and negative affect factors, and affect and trait factors, were distinct but correlated; Democratic and Republican politician factors were uncorrelated. Information on the subject types moderated these relationships.

Prosthetic limb use in Australia 1981-1985 under the Free Limb Scheme

A study has been made of data on 19,421 prosthetic limbs prescribed for 12,143 Australians under the Free Limb Scheme in the years 1981-1985. These prostheses consisted of 18,119 legs and 1,302 arms. The mean age of the lower limb prosthesis user was 52.8 and the upper limb prosthesis user 31.3 years. Males outnumbered females by 3 to 1 in the upper limb prosthesis users, and 2.8 to 1 with lower limb prosthesis users. Below-knee prostheses, patellar-tendon-bearing and thigh-lacing prostheses, made up 58.7% of all prostheses prescribed in the time span. Below-elbow prostheses were the commonest upper limb prostheses with children being the most frequent users. Comparisons with other studies of large number of prosthesis users show an older mean age in Australia and more below-knee prosthesis users than in American studies.

Compact negatively curved manifolds (of dim [unk] 3,4) are topologically rigid

Let M be a complete (connected) Riemannian manifold having finite volume and whose sectional curvatures lie in the interval [c(1), c(2)] with -infinity < c(1)[unk]c(2) < 0. Then any proper homotopy equivalence h:N --> M from a topological manifold N is properly homotopic to a homeomorphism, provided the dimension of M is >5. In particular, if M and N are both compact (connected) negatively curved Riemannian manifolds with isomorphic fundamental groups, then M and N are homeomorphic provided dim M [unk] 3 and 4. {If both are locally symmetric, this is a consequence of Mostow's rigidity theorem [Mostow, G. D. (1967) Publ. Inst. Haut. Etud. Sci. 34, 53-104].} When M has infinite volume we can still calculate the surgery L-groups of pi(1)M, even when dim M = 3, 4, or 5, provided M is locally symmetric. An identification of the weak homotopy type of the homeomorphism group of (finite volume) M is also made through a stable range. We have previously announced these results for the special case that c(1) = c(2) = -1.

The Free Limb Scheme and the limb-deficient child in Australia

A review was undertaken of computerized data on 547 children aged 0-14 years, treated under the Free Limb Scheme in Australia in the years 1981-85, and of children in New South Wales, Queensland and South Australia having major amputations in some of these years. The male/female ratio was 1.8:1. There were 171 children with upper limb deficits and 376 children with lower limb deficits. The distribution of the limb deficits of the children treated under the free limb scheme is shown. The ratio of congenital:acquired limb deficiency is known for New South Wales and was 3.7:1. The prevalence of prosthetic use in Australian children is 14.8/100,000 children.

Algebraic K-theory of discrete subgroups of Lie groups

Let G be a Lie group (with finitely many connected components) and Gamma be a discrete, cocompact, torsion-free subgroup of G. We rationally calculate the algebraic K-theory of the integral group ring ZGamma in terms of the homology of Gamma with trivial rational coefficients.

Algebraic K-theory of spaces stratified fibered over hyperbolic orbifolds

Among other results, we rationally calculate the algebraic K-theory of any discrete cocompact subgroup of a Lie group G, where G is either O(n, 1), U(n, 1), Sp(n, 1), or F(4), in terms of the homology of the double coset space Gamma\G/K, where K is a maximal cocompact subgroup of G. We obtain the formula K(n)(ZGamma) [unk] [unk] congruent with [unk](i=0) (infinity)H(i)(Gamma\G/K; [unk](n-i)), where [unk](j) is a stratified system of Q vector spaces over Gamma\G/K and the vector space [unk](j)(GammagK) corresponding to the double coset GammagK is isomorphic to K(J)(Z(Gamma [unk] gKg(-1))) [unk] Q. Note Gamma [unk] gKg(-1) is a finite subgroup of Gamma. Earlier, a similar formula for discrete cocompact subgroups Gamma of the group of rigid motions of Euclidean space was conjectured by F. T. Farrell and W. C. Hsiang and proven by F. Quinn.

Effect of rate and time of gain after weaning on the development of replacement beef heifers

Three experiments were conducted during three consecutive years to compare rate and time of gain of weaned heifer calves on growth, reproductive development and future calf production. Three groups of Angus X Hereford heifers were fed in one of the following regimens from 45 d after weaning until breeding: (1) no gain the first one-half of the development period followed by .91 kg x head-1 x d-1 gain the last one-half; (2) .45 kg x head-1 x d-1 gain the entire trial and (3) .91 kg x head-1 x d-1 the first one-half of the development period and no gain the last one-half. The same diet was fed to all heifers, but the intake was varied to meet weight gain requirements. Wither height and heart girth increased (P less than .05) during the periods the heifers were fed to gain weight. By the end of the feeding trials, there were not differences (P greater than .05) in any of the growth measures. There were no differences (P greater than .05) in age at puberty, conception rate or calf production the following year. Adequate growth and development of replacement heifers is necessary, but much latitude exists in the rate and time of growth between weaning and breeding.

Multidimensional Scaling Of Derived Dissimilarities

In past research, a matrix of squared profile distances, δ, has sometimes been multidimensionally scaled rather than the matrix of original dissimilarities, D. It is thought that scaling solutions derived from δ have lower stress and enhanced interpretability when applied to data generated by sorting. Two experiments were performed to investigate the consequences of the delta transformation. First, random numbers resembling data collected by the method of sorting were simulated. Scaling solutions derived from δ matrices invariably had lower stress than solutions computed from the associated D matrices. This result suggests that the delta transformation may reduce stress irrespective of any change in interpretability. Simulated dissimilarity matrices were then generated from known stimulus configurations. It was found that: (1) nonmetric multidimensional scaling solutions for δ matrices had relatively lower stress; but under low error conditions (2) solution based on D were more closely related to the underlying configurations; and (3) determination of dimensionality by inspection of the stress plot was somewhat more difficult for solutions based on δ. These results can be understood by observing that the delta transformation tends to increase the size of large distances in the derived configurations relative to small distances.