Building an Integrated Data Infrastructure to Examine the Spectrum of Suicide Risk Factors in Philadelphia Medicaid.

While there are many data-driven approaches to identifying individuals at risk of suicide, they tend to focus on clinical risk factors, such as previous psychiatric hospitalizations, and rarely include risk factors that occur in nonclinical settings, such as jails or emergency shelters. A better understanding of system-level encounters by individuals at risk of suicide could help inform suicide prevention efforts. In Philadelphia, we built a community-level data infrastructure that encompassed suicide death records, behavioral health claims, incarceration episodes, emergency housing episodes, and involuntary commitment petitions to examine a broader spectrum of suicide risk factors. Here, we describe the development of the data infrastructure, present key trends in suicide deaths in Philadelphia, and, for the Medicaid-eligible population, determine whether suicide decedents were more likely to interact with the behavioral health, carceral, and housing service systems compared to Medicaid-eligible Philadelphians who did not die by suicide. Between 2003 and 2018, there was an increase in the number of annual suicide deaths among Medicaid-eligible individuals, in part due to changes in Medicaid eligibility. There were disproportionately more suicide deaths among Black and Hispanic individuals who were Medicaid-eligible, who were younger on average, compared to suicide decedents who were never Medicaid-eligible. However, when we accounted for the racial and ethnic composition of the Medicaid population at large, we found that White individuals were four times as likely to die by suicide, while Asian, Black, Hispanic, and individuals of other races were less likely to die by suicide. Overall, 58% of individuals who were Medicaid-eligible and died by suicide had at least one Medicaid-funded behavioral health claim, 10% had at least one emergency housing episode, 25% had at least one incarceration episode, and 22% had at least one involuntary commitment. By developing a data infrastructure that can incorporate a broader spectrum of risk factors for suicide, we demonstrate how communities can harness administrative data to inform suicide prevention efforts. Our findings point to the need for suicide prevention in nonclinical settings such as jails and emergency shelters, and demonstrate important trends in suicide deaths in the Medicaid population.

Luminescent quantum dot films improve light use efficiency and crop quality in greenhouse horticulture.

The spectral quality of sunlight reaching plants remains a path for optimization in greenhouse cultivation. Quantum dots represent a novel, emission-tunable luminescent material for optimizing the sunlight spectrum in greenhouses with minimal intensity loss, ultimately enabling improved light use efficiency of plant growth without requiring electricity. In this study, greenhouse films containing CuInS2/ZnS quantum dots were utilized to absorb and convert ultraviolet and blue photons from sunlight to a photoluminescent emission centered at 600 nm. To analyze the effects of the quantum dot film spectrum on plant production, a 25-week tomato trial was conducted in Dutch glass greenhouses. Plants under the quantum dot film experienced a 14% reduction in overall daily light integral, resulting from perpendicular photosynthetically active radiation transmission of 85.3%, mainly due to reflection losses. Despite this reduction in intensity, the modified sunlight spectrum and light diffusion provided by the quantum dot film gave rise to 5.7% improved saleable production yield, nearly identical total fruiting biomass production, 23% higher light use efficiency (g/mol), 10% faster vegetative growth rate, and 36% reduced tomato waste compared to the control, which had no additional films. Based on this result, materials incorporating quantum dots show promise in enabling passive, electricity-free spectrum modification for improving crop production in greenhouse cultivation, but extensive controlled crop studies are needed to further validate their effectiveness.

Optimizing spectral quality with quantum dots to enhance crop yield in controlled environments.

Bioregenerative life-support systems (BLSS) involving plants will be required to realize self-sustaining human settlements beyond Earth. To improve plant productivity in BLSS, the quality of the solar spectrum can be modified by lightweight, luminescent films. CuInS2/ZnS quantum dot (QD) films were used to down-convert ultraviolet/blue photons to red emissions centered at 600 and 660 nm, resulting in increased biomass accumulation in red romaine lettuce. All plant growth parameters, except for spectral quality, were uniform across three production environments. Lettuce grown under the 600 and 660 nm-emitting QD films respectively increased edible dry mass (13 and 9%), edible fresh mass (11% each), and total leaf area (8 and 13%) compared with under a control film containing no QDs. Spectral modifications by the luminescent QD films improved photosynthetic efficiency in lettuce and could enhance productivity in greenhouses on Earth, or in space where, further conversion is expected from greater availability of ultraviolet photons.

Tinea capitis in Birmingham: survey of elementary school students.

Trichophyton tonsurans is currently the leading cause of tinea capitis, but was only introduced into the United States less than six decades ago. In this study, we found a prevalence of 11% in Birmingham, Alabama, which is similar to earlier reports from other geographic regions. Despite previous reports concerning escalation, the prevalence appears to be stable over the past decade.

Cutaneous leishmaniasis in Texas: A northern spread of endemic areas.

Leishmaniasis, an infection caused by various species of Leishmania protozoa, is usually transmitted by the bite of phlebotomine sandflies. The clinical presentations are extremely diverse and dependent on a variety of host and parasitic factors. Although rare in the United States, cutaneous leishmaniasis is endemic in south-central Texas. At this time, no autochthonous cases of cutaneous leishmaniasis are known to have been reported in north Texas. We report 9 autochthonous cases of cutaneous leishmaniasis obtained in residents of north Texas. None of these patients had any travel history to areas known to be endemic for Leishmania.

Melanoma in situ involving an epidermal inclusion (infundibular) cyst.

Epidermal inclusion (infundibular) cysts are common tumors encountered in the practice of dermatology and dermatopathology. Although benign, numerous pathological processes, including benign and malignant tumors, inflammatory dermatoses, and certain infectious entities, have been reported to occur within the epithelial lining of infundibular cysts. We report a rare case of malignant melanoma in situ involving the epithelium of an epidermal inclusion cyst in contiguity with an adjacent malignant melanoma.

Alefacept in the treatment of psoriatic nail disease: a proof of concept study.

Nail psoriasis can be debilitating and as therapeutic options are limited, it can be notoriously difficult to treat. As there are many new medications currently undergoing clinical trials in psoriasis, questions have arisen concerning the effectiveness of these new therapies with regard to psoriatic nail disease. We present the results of a prospective, open-label, proof of concept study to determine the efficacy and safety of alefacept in subjects with moderate to severe nail psoriasis.