Chromosome 22q11.2 Deletion (DiGeorge Syndrome): Immunologic Features, Diagnosis, and Management.

PURPOSE OF REVIEW: This review focuses on immunologic findings, relationships among immunologic findings and associated conditions of autoimmunity and atopy, and management of immunologic disease in chromosome 22q11.2 deletion syndrome (22q11.2DS, historically known as DiGeorge syndrome). RECENT FINDINGS: The implementation of assessment of T cell receptor excision circles (TRECs) in newborn screening has led to increased detection of 22q11.2 deletion syndrome. While not yet applied in clinical practice, cell-free DNA screening for 22q11.2DS also has the potential to improve early detection, which may benefit prompt evaluation and management. Multiple studies have further elucidated phenotypic features and potential biomarkers associated with immunologic outcomes, including the development of autoimmune disease and atopy. The clinical presentation of 22q11.2DS is highly variable particularly with respect to immunologic manifestations. Time to recovery of immune system abnormalities is not well-defined in current literature. An understanding of the underlying causes of immunologic changes found in 22q11.2DS, and the progression and evolution of immunologic changes over the lifespan have expanded over time and with improved survival. An included case highlights the variability of presentation and potential severity of T cell lymphopenia in partial DiGeorge syndrome and demonstrates successful spontaneous immune reconstitution in partial DiGeorge syndrome despite initial severe T cell lymphopenia.

Creating a Vision for a Healthier Workforce Using a Systems-Based Approach.

CONTEXT: The public health system faces unprecedented challenges due to the pandemic, racism, health inequity, and the politicization of public health. At all levels of the system, the workforce is experiencing distress, burnout, safety issues, and attrition. Public health is being challenged to demonstrate and justify its impact and value, while also leveraging opportunities for learning and system strengthening. PROGRAM: To explore the current state and identify opportunities to strengthen the public health system, the Region 7 Midwestern Public Health Training Center (MPHTC), with support from Engaging Inquiry, embarked on a distinctive type of systems analysis, called "dynamic systems mapping." IMPLEMENTATION: This approach brought together diverse sectors of public health partners in the region to develop a rich contextual narrative and system-level understanding to highlight and align existing and emergent strengths, areas for growth, and tangible goals for the immediate- and long-term sustainability of local and regional health. EVALUATION: Focus groups and workshops were conducted with diverse practitioners to identify upstream causes and downstream effects of 11 key forces driving system behavior. These focus groups resulted in the development of a visual map that MPHTC is utilizing to identify opportunities for leverage, develop strategies to maximize the potential impact of these leverage points, as well as facilitate continuous learning. DISCUSSION: Public health utilization of systems mapping is a valuable approach to strengthening local and national system responses to current and future public health needs. Outcomes and lessons learned from the systems mapping process are discussed.

Demographic and Risk-Factor Differences between Users and Non-Users of Unscheduled Healthcare among Pediatric Outpatients with Persistent Asthma.

This study assesses differences between users and non-users of unscheduled healthcare for persistent childhood asthma, with regard to select demographic and risk factors. The objectives are to provide important healthcare utilization information and a foundation for future research on self-management effectiveness (SME), informed by a recently developed "holistic framework" for measuring SME in childhood asthma. An 18-month retrospective chart review was conducted on 59 pediatric outpatients with persistent asthma-mild, moderate, or severe, to obtain data on various demographic and risk factors, and healthcare use for each child. The study examined five types of "unscheduled" healthcare use. Users had non-zero encounters (at least one) in any of the five types; non-users had zero encounters (not even one) in all five types. Differences between users and non-users were assessed using contingency table and logistic regression analysis. There were 25 users and 34 non-users of unscheduled healthcare. Each severity category contained users and non-users. The only statistically significant finding was that the mild persistent category had fewer users than severe persistent (p < 0.05). There were no significant differences between users and non-users for any other demographic or risk factor examined. After adjusting for asthma severity, there were no other significant differences between users and non-users of unscheduled healthcare. This is a crucial finding which suggests that something else is driving unscheduled healthcare use in these children, given there were users and non-users in each asthma severity category. These results provide impetus for future research on the role of other aspects of the "holistic framework" in explaining differences in uses of unscheduled healthcare in persistent childhood asthma.

Measurement of Key Constructs in a Holistic Framework for Assessing Self-Management Effectiveness of Pediatric Asthma.

The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the importance creating a provider-patient partnership to enable patients/families to monitor and take control of their asthma, so that treatment can be adjusted as needed. However, major shortfalls continue to be reported in provider adherence to EPR-3 guidelines. For providers to be more engaged in asthma management, they need a comprehensive set of resources for measuring self-management effectiveness of asthma, which currently do not exist. In a previously published article in the Journal of Asthma and Allergy, the authors conducted a literature review, to develop a holistic framework for understanding self-management effectiveness of pediatric asthma. The essence of this framework, is that broad socioecological factors can influence self-agency (patient/family activation), to impact self-management effectiveness, in children with asthma. A component of socio-ecological factors of special relevance to providers, would be the quality of provider-patient/family communication on asthma management. Therefore, the framework encompasses three key constructs: (1) Provider-patient/family communication; (2) Patient/family activation; and (3) Self-management effectiveness. This paper conducts an integrative review of the literature, to identify existing, validated measures of the three key constructs, with a view to operationalizing the framework, and discussing its implications for asthma research and practice.

On the Electronic Nature of Bis((Z)-1-(benzo[d]oxazol-2-yl)-3.3.3-trifluoroprop-1-en-2-ate)palladium.

The electronic nature of the recently reported complex, bis((Z)-1-(benzo[d]oxazol-2-yl)-3.3.3-trifluoroprop-1-en-2-ate)palladium, is re-investigated by a combination of spectroscopy (NMR, IR, magnetic moment, etc.) and Density Functional Theory (DFT: B3LYP 6-31G*/LANL2DZ). In contrast to the recent report, the title complex displays all the properties of diamagnetism and hence retains the properties of a formally Pd(II) square planar complex with a bis-κ2-N,O-donor ligand set. A modified synthetic route is also presented which improves the yield of the compound.

Alternative fast analysis method for cellulose sponge surface sampling wipes with low concentrations of Bacillus Spores.

Environmental sampling is a critical component of the post decontamination verification process following a bioterrorism event. The current work was performed to produce a less labor-intensive method for processing cellulose sponge-wipes used for sampling areas potentially contaminated with low concentrations (i.e., post-decontamination) of Bacillus anthracis spores. An alternative fast-analysis processing method was compared to the processing protocol validated by the Centers for Disease Control and Prevention (CDC) for the Laboratory Response Network (LRN). Glazed tile coupons (1102 cm2) were inoculated with 50, 500, or 5000 spores of Bacillus thuringiensis subsp. kurstaki (Btk), then sampled with cellulose sponges. Sampling was limited to a 25- by 25-cm area and performed in the same manner as the CDC sampling method. Samples were then processed using either the alternative "Fast Analysis" method or the "CDC method". Three different analysts repeated the tests at each concentration utilizing each method. Mean recoveries, labor time, and potentially hazardous waste produced were compared for the two methods. The mean percent recoveries and standard errors for the samples processed using the "CDC method" were 39.9 ±â€¯6.7, 43 ±â€¯7.6, and 36.8 ±â€¯10.1 for the 5000, 500, and 50 spore loading levels, respectively; compared to 54.2 ±â€¯12.9, 64.2 ±â€¯21.7, and 45.2 ±â€¯8.6 for the "Fast Analysis" method. At each titer tested the "Fast Analysis" method resulted in a statistically significant higher percent recovery. Furthermore, analysts processed samples utilizing the "Fast Analysis" method in less than half the time and generated half as much potentially hazardous waste compared to the "CDC method".

A vulnerable population: families of patients in adult critical care.

Families of patients in adult critical care are susceptible to physiological symptoms, emotional distress, persuasion, burden, and postintensive care syndrome-family, as defined by the Society of Critical Care Medicine. The specific aims of this article are to (1) describe the state of science about the concept of vulnerability of families of patients in adult critical care, through analysis and synthesis of relevant literature; (2) explore resources available to reduce or prevent vulnerability of this population; and (3) propose considerations for research with this population. Concept analysis and synthesis strategies support the definition of this concept through review of the literature to describe antecedents, defining characteristics, and consequences of the vulnerability of families of patients in adult critical care. The authors present resources for both families and health care professionals and recommendations for potential collaborative efforts that could reduce risks and promote the health of this vulnerable population.

Spectrum of antimicrobial activity associated with ionic colloidal silver.

OBJECTIVES: Silver has historically and extensively been used as a broad-spectrum antimicrobial agent. However, the Food and Drug Administration currently does not recognize colloidal silver as a safe and effective antimicrobial agent. The goal of this study was to further evaluate the antimicrobial efficacy of colloidal silver. DESIGN: Several strains of bacteria, fungi, and viruses were grown under multicycle growth conditions in the presence or absence of ionic colloidal silver in order to assess the antimicrobial activity. RESULTS: For bacteria grown under aerobic or anaerobic conditions, significant growth inhibition was observed, although multiple treatments were typically required. For fungal cultures, the effects of ionic colloidal silver varied significantly between different genera. No viral growth inhibition was observed with any strains tested. CONCLUSIONS: The study data support ionic colloidal silver as a broad-spectrum antimicrobial agent against aerobic and anaerobic bacteria, while having a more limited and specific spectrum of activity against fungi.

Mexican American youths' and mothers' explanatory models of diabetes prevention.

PURPOSE: To describe Mexican American mothers' and youths' explanatory models of promoting health and preventing diabetes in 12-14 year olds. DESIGN AND METHODS: In this descriptive study, interviews produced mothers' (n= 21) and adolescents' (n= 20) explanatory models. RESULTS: Mothers' and youths' views of causes of diabetes were mostly concordant with the biomedical model. They saw shared responsibility for health promotion and prevention. PRACTICE IMPLICATIONS: Mothers and youths want help to promote health and prevent diabetes. Providers can apply explanatory models in interventions.

Leisure-time physical activity among midlife Korean immigrant women in the US.

The purpose of the study was to investigate the level of leisure-time physical activity (LTPA) among midlife Korean American women and to determine the relationships of LTPA with individual characteristics and behavior-specific cognition and affects. A cross-sectional descriptive study of 152 middle-aged Korean American women in Central Texas was conducted using a health-promotion model of physical activity adapted from Pender's Health Promotion Model. The results showed that 32% of the participants were not engaged in any form of exercise. The level of acculturation was not significantly related to the amount of physical activity. After age, level of acculturation, education, income, and marital status were controlled, LTPA was significantly associated with perceived benefits and barriers and social support. Physical inactivity, which was common in this group of immigrant women, warrants further rigorous investigation to determine the dynamics of the women's involvement in more physical activity.

Public health nursing: the generalist in a specialized environment.

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice.

Elementary students in classes for the emotionally disturbed: characteristics and classroom behavior.

Data are presented on 147 elementary students enrolled in special-education classes for the emotionally disturbed/behaviorally disordered, housed in self-contained classrooms within the regular public schools of a large urban district. Demographic, psychiatric, academic, and observational characteristics were assessed. From these data, inferences are made about the needs of children enrolled in these classes.