Racial/Ethnic Trends in Virtual Mental Health Care Utilization Among Undergraduate Students: A Descriptive Study.

BACKGROUND: Undergraduate students are particularly in need of mental health support, but demand has far surpassed resources. This gap between mental health diagnoses and support is particularly large among Asian, Hispanic/Latinx, and Black students. Supplementing on-campus care with a virtual-only behavioral health partner may shift these trends. OBJECTIVE: This study is aimed at comparing the number of undergraduate students from different racial/ethnic groups (White, Asian, Islander, Hispanic/Latinx, Black, Native, and Multiracial) engaging in virtual mental health visits as part of a partnership with a company providing virtual-only care, with the total enrolled undergraduate students at the same 113 institutions. METHODS: We used de-identified visit data and self-reported race/ethnicity to define the "patient" population of undergraduates accessing care. We compared that to the full "student" population of undergraduates among the same schools, available as part of the Integrated Postsecondary Education Data System (IPEDS). RESULTS: Patient population race/ethnicity (N = 14,870) differed significantly from student population race/ethnicity (N = 619,459). A significant effect ( χ 26 = 2258, P < .001) indicated that patient demographics differed from student demographics. We found proportionally more Asian, Black, and Multiracial patients than students. At the same time, we found proportionally fewer White and Hispanic/Latinx patients than students. CONCLUSIONS: We conclude that, in contrast to prior literature in traditional mental health care, some racial/ethnic minority undergraduates (Asian, Black, and Multiracial) may actually access care at a higher rate under a fully virtual model. On the other hand, White and Hispanic/Latinx students may access care less frequently.

Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up.

Almost a quarter of patients with PAO will sustain a subsequent fracture; patients need to be informed about potential risks before deciding for further pregnancies. INTRODUCTION: Pregnancy and lactation-associated osteoporosis (PAO) is a severe type of premenopausal osteoporosis which predominantly occurs in the last trimester of pregnancy or immediately postpartum. Long-term follow-up data including subsequent fracture risk have yet to be reported. METHODS: This single-center prospective cohort study investigated the subsequent fracture risk of all 107 patients with PAO who were referred to our institution. RESULTS: Overall, 107 presented with at least one fracture. Each patient sustained on average four fractures most commonly at the thoracolumbar spine. During a median of 6 years of follow-up, 26 (24.3%) of patients who had a fracture at baseline reported a subsequent fracture. Overall, 30 PAO patients (28%) reported a further pregnancy. In subsequent pregnancies, 6 (20%) of patients reported a subsequent fracture. Patients with up to 1 vs. > 1 fracture at time of diagnosis showed a 3 (10%) and 25 (27%) subsequent fracture rate, respectively (p = 0.047). There was a significant correlation between the number of fractures at time of diagnosis and subsequent fracture risk (N = 26,p= 0.56, p = 0.003). CONCLUSIONS: Almost a quarter of patients with PAO will sustain a subsequent fracture, and this fracture risk correlates with the number of fractures at time of diagnosis. Patients with PAO need to be informed about their potential subsequent fracture risk before deciding for further pregnancies.

Limitations of Immunomagnetic Separation for Detection of the Top Seven Serogroups of Shiga Toxin-Producing Escherichia coli.

Shiga toxin-producing Escherichia coli (STEC) strains are foodborne pathogens that negatively impact human health and compromise food safety. Serogroup O157 is the most frequently isolated and studied STEC serogroup, but six others (O26, O45, O103, O111, O121, and O145) have also been identified as significant sources of human disease and collectively have been referred to as the "top six" pathogenic serogroups. Because detection methods for non-O157 serogroups are not yet refined, the objective of this study was to compare the effectiveness of immunomagnetic separation (IMS) for recovery of serogroup O157 isolates with that for each of the top six E. coli serogroups in pure and mixed cultures of STEC at 103 to 107 CFU/mL. After serogroup-specific IMS, DNA was extracted from cultured isolates to analyze the specificity of each IMS assay using conventional and quantitative PCR. In pure cultures, DNA copy number obtained after IMS was lower for O111 and O157 (P < 0.01) than for other serogroups. Based on quantitative PCR (qPCR) analyses, specificity was reduced for all IMS assays when STEC isolates were mixed at 7 log CFU/mL, although the O157 IMS assays recovered only O157 over a wider range of concentrations than did assays for non-O157 serogroups. At the lowest dilution tested, conventional PCR was specific for all serogroups except O121 and O145. For these two serogroups, no dilution tested recovered only O121 or O145 when evaluated with conventional PCR. Refinements to IMS assays, development of selective media, and determination of optimal enrichment times to reduce background microflora or competition among serogroups would be especially beneficial for recovery of O111, O121, and O145 serogroups to improve STEC detection and isolation.

Heat and desiccation are the predominant factors affecting inactivation of Bacillus licheniformis and Bacillus thuringiensis spores during simulated composting.

AIMS: The suitability of composting for disposal of livestock mortalities due to Bacillus anthracis was assessed by measuring viability of surrogate spores from two strains each of Bacillus licheniformis and Bacillus thuringiensis after a heating cycle modelled on a cattle composting study. METHODS AND RESULTS: Sporulation was attempted from 10 to 37°C, but poor yields at lower temperatures resulted in 25, 30 and 37°C being selected to generate sufficient spores (8 log10  CFU ml(-1) ) for experiments. Spores were inoculated into 3 g autoclaved dried-ground compost rehydrated with 6 ml water or silica beads in a factorial design for each strain, sporulation temperature, matrix and sampling day (0, 25, 50, 100, 150). Maximum incubation temperature was 62°C, but spores were maintained at ≥55°C for 78 of 150 days. Although significant differences existed among Bacillus strains and sporulation temperatures, numbers of viable spores after 150 days averaged 1·3 log10  CFU g(-1) , a 5·2 log10 reduction from day 0. CONCLUSIONS: Spore inactivation was likely due to heat and desiccation as matrices were autoclaved prior to incubation, negating impacts of microflora. SIGNIFICANCE AND IMPACT OF STUDY: Results support composting for disposal of anthrax mortalities, provided long-term thermophillic heating is achieved. Due to limited sporulation at 10°C, livestock mortalities from anthrax at this or lower ambient temperatures would likely be of lower risk for disease transmission.

Compost biodegradation of recalcitrant hoof keratin by bacteria and fungi.

AIMS: Compost activities efficiently break down a wide range of organic substances over time. In this study, bovine hoof was used as recalcitrant protein model to gain so far cryptic information on biodegradation during livestock mortalities composting. METHODS AND RESULTS: Bovine hooves (black and white), containing different amounts of melanin, placed into nylon bags were monitored during composting of cattle mortalities for up to 230 days. Besides physiochemical analysis, bacterial 16S and fungal 18S DNA fragments were amplified by PCR and profiles were separated by DGGE. Sequence analysis of separated fragments revealed various bacterial and fungal identities during composting. The microbial diversity was affected by a time-temperature interaction and by the hoof colour. Our molecular data, supported by electron microscopy, suggest hoof colonization by shifting bacteria and fungi communities. CONCLUSION: During composting, microbial communities work collaboratively in the degradation of recalcitrant organic matter such as keratin over time. SIGNIFICANCE AND IMPACT OF THE STUDY: A number of biomolecules including recalcitrant proteins may persist in environmental reservoirs, but breakdown can occur during composting. A combination of bioactivity and physiochemical conditions appear to be decisive for the fate of persistent biomolecules.

Impacts of sporulation temperature, exposure to compost matrix and temperature on survival of Bacillus cereus spores during livestock mortality composting.

AIMS: To investigate impact of sporulation and compost temperatures on feasibility of composting for disposal of carcasses contaminated with Bacillus anthracis. METHODS AND RESULTS: Two strains of B. cereus, 805 and 1391, were sporulated at either 20 or 37°C (Sporulation temperature, ST) and 7 Log10 CFU g(-1) spores added to autoclaved manure in nylon bags (pore size 50 µm) or in sealed vials. Vials and nylon bags were embedded into compost in either a sawdust or manure matrix each containing 16 bovine mortalities (average weight 617 ± 33 kg), retrieved from compost at intervals over 217 days and survival of B. cereus spores assessed. A ST of 20°C decreased spore survival by 1·4 log10 CFU g(-1) (P < 0·05) compared to a 37°C ST. Spore survival was strain dependent. Compost temperatures >55°C reduced spore survival (P < 0·05) and more frequently occurred in the sawdust matrix. CONCLUSIONS: Sporulation and compost temperatures were key factors influencing survival of B. cereus spores in mortality compost. SIGNIFICANCE AND IMPACT OF THE STUDY: Composting may be most appropriate for the disposal of carcasses infected with B. anthracis at ambient temperatures ≤20°C under thermophillic composting conditions (>55°C).

Clinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil.

BACKGROUND: Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions. AIM: To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients. METHODS: This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves. RESULTS: Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis. CONCLUSIONS: In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.

High-dose remifentanil prevents development of thermal hyperalgesia in a neuropathic pain model.

BACKGROUND: Intraoperative nerve lesions can lead to chronic postoperative pain. There are conflicting data as to whether or not anaesthetics administered intraoperatively are beneficial. We investigated if remifentanil administered at the time of nerve injury was able to attenuate neuropathic hypersensitivity. METHODS: Rats were anaesthetized with isoflurane, endotracheally intubated, and a tail vein catheter was inserted. Rats received an i.v. infusion of either saline or low- or high-dose remifentanil (2 or 20 µg kg(-1) min(-1), respectively) for 20 min. During this time, rats received a spinal nerve L5 transection to induce neuropathic pain or a sham procedure. Behavioural tests to assess mechanical and cold allodynia and heat hyperalgesia were performed on postoperative days 1, 3, 7, 14, 21, and 28. RESULTS: Sham-operated animals exhibited no hypersensitivity regardless of the intraoperative remifentanil dose. In rats which received spinal nerve L5 transection, mechanical and cold allodynia developed with no significant differences between treatment groups. However, thermal hyperalgesia was reduced in rats given high-dose remifentanil: mean (standard deviation) area under the curve 426 (53) compared with 363 (34) and 342 (24) in saline or low-dose remifentanil treated rats, respectively (P<0.05). CONCLUSIONS: High-dose remifentanil administered at the time of transection of the spinal nerve at L5 prevents subsequent thermal hyperalgesia.

Clinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil

BACKGROUND: Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions. AIM: To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients. METHODS: This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves. RESULTS: Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis. CONCLUSIONS: In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.

Problems of diabetes management in the immigrant population in Germany.

AIM: To compare prospectively the effect of diabetes management in the immigrant and the native population in Berlin, Germany. METHODS: Diabetes patients attending a metabolic outpatient clinic in an area with a high immigrant population were studied at the start of the training program and after 12 months of participation. RESULTS: 1607 of 2099 patients with at least one post-training visit (76.6%) provided analysable data. Of these 362 (22.5%) were immigrants. Initial hemoglobin A1c (HbA1c) was higher in the immigrants. Immigrants were 5 years younger and had a more recent diagnosis of diabetes. HbA1c fell by 1.4 and 1.5 percentage points in the immigrants and natives, leaving a greater proportion of the immigrants above the target value of 6.5%. Analysis of patients matched according to baseline HbA1c, sex and age showed a smaller decrease in mean HbA(1c) for the immigrants. The percent of patients with hypertension, obesity, dyslipidaemia or diabetic complications was comparable in both groups initially and after 12 months. CONCLUSION: Immigrants had a higher HbA1c concentration at baseline and after 12 months compared to natives, despite a similar decline in HbA1c percentage points. More investigations are warranted to identify the causes, such as dietary habits, language difficulties, education and others.

Farm-to-fork characterization of Escherichia coli associated with feedlot cattle with a known history of antimicrobial use.

This study investigated antimicrobial-resistant (AR) Escherichia coli isolated from "farm-to-fork" production of cattle fed diets containing the antimicrobial growth promoter (AGP) chlortetracycline plus sulfamethazine (44ppm each, AS700) or no AGP (control). For each treatment, samples included: feces just prior to euthanization; hides after euthanization; intestinal digesta from the lower digestive tract; carcasses immediately after evisceration and after 24h in the chiller; and ground beef stored at 5 degrees C for 1 and 8days. Samples were also collected from the abattoir environment and from air during hide removal. Total, ampicillin (Amp(r))-, and tetracycline (Tet(r))-resistant E. coli were isolated on MacConkey agar or MacConkey agar containing ampicillin or tetracycline, respectively. Amp(r) and Tet(r)E. coli were isolated from the feces and hides of all cattle. Compared to the control, the prevalence of Amp(r) (26.5% vs. 7.9%) and Tet(r) (50.9% vs. 12.6%) E. coli was greater in feces from AS700 treated animals (P<0.05), but was similar between treatments for hide samples (P>0.05). The prevalence of carcass or ground beef contamination with AR E. coli was not different between treatments. Resistant E. coli were isolated from the abattoir environment after processing of both groups of cattle. Susceptibilities to 11 antimicrobials and pulsed-field gel electrophoresis (PFGE) analyses were conducted on 360 Amp(r) and Tet(r)E. coli isolates. Twenty-five antibiogram profiles were detected, with isolates exhibiting resistance to up to 9 antimicrobials. Most (28.2%) Amp(r)E. coli were also resistant to streptomycin and tetracycline, whereas Tet(r)E. coli (53.5%) were mainly resistant to only tetracycline. Thirty one genotypes were detected by PFGE with most isolates from meat and environmental samples having similar genetic profiles to isolates from hides or digesta. These data demonstrate that antimicrobial-resistant E. coli can contaminate meat products during slaughter and enter the food chain regardless of whether or not cattle are administered AGP. The abundance of AR E. coli on the hides of animals is likely a key element for controlling end-product contamination.

Longitudinal characterization of resistant Escherichia coli in fecal deposits from cattle fed subtherapeutic levels of antimicrobials.

Model fecal deposits from cattle fed or not fed antimicrobial growth promoters were examined over 175 days in the field for growth and persistence of total Escherichia coli and numbers and proportions of ampicillin-resistant (Amp(r)) and tetracycline-resistant (Tet(r)) E. coli. In addition, genotypic diversity and the frequency of genetic determinants encoded by Amp(r) and Tet(r) E. coli were investigated. Cattle were fed diets containing chlortetracycline (44 ppm; A44 treatment group), chlortetracycline plus sulfamethazine (both at 44 ppm; AS700 treatment group), or no antibiotics (control). Fecal deposits were sampled 12 times over 175 days. Numbers of Tet(r) E. coli in A44 and AS700 deposits were higher (P < 0.001) than those of controls and represented up to 35.6% and 20.2% of total E. coli, respectively. A time-by-treatment interaction (P < 0.001) was observed for the numbers of Tet(r) and Amp(r) E. coli. Except for Amp(r) E. coli in control deposits, all E. coli numbers increased (P < 0.001) in deposits up to day 56. Even after 175 days, high Tet(r) E. coli numbers were detected in A44 and AS700 deposits [5.9 log(10) CFU (g dry matter)(-1) and 5.4 log(10) CFU (g dry matter)(-1), respectively]. E. coli genotypes, as determined by pulsed-field gel electrophoresis, were diverse and were influenced by the antimicrobial growth promoter and the sampling time. Of the determinants screened, bla(TEM1), tetA, tetB, tetC, sul1, and sul2 were frequently detected. Occurrence of determinants was influenced by the feeding of antimicrobials. Fecal deposits remain a source of resistant E. coli even after a considerable period of environmental exposure.

Pegvisomant increases intra-abdominal fat in patients with acromegaly: a pilot study.

OBJECTIVE: Acromegalic patients have increased lipolysis and decreased fat mass as well as reduced insulin sensitivity and glucose intolerance. During somatostatin analog therapy, these changes persist despite GH suppression, but they are now due to drug-induced suppression of insulin secretion. By contrast, during pegvisomant (PEG) therapy, GH no longer stimulates lipolysis due to the blockade of its receptor, while insulin action is unabated. Hence, both insulin sensitivity and fat mass, including intra-abdominal fat, should increase. We therefore studied intra-abdominal fat and insulin resistance in acromegalic patients after a 3-month octreotide-washout period, i.e., during untreated acromegaly, and during PEG treatment. METHODS: Five acromegalic patients, not controlled on octreotide (OCT) therapy, were studied after 3-month OCT washout and 6-month PEG therapy. Insulin sensitivity was determined by homeostatic model assessment value and hyperinsulinemic, normoglycemic clamp. Subcutaneous and intra-abdominal fat were measured by electron beam computed tomography. RESULTS: During PEG therapy, all the patients had normal, age-adjusted IGF-I concentrations. Compared with washout, insulin sensitivity (HOMA and M value) was not significantly different. However, intra-abdominal fat mass increased significantly during therapy (median (range) cm(2): 112 (84-480) and 172 (112-524) respectively, P<0.05), while subcutaneous fat was not significantly different. Low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides remained unchanged. CONCLUSIONS: During PEG therapy of acromegalic patients, intra-abdominal fat increases. Visceral obesity is a risk factor for cardiovascular disease. Hence, confirmation and further studies in a larger cohort of acromegalic patients on PEG treatment are warranted.

[Congenital intestinal lymphangiectasia: a rare differential diagnosis in hypoproteinemia in infants]. / Kongenitale intestinale Lymphangiektasie: Eine seltene Differerenzialdiagnose hypoproteinämischer Odeme im Säuglingsalter.

BACKGROUND: Congenital intestinal lymphangiectasia is a rare disease in childhood, which may already cause protein-losing enteropathy in newborns. PATIENT, METHODS AND RESULTS: This is a case report of an infant with generalized edema and protein-losing enteropathy, in whom intestinal lymphangiectasia was diagnosed at the age of two months. Following repetitive intravenous albumin und gamma globulin infusions, the elimination of long-chain fats from the diet and the substitution with medium-chain triglycerides (MCT) led to an improvement of the protein-losing enteropathy. CONCLUSION: In newborns with low level of serum protein and edema protein-losing enteropathy caused by congenital lymphangiectasia might be considered as a differential diagnosis.