Commonwealth of Virginia

The etiology of a large proportion of gastrointestinal illness is unknown. In this study, random Sanger sequencing and pyrosequencing approaches were used to analyze fecal specimens from a gastroenteritis outbreak of unknown etiology in a child care center. Multiple sequences with limited identity to known astroviruses were identified. Assembly of the sequences and subsequent reverse transcription-PCR (RT-PCR) and rapid amplification of cDNA ends generated a complete genome of 6,586 nucleotides. Phylogenetic analysis demonstrated that this virus, named astrovirus VA1 (AstV-VA1), is highly divergent from all previously described astroviruses. Based on RT-PCR, specimens from multiple patients in this outbreak were unequivocally positive for Ast-VA1.

Little is known about the incidence of malingering or the diagnostic criteria for malingering employed by forensic clinical psychologists conducting pretrial evaluations for the criminal justice system. The clinical presentations of 39 criminal defendants diagnosed as malingering psychotic symptoms were contrasted with 25 defendants diagnosed as genuinely psychotic. The incidence of diagnosed malingering was 8% in a series of 314 consecutive evaluations. Malingerers differed from psychotics on 14 of 24 clinical presentation variables, including measures of general presentation, affect, hallucinations, delusions, and formal thought disorder. Results indicate consistent clinical features associated with the diagnosis of malingered psychosis.

A questionnaire survey of 285 consecutively recruited adolescents who were adjudicated to juvenile correctional facilities in Virginia was conducted using the Inhalant Use Questionnaire (1). White youths (36.1%) and youths from other ethnic backgrounds (44.4%) are significantly more likely to report past inhalant use than black youths (1.4%). The median age reported for first-time use of inhalants is 13 years. Youths were divided between those who experimented with inhalants (27%) and those who were heavy users (27%). Huffing was preferred by 60% of youths. Of the youths, 52% reported using inhalants with friends present, whereas 34% used inhalants when they were alone. Sites where youths reported inhalant use include at a friend's home (68%), at home (54%), on the street (40%), at parties (28%), on school grounds (26%), and at school (18%). There are no gender differences in age of onset of inhalant use, lifetime frequency of inhalant use, frequency of inhalant use in the past year, or preferred method of using inhalants. The five substances most frequently used as inhalants include gasoline (by 57.4%), Freon (40.45%), butane lighter fluid (38.3%), glue (29.8%), and nitrous oxide (23.4%). There were no gender differences for use of other products.

Noroviruses (NoVs) are recognized as the leading cause of epidemic and sporadic acute gastroenteritis. Early detection of NoV is crucial to control the spread of the disease. In this study, we evaluated the diagnostic accuracy, analytical sensitivity, and analytical reactivity of the IDEIA Norovirus assay (an enzyme immunoassay [EIA]) in a prospective and retrospective study design. A total of 557 prospectively collected fecal samples and a panel of 97 archived fecal samples, including 21 different GI and GII genotypes, were tested by conventional reverse transcription-PCR (RT-PCR)/bidirectional sequencing, real-time RT-PCR, and electron microscopy. The sensitivity and specificity of the EIA were 57.6% and 91.9%, respectively. The sensitivity for detecting NoV in fecal samples from outbreaks improved from 44.1% when three samples were tested to 76.9% when five samples per outbreak were tested. The EIA was able to detect strains from 7 GI and 11 GII genotypes. The analytical sensitivity of the EIA was 3.1 x 10(6) and 1.6 x 10(7) virus particles g(-1) of fecal sample for NoV GI and GII strains, respectively. Most GII samples positive by EIA had a threshold cycle (C(T)) of <26.5, and 50% of the GII samples negative by EIA had a C(T) of >25.6, suggesting that, although strains from genotypes GI.8, GII.10, and GII.16 were not detected, the low sensitivity of the EIA is primarily caused by low virus concentration. In conclusion, the current EIA may be of use as a rapid screening test during a norovirus outbreak investigation when multiple fecal samples are available; however, sporadic samples should be tested by molecular methods.

OBJECTIVE: Based on the Health Belief Model, this study investigates differences among ethnically diverse, low-income women in the USA to inform better outreach strategies to encourage participation in the Centers for Disease Control & Prevention (CDC)- sponsored breast and cervical cancer early detection program. DESIGN: Program-eligible, low-income, Hispanic, Vietnamese and Cambodian American women who were over the age of 40 volunteered to be interviewed in their first language for the study. A total of 78 women completed the interviews. RESULTS: All three samples of women were more likely to perceive barriers to having a mammogram performed compared to the non-minority normative group. Hispanic and Vietnamese women were more similar in their health beliefs and behaviors than Vietnamese and Cambodian women. CONCLUSION: This study supports other research on the barriers and health belief differences found among ethnic minority women in the USA. Further, these findings suggest that it is not advisable to collapse ethnic groups into general categories such as 'Asian' when planning cancer control strategies, as differences were found by country of origin.

Liquid chromatography/quadrupole time of flight mass spectrometry (LC/QTOF MS) utilizing electrospray ionization was employed to monitor protein expression in Escherichia coli and Shigella organisms. Comparison with MALDI/TOF-MS revealed more proteins, particularly above 15 kDa. A combination of automated charge state deconvolution, spectral mirroring, and spectral subtraction was used to reveal subtle differences in the LC/MS data. Reproducible intact protein biomarker candidates were discovered based on their unique mass, retention time, and relative intensity. These marker candidates were implemented to differentiate closely related strain types, (e.g., two distinct isolates of E. coli O157:H7) and to correctly identify unknown pathogens. This LC/MS approach is less labor-intensive than pulsed-field gel electrophoresis, affords greater specificity than real-time PCR, and requires no primers or antibodies. Additionally, this approach would be beneficial during outbreaks of foodborne disease or bioterrorism investigations by complementing methods typically used in diagnostic microbiology laboratories.

Improved diagnostics remains a fundamental goal of biomedical research. This study was designed to assess cytokine biomarkers that could predict bone loss (BL) in localized aggressive periodontitis. 2,058 adolescents were screened. Two groups of 50 periodontally healthy adolescents were enrolled in the longitudinal study. One group had Aggregatibacter actinomycetemcomitans (Aa), the putative pathogen, while the matched cohort did not. Cytokine levels were assessed in saliva and gingival crevicular fluid (GCF). Participants were sampled, examined, and radiographed every 6 months for 2-3 years. Disease was defined as radiographic evidence of BL. Saliva and GCF was collected at each visit, frozen, and then tested retrospectively after detection of BL. Sixteen subjects with Aa developed BL. Saliva from Aa-positive and Aa-negative healthy subjects was compared to subjects who developed BL. GCF was collected from 16 subjects with BL and from another 38 subjects who remained healthy. GCF from BL sites in the 16 subjects was compared to healthy sites in these same subjects and to healthy sites in subjects who remained healthy. Results showed that cytokines in saliva associated with acute inflammation were elevated in subjects who developed BL (i.e., MIP-1α MIP-1β IL-α, IL-1β and IL-8; p<0.01). MIP-1α was elevated 13-fold, 6 months prior to BL. When MIP-1α levels were set at 40 pg/ml, 98% of healthy sites were below that level (Specificity); whereas, 93% of sites with BL were higher (Sensitivity), with comparable Predictive Values of 98%; p<0.0001; 95% C.I. = 42.5-52.7). MIP-1α consistently showed elevated levels as a biomarker for BL in both saliva and GCF, 6 months prior to BL. MIP-1α continues to demonstrate its strong candidacy as a diagnostic biomarker for both subject and site vulnerability to BL.

Gabapentin, a GABA analogue, is a nonopioid prescribed for seizure control and neuralgic pain. Its abuse for recreational purposes has been increasing in recent years as the number of prescriptions also increases. In our series, we review 104 cases of decedents who tested positive for gabapentin in postmortem blood samples and an additional 53 nonfatal cases of motor vehicle drivers suspected of driving under the influence. In 47.1% of the fatality cases, gabapentin was directly involved in death. Most gabapentin fatalities had several other intoxicants present (opioids, over-the-counter medications, antianxiety, and antidepressant medications). In cases in which gabapentin was determined to be a cause of death, the blood concentrations ranged from 1.1 to 134.0 mg/L. Persons who died of a gabapentin-related drug death were prescribed the drug legitimately 91.4% of the time, with 84.2% of those also having a known prior history of abuse or misuse of prescription medications.

ABSTRACT A microsphere-based immunoassay (MIA) was previously developed that is capable of determining the presence of anti-West Nile (WN) virus or anti-St. Louis encephalitis (SLE) virus immunoglobulin M (IgM) antibodies in human serum or cerebrospinal fluid. The original data set on which the classification rules were based comprised 491 serum specimens obtained from the serum bank at the Division of Vector-Borne Infectious Diseases of the Centers for Disease Control and Prevention (DVBID). The classification rules were used to provide a result and to determine whether confirmatory testing was necessary for a given sample. A validation study was coordinated between the DVBID and five state health laboratories to determine (i) the reproducibility of the test between different laboratories, (ii) the correlation between the IgM-enzyme-linked immunosorbent assay (MAC-ELISA) and the MIA, and (iii) whether the initial nonspecific parameters could be refined to reduce the volume of confirmatory testing. Laboratorians were trained in the method, and reagents and data analysis software developed at the DVBID were shipped to each validating laboratory. Validating laboratories performed tests on approximately 200 samples obtained from their individual states, the collections of which comprised approximately equal numbers of WN virus-positive and -negative samples, as determined by MAC-ELISA. In addition, 377 samples submitted to the DVBID for arbovirus testing were analyzed using the MIA and MAC-ELISA at the DVBID only. For the specimens tested at both the state and the DVBID laboratories, a correlation of results indicated that the technology is readily transferable between laboratories. The detection of IgM antibodies to WN virus was more consistent than detection of IgM antibodies to SLE virus. Some changes were made to the analysis software that resulted in an improved accuracy of diagnosis.

This paper examined association of self-esteem, self-efficacy, and career resilience with the responses of 171 United States Army personnel making the transition to civilian jobs. Specifically, the study addresses whether personality traits are related to the appraisal of the transition from Army to civilian life and to how individuals plan to manage the transition to yield employment success. Self-esteem, self-efficacy, and career resilience were the personality variables examined. Only self-esteem and career resilience were related to harm appraisals of the transition. None of the personality variables were related to use of coping strategies. Limitations of the study and suggestions for research are provided.

Ten patients [9 men and 1 woman; mean age 42.4 +/- 8.5 (+/- SD) years] who were smokers and who suffered the complications of self-induced water intoxication and psychosis (SIWIP) (8 patients with schizophrenic disorders, 1 patient with manic-depressive illness, 1 patient with dementia) are reported. Each patient underwent serial determinations of parameters of water metabolism including plasma and urine osmolality and plasma arginine vasopressin (AVP). The syndrome of inappropriate antidiuresis (SIAD) was found in each patient. Because of the reported effect that cigarette smoking has on antidiuresis, we correlated serum nicotine (NIC) levels with plasma and urine osmolality, AVP, and 24-hour urine volume (24 degrees-UV). We found no relationship between NIC and plasma or urine osmolality, AVP, or 24 degrees-UV. In the presence of SIWIP and SIAD, we infer the limbic-hypothalamic neurotransmitters in these psychotic patients are sufficiently powerful in stimulating both compulsive water drinking and inappropriate release of AVP so as to overshadow any effects that NIC may have on water metabolism.

Fourteen patients receiving multiple antipsychotic drugs in a state mental hospital long-term unit comprised the study sample. They completed a 1-year clinical trial to reduce such drugs to a single antipsychotic agent. Six of the 14 patients were successfully converted to a single antipsychotic drug without clinical deterioration. Eight patients showed marked psychiatric decompensation when converted to single antipsychotic therapy. Factors that may have contributed to this difference are discussed.

A method is presented for simultaneous gas chromatographic determinations of cocaine end benzoylecgonine in biological fluids and tissues. The method involves an extraction cleanup and elkylation of benzoylecgonine using phase-transfer catalysis by tetrahexylammonium chloride. Data regarding the distribution of cocaine end benzoylecgonine in postmortem samples ore presented, and evidence is presented for the detection of cinnamoylcocaine and cinnamoylecgonine in fluids from some cocaine abusers.

INTRODUCTION: We report a case of digoxin-like toxicity because of ingestion of foraged plants. This patient presented with nausea, vomiting, bradycardia, and hypotension after ingesting Veratrum viride (false hellebore). The patient's serum specimen demonstrated a positive digoxin level (0.38 ng/mL) measured by a clinical tubidimetric immunoassay. We hypothesize that steroidal alkaloid compounds contained in V. viride cross-react with the Multigent Digoxin immunoassay reagent antibodies. RESULTS: Plant extracts from V. viride demonstrated cross-reactivity to Multigent reagent antibodies but did not bind therapeutic DigiFab antibodies. Gas chromatography/mass spectrometry analyses identified several steroidal alkaloid compounds present in the V. viride extracts: jervine, ribigirvine, solanidine, and veratraman. CONCLUSIONS: This study indicates that compounds extracted from V. viride can cross-react with a clinical Digoxin immunoassay. Yet these extracts did not bind DigiFab antibody fragments used for therapeutic intervention. Providers should not unnecessarily administer DigiFab fragments as an antidote in symptomatic V. viride toxic patients.

Automated immunoaffinity solid-phase extraction followed by liquid chromatography-tandem mass spectrometry and chemical analogue internal standardization is employed to detect and quantify the aflatoxins AFB(1), AFB(2), AFG(1), AFG(2), and the metabolites AFM(1) and AFP(1) in urine. The dynamic range of the method is nearly three orders of magnitude with limits of detection in the low femtogram on column range. The method was validated over a 12-day period by eight analysts. This method is suitable for agricultural, forensic, and public health laboratories during an accidental outbreak or a chemical terrorism event where a rapid and accurate diagnosis of aflatoxicosis is needed.

James C. Creech, Jay Corzine, Lin Huff-Corzine; Theory Testing and Lynching: Another Look at the Power Threat Hypothesis, Social Forces, Volume 67, Issue 3, 1 M

Competition law has been used to target several practices by large online platforms, like Google, Amazon, and Facebook (Meta) through the prohibition against abuse of dominance in Article 102 Treaty of the Functioning of the European Union (TFEU).1 Some of these decisions have already been successfully defended in the Court of Justice of the European Union, but the efficiency of the remedies they have imposed has been questioned.2 A handful of large digital platforms still wield substantial economic and political power, and they are perceived as facing little competition. Moreover, some platforms are effectively unavoidable when navigating digital markets. Even though the European Commission has successfully defended cases of abuse of dominance under Article 102 of the Treaty of the Functioning of the European Union against online platforms in the European Court of Justice, it has been questioned how efficient the imposed remedies have been in restoring competition in these digital markets. Based on an interpretation of the limitations to remedy design imposed by the principles of proportionality, necessity, and effectiveness, this article argues that there are three factors that are relevant when considering breakups for systematic non-compliance under Article 18 of the Digital Markets Act. The three key factors for evaluating whether divestiture is an appropriate remedy in case of systematic non-compliance by a gatekeeper are identified as follows: (i) whether it concerns repeated infringement of the same or of several different obligations; (ii) the type of obligations the non-compliance concerns; and (iii) the relative costs and benefits in the specific platform market. The analysis of the conditions for imposing divestiture as a remedy under the Digital Markets Act makes an important contribution to a little-explored enforcement aspect of this new Regulation. On this background, the discussion of whether big tech giants like Google, Amazon, or Meta (Facebook) should be broken up to ensure fairer and more competitive markets resurfaces periodically. Breakups of large companies as a remedy for anticompetitive behaviour are one of the most controversial competences under competition law, and such measures are rarely used outside of merger control. In the USA, Senator Elizabeth Warren has been in favour of more rigorous antitrust enforcement, including breakups, as have proponents of the New Brandeis movement like Lina Khan and Tim Wu.3 The breakup of Standard Oil shaped American antitrust law, and even though there have been few such divestitures in later years, it is still a tool that can be revived. In the USA, this could happen through the newly filed lawsuit against Google’s advertisement technology services.4 In the EU, on the other hand, breakups have rarely been as a remedy in abuse of dominance cases under Article 102 such as breakups, are more and a in the Competition has it that breakups are a of competition law have on digital platforms that technology like and an of new to of online and the of the Digital Markets Act to the for platform markets by for large digital platforms that are a new for the of and digital in for and The on but the Commission can or remedies in cases of systematic infringement of the little has been to the of breakups as a remedy to ensure the and such remedies in efficient enforcement of the efficient enforcement is a for the efficiency of the new to ensure a and of competition in these markets. 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INTRODUCTION: Long pulse width stimulation (LPWS; 120-150 ms) has the potential to stimulate denervated muscles and to restore muscle size in denervated people with spinal cord injury (SCI). We will determine if testosterone treatment (TT)+LPWS would increase skeletal muscle size, leg lean mass and improve overall metabolic health in persons with SCI with denervation. We hypothesise that the 1-year TT+LPWS will upregulate protein synthesis pathways, downregulate protein degradation pathways and increase overall mitochondrial health. METHODS AND ANALYSIS: Twenty-four male participants (aged 18-70 years with chronic SCI) with denervation of both knee extensor muscles and tolerance to the LPWS paradigm will be randomised into either TT+neuromuscular electrical stimulation via telehealth or TT+LPWS. The training sessions will be twice weekly for 1 year. Measurements will be conducted 1 week prior training (baseline; week 0), 6 months following training (postintervention 1) and 1 week after the end of 1 year of training (postintervention 2). Measurements will include body composition assessment using anthropometry, dual X-ray absorptiometry and MRI to measure size of different muscle groups. Metabolic profile will include measuring of basal metabolic rate, followed by blood drawn to measure fasting biomarkers similar to hemoglobin A1c, lipid panels, C reactive protein, interleukin-6 and free fatty acids and then intravenous glucose tolerance test to test for insulin sensitivity and glucose effectiveness. Finally, muscle biopsy will be captured to measure protein expression and intracellular signalling; and mitochondrial electron transport chain function. The participants will fill out 3 days dietary record to monitor their energy intake on a weekly basis. ETHICS AND DISSEMINATION: The study was approved by Institutional Review Board of the McGuire Research Institute (ID # 02189). Dissemination plans will include the Veteran Health Administration and its practitioners, the national SCI/D services office, the general healthcare community and the veteran population, as well as the entire SCI community via submitting quarterly letters or peer-review articles. TRIAL REGISTRATION NUMBER: NCT03345576.

Sanctioned trauma center designation began in the late 1970's to improve hospital capabilities to care for injured patients. Guided by criteria established by the American College of Surgeons Committee on Trauma and led by surgeons dedicated to improving trauma care, many states focused early on the quality of care issue only to later struggle with the political consequences that followed the designation process. Institutional commitment to trauma care was often stated but seldom measured. Unlike the designation process with its strong emphasis on capabilities assessment, the verification process focused on performance documentation. Confirmation was sought in response time of key personnel, completeness of registry database, and trauma death audits. Trauma Committee minutes were reviewed and prehospital personnel interviewed to confirm institutional involvement in paramedic education and overall EMS system design. Other areas of documentation included trauma education at all levels, research, nursing audits, and outreach programs. We conclude that trauma center designation and verification are both essential and complementary. Effective trauma system performance requires trauma center designation plus a verification process to confirm institutional commitment of these resources for optimal care of the injured patient.

A liquid chromatographic method for the quantitation of thiopental in blood and tissues is presented. Quantitation in blood utilizes a single step dichloromethane extraction at pH 5.5. After mixing and centrifugation, the organic layer is evaporated to dryness at 40 degrees C and the residue reconstituted with methanol. Tissue extraction includes an alkaline clean-up step followed by re-extraction with dichloromethane after acidification. Either of two 10 mu columns can be used: a C8 or a C18 column. The mobile phase was methanol:water (60:40) at a flow of 2 mL/min. The wavelength of detection was 290 nm. Thiopental can be detected to 1 mg/L using this procedure, and no interferences with other acidic or neutral drugs were found.