Exposure to dogs in infancy, and especially around the time of birth, is associated with changes in immune development and reductions in wheezing and atopy. These findings are not explained by exposure to endotoxin, ergosterol, or muramic acid.

The lungs of patients with cystic fibrosis (CF) are colonized initially by Pseudomonas aeruginosa, which is associated with progressive lung destruction and increased mortality. The pathogenicity of P. aeruginosa is caused by a number of virulence factors, including exotoxin A (ETA) and the type III cytotoxins (ExoS, ExoT, ExoU, and ExoY). P. aeruginosa contacts the plasma membrane to deliver type III cytotoxins through a channel formed by PopB, PopD, and PcrV; ETA enters mammalian cells via receptor-mediated endocytosis. The Wisconsin CF Neonatal Screening Project is a longitudinal investigation to assess the potential benefits and risks of newborn screening for CF; the project was the source of serum samples used in this study. Past studies evaluated the longitudinal appearance of antibodies to ETA and elastase and P. aeruginosa infections in patients with CF. The current study characterized the longitudinal appearance of antibodies to components of the type III system in children with CF. Western blot analyses showed that serum antibodies to PopB, PcrV, and ExoS were common. Longitudinal enzyme-linked immunosorbent assays determined that the first detection of antibodies to pooled ExoS/PopB occurred at a time similar to those of detection of antibodies to a P. aeruginosa cell lysate and the identification of oropharyngeal cultures positive for P. aeruginosa. This indicates that children with CF are colonized early with P. aeruginosa expressing the type III system, implicating it in early pathogenesis, and implies that surveillance of clinical symptoms, oropharyngeal cultures, and seroconversion to type III antigens may facilitate early detection of P. aeruginosa infections.

Storm direction modulates a hydrograph's magnitude and duration, thus having a potentially large effect on local flood risk. However, how changes in the preferential storm direction affect the probability distribution of peak flows remains unknown. We address this question with a novel Monte Carlo approach where stochastically transposed storms drive hydrologic simulations over medium and mesoscale watersheds in the Midwestern United States. Systematic rotations of these watersheds are used to emulate changes in the preferential storm direction. We found that the peak flow distribution impacts are scale‐dependent, with larger changes observed in the mesoscale watershed than in the medium‐scale watershed. We attribute this to the high diversity of storm patterns and the storms' scale relative to watershed size. This study highlights the potential of the proposed stochastic framework to address fundamental questions about hydrologic extremes when our ability to observe these events in nature is hindered by technical constraints and short time records.

BackgroundHypertension (HTN) is the most prevalent cardiovascular disease (CVD) risk factor among adults with rheumatic conditions. However, we found that blood pressures were addressed in <1/3 of rheumatology visits, even when severely elevated (≥160/100 mmHg). At this range, only 11 patients need to be treated for HTN to prevent one CVD event. In primary care, HTN protocols executed by nurses (RNs) or medical assistants (MAs) during vital sign assessment have improved control of high blood pressure (BP). Yet, such protocols have not been tested in rheumatology clinics.ObjectivesOur objective was to study the feasibility and impact of an intervention using a staff HTN protocol to facilitate timely (<4 wks per Medicare quality measure) primary care follow-up for patients with high blood pressures at rheumatology visits.MethodsWe conducted a pre-post study in three academic rheumatology clinics. All eligible adult (≥18 years-old) rheumatology visits with BP ≥140/90 mmHg (12/2014–5/2015) were compared to pre-intervention visits (2012–9/2014). Our multi-dimensional intervention included: (1) educating staff on HTN, rheumatologic diseases, and CVD risk, (2) electronic health record (EHR) alerts for staff to re-measure BPs if ≥140/90 and 3) cuing brief patient education and scheduling primary care follow-up if 2nd BP ≥140/90, and (4) monthly audit and feedback with staff about performance. We assessed timely primary care follow-up of high BPs among patients who received primary care in our system using EHR data.We performed multivariable logistic regression and compared the odds (OR, 95%CI) of timely primary care follow-up before and during intervention, while controlling for baseline socio-demographics, comorbidities, utilization, and clinic.ResultsWe compared 689 intervention period visits to 4,683 pre-intervention visits with BPs ≥140/90. Patient groups were comparable before and during intervention. Staff initiated BP re-measurement in 80% of eligible visits during intervention months 4–6, compared to <1% pre-intervention; overall improvement 60%, p<0.001. More patients received timely primary care follow-up for HTN during the intervention, (44%, vs 29% before, p=0.0003). Multivariable analysis showed that eligible visits during the intervention had two-fold higher odds of timely follow-up compared to pre-intervention, OR 2.1, 1.4–3.0 (p<0.0001). We observed positive associations between timely follow-up and race (black vs. white OR 1.7, 1.1–2.5) and diabetes (vs. no diabetes OR 1.3, 1.01–1.6) post intervention.ConclusionsOur intervention was feasible for usual rheumatology clinic staff and it doubled rates of timely BP follow-up. Future studies should examine this intervention in other rheumatology clinics, and its impact on HTN control to reduce CVD risk in rheumatology patients.Disclosure of InterestC. Bartels Grant/research support from: Independent Grants for Learning and Change (Pfizer), E. Ramly: None declared, H. Johnson: None declared, P. McBride: None declared, Z. Li: None declared, Y. Zhao: None declared...

No abstract