Explore the vast range of titles available.

Sam Childers is a drug-dealing criminal who undergoes an astonishing spiritual transformation and makes a life-changing decision to travel to war-torn East Africa. After witnessing unspeakable horrors faced by innocent children, he vows to save them at any cost, including his own safety. Childers begins waging a relentless battle against the territory's renegade militia, leading harrowing missions behind enemy lines to rescue kidnapped orphans and restore peace to their lives and eventually his own.

The sensitivity of the honey bee, Apis mellifera L. (Hymeonoptera: Apidae), brain volume and density to behavior (plasticity) makes it a great model for exploring the interactions between experience, behavior, and brain structure. Plasticity in the adult bee brain has been demonstrated in previous experiments. This experiment was conducted to identify the potentials and limitations of MicroCT (micro computed tomograpy) scanning “live” bees as a more comprehensive, non-invasive method for brain morphology and physiology. Bench-top and synchrotron MicroCT were used to scan live bees. For improved tissue differentiation, bees were fed and injected with radiographic contrast. Images of optic lobes, ocelli, antennal lobes, and mushroom bodies were visualized in 2D and 3D rendering modes. Scanning of live bees (for the first time) enabled minimally-invasive imaging of physiological processes such as passage of contrast from gut to haemolymph, and preliminary brain perfusion studies. The use of microCT scanning for studying insects (collectively termed ‘diagnostic radioentomology’, or DR) is increasing. Our results indicate that it is feasible to observe plasticity of the honey bee brain in vivo using diagnostic radioentomology, and that progressive, real-time observations of these changes can be followed in individual live bees. Limitations of live bee scanning, such as movement errors and poor tissue differentiation, were identified; however, there is great potential for in-vivo, non-invasive diagnostic radioentomology imaging of the honey bee for brain morphology and physiology.

Patients with IBD are at increased risk for osteopenia due to malabsorption, chronic inflammation, and corticosteroid therapy. Pediatric IBD patients are at a greater risk than the general population for low vitamin D levels, which can contribute to osteopenia. Although a lower limit of 20 ng/mL for vitamin D 25OH levels is still considered indicative of vitamin D sufficiency in children, data in adults suggests a higher cutoff of 32 ng/mL.MethodsA baseline, IRB-approved, retrospective chart review of 168 active pediatric IBD patients at Penn State Hershey Children's Hospital was completed in March 2013. IBD patients were considered “screened” for vitamin D levels if their level had been measured in the previous 12 months. “Treatment” was defined as documentation that vitamin D supplementation was started or increased after the level was checked and found to be low. Our definition of vitamin D sufficiency was ≥30ng/mL. Within 3 months of the chart review, 2 interventions were conducted in an attempt to improve monitoring and treatment rates. An educational session regarding current Pediatric IBD vitamin D screening rates at Penn State Hershey and the importance of vitamin D supplementation was presented at a Pediatric Gastroenterology faculty meeting. An outpatient IBD laboratory order set, that included a vitamin D level, was created. A repeat retrospective chart review was completed on the 168 IBD patients twelve months after these interventions were implemented.ResultsThe baseline chart review found that 65% (110) had a vitamin D level recorded at any time in the past, and 54% (91) had their vitamin D level checked in the prior year. Of those patients who had their vitamin D level checked in the prior year, 54% (59) had a level ≥30 ng/mL and 46% (51) had a level <30 ng/mL. Of those patients with a vitamin D level <30 ng/mL, 83% (42) were on vitamin D supplementation. The repeat chart review demonstrated an improvement in screening with 10 additional patients having documented vitamin D levels who did not have vitamin D levels documented previously. 71% (120) had a vitamin D level recorded at any time in the past with 55% (92) having their vitamin D level checked in the prior year. Of those patients who had their vitamin D level checked during this prior year, 61% (73) had a level ≥30 ng/mL and 39% (47) had a level of <30 ng/mL. In those patients with a vitamin D level <30 ng/mL, 96% (45) were on vitamin D supplementation.ConclusionsPediatric gastroenterologists should be screening for vitamin D deficiency in patients with IBD at least annually. The 2 interventions in this study, an educational session with Pediatric GI faculty and the introduction of a new IBD laboratory order set, improved the vitamin D screening rate among the cohort of patients from 65% to 71% of patients who had a documented vitamin D level. Finally, of those patients with deficient or insufficient vitamin D levels (<30 ng/mL) an increase from 83% to 96% of patients were started on vitamin D supplementation.

Anxiety and depression have been shown to be increased in IBD patients. Screening for anxiety and depression is recommended for pediatric IBD patients. Impaired mental health can hinder physical recovery from disease. Psychology support in a multidisciplinary IBD clinic can help identify and address these issues. Unfortunately, cost of mental health care is one of the barriers to provision of psychology services to IBD patients. Our center has been able to integrate a clinical psychologist into our multidisciplinary pediatric IBD clinic. We describe our experience with billing codes and reimbursement, with the goal of sharing the knowledge for other IBD clinics to be able to incorporate psychology services into their clinics.MethodsOver the course of a 7 month pilot trial, our psychology provider (T.Z.) has seen a median of 7 (range 3–9) patients per half-day pediatric IBD clinic session. T.Z spends 15 to 20 minutes with each patient, reviewing the results of their anxiety (SCARED Child version) and depression (CES-DC) screens. He provides coping strategies as appropriate. He makes referrals for outpatient behavioral health (e.g., individual, family or group), if needed. The billing codes used are health and behavioral assessment codes including 96150, 96152, 96154 and 96151. The reports generated by our billing department provided type of primary insurance (government, commercial or self-pay) and number of days until reimbursement for patients seen in the monthly pediatric IBD clinic from January 2015 through July 2015.ResultsOf 40 patients seen by our clinical psychologist from January 2015 through July 2015, reimbursement was received for 26 patients (65%). Of patients for whom no reimbursement was received, 5/14 (35.7%) had commercial insurance. 21/40 (52.5%) of the patients had commercial insurance with the rest having government insurance. Median time from appointment to payment was 26 days for commercial insurance with range of 14 to 113 days. For patients with government insurance, median time to payment was 23 days with range of 13 to 51 days.ConclusionsThe need for psychology care for IBD patients is recognized. One of the barriers is reimbursement for the mental health provider. By using health and behavioral assessment codes including 96150, 96152, 96154 and 96151, our clinical psychologist has been able to bill for his services and receive some reimbursement from both commercial and government insurance. We believe that addressing the issue of reimbursement and including psychology in our IBD clinic has improved our patients' access to mental health services, an important component in taking care of the whole patient. Psychology providers can be successfully integrated into a multidisciplinary IBD clinic and reimbursed for the care they provide. We hope that other centers will find our model useful in helping take care of their patients.

American foulbrood (AFB), caused by Paenibacillus larvae, is a devastating disease in honeybees. In most countries, the disease is controlled through compulsory burning of symptomatic colonies causing major economic losses in apiculture. The pathogen is endemic to honeybees world-wide and is readily transmitted via the movement of hive equipment or bees. Molecular epidemiology of AFB currently largely relies on placing isolates in one of four ERIC-genotypes. However, a more powerful alternative is multi-locus sequence typing (MLST) using whole-genome sequencing (WGS), which allows for high-resolution studies of disease outbreaks. To evaluate WGS as a tool for AFB-epidemiology, we applied core genome MLST (cgMLST) on isolates from a recent outbreak of AFB in Sweden. The high resolution of the cgMLST allowed different bacterial clones involved in the disease outbreak to be identified and to trace the source of infection. The source was found to be a beekeeper who had sold bees to two other beekeepers, proving the epidemiological link between them. No such conclusion could have been made using conventional MLST or ERIC-typing. This is the first time that WGS has been used to study the epidemiology of AFB. The results show that the technique is very powerful for high-resolution tracing of AFB-outbreaks.

In this study, the potential of the so-called black-box optimisation (BBO) to increase the efficiency of simulation studies in power engineering is evaluated. Three algorithms (“Multilevel Coordinate Search” (MCS) and “Stable Noisy Optimization by Branch and Fit” (SNOBFIT) by Huyer and Neumaier and “blackbox: A Procedure for Parallel Optimization of Expensive Black-box Functions” (blackbox) by Knysh and Korkolis) are implemented in MATLAB and compared for solving two use cases: the analysis of the maximum rotational speed of a gas turbine after a load rejection and the identification of transfer function parameters by measurements. The first use case has a high computational cost, whereas the second use case is computationally cheap. For each run of the algorithms, the accuracy of the found solution and the number of simulations or function evaluations needed to determine the optimum and the overall runtime are used to identify the potential of the algorithms in comparison to currently used methods. All methods provide solutions for potential optima that are at least 99.8% accurate compared to the reference methods. The number of evaluations of the objective functions differs significantly but cannot be directly compared as only the SNOBFIT algorithm does stop when the found solution does not improve further, whereas the other algorithms use a predefined number of function evaluations. Therefore, SNOBFIT has the shortest runtime for both examples. For computationally expensive simulations, it is shown that parallelisation of the function evaluations (SNOBFIT and blackbox) and quantisation of the input variables (SNOBFIT) are essential for the algorithmic performance. For the gas turbine overspeed analysis, only SNOBFIT can compete with the reference procedure concerning the runtime. Further studies will have to investigate whether the quantisation of input variables can be applied to other algorithms and whether the BBO algorithms can outperform the reference methods for problems with a higher dimensionality.

Studies of transition readiness in young adults with inflammatory bowel diseases (IBD) suggest that patients often lack disease-specific knowledge and are not confident in their ability to manage their IBD. This can lead to worsening disease activity and increased healthcare utilization. It is crucial that pediatric IBD healthcare providers prepare young adults, but it is unclear how well they utilize transition readiness tools. To address this, the Transition of Care Innovation Community within ImproveCareNow, a pediatric IBD quality improvement collaborative, designed a survey to identify and measure how pediatric IBD centers assess transition readiness and implement the transfer of care.MethodsPediatric gastroenterology centers participating in ImproveCareNow were invited to complete a 27-item electronic survey via REDCap. One medical provider completed the survey for each institution. The chi-square test was used for statistical analysis and P < 0.05 was considered statistically significant.ResultsOf the 75 ImproveCareNow participating centers, 49 centers (65%) completed the survey. Seventeen of 49 centers (35%) used a transition checklist with their IBD patients. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) transition checklist and the Transition Readiness Assessment Questionnaire (TRAQ) were the 2 most common transition tools used. Sixty-five percent of centers using a transition checklist start to administer the checklist to patients between 12 and 14 year old. In the centers with a formal IBD clinic, 43% of centers used a transition checklist, compared with 24% of centers without an IBD clinic (P = 0.166). Of the 16 centers with a social worker and/or psychologist in their IBD clinic, 8 centers (50%) used a transition checklist, compared with 4 (33%) of the 12 centers without these providers (P = 0.378). Age was the most common factor (96% of centers) influencing when to transfer a patient to adult gastroenterology. In the process of transferring a patient from pediatric to adult gastroenterology providers, 73% of centers reported a hand-off of information at the time of transfer. Centers with an IBD clinic were more likely to report this hand-off than those without a formal IBD clinic (89% versus 52%, P = 0.004). An adult gastroenterologist was involved in a formal Transition clinic in 14% of center with an IBD clinic, compared with 5% of the centers without an IBD Clinic (P = 0.034).ConclusionsOur survey of 49 ImproveCareNow centers is the first study to assess actual transitioning and transfer practices in pediatric IBD care. Centers with an established IBD clinic that also had a social worker and/or psychologist used a transition checklist more often than centers without these multidisciplinary resources. In addition, centers with an IBD clinic were more likely to utilize a formal transfer of care process. These findings support previous studies, which show that successful transition and self-management require a multidisciplinary approach to transition planning that includes behavioral medicine and social work.

Malpighamoeba mellificae is a protozoan that infects the Malpighian tubules of honey bees. The amoebae, ingested as cysts, develop into trophozoites that feed upon tubule epithelia. The resulting damage of the Malpighian tubules can induce an imbalance of waste excretion and hemolymph exchange. This causes the so-called amoebiasis disease in adult bees, which may co-occur with Nosema infections. Most reports of this amoeba are from the 1960s and earlier, and knowledge of the disease and its spreading is very poor. The lack of any genetic marker for the species hampers its sensitive identification using molecular tools and gaining knowledge on its epidemiology. Here, we present a diagnostic RT-qPCR assay, consisting of two primers and one probe that were developed based on 18S rRNA sequences of the amoeba, generated with metagenomic sequencing of Malpighian tubules with and without M. mellificae cysts. The assay was initially tested and adjusted with samples microscopically tested for the presence of M. mellificae cysts. Later, it was validated and material with unknown infection status was tested. The sensitive diagnostic Malpighamoeba disease 18S assay is now ready to be applied for honey bee health monitoring purposes and to investigate the prevalence of M. mellificae in more detail.