Wyoming State Department of Health

Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency marked by elevated IgE levels, recurrent skin and pulmonary infections, and immune dysregulation. While typically diagnosed in childhood, adult presentations can occur, often complicated by structural lung disease, opportunistic infections, and malignancies. We report a 37-year-old female with signal transducer and activator of transcription 3 (STAT3)-deficient HIES, diffuse large B-cell lymphoma (DLBCL) in remission, rituximab-induced hypogammaglobulinemia, and recurrent infections, who presented with acute-on-chronic dyspnea. Imaging revealed a large cavitary lesion in the left upper lobe. Despite 30 days of appropriate antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative organisms, her respiratory status deteriorated, necessitating intubation. Subsequent bronchoalveolar lavage and serum galactomannan testing confirmed invasive pulmonary aspergillosis (IPA) as the etiology of her deterioration, prompting combination antifungal therapy. This case highlights the importance of maintaining a broad differential diagnosis in immunocompromised patients with worsening respiratory symptoms despite antibiotics. Early consideration and testing for fungal infections in high-risk populations can prevent diagnostic delay and improve outcomes.

BackgroundAlzheimer's disease and related dementias (ADRD) lead to progressive cognitive and physical decline. ADRD affects over 6 million adults over 65 in the US, with prevalence expected to double by 2050. Management of ADRD requires support from over 11 million unpaid caregivers, many of whom report increased stress, depression, and anxiety.To address the needs of people with dementia (PWD) and their caregivers, Remo Health provides three services on its technological platform: Learn, a digital library of evidence‐based, expert‐reviewed content spanning the dementia journey; Community, a free, online caregiver community that offers 24/7 access to secure, bidirectional communication with dementia experts and others with similar lived experiences; and Clinical Care, interdisciplinary, comprehensive memory care provided via telehealth. This study describes data from caregivers on Remo Community.MethodTo enter the Remo Community forum, caregivers must complete a brief electronic survey. We conducted simple descriptive statistics of recently added questions to better understand demographics, diagnosis and functional status of the PWD, and caregivers’ areas of greatest need.ResultDuring the study time period (12/9/24 to 1/24/25), 1,013 caregivers across 39 states newly signed up for Community and total members on Community reached 13,098. Most (69%) completed the new onboarding survey and reported mean age as 75 years (SD 12.5). “Alzheimer's” was the most commonly reported diagnosis (33%), followed by “no diagnosis” (26%). Perceived functional status ranged from “independent” (18%) to “dependent” (26%). Among those with “no diagnosis,” 21% reported the PWD is “dependent” for activities of daily living. Caregivers expressed their top needs as information on “caregiver coping and support” (42%), “brain health and wellbeing” (13%), and “dementia basics” (11%).ConclusionIn contrast to other studies, we found that older caregivers of PWD across the US can complete electronic surveys and seek information in online forums, particularly around coping with their responsibilities and understanding basic information about cognitive disorders. Results revealed dementia diagnosis must be prioritized, as caregivers reported many undiagnosed individuals they care for are functionally dependent. Future studies will incorporate clinical data and longitudinally examine the benefits of Remo Community for both caregivers and PWD.

Abstract The decarbonization of Utah’s coal-fired power plants is essential for achieving the state and federal climate policy targets, including the Utah Roadmap objective of a 50% reduction in greenhouse gas emissions by 2030 and the U.S. Environmental Protection Agency’s (EPA) proposal to achieve a 90% reduction in CO₂ emissions from power generation by 2035. This study presents a comprehensive parametric analysis to evaluate the technical, economic, and regulatory implications of retrofitting Utah’s coal-fired power plants with carbon capture and storage (CCS). Three coal-fired power plants were examined, collectively consisting of six electric generating units (EGUs). The Bonanza unit was selected as a case study to explore the influence of different operational parameters, policy frameworks, and economic factors. Three CO₂ capture technologies including: amine-based absorption, solid adsorption, and membrane separation are assessed. Among these, amine-based absorption demonstrates superior performance, offering higher net power output, improved thermal efficiency, and lower costs across all evaluated economic metrics. Capture efficiency emerged as a critical parameter in the analysis, increasing CO₂ capture rate from 85% to 95% significantly reduced emissions and the cost per ton of CO₂ captured, but also led to higher parasitic energy loads, cooling water demand, and levelized cost of electricity (LCOE). The impact of plant operating mode showed that ultra-supercritical systems delivered higher efficiency and lower emissions, whereas subcritical plants were more economically viable due to lower capital costs. Incorporating a natural gas auxiliary system improved net plant efficiency and water use but increased the LCOE due to high gas prices and limited operational lifespan in Utah. Sensitivity to coal price was linear, with a 25% reduction in coal cost significantly improving LCOE and CO₂ mitigation economics. Capacity factor had a strong influence, with higher utilization rates substantially lowering all cost metrics. From a policy perspective, imposing taxes on CO₂ emissions raised project costs; a breakeven tax of ~$83/ton of CO2 was needed to make CCS competitive with the base/existing case (Without CCS). In contrast, the 45Q federal tax credit had a strong positive effect: a $20/ton credit enabled CCS feasibility for most EGUs, while credits above $60/ton led to negative CO₂ avoidance costs. The results confirm that CCS viability hinges not on any single factor but on the alignment of capture technology, efficiency, fuel economics, and incentive structures. A hybrid policy combining carbon emission taxation with targeted tax credits as well as capturing efficiencies technological advancements presents the most viable path to enabling deep decarbonization in Utah’s aging coal fleet.

Issue: There continues to be much confusion among Vietnam and Vietnam-Era veterans, Non-Governmental Organizations, the Department of Defense, the Department of Veterans Affairs, and others as to the differences between the uses of military “tactical” herbicides versus the military use of “commercial” herbicides during the Vietnam War. If veterans were presumptively exposed to tactical herbicides while in military service in Vietnam, 9 January 1962 – 7 May 1975, they were entitled for health care for any of 19 different conditions “presumed to be service connected.” Health care and compensation were provided by the Agent Orange Act of 1991. Approximately 50,000 United States Air Force Veterans served at Royal Thai Airbases in the Kingdom of Thailand during the Vietnam War, especially during the years 1965-1971. Thailand veterans were previously eligible for health care for any injuries they incurred during their service. However, they were not eligible for conditions under the Agent Orange Act. Nevertheless, there have been numerous allegations that US Thailand veterans were indeed exposed to the wide-spread use of the same tactical herbicides, e.g. Agents Orange, White, and Blue, that had routinely been used in Vietnam to control unwanted vegetation. In 2022, the US Congress passed the PACT Act that permitted veterans who served in Thailand and Guam during the Vietnam War to be eligible for health care and compensation for 26 different conditions “presumed to be service connected” to their exposure to Agent Orange and other tactical herbicides while in service in Thailand during the period 9 January 1962 to 30 June 1976. The Congress made the decision despite the absence of any evidence from available historical records or the absence of any knowledge about the use of “commercial herbicides” during the Vietnam War. Thus, the issue is whether Thailand veterans were exposed to tactical herbicides or commercial herbicides and has that exposure impacted their long-term health. Background: The first use of tactical herbicides was on 7 January 1962 in Operation RANCHHAND in South Vietnam. Approximately 74.2 million L of Agents Orange, White and Blue were sprayed on jungles, mangroves, savannas and for crop denial. Records confirmed that limited quantities of tactical herbicides were stored in Thailand for missions by RANCH HAND in Laos. When Thailand joined the Allied Forces in the Vietnam War in September 1964, the Thai government, under the Rules of Engagement, did not permit tactical herbicides to be used for vegetation control on Royal Thai Airbases. If not tactical herbicides, could commercial herbicides be the explanation for Thailand veteran allegations? Tactical herbicides differed from commercial herbicides in the development and testing of formulations, purchase specifications, guidelines, regulatory oversight, shipment requirements, toxicological evaluations and military record keeping. Findings: Recently identified procurement records confirm that at least 262, 800 L of commercial low volatile 2,4-D and 2,4,5-T herbicides were shipped and approved for vegetation control on four airbases in Vietnam, 1962-1971. Records confirm that the total volume of low volatile 2,4,5-T shipped to Thailand was 29,120 L. Distribution to the Royal Thai Airbases and subsequent vegetation control was the responsibility of Pacific Architect & Engineers, a private company trained as commercial herbicide applicators for both Vietnam and Thailand. Dioxin (TCDD) analysis confirmed that the low volatile 2,4,5-T was ~ 1 ppm, and the rate of application, ~ 2.4 kg/ha, was similar to the same formulation sprayed in 1966 on 2.3 million ha on rangeland and pasture in the United States. It was also a choice herbicide for control of unwanted vegetation on most of the Department of Defense’s more 500 bases worldwide. Policy Considerations: The Congress of the United States, the Department of Veterans Affairs, and the Thailand Veterans simply refused to accept the reality that little or no exposure to either tactical or commercial herbicides or TCDD ever occurred on Royal Thai Airbases in Thailand. The dilemma for the DVA is that to recognize Thailand veterans for commercial herbicide exposure fails to acknowledge that millions of military men and women were on hundreds of military bases worldwide that were sprayed with the same low volatile 2,4-D and 2,4,5-T commercial herbicides from 1962 -1972.

We are three educators working in rural space. We came together to craft a story of early-career teachers’ experiences working in an intermountain western boomtown. To uncover the unique challenges of this context, we explored themes related to schooling in communities undergoing economic dislocation represented through master narratives of boom and bust. Teachers confront these challenges in both phases of the cycle. Here we tell a story about teaching in the boom, one that nests within the boosterism associated with the economic good times. Those good times, however, are ever shadowed by awareness of the consequences of the inevitable bust. These economic trends originate in places far from the impacted communities. Early-career teachers, exposed to in-flux classrooms, often bear this weight. From that experience, we present a resultant protean rural narrative, and we hope that through its telling we may share unique insights that resonate among other educators, regardless of setting. Keywords: rural, early-career teachers, boom-bust, narrative

IntroductionIn patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke, higher recanalization scores using the Thrombolysis In Cerebral Ischemia (TICI) score were demonstrated to predict EVT outcomes. Successful recanalization is commonly used to report TICI 2B score or higher corresponding to recanalization of at least 50% of the target territory. In this work, we study the risk-benefits associated with continued attempt to achieve higher TICI score beyond TICI 2B as function of procedure time.MethodsThis is a retrospective registry-based study of patients undergoing EVT for AIS at 30 centers internationally. Patients were reviewed for their demographics, admission deficits, and technical outcomes. The cohort was split into 4 groups: (1) patients with TICI 2B recanalization without attempts to enhance score, (2) patients with TICI 2B recanalization for whom additional attempts were made for higher score, and (3) patients with TICI 0–2A. Primary outcome is modified Rankin Score (mRS) at 90 days, secondary outcomes included improvement in post-procedural National Institute of Health Stroke Scale (NIHSS), final TICI score, and symptomatic intracranial hemorrhage (sICH). Successful recanalization was defined as TICI-2B or more, and complete recanalization was defined as TICI-3. Logistic regression models were used to study outcome predictors while controlling for admission and technical covariates using step-wise backpropagation to avoid bias in variable selection. Adjusted odds ratios (aOR) were reported.ResultsA total of 3071 patients were included in this study with mean age of 68, 48% females, and 89% rate of successful recanalization. We first compared groups (1) and (2) using logistic regression models, patients with additional attempts to improve TICI 2B score (Group 2) were associated with higher odds of achieving TICI 3 (aOR=6.8,p<0.001), but had significantly lower odds of good outcome (mRS 0–2) (aOR=0.73,p<0.001) without impact on rates of sICH. When comparing patients in group (2) to patients without successful recanalization (group 3), continued EVT past TICI-2B did not result in higher odds of good outcome compared to those with TICI1–2A (aOR=1.17,p=0.41). Using sensitivity analysis, we demonstrate that in patients who achieve TICI-2B within 15 min of puncture, additional attempts at improving the score was associated with higher odds of TICI-3 (aOR=35,p<0.01) without negative influence on functional outcome.(aOR=0.96,p=0.89). However, in patients where initial TICI-2B score was attained after 15 min of puncture, further attempts are associated with higher odds of TICI-3 (aOR=6.8,p<0.01) but with significantly lower odds of good outcome (aOR=67,p=0.015). Finally, longer time to conclude EVT procedure after TICI-2B was independently associated with lower odds of good outcome (aOR=0.88,p=0.021).ConclusionsIn patients with successful recanalization who achieved below perfect reperfusion scores, additional recanalization trials carry the cost of worsening outcomes specifically in patients whose initial recanalization required more than 15 min. Future prospective studies are needed to study whether achieving the point of trade-off between achieving perfect recanalization scores and patient outcomes.DisclosuresB. El Baba: None. Y. Zohdy: None. R. Chalhoub: None. B. Howard: None. C. Cawley: None. F. Akbik: None. D. Barrow: None. A. Pabaney: None. F. Tong: None. S. Alkasab: 1; C; Stryker. P. Jabbour: 2; C; Balt, Cerus endovascular, MicroVention, Medtronic. N. Goyal: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra, Siemens. 2; C; Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. 4; C; Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. F. Siddiqui: None. S. Yoshimura: None. M. Park: 5; C; Medtronic. W. Brinjikji: None. C. Maatouk: 2; C; Silk Road, Penumbra, Microvention, Stryker. 3; C; Silk Road, Penumbra. D. Romano: None. D. Altschul: None. R. Williamson: None. M. Moss: None. R. De Leacy: 1; C; Hyprevention, Kaneka Medical, Siemens Healthineers, SNIS foundation. 2; C; Stryker Neurovascular, Imperative Care, Cerenovus, Asahi Intec. 4; C; Synchron, Endostream, Q’Apel, Spartan Micro. 6; C; Editorial Board JNIS. M. Ezzeldin: None. P. Kan: 1; C; U18EB029353–01. 2; C; Stryker Neurovascular, Imperative Care, Microvention. 6; C; Editorial Board JNIS. M. Levitt: 1; C; Stryker, Medtronic. 2; C; Medtronic, Aeaean Advisers. 4; C; Hyperion Surgical, Proprio, Synchron, Cerebrotech, Fluid Biomed, Stereotaxis. 6; C; Travel support: Penumbra, Editorial board, Journal of NeuroInterventional Surgery, Metis Innovative: Adviser. R. Grandhi: None. A. Spiotta: 2; C; Stryker, Terumo, Penumbra, RapidAI. J. Mascitelli: 2; C; Stryker. J. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Department of Defense, Neurosurgery Catalyst. 4; C; NTI, Cognition. A. Alawieh: 6; C; Penumbra.

Highlights RGB trail cams above maize crop collected images every 15 minutes, day and night, to monitor leaf curl. Fractional canopy cover ( fc ,%) was constant for full irrigation but reduced during the day for limited irrigation. Techniques were developed to estimate reductions in water use (i.e., evapotranspiration) using images of fc. Measurements of fc prior to wilting represent transpiration demand ( K cb ), and reductions of fc represent stress ( K s ). Abstract. By differentiating green and non-green pixels of RGB images of crop canopy, the fractional canopy cover (fc,%) can be estimated and subsequently used to estimate crop transpiration demand (e.g., K cb , basal crop coefficient, following FAO-56 methodology). While unstressed maize crops maintain consistent fc through the day, leaves of heat or water stressed crops will curl, thereby reducing the instantaneous fc and the associated transpiration. This paper reports the effects of diurnal leaf curl and subsequent fc reduction on full and limited water treatments of irrigated maize through nadir images obtained every 15 minutes. Results suggest that fc images obtained in the early morning (fc NS ) are typically representative of a non-stressed condition and can be used to estimate K cb . Reduction of fc throughout the day (i.e., fc/fc NS ) was compared to water stress coefficient K s obtained from neutron probe and TDR measurement and showed that fc/fc NS from hours 11 a.m. to 2 p.m. had a high correlation (R 2 = 0.773), indicating that mid-day fractional canopy cover reduction could be used as a proxy for K s . This method creates new opportunities for estimating crop water stress during vegetative growth but also highlights potentially unknown challenges regarding lower resolution remote sensing during the same growth stages. Keywords: Basal crop coefficient, Canopy cover, Crop coefficient, Evapotranspiration, Stomatal conductance, Stress crop coefficient, Transpiration, Water stress.

Abstract Recent MMWR results estimate long COVID prevalence at 6.0% in June 2023, while the percentage of those with COVID reporting long COVID was 11.0%. The 2022 Behavioral Risk Factor Surveillance System addressed COVID (positive test) and long COVID (symptoms lasting ≥3 months) in a population-based sample from each state and DC. Results for 385,617 adults indicated 34.4% had ever had COVID, 21.9% of whom reported long COVID, representing 7.4% of all adults. State rates ranged from 25.4% - 40.8% for COVID and 4.1%- 11.1% for long COVID. Groups with high rates for both included women, younger adults, those with children in the household, plus those reporting obesity, asthma, chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD). Highest adjusted odds ratios for COVID were 2.34 (95% CI 2.20-2.49) for age 18-24 years vs. age 65+ while for long COVID it was 2.81 (2.53-3.13) for 3+ of the 5 conditions. Most frequently reported problems for those with long COVID were fatigue (26.0%), shortness of breath (18.8%), loss of taste or smell (17.2%), and memory problems (9.9%). Results show the need for state-based data and suggest a focus on younger adults is needed to address COVID and long COVID.