Science.gov

Sample records for 30-day postoperative pause

  1. Effects of erythropoietin on posttraumatic place learning in fimbria-fornix transected rats after a 30-day postoperative pause.

    PubMed

    Malá, Hana; Rodriguez Castro, Maria; Dall Jørgensen, Katrine; Mogensen, Jesper

    2007-10-01

    Human recombinant erythropoietin (EPO) has been shown to exert neuroprotective effects following both vascular and mechanical brain injury. Previously, we showed that behavioral symptoms associated with mechanical lesions of the hippocampus are nearly abolished due to EPO treatment. In these studies, the EPO administration took place simultaneously with the infliction of brain injury and the rehabilitation training started 6-7 days postoperatively. In the present study, we tested whether the therapeutic effect of EPO on the acquisition of an allocentric eight-arm radial maze spatial task also manifests itself if the rehabilitative training is postponed. Postoperatively, the animals were left without any specific stimulation for 30 days. The current results show an improved behavioral performance of the EPO-treated lesioned group relative to the saline-treated lesioned group, and confirm EPO's therapeutic effect even in case of postponed rehabilitation. However, compared to the control group, the EPO-treated lesioned group demonstrated an impaired task acquisition. All subjects eventually recovered functionally. Subsequently, the animals were given behavioral challenges during which the cue constellation in the room was changed. The challenges revealed that, although the EPO-treated lesion group had achieved the same level of task proficiency as the control group, the cognitive mechanisms mediating the task performance in the EPO-treated lesion group (as well as in the saline-treated lesion group) were dissimilar from those mediating the task in the control group. Both the EPO-treated and the saline-treated lesion group demonstrated an increased dependency on the original cue configuration. PMID:17970627

  2. Postoperative Morbidity by Procedure and Patient Factors Influencing Major Complications Within 30 Days Following Shoulder Surgery

    PubMed Central

    Shields, Edward; Iannuzzi, James C.; Thorsness, Robert; Noyes, Katia; Voloshin, Ilya

    2014-01-01

    Background: Little data are available to prioritize quality improvement initiatives in shoulder surgery. Purpose: To stratify the risk for 30-day postoperative morbidity in commonly performed surgical procedures about the shoulder completed in a hospital setting and to determine patient factors associated with major complications. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study utilized the National Surgical Quality Improvement Program (NSQIP) database from the years 2005 to 2010. Using Current Procedural Terminology codes, the database was queried for shoulder cases that were divided into 7 groups: arthroscopy without repair; arthroscopy with repair; arthroplasty; clavicle/acromioclavicular joint (AC) open reduction and internal fixation (ORIF)/repair; ORIF of proximal humeral fracture; open tendon release/repair; and open shoulder stabilization. The primary end point was any major complication, with secondary end points of incisional infection, return to the operating room, and venothromboembolism (VTE), all within 30 days of surgery. Results: Overall, 11,086 cases were analyzed. The overall major complication rate was 2.1% (n = 234). Factors associated with major complications on multivariate analysis included: procedure performed (P < .001), emergency case (P < .001), pulmonary comorbidity (P < .001), preoperative blood transfusion (P = .033), transfer from an outside institution (P = .03), American Society of Anesthesiologists (ASA) score (P = .006), wound class (P < .001), dependent functional status (P = .027), and age older than 60 years (P = .01). After risk adjustment, open shoulder stabilization was associated with the greatest risk of major complications relative to arthroscopy without repair (odds ratio [OR], 5.56; P = .001), followed by ORIF of proximal humerus fracture (OR, 4.90; P < .001) and arthroplasty (OR, 4.40; P < .001). These 3 groups generated over 60% of all major complications. Open shoulder

  3. Preventing 30-day readmissions.

    PubMed

    Stevens, Sherri

    2015-03-01

    Preventing 30-day readmissions to hospitals is a top priority in the era of health care reform. New regulations will be costly to health care facilities because of payment guidelines. The most frequently readmitted medical conditions are acute myocardial infarction, heart failure, and pneumonia. The transition from the hospital and into the home has been classified as a vulnerable time for many patients. During this time of transition patients may fail to fully understand their discharge instructions. Ineffective communication, low health literacy, and compliance issues contribute to readmissions. Telehealth and the use of technology may be used to prevent some readmissions. PMID:25680492

  4. 75 FR 45121 - Agency Information Collection Request; 30-Day Public Comment Request; 30-Day Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request; 30-Day Notice... Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human...

  5. Ares I-X 30 Day Report

    NASA Technical Reports Server (NTRS)

    Ess, Bob; Smith, Marshall

    2009-01-01

    This slide presentation represents the 30 day report on the Ares I-X test flight. Included in the review is information on the following areas: (1) Ground Systems, (2) Guidance, Navigation and Control, (3) Roll Response, (4) Vehicle Response, (5) Control System Performance, (6) Structural Damping, (7) Thrust Oscillation, (8) Stage Separation, (9) Connector Assessment, (10) USS Splashdown, (11) Data Recorder and (12) FS Hardware Assessment.

  6. Risk Factors for 30-Day Hospital Readmission among General Surgery Patients

    PubMed Central

    Kassin, Michael T; Owen, Rachel M; Perez, Sebastian; Leeds, Ira; Cox, James C; Schnier, Kurt; Sadiraj, Vjollca; Sweeney, John F

    2012-01-01

    Background Hospital readmission within 30-days of an index hospitalization is receiving increased scrutiny as a marker of poor quality patient care. This study identifies factors associated with 30-day readmission following General Surgery procedures. Study Design Using standard National Surgical Quality Improvement Project (NSQIP) protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient General Surgery procedures at a single academic center between 2009 and 2011. Data were merged with our institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted. Univariate and multivariate analysis was utilized to identify risk factors associated with 30-day readmission. Results 1442 General Surgery patients were reviewed. 163 (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal complaint/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound (p<0.05 for all variables). Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (OR 4.20, 95% CI 2.89–6.13). Conclusions Risk factors for readmission after General Surgery procedures are multi-factorial; however, postoperative complications appear to drive readmissions in

  7. Examining pauses in Alzheimer's discourse.

    PubMed

    Davis, Boyd H; Maclagan, Margaret

    2009-01-01

    This discussion examines how speaker pauses, both filled and silent, are keyed to functions within a conversation and to functions within narration. In Alzheimer's discourse, pause-fillers can be both placeholders and hesitation markers; they may be ohs and ums or longer formulaic phrases. Extracts from the speech of 4 older women from the United States and from New Zealand are reviewed for changes in syntactic complexity, for retention of story components, and for pauses. The extracts illustrate these functions for silent pauses: as word-finding; as planning at word, phrase, and narrative component levels; and as pragmatic compensation as other interactional and narrative skills decrease. PMID:19150969

  8. 75 FR 48971 - 30-Day Notice; Agency Information Collection Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-12

    ... HUMAN SERVICES 30-Day Notice; Agency Information Collection Request AGENCY: Office of the Secretary, HHS. Agency Information Collection Request. 30 Day Public Comment Request. In compliance with the requirement...), Department of Health and Human Services, is publishing the following summary of a proposed collection...

  9. 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis

    PubMed Central

    McNamara, Erin R.; Kurtz, Michael P.; Schaeffer, Anthony J.; Logvinenko, Tanya; Nelson, Caleb P.

    2015-01-01

    Summary Introduction Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures. Objective To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event. Study design We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression. Results There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection(see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score. Discussion The ACS-NSQIPP provides a tool to examine short

  10. Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

    PubMed Central

    Feinberg, Adina E.; Elnahas, Ahmad; Bashir, Shaheena; Cleghorn, Michelle C.; Quereshy, Fayez A.

    2016-01-01

    Background Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes. Results There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion. Conclusion Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients. PMID:27240135

  11. Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery

    PubMed Central

    Kim, Jin; Oh, In-Kyoung; Yoon, Sang-Hee; Lee, Sun-Joo; Kim, Soo-Nyung; Kang, Soon-Beom

    2015-01-01

    Objective To determine the relationship between preoperative hypoalbuminemia and the development of complications after gynecological cancer surgery, as well as postoperative bowel function and hospital stay. Methods The medical records of 533 patients with gynecological cancer surgery at Konkuk University Hospital between 2005 and 2013 were reviewed. Serum albumin level <3.5 g/dL was defined as hypoalbuminemia. All perioperative complications within 30-days after surgery, time to resumption of normal diet and length of postoperative hospital stay, were analyzed. Regression models were used to assess predictors of postoperative morbidity. Results The median age was 49 years (range, 13 to 85 years). Eighty patients (15%) had hypoalbuminemia. Hypoalbuminemic patients had significantly higher consumption of alcohol >2 standard drinks per day, lower American Society of Anesthesiologist score, higher frequency of ascites, and more advanced stage compared with non-hypoalbuminemic patients. Overall complication rate within 30-days after surgery was 20.3% (108 out of 533). Hypoalbuminemic patients were more likely to develop postoperative complications compared to non-hypoalbuminemic patients (34.3% vs. 17.8%, P=0.022), and had significantly longer median time to resumption of normal diet (3.3 [1-6] vs. 2.8 [0-15] days, P=0.005) and length of postoperative hospital stay (0 [7-50] vs. 9 [1-97] days, P=0.014). In multivariate analysis, age >50 (odds ratio [OR], 2.478; 95% confidence interval [CI], 1.310 to 4.686; P=0.005), operation time (OR, 1.006; 95% CI, 1.002 to 1.009; P=0.006), and hypoalbuminemia (OR, 2.367; 95% CI, 1.021 to 5.487; P=0.044) were the significant risk factor for postoperative complications. Conclusion Preoperative hypoalbuminemia in patients with elective surgery for gynecologic malignancy is an independent predictor of 30-days postoperative complications. Identification of this subset and preoperative optimization of nutritional status may improve

  12. Causes and incidence of 30 day hospital re-admissions after primary TKJR

    PubMed Central

    Mortimer, John; van Dalen, John

    2016-01-01

    Objective: 30 day re-admission of patients following TKJR is estimated between 0.9-9.9%. It’s a cause of significant cost to the healthcare system and marks significant patient morbidity. Aim: The aim of this study is to describe the causes and incidence of patient re-admission to hospital within 30 days of a primary total knee joint replacement between 2009-2015 in a single centre. Methods: In a retrospective cohort study, computerized records were used to evaluated the causes and incidence of patient re-admission within 30 days of discharge following primary TKJR. Results: The total 30 day Re-admission rate was 5.0%. Medical causes for re-admission accounted for 29% of re-admissions. 34% were attributed to non-specific pain/swelling. Infection was attributed to 26%. 29% of patients presented with wound problems, either infective or non-infective. The total incidence of re-operation at 30 days was 0.77%. Conclusions: Our rate of re-admission is consistent with previous studies in the literature. Many patients were found to have no specific cause for re-admission. This suggests it may be possible to further reduce re-admission rates with improved patient education and management of common post-operative symptoms such as pain and swelling. Infection remains a common complication; fortunately the majority superficial infections are successfully treated with antibiotics and few requiring a washout operation. Medical complications account for almost a third showing the importance of good management of patient medical co-morbidities and risk factors.

  13. 78 FR 29147 - 30-Day Notice and Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-17

    ..., 2013 at 78 FR 14807, allowing for OMB review and a 60-day public comment period. No comments were... SECURITY United States Secret Service 30-Day Notice and Request for Comments SUMMARY: The Department of... United States Secret Service, Department of Homeland Security, and sent via electronic mail to...

  14. 75 FR 160 - Paperwork Reduction Act; 30-Day Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-04

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF NATIONAL DRUG CONTROL POLICY Paperwork Reduction Act; 30-Day Notice AGENCY: Office of National Drug Control Policy. The Office of National Drug Control Policy (ONDCP) proposes the collection of information concerning...

  15. Discharge Outcomes in Seniors Hospitalized for More than 30 Days

    ERIC Educational Resources Information Center

    Kozyrskyj, Anita; Black, Charlyn; Chateau, Dan; Steinbach, Carmen

    2005-01-01

    Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using…

  16. Vitamin D status predicts 30 day mortality in hospitalised cats.

    PubMed

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F; Lalor, Stephanie M; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  17. Vitamin D Status Predicts 30 Day Mortality in Hospitalised Cats

    PubMed Central

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F.; Lalor, Stephanie M.; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X.; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J.

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  18. The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty.

    PubMed

    Ramos, Nicholas L; Karia, Raj J; Hutzler, Lorraine H; Brandt, Aaron M; Slover, James D; Bosco, Joseph A

    2014-04-01

    Previous studies have demonstrated no significant difference in overall functional outcomes of patients discharged to a sub acute setting versus home with health services after total joint arthroplasty. These findings coupled with pressure to reduce health care costs and the implementation of a prospective payment system under Medicare have supported the use of home rehabilitation services and the trend towards earlier discharge after hospitalization. While the overall functional outcome of patients discharged to various settings has been studied, there is a relative dearth of investigation comparing postoperative complications and readmission rates between various discharge dispositions. Our study demonstrated patients discharged home with health services had a significantly lower 30 day readmission rate compared to those discharged to inpatient rehab facilities. Patients discharged to rehab facilities have a higher incidence of comorbidity and this association could be responsible for their higher rate of readmission. PMID:24183369

  19. Syllable Timing and Pausing: Evidence from Cantonese

    ERIC Educational Resources Information Center

    Perry, Conrad; Wong, Richard Kwok-Shing; Matthews, Stephen

    2009-01-01

    We examined the relationship between the acoustic duration of syllables and the silent pauses that follow them in Cantonese. The results showed that at major syntactic junctures, acoustic plus silent pause durations were quite similar for a number of different syllable types whose acoustic durations differed substantially. In addition, it appeared…

  20. A Pause as a Cause of Change.

    ERIC Educational Resources Information Center

    Leal, Carmen Fernandez

    This paper considers four levels of analysis in the observation of the prosodic features of pause in speech: phonetic; syntactic; semantic; and informative. On the phonetic level, a pause is related to length and intonation, and intonation in turn, being a result of the speaker's meaning, constitutes an expression of his/her emotional state. On…

  1. On Judging Pauses in Spontaneous Speech

    ERIC Educational Resources Information Center

    Martin, James G.

    1970-01-01

    Spectrograms of spontaneous speech revealed that syllables preceding a judged-pause location were usually longer than those following, whether or not a silent interval was present. Most judged-pause locations were junctures, but syllable length governed judgments independently of juncture cues. (Author/FWB)

  2. Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage.

    PubMed

    Greenberg, Jacob K; Washington, Chad W; Guniganti, Ridhima; Dacey, Ralph G; Derdeyn, Colin P; Zipfel, Gregory J

    2016-03-01

    OBJECT Hospital readmission is a common but controversial quality measure increasingly used to influence hospital compensation in the US. The objective of this study was to evaluate the causes for 30-day hospital readmission following aneurysmal subarachnoid hemorrhage (SAH) to determine the appropriateness of this performance metric and to identify potential avenues for improved patient care. METHODS The authors retrospectively reviewed the medical records of all patients who received surgical orendovas-cular treatment for aneurysmal SAH at Barnes-Jewish Hospital between 2003 and 2013. Two senior faculty identified by consensus the primary medical/surgical diagnosis associated with readmission as well as the underlying causes of rehospitalization. RESULTS Among 778 patients treated for aneurysmal SAH, 89 experienced a total of 97 readmission events, yielding a readmission rate of 11.4%. The median time from discharge to readmission was 9 days (interquartile range 3-17.5 days). Actual hydrocephalus or potential concern for hydrocephalus (e.g., headache) was the most frequent diagnosis (26/97, 26.8%), followed by infections (e.g., wound infection [5/97, 5.2%], urinary tract infection [3/97, 3.1%], and pneumonia [3/97, 3.1%]) and thromboembolic events (8/97, 8.2%). In most cases (75/97, 77.3%), we did not identify any treatment lapses contributing to readmission. The most common underlying causes for readmission were unavoidable development of SAH-related pathology (e.g., hydrocephalus; 36/97, 37.1%) and complications related to neurological impairment and immobility (e.g., thromboembolic event despite high-dose chemoprophylaxis; 21/97, 21.6%). The authors determined that 22/97 (22.7%) of the readmissions were likely preventable with alternative management. In these cases, insufficient outpatient medical care (for example, for hyponatremia; 16/97, 16.5%) was the most common shortcoming. CONCLUSIONS Most readmissions after aneurysmal SAH relate to late consequences of

  3. A universal transcription pause sequence is an element of initiation factor σ70-dependent pausing.

    PubMed

    Bird, Jeremy G; Strobel, Eric J; Roberts, Jeffrey W

    2016-08-19

    The Escherichia coli σ70 initiation factor is required for a post-initiation, promoter-proximal pause essential for regulation of lambdoid phage late gene expression; potentially, σ70 acts at other sites during transcription elongation as well. The pause is induced by σ70 binding to a repeat of the promoter -10 sequence. After σ70 binding, further RNA synthesis occurs as DNA is drawn (or 'scrunched') into the enzyme complex, presumably exactly as occurs during initial synthesis from the promoter; this synthesis then pauses at a defined site several nucleotides downstream from the active center position when σ70 first engages the -10 sequence repeat. We show that the actual pause site in the stabilized, scrunched complex is the 'elemental pause sequence' recognized from its frequent occurrence in the E. coli genome. σ70 binding and the elemental pause sequence together, but neither alone, produce a substantial transcription pause. PMID:27098041

  4. Mechanism of NusG-stimulated pausing, hairpin-dependent pause site selection and intrinsic termination at overlapping pause and termination sites in the Bacillus subtilis trp leader

    PubMed Central

    Yakhnin, Alexander V.; Babitzke, Paul

    2010-01-01

    Summary The Bacillus subtilis trpEDCFBA operon is regulated by TRAP-dependent transcription attenuation and translation repression mechanisms. Previous results showed that NusA and NusG cooperatively stimulate RNA polymerase pausing at U107 and U144 in the trp leader, and that NusG is required for pausing at U144 in vivo. Pausing at U107 and U144 participate in the attenuation and translation repression mechanisms, respectively, by providing additional time for TRAP binding. The intrinsic trp leader terminator overlaps the hairpin-dependent U144 pause site. Here, we conducted a systematic mutational analysis of the terminator/pause region. Deletion of the hairpin reduced pausing but did not affect pause site selection. Thus, hairpin-stimulated pausing is a more appropriate term than hairpin-dependent pausing for this pause site. In contrast, minor changes to the hairpin abolished termination. Sequences in the U-rich/T-rich tract following the hairpin affected termination and pausing differentially. The distance between the hairpin and the 3’ end of the RNA dictates the position of termination, whereas the sequence downstream from the hairpin is responsible for pause site selection. NusA was found to increase both pausing and termination by reducing the rate of transcription. We also found that NusG-stimulated pausing is sequence specific and that NusG does not affect termination. PMID:20384694

  5. Mechanism of NusG-stimulated pausing, hairpin-dependent pause site selection and intrinsic termination at overlapping pause and termination sites in the Bacillus subtilis trp leader.

    PubMed

    Yakhnin, Alexander V; Babitzke, Paul

    2010-05-01

    The Bacillus subtilis trpEDCFBA operon is regulated by TRAP-dependent transcription attenuation and translation repression mechanisms. Previous results showed that NusA and NusG cooperatively stimulate RNA polymerase pausing at U107 and U144 in the trp leader, and that NusG is required for pausing at U144 in vivo. Pausing at U107 and U144 participate in the attenuation and translation repression mechanisms, respectively, by providing additional time for TRAP binding. The intrinsic trp leader terminator overlaps the hairpin-dependent U144 pause site. Here, we conducted a systematic mutational analysis of the terminator/pause region. Deletion of the hairpin reduced pausing but did not affect pause site selection. Thus, hairpin-stimulated pausing is a more appropriate term than hairpin-dependent pausing for this pause site. In contrast, minor changes to the hairpin abolished termination. Sequences in the U-rich/T-rich tract following the hairpin affected termination and pausing differentially. The distance between the hairpin and the 3' end of the RNA dictates the position of termination, whereas the sequence downstream from the hairpin is responsible for pause site selection. NusA was found to increase both pausing and termination by reducing the rate of transcription. We also found that NusG-stimulated pausing is sequence specific and that NusG does not affect termination. PMID:20384694

  6. Interword and intraword pause threshold in writing.

    PubMed

    Chenu, Florence; Pellegrino, François; Jisa, Harriet; Fayol, Michel

    2014-01-01

    Writing words in real life involves setting objectives, imagining a recipient, translating ideas into linguistic forms, managing grapho-motor gestures, etc. Understanding writing requires observation of the processes as they occur in real time. Analysis of pauses is one of the preferred methods for accessing the dynamics of writing and is based on the idea that pauses are behavioral correlates of cognitive processes. However, there is a need to clarify what we are observing when studying pause phenomena, as we will argue in the first section. This taken into account, the study of pause phenomena can be considered following two approaches. A first approach, driven by temporality, would define a threshold and observe where pauses, e.g., scriptural inactivity occurs. A second approach, linguistically driven, would define structural units and look for scriptural inactivity at the boundaries of these units or within these units. Taking a temporally driven approach, we present two methods which aim at the automatic identification of scriptural inactivity which is most likely not attributable to grapho-motor management in texts written by children and adolescents using digitizing tablets in association with Eye and Pen (©) (Chesnet and Alamargot, 2005). The first method is purely statistical and is based on the idea that the distribution of pauses exhibits different Gaussian components each of them corresponding to a different type of pause. After having reviewed the limits of this statistical method, we present a second method based on writing dynamics which attempts to identify breaking points in the writing dynamics rather than relying only on pause duration. This second method needs to be refined to overcome the fact that calculation is impossible when there is insufficient data which is often the case when working with young scriptors. PMID:24723896

  7. Interword and intraword pause threshold in writing

    PubMed Central

    Chenu, Florence; Pellegrino, François; Jisa, Harriet; Fayol, Michel

    2014-01-01

    Writing words in real life involves setting objectives, imagining a recipient, translating ideas into linguistic forms, managing grapho-motor gestures, etc. Understanding writing requires observation of the processes as they occur in real time. Analysis of pauses is one of the preferred methods for accessing the dynamics of writing and is based on the idea that pauses are behavioral correlates of cognitive processes. However, there is a need to clarify what we are observing when studying pause phenomena, as we will argue in the first section. This taken into account, the study of pause phenomena can be considered following two approaches. A first approach, driven by temporality, would define a threshold and observe where pauses, e.g., scriptural inactivity occurs. A second approach, linguistically driven, would define structural units and look for scriptural inactivity at the boundaries of these units or within these units. Taking a temporally driven approach, we present two methods which aim at the automatic identification of scriptural inactivity which is most likely not attributable to grapho-motor management in texts written by children and adolescents using digitizing tablets in association with Eye and Pen© (Chesnet and Alamargot, 2005). The first method is purely statistical and is based on the idea that the distribution of pauses exhibits different Gaussian components each of them corresponding to a different type of pause. After having reviewed the limits of this statistical method, we present a second method based on writing dynamics which attempts to identify breaking points in the writing dynamics rather than relying only on pause duration. This second method needs to be refined to overcome the fact that calculation is impossible when there is insufficient data which is often the case when working with young scriptors. PMID:24723896

  8. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

    PubMed Central

    Brennan, Jesse J.; Chan, Theodore C.; Killeen, James P.; Castillo, Edward M.

    2015-01-01

    Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions. PMID:26759647

  9. 78 FR 65695 - 30-Day Notice of Proposed Information Collection: Technical Processing Requirements for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    .... ACTION: Correction, notice. SUMMARY: On October 25, 2013 at 78 FR 64146 HUD published a 30 day notice of... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Technical Processing Requirements..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  10. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION SECURITY FUTURES PRODUCTS Narrow-Based Security Indexes § 41.12 Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale...

  11. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Delivery of merchandise. Within the 30-day period set forth in paragraph (b) of this section, the importer... 19 Customs Duties 2 2010-04-01 2010-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance...

  12. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Delivery of merchandise. Within the 30-day period set forth in paragraph (b) of this section, the importer... 19 Customs Duties 2 2013-04-01 2013-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance...

  13. Robotic CABG decreases 30-day complication rate, length of stay and acute care facility discharge rate compared to conventional surgery

    PubMed Central

    Leyvi, Galina; Forest, Stephen; Srinivas, V. S.; Greenberg, Mark; Wang, Nan; Mais, Alec; Snyder, Max; DeRose, Joseph J.

    2015-01-01

    Summary Objective The objective of this study was to compare the short term outcomes of robotic with conventional on pump coronary artery bypass grafting (CABG). Methods The study population included 2091 consecutive patients who underwent either conventional or robotic CABG from January 2007 to March 2012. Pre-operative, intra-operative and 30-day post-operative variables were collected for each group. In order to compare the incidence of rapid recovery between conventional and robotic CABG, the surrogate variables of early discharge and discharge to home (versus rehabilitation or acute care facility) were evaluated. A multivariate logistic regression analysis was utilized. Results One hundred and fifty robotic and 1,619 conventional CABG cases were analyzed. Multivariate logistic regression analysis demonstrated that robotic surgery was a strong predictor of lower 30-day complications (OR = 0.24, p=0.005), short length of stay (OR 3.31, p < 0.001), and decreased need for an acute care facility (OR 0.55, p = 0.032). In the presence of complications (NY State Complication Composite), the robotic technique was not associated with a change in discharge status. Conclusions In this retrospective review robotic CABG was associated with a lower 30-day complication rate, a shorter length of stay and a lower incidence of acute care facility discharge than conventional on pump CABG. It may suggest a more rapid recovery to pre-operative status after robotic surgery: however, only a randomized prospective study could confirm the advantages of a robotic approach PMID:25238421

  14. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect

    PubMed Central

    Kozak, Marcelo Felipe; Kozak, Ana Carolina Leiroz Ferreira Botelho Maisano; Marchi, Carlos Henrique De; de Godoy, Moacyr Fernandes; Croti, Ulisses Alexandre; Moscardini, Airton Camacho

    2015-01-01

    Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect. Objective To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect. Methods We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%). Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%. Results At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%). The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26), unlike patients without such abnormalities (P=0.016). During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02). However, after a multivariate analysis, none of the factors reached significance. Conclusion None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit more of the operation. PMID:26107451

  15. Automatic Method of Pause Measurement for Normal and Dysarthric Speech

    ERIC Educational Resources Information Center

    Rosen, Kristin; Murdoch, Bruce; Folker, Joanne; Vogel, Adam; Cahill, Louise; Delatycki, Martin; Corben, Louise

    2010-01-01

    This study proposes an automatic method for the detection of pauses and identification of pause types in conversational speech for the purpose of measuring the effects of Friedreich's Ataxia (FRDA) on speech. Speech samples of [approximately] 3 minutes were recorded from 13 speakers with FRDA and 18 healthy controls. Pauses were measured from the…

  16. Effect of feeding in 30-day bioaccumulation assays using Hyalella azteca in fluoranthene-dosed sediment

    SciTech Connect

    Harkey, G.A.; Landrum, P.F.

    1995-12-31

    Current protocols for conducting freshwater sediment bioaccumulation tests require that food be added to exposures. To determine effects of adding food, 30-day bioaccumulation assays were conducted with H. azteca exposed to sediment dosed with four concentrations (0.05 to 1,267 nmol/g dry weight) of fluoranthene. Accumulation was significantly greater in fed versus non-fed animals at all dose levels after 96 and 240 hours of exposure and continued to be greater after 30 days in the low dose levels. At sediment concentrations above 634 nmol/g dw, survival of unfed animals dropped to 34% after 30 days, However, after 30 days, reproduction was observed in fed animals exposed to sediment concentrations > 16 times the expected LC50 calculated for fluoranthene in sediment. These data raise questions concerning the interpretation of standard toxicity and bioaccumulation tests when food is routinely added.

  17. 78 FR 59046 - 30-Day Notice of Proposed Information Collection: Federal Labor Standards Questionnaire(s...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Federal Labor Standards..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  18. 78 FR 60886 - Submission for OMB Review; 30-day Comment Request; Quantification of Behavioral and Physiological...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... best assured of having their full effect if received within 30-days of the date of this publication... different drugs. The primary purpose of the data collected is to determine eligibility in a...

  19. 78 FR 44579 - 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program Evaluation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program.... A. Overview of Information Collection Title of Information Collection: Fellowship Placement Pilot.... Description of the need for the information and proposed use: The Fellowship Placement Program places...

  20. 77 FR 50157 - Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of Collection of Information; Opportunity for Public Comment AGENCY: National Park...

  1. 78 FR 36562 - 30-Day Notice of Proposed Information Collection: Home Equity Conversion Mortgage (HECM...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Home Equity Conversion Mortgage... Information Collection Title of Information Collection: Home Equity Conversion Mortgage (HECM) Insurance... Mortgage Information Technology (HERMIT) System is HUD's system of record for the HECM program and...

  2. 78 FR 36561 - 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal Advisory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal... Information Collection: The Housing Counseling Federal Advisory Committee Membership Application. OMB Approval... for the information and proposed use: The Housing Counseling Federal Advisory Committee (HCFAC)...

  3. 78 FR 39001 - 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and Physical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and Physical Inspection Requirements AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice... Information Collection: Uniform Physical Standards and Physical Inspection Requirements. OMB Approval...

  4. 78 FR 37834 - Submission for OMB review; 30-Day Comment Request; Federal Interagency Traumatic Brain Injury...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-24

    ... HUMAN SERVICES National Institutes of Health Submission for OMB review; 30-Day Comment Request; Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System Data Access Request SUMMARY: Under the... Collection: Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System Data...

  5. Utility of Socioeconomic Status in Predicting 30-Day Outcomes After Heart Failure Hospitalization

    PubMed Central

    Eapen, Zubin J.; McCoy, Lisa A.; Fonarow, Gregg C.; Yancy, Clyde W.; Miranda, Marie Lynn; Peterson, Eric D.; Califf, Robert M.; Hernandez, Adrian F.

    2015-01-01

    Background An individual's socioeconomic status (SES) is associated with health outcomes and mortality, yet it is unknown whether accounting for SES can improve risk-adjustment models for 30-day outcomes among Centers for Medicare & Medicaid Services (CMS) beneficiaries hospitalized with heart failure (HF). Methods and Results We linked clinical data on hospitalized HF patients in the Get With The Guidelines®-HF™ database (01/2005–12/2011) with CMS claims and county-level SES data from the 2012 Area Health Resources Files. We compared the discriminatory capabilities of multivariable models that adjusted for SES, patient, and/or hospital characteristics to determine whether county-level SES data improved prediction or changed hospital rankings for 30-day all-cause mortality and rehospitalization. After adjusting for patient and hospital characteristics, median household income (per $5,000 increase) was inversely associated with odds of 30-day mortality (OR 0.97, 95% CI 0.95–1.00, p=0.032), and the percentage of persons with at least a high school diploma (per 5 unit increase) was associated with lower odds of 30-day rehospitalization (OR 0.95, 95% CI 0.91–0.99).After adjustment for county-level SES data, relative to whites, Hispanic ethnicity (OR 0.70, 95% CI 0.58, 0.83) and black race (OR 0.57, 95% CI: 0.50–0.65) remained significantly associated with lower 30-day mortality, but had similar 30-day rehospitalization. County-level SES did not improve risk adjustment or change hospital rankings for 30-day mortality or rehospitalization. Conclusions County-level SES data are modestly associated with 30-day outcomes for CMS beneficiaries hospitalized with HF, but do not improve risk adjustment models based on patient characteristics alone. PMID:25747700

  6. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... not qualify for, or the payor does not apply, the 90-day grace period described in § 1.6049-5(d)(2)(ii... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Special 30-day rules for certain...

  7. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... not qualify for, or the payor does not apply, the 90-day grace period described in § 1.6049-5(d)(2)(ii... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Special 30-day rules for certain...

  8. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... not qualify for, or the payor does not apply, the 90-day grace period described in § 1.6049-5(d)(2)(ii... 26 Internal Revenue 15 2011-04-01 2011-04-01 false Special 30-day rules for certain...

  9. Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

    PubMed Central

    Safatli, Diaa A.; Günther, Albrecht; Schlattmann, Peter; Schwarz, Falko; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background: Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts. Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. Results: From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661–0.796, P < 0.001), bleeding volume (OR = 1.012 per ml, 95% CI = 1.007 – 1.017, P < 0.001), and infratentorial hematoma location (OR = 5.381, 95% CI = 2.166-13.356, P = 0.009) were significant predictors for the 30-day mortality. After receiver operating characteristics analysis, we defined a “high-risk group” for an unfavorable short-term outcome with GCS <11 and ICH volume >32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001). Conclusions: GCS score on admission together with the baseline volume and localization of the hemorrhage are strong

  10. Sinus Pause in Association with Lyme Carditis

    PubMed Central

    Dibs, Samer R.; Friedman, Harvey

    2015-01-01

    Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis. PMID:26175640

  11. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect

    PubMed Central

    Kozak, Marcelo Felipe; Kozak, Ana Carolina Leiroz Ferreira Botelho Maisano; Marchi, Carlos Henrique De; Hassem Sobrinho Junior, Sirio; Croti, Ulisses Alexandre; Moscardini, Airton Camacho

    2015-01-01

    Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of surgical repair of complete atrioventricular septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger presenting with complete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down syndrome. At the time of preoperative evaluation, there were 26 cases with moderate or severe left atrioventricular valve regurgitation (49.1%). Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or severe left atrioventricular valve regurgitation (39.6%). After performing a multivariate analysis, the only significant factor associated with moderate or severe left atrioventricular valve regurgitation was the absence of Down syndrome (P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect at our practice. PMID:26313720

  12. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

    PubMed Central

    Kitchell, Ellen; Etherton, Sarah Shelby; Duarte, Piper; Halm, Ethan A.; Jain, Mamta K.

    2015-01-01

    Abstract Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4–14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population. PMID:26154066

  13. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding

    PubMed Central

    Lee, Yoo Jin; Min, Bo Ram; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok; Jeon, Seong Woo

    2016-01-01

    Background/Aims: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. Methods: A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. Results: Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age ≥ 65 years, and hypotension (systolic pressure < 90 mmHg) during hospitalization were significant predictive factors of 30-day mortality. Conclusions: Comorbidity of DM or metastatic malignancy, age ≥ 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition. PMID:26767858

  14. Using data linkage to generate 30-day crash-fatality adjustment factors for Taiwan.

    PubMed

    Lai, Ching-Huei; Huang, Wei-Shin; Chang, Kai-Kuo; Jeng, Ming-Chang; Doong, Ji-Liang

    2006-07-01

    Different countries have their own police reporting time standards for counting the number of fatalities in reported crashes. A rapid estimation method (such as adjustment factor) for the comparison is important. The data-linkage technique was used to combine police-reported crash data and vital registration data, in order to generate 30-day fatality adjustment factors for various reporting time standards, which could also shed light on the fatal injury trend over time. The major findings were as follows. Firstly, a conservative 30-day fatality adjustment factor for the first day (or 24 h) would be 1.54 (or 1.35) in an area with a large motorcycle population, like Taiwan. This produced 20-40% higher 30-day fatalities than UK Transport Research Laboratory predicted, and 15-25% higher fatalities than those in Europe/Japan. Secondly, after excluding motorcycle impacts, the Taiwanese factors suggested 8-14% higher fatalities within 30 days than those in Europe/Japan. Third, motorcycle fatalities influenced the overall 30-day fatality trend within 3 days. In the future, both the police under-reporting problem and the motorcycle/overall fatal injury pattern within 3 days after crashing in developing countries like Taiwan merit further investigation. PMID:16430844

  15. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism

    PubMed Central

    Ghiasi, Farzin; Ahmadpoor, Amin; Amra, Babak

    2015-01-01

    Background: Pulmonary embolism (PE) is the most life-threatening form of venous thrombosis which causes the majority of mortalities in this category. Obstructive sleep apnea (OSA) has been indicated as one of the risk factors for thromboembolism because of hemostatic alterations. The present study was designed to seek for the relationship between OSA and 30-day mortality of patients with PE. Materials and Methods: This prospective cohort study was conducted among 137 consecutive patients referred to hospital with symptoms of PE and preliminary stable hemodynamic. Confirmation of PE was made by multislice computed tomography pulmonary angiography and in the case of contraindication; V/Q lung scan and Doppler sonography were done. A STOP-Bang Questionnaire was used to determine patients with high- and low-risk of OSA. Patients were followed up for 1-month, and their survivals were recorded. Results: This study showed that there was no relationship between OSA and 30-day mortality (P = 0.389). Chronic kidney disease (P = 0.004), hypertension (P = 0.003), main thrombus (P = 0.004), and segmental thrombus (P = 0.022) were associated with 30-day mortality. In the logistic regression analysis, history of chronic kidney disease was diagnosed as a risk factor for 30-day mortality among the PE patients (P = 0.029, odds ratio = 4.93). Conclusion: Results of this study showed 30-day mortality was not affected by OSA directly. In fact, it was affected by complications of OSA such as hypertension and thrombus. Also, positive history of chronic kidney disease increased the risk of 30-day mortality. PMID:26622255

  16. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease

    PubMed Central

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann; Petersen, Michael Mørk

    2016-01-01

    Abstract Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group. We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton. We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR). All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80–10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16–19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality. PMID:27082592

  17. Myelinated fibers of the mouse spinal cord after a 30-day space flight.

    PubMed

    Povysheva, T V; Rezvyakov, P N; Shaimardanova, G F; Nikolskii, E E; Islamov, R R; Chelyshev, Yu A; Grygoryev, A I

    2016-07-01

    Myelinated fibers and myelin-forming cells in the spinal cord at the L3-L5 level were studied in C57BL/6N mice that had spent 30 days in space. Signs of destruction of myelin in different areas of white matter, reduction of the thickness of myelin sheath and axon diameter, decreased number of myelin-forming cells were detected in "flight" mice. The stay of mice in space during 30 days had a negative impact on the structure of myelinated fibers and caused reduced expression of the markers myelin-forming cells. These findings can complement the pathogenetic picture of the development of hypogravity motor syndrome. PMID:27595822

  18. Lower 30-day readmission rates with roflumilast treatment among patients hospitalized for chronic obstructive pulmonary disease

    PubMed Central

    Fu, Alex Z; Sun, Shawn X; Huang, Xingyue; Amin, Alpesh N

    2015-01-01

    Background Few data exist related to the impact of roflumilast on health care utilization. This retrospective study estimated 30-day hospital readmission rates between patients who did and did not use roflumilast among those with COPD hospitalizations. Methods Data were from MarketScan, a large US commercial health insurance claims database. Patients aged ≥40 years with at least one hospitalization for COPD between 2010 and 2011 were included. The roflumilast group included patients who used roflumilast within 14 days after the first hospitalization (index), while the comparison group (non-roflumilast) included patients who did not use roflumilast during the study period. Continuous enrollment for at least 6 months before and 30 days after the index date was required. The 30-day hospitalization rate was calculated after the index hospitalization. Conditional logistic regression with propensity score 1:3 matching was employed to assess the difference in 30-day hospital readmission rates between the roflumilast and non-roflumilast groups, adjusting for baseline characteristics, comorbidity, health care utilization, and COPD medication use within 14 days after the index date. Results A total of 15,755 COPD patients met the selection criteria, ie, 366 (2.3%) in the roflumilast group and 15,389 (97.7%) in the non-roflumilast group. The mean (± standard deviation) age was 71±12.5 years and 52% were female. After propensity score matching, all-cause 30-day hospitalization rates were 6.9% and 11.1% in the roflumilast and non-roflumilast groups, respectively. COPD-related 30-day hospitalization rates were 6.3% and 9.2% in the roflumilast and non-roflumilast groups, respectively. Conditional logistic regression identified a significantly lower likelihood of all-cause 30-day readmission (odds ratio 0.59, 95% confidence interval 0.37–0.93, P=0.023) for roflumilast patients relative to non-roflumilast patients. Conclusion This study showed, in a real-world setting, that

  19. Automatic method of pause measurement for normal and dysarthric speech.

    PubMed

    Rosen, Kristin; Murdoch, Bruce; Folker, Joanne; Vogel, Adam; Cahill, Louise; Delatycki, Martin; Corben, Louise

    2010-02-01

    This study proposes an automatic method for the detection of pauses and identification of pause types in conversational speech for the purpose of measuring the effects of Friedreich's Ataxia (FRDA) on speech. Speech samples of approximately 3 minutes were recorded from 13 speakers with FRDA and 18 healthy controls. Pauses were measured from the intensity contour and fit with bimodal lognormal distributions using the Expectation-Maximization algorithm in Matlab. In the speakers with FRDA, both modes in the pause distributions had significantly larger means, with disproportionately fewer pauses associated with the first mode. From this preliminary study, it is concluded that distributional analysis of pause duration holds promise as a useful method of measuring the effects of FRDA on functional speech. PMID:20100043

  20. Rotational dynamics of cargos at pauses during axonal transport

    SciTech Connect

    Gu, Yan; Sun, Wei; Wang, Gufeng; Jeftinija, Ksenija; Jeftinija, Srdija; Fang, Ning

    2012-08-28

    Direct visualization of axonal transport in live neurons is essential for our understanding of the neuronal functions and the working mechanisms of microtubule-based motor proteins. Here we use the high-speed single particle orientation and rotational tracking technique to directly visualize the rotational dynamics of cargos in both active directional transport and pausing stages of axonal transport, with a temporal resolution of 2 ms. Both long and short pauses are imaged, and the correlations between the pause duration, the rotational behaviour of the cargo at the pause, and the moving direction after the pause are established. Furthermore, the rotational dynamics leading to switching tracks are visualized in detail. These first-time observations of cargo's rotational dynamics provide new insights on how kinesin and dynein motors take the cargo through the alternating stages of active directional transport and pause.

  1. 78 FR 66042 - 30-Day Notice of Proposed Information Collection: Section 3 Business Registry Pilot Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Section 3 Business Registry Pilot..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  2. 75 FR 45118 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden;...

  3. 75 FR 45120 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden;...

  4. 75 FR 45118 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  5. 77 FR 29348 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary...

  6. 75 FR 63479 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is..., Director, Office of Resources Management; Office of the Chief Information Officer. BILLING CODE 4150-45-P...

  7. 77 FR 47702 - 30-Day Notice of Request for Approval: Statutory Authority To Preserve Rail Service

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... this collection in the Federal Register on February 10, 2012, at 77 FR 7236-37 (60-day notice). That... Surface Transportation Board 30-Day Notice of Request for Approval: Statutory Authority To Preserve Rail Service AGENCY: Surface Transportation Board, DOT. ACTION: Notice and request for comments. SUMMARY:...

  8. 75 FR 77935 - 30-Day Notice of Proposed Information Collection: DS-160, Online Application for Nonimmigrant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: DS-160, Online Application for Nonimmigrant Visa, OMB 1405... of 1995. Title of Information Collection: Online Application for Nonimmigrant Visa. OMB...

  9. 75 FR 21294 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... Office of Management and Budget to extend data collection regarding the status of the health care system... September 2009 HHS has collected data on bed availability, health care system resource needs such as... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office...

  10. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Abandonment by importer within 30 days after entry. 158.42 Section 158.42 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) RELIEF FROM DUTIES ON MERCHANDISE LOST, DAMAGED, ABANDONED, OR EXPORTED Destroyed, Abandoned,...

  11. 78 FR 79474 - 30-Day Notice of Proposed Information Collection: Father's Day

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-30

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  12. 78 FR 24220 - Submission for OMB Review; 30-Day Comment Request: Women's Health Initiative Observational Study

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-24

    ... Next of kin 936 1 .6/60 92 Physician/Office Staff 17 1 5/60 1 * Annual burden is placed on health care... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-Day Comment Request:...

  13. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Indexes underlying futures contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION SECURITY FUTURES PRODUCTS Narrow-Based Security Indexes § 41.12 Indexes underlying futures contracts trading for...

  14. 75 FR 67976 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... requirements of Section 512 of the Recovery Act, set forth by the Office of Management and Budget (OMB) under... HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  15. 78 FR 19496 - Submission for OMB Review; 30-day Comment Request; The National Cancer Institute (NCI...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-01

    ... of eHealth/ mHealth tobacco cessation intervention programs. SmokefreeTXT has been developed (and is... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request;...

  16. 78 FR 40314 - 30-Day Notice of Proposed Information Collection: Fair Housing Initiatives Program Grant

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Fair Housing Initiatives Program Grant AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: HUD has...

  17. 77 FR 62595 - 30-Day Notice of Proposed Information Collection: Passport Demand Forecasting Study

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-15

    ... Notice of Proposed Information Collection: Passport Demand Forecasting Study ACTION: Notice of request... Department of State has submitted the information collection described below to the Office of Management and... is to allow 30 days for public comment. DATES: Submit comments directly to the Office of...

  18. 78 FR 46359 - 30-Day Notice of Proposed Information Collection: Federal Labor Standards Payee Verification and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-31

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  19. 78 FR 64146 - 30-Day Notice of Proposed Information Collection: Technical Processing Requirements for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  20. Enhanced recovery of Phytophthora ramorum from soil following 30 days storage at 4C

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chlamydospores of Phytophthora ramorum produced by mixing 20 percent V8 juice broth cultures with sand and incubating over a 30 day period were used to infest field soil at densities ranging from 0.2 to 42 chlamydospores per cubic centimeter of soil. Chlamydospore recovery was determined by baiting...

  1. 78 FR 36564 - 30-Day Notice of Proposed Information Collection: Multifamily Default Status Report

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily Default Status Report..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard... Report. OMB Approval Number: 2502-0041. Type of Request: Extension of a currently approved...

  2. 78 FR 39305 - 30-Day Notice of Proposed Information Collection: OSHC Progress Report Template

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: OSHC Progress Report Template AGENCY... Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at Colette.Pollard... Information Collection Title of Information Collection: OSHC Progress Report Template. OMB Approval...

  3. 78 FR 1916 - 30-Day Notice of Proposed Information Collection: Smart Traveler Enrollment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-09

    ...The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995 we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public...

  4. 77 FR 37706 - Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of Collection of Information; Opportunity for Public Comment AGENCY: National Park Service,...

  5. 76 FR 78012 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  6. 78 FR 76187 - 30-Day Notice of Proposed Information Collection: Exchange Programs Alumni Web Site Registration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ...The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995 we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public...

  7. 78 FR 7436 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-01

    ... in the Federal Register (77 FR 69865) on November 21, 2012, and allowed 60 days for public comment... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Request for Public Comment: 30-Day Proposed Information...

  8. 75 FR 48970 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Agency Information Collection Request; 30-Day Public Comment... Human Services, is publishing the following summary of a proposed collection for public...

  9. 75 FR 48969 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30 Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  10. 76 FR 10364 - Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov AGENCY... Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human...

  11. 76 FR 10035 - Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov AGENCY... Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human...

  12. 76 FR 10034 - Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov AGENCY... Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human...

  13. 75 FR 45120 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  14. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Special 30-day rules for certain reportable payments. 31.3406(d)-3 Section 31.3406(d)-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT TAXES AND COLLECTION OF INCOME TAX AT SOURCE EMPLOYMENT TAXES AND COLLECTION OF INCOME TAX AT SOURCE Collection...

  15. 78 FR 36560 - 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal, Periodic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th... Title of Information Collection: FHA Lender Approval, Annual Renewal, Periodic Updates and...

  16. 78 FR 36563 - 30-Day Notice of Proposed Information Collection: Single Family Premium Collection Subsystem...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Single Family Premium Collection... to the proposal by name and/or OMB Control Number and should be sent to: HUD Desk Officer, Office of... access this number through TTY by calling the toll-free Federal Relay Service at (800) 877-8339. This...

  17. 75 FR 63478 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary...

  18. 78 FR 60293 - Submission for OMB Review; 30-Day Comment Request; Application for the Postdoctoral Research...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-01

    ... HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-Day Comment Request...)(D) of the Paperwork Reduction Act of 1995, the National Institutes of Health (NIH) has submitted to the Office of Management and Budget (OMB) a request to review and approve the information...

  19. 78 FR 47335 - 30-Day Notice of Proposed Information Collection: Section 811 Project Rental Assistance for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-05

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  20. 75 FR 27346 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary...

  1. 76 FR 59701 - Agency Information Collection Request. 30 Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30 Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary...

  2. NEUROPHYSIOLOGICAL EFFECTS OF 30 DAY CHRONIC EXPOSURE TO TOLUENE IN RATS

    EPA Science Inventory

    Long-Evans hooded rats were exposed to 1000 ppm toluene or 0 ppm toluene 6 hr/day, 5 days/week for 30 days. Following removal from the exposure conditions (18-26 hr) flash-evoked potentials were recorded to paired light flashes and pentylenetetrazol (PTZ) seizure properties were ...

  3. 78 FR 70956 - 30-Day Notice of Proposed Information Collection: Assessment of Native American, Alaska Native...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Assessment of Native American... Title of Information Collection: Assessment of Native American, Alaska Native and Native Hawaiian... American and Alaskan Native populations, most notably through the Indian Housing Block Grant. The level...

  4. 78 FR 75365 - 30-Day Notice of Proposed Information Collection: Assessment of Native American, Alaska Native...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Assessment of Native American... Collection: Assessment of Native American, Alaska Native and Native Hawaiian Housing Needs. OMB Approval... the United States. HUD provides funding though several programs to Native American and Alaskan...

  5. 78 FR 69103 - 30-Day Notice of Proposed Information Collection: Quality Control for Rental Assistance Subsidy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Quality Control for Rental..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW... equipment, which are being used in part because they reduce interview times. The software also provides...

  6. 76 FR 67454 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-01

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... numbered 4.C and titled ] ``Previous Grants.gov Tracking Number''; (2) Modification of an existing...

  7. 76 FR 40913 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-12

    ... respondent (in hours) hours Survey Human Resource Manager 3,000 1 30/60 1,500 Focus Group Protocol Employees in All 48 1 1.5 72 Occupations Key Informant Interview Script...... Human Resource Manager 20 1 45/60... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office...

  8. 30-Day Mortality in Acute Pulmonary Embolism: Prognostic Value of Clinical Scores and Anamnestic Features

    PubMed Central

    Bach, Andreas Gunter; Taute, Bettina-Maria; Baasai, Nansalmaa; Wienke, Andreas; Meyer, Hans Jonas; Schramm, Dominik; Surov, Alexey

    2016-01-01

    Purpose Identification of high-risk patients with pulmonary embolism is vital. The aim of the present study was to examine clinical scores, their single items, and anamnestic features in their ability to predict 30-day mortality. Materials and Methods A retrospective, single-center study from 06/2005 to 01/2010 was performed. Inclusion criteria were presence of pulmonary embolism, availability of patient records and 30-day follow-up. The following clinical scores were calculated: Acute Physiology and Chronic Health Evaluation II, original and simplified pulmonary embolism severity index, Glasgow Coma Scale, and euroSCORE II. Results In the study group of 365 patients 39 patients (10.7%) died within 30 days due to pulmonary embolism. From all examined scores and parameters the best predictor of 30-day mortality were the Glasgow Coma scale (≤ 10) and parameters of the circulatory system including presence of mechanical ventilation, arterial pH (< 7.335), and systolic blood pressure (< 99 mm Hg). Conclusions Easy to ascertain circulatory parameters have the same or higher prognostic value than the clinical scores that were applied in this study. From all clinical scores studied the Glasgow Coma Scale was the most time- and cost-efficient one. PMID:26866472

  9. 78 FR 49280 - 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile Transmittal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile..., 2013. A. Overview of Information Collection Title of Information Collection: Third-Party Documentation... of the need for the information and proposed use: The use of the Third-Party Documentation...

  10. Heart failure performance measures: do they have an impact on 30-day readmission rates?

    PubMed

    Mazimba, Sula; Grant, Nakash; Parikh, Analkumar; Mwandia, George; Makola, Diklar; Chilomo, Christine; Redko, Cristina; Hahn, Harvey S

    2013-01-01

    Congestive heart failure (CHF) accounts for more health care costs than any other diagnosis. Readmissions contribute to this expenditure. The authors evaluated the relationship between adherence to performance metrics and 30-day readmissions. This was a retrospective study of 6063 patients with CHF between 2001 and 2008. Data were collected for 30-day readmissions and compliance with CHF performance measures at discharge. Rates of readmission for CHF increased from 16.8% in 2002 to 24.8% in 2008. Adherence to performance measures increased concurrently from 95.8% to 99.9%. Except for left ventricular function (LVF) assessment, the 30-day readmission rate was not associated with adherence to performance measures. Readmitted patients had twice the odds of not having their LVF assessed (odds ratio = 2.0; P < .00005; 95% confidence interval = 1.45-2.63). CHF performance measures, except for the LVF assessment, have little relationship to 30-day readmissions. Further studies are needed to identify performance measures that correlate with quality of care. PMID:23110998

  11. 78 FR 38070 - 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing... Marketing (AFHM) Plan. OMB Approval Number: 2529-0013. Type of Request: Extension of a currently approved collection. Form Number: HUD-935.2A Affirmative Fair Housing Marketing (AFHM) Plan (Multifamily),...

  12. 78 FR 52008 - 30-Day Notice of Proposed Information Collection: Multifamily Housing Service Coordinator Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily Housing Service..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  13. 75 FR 48968 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-12

    ... HUMAN SERVICES Agency Information Collection Request. 30 Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... is a biennial survey of the blood collection and utilization community to produce reliable...

  14. 75 FR 66101 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-27

    ... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is..., OMB number, and OS document identifier, to Sherette.funncoleman@hhs.gov , or call the Reports... collections within 30 days of this notice directly to the OS OMB Desk Officer; faxed to OMB at...

  15. 75 FR 13288 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-19

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... conduct a nationwide survey which will use computer-assisted telephone interviews (CATI) to interview...

  16. 78 FR 38064 - Submission for OMB review; 30-day comment request: NLM PEOPLE LOCATOR® System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... HUMAN SERVICES National Institutes of Health Submission for OMB review; 30-day comment request: NLM... comment. The National Library of Medicine (NLM), National Institutes of Health, may not conduct or sponsor... instruments or request more information on the proposed project contact: David Sharlip, NLM Project...

  17. 76 FR 71036 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  18. 76 FR 33761 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-09

    ... HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... research leverages best practices in behavior change, interaction design, and service innovation...

  19. 78 FR 52781 - 30-Day Notice of Proposed Information Collection: Disclosure of Adjustable Rate Mortgages (ARMs...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-26

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Disclosure of Adjustable Rate... or speech impairments may access this number through TTY by calling the toll-free Federal Relay... Collection: Disclosure of Adjustable Rate Mortgages (ARMs) Rates. OMB Approval Number: 2502-0322. Type...

  20. 78 FR 52006 - 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit Instrument

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit..., Department of Housing and Urban Development, 451 7th Street, SW., Washington, DC 20410; email Colette...

  1. 78 FR 52007 - 30-Day Notice of Proposed Information Collection: Management Certification and Management Entity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Management Certification and... Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW., Washington,...

  2. Low platelet activity predicts 30 days mortality in patients undergoing heart surgery.

    PubMed

    Kuliczkowski, Wiktor; Sliwka, Joanna; Kaczmarski, Jacek; Zysko, Dorota; Zembala, Michal; Steter, Dawid; Zembala, Marian; Gierlotka, Marek; Kim, Moo Hyun; Serebruany, Victor

    2016-03-01

    Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival. PMID:26366827

  3. Health literacy and 30-day hospital readmission after acute myocardial infarction

    PubMed Central

    Bailey, Stacy Cooper; Fang, Gang; Annis, Izabela E; O'Conor, Rachel; Paasche-Orlow, Michael K; Wolf, Michael S

    2015-01-01

    Objective To assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI). Design Retrospective cohort study. Setting and participants A National Institute of Aging (NIA) study cohort of 696 adult, English-speaking primary care patients, aged 55–74 years, was used to assess the validity of derived health literacy estimates. Claims from 7733 Medicare beneficiaries hospitalised for AMI in 2008 in North Carolina and Illinois were used to investigate the association between health literacy estimates and 30-day hospital readmissions. Measures The NIA cohort was administered 3 common health literacy assessments (Newest Vital Sign, Test of Functional Health Literacy in Adults, and Rapid Estimate of Adult Literacy in Medicine). Health literacy estimates at the census block group level were derived via a predictive model. 30-day readmissions were measured from Medicare claims data using a validated algorithm. Results Fair agreement was found between derived estimates and in-person literacy assessments (Pearson Correlation coefficients: 0.38–0.51; κ scores: 0.38–0.40). Medicare enrollees with above basic literacy according to derived health literacy estimates had an 18% lower risk of a 30-day readmission (RR=0.82, 95% CI 0.73 to 0.92) and 21% lower incidence rate of 30-day readmission (IRR=0.79, 95% CI 0.68 to 0.87) than patients with basic or below basic literacy. After adjusting for demographic and clinical characteristics, the risk of 30-day readmission was 12% lower (p=0.03), and the incidence rate 16% lower (p<0.01) for patients with above basic literacy. Conclusions Health literacy, as measured by a predictive model, was found to be a significant, independent predictor of 30-day readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction

  4. Prosodic complexity and phrase length as factors in pause duration

    NASA Astrophysics Data System (ADS)

    Krivokapic, Jelena

    2001-05-01

    Research on pauses has mainly focused on predicting the likelihood of pause occurrence and on the effect of syntactic structure on pause duration within an utterance. Very little is known about what factors, apart from syntactic and discourse factors, influence the length of pauses between utterances or phrases. This experiment examines the effect of prosodic structure and phrase length on pause duration. Subjects read 24 English sentences varying along the following parameters: (a) the length in syllables of the intonational phrase preceding and following the pause and (b) the prosodic structure of the intonational phrase preceding and following the pause, specifically whether or not the intonational phrase branches into smaller phrases. In order to minimize variability due to speech rate and individual differences, speakers read sentences synchronously in dyads (Cummins, 2002; Zvonik and Cummins, 2002). The results show that length has a significant effect on pause duration both pre- and postboundary for all dyads, and that prosodic complexity has a significant postboundary effect for some dyads. The possible reasons for the observed pause duration effects and the implications of these results on the question of incrementality in speech production are discussed. [Work supported by NIH DC03172.

  5. Pause Point Spectra in DNA Constant-Force Unzipping

    PubMed Central

    Weeks, J. D.; Lucks, J. B.; Kafri, Y.; Danilowicz, C.; Nelson, D. R.; Prentiss, M.

    2005-01-01

    Under constant applied force, the separation of double-stranded DNA into two single strands is known to proceed through a series of pauses and jumps. Given experimental traces of constant-force unzipping, we present a method whereby the locations of pause points can be extracted in the form of a pause point spectrum. A simple theoretical model of DNA constant-force unzipping is presented, which generates theoretical pause point spectra through Monte Carlo simulation of the unzipping process. The locations of peaks in the experimental and theoretical pause point spectra are found to be nearly coincident below 6000 basepairs for unzipping the bacteriophage λ-genome. The model only requires the sequence, temperature, and a set of empirical basepair binding and stacking energy parameters, and the good agreement with experiment suggests that pause point locations are primarily determined by the DNA sequence. The model is also used to predict pause point spectra for the bacteriophage φX174 genome. The algorithm for extracting the pause point spectrum might also be useful for studying related systems which exhibit pausing behavior such as molecular motors. PMID:15695634

  6. New consensus definition for acute kidney injury accurately predicts 30-day mortality in cirrhosis with infection

    PubMed Central

    Wong, Florence; O’Leary, Jacqueline G; Reddy, K Rajender; Patton, Heather; Kamath, Patrick S; Fallon, Michael B; Garcia-Tsao, Guadalupe; Subramanian, Ram M.; Malik, Raza; Maliakkal, Benedict; Thacker, Leroy R; Bajaj, Jasmohan S

    2015-01-01

    Background & Aims A consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined as an increase in serum creatinine by >50% from the stable baseline value in <6 months or by ≥0.3mg/dL in <48 hrs. We prospectively evaluated the ability of these criteria to predict mortality within 30 days among hospitalized patients with cirrhosis and infection. Methods 337 patients with cirrhosis admitted with or developed an infection in hospital (56% men; 56±10 y old; model for end-stage liver disease score, 20±8) were followed. We compared data on 30-day mortality, hospital length-of-stay, and organ failure between patients with and without AKI. Results 166 (49%) developed AKI during hospitalization, based on the consensus criteria. Patients who developed AKI had higher admission Child-Pugh (11.0±2.1 vs 9.6±2.1; P<.0001), and MELD scores (23±8 vs17±7; P<.0001), and lower mean arterial pressure (81±16mmHg vs 85±15mmHg; P<.01) than those who did not. Also higher amongst patients with AKI were mortality in ≤30 days (34% vs 7%), intensive care unit transfer (46% vs 20%), ventilation requirement (27% vs 6%), and shock (31% vs 8%); AKI patients also had longer hospital stays (17.8±19.8 days vs 13.3±31.8 days) (all P<.001). 56% of AKI episodes were transient, 28% persistent, and 16% resulted in dialysis. Mortality was 80% among those without renal recovery, higher compared to partial (40%) or complete recovery (15%), or AKI-free patients (7%; P<.0001). Conclusions 30-day mortality is 10-fold higher among infected hospitalized cirrhotic patients with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure. PMID:23999172

  7. A Population-Based Study of 30-day Incidence of Ischemic Stroke Following Surgical Neck Dissection

    PubMed Central

    MacNeil, S. Danielle; Liu, Kuan; Garg, Amit X.; Tam, Samantha; Palma, David; Thind, Amardeep; Winquist, Eric; Yoo, John; Nichols, Anthony; Fung, Kevin; Hall, Stephen; Shariff, Salimah Z.

    2015-01-01

    Abstract The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries. A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain. A retrospective cohort study using data from linked administrative and registry databases (1995–2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes. A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05–2.53), and a history of diabetes (OR 1.60, 95% CI 1.02–2.49), hypertension (OR 2.64, 95% CI 1.64–4.25), or prior stroke (OR 4.06, 95% CI 2.29–7.18). Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy. PMID:26287406

  8. Laparoscopic sleeve gastrectomy at a new bariatric surgery centre in Canada: 30-day complication rates using the Clavien–Dindo classification

    PubMed Central

    Falk, Vanessa; Twells, Laurie; Gregory, Deborah; Murphy, Raleen; Smith, Chris; Boone, Darrell; Pace, David

    2016-01-01

    Background Newfoundland and Labrador (NL) has the highest rate of obesity in Canada, prompting the establishment of a bariatric surgery program at the Health Sciences Centre in NL. This retrospective study examined 30-day complication rates in more than 200 consecutive patients who underwent laparoscopic sleeve gastrectomy (LSG) between May 2011 and February 2014. Methods We performed a chart review and collected data on 30-day postoperative complications. Complications were graded and reported using the Clavien–Dindo classification. Grades I and II were defined as minor and grades III and higher were defined as major complications. Results We reviewed the charts of the first 209 patients to undergo LSG. The mean body mass index was 49.2, 81% were women and the average age was 43 years. Comorbidities included hypertension (55.0%), obstructive sleep apnea (46.4%), dyslipidemia (42.1%), diabetes (37.3%), osteoarthritis (36.4%) and cardiovascular disease with previous cardiac stents (5.3%). Furthermore, 38.3% of patients reported psychiatric diagnoses, such as depression and anxiety. The overall 30-day complication rate was 15.3%. The complication rate for minor complications was 13.4% and for major complications was 1.9% (2 leaks, 1 stricture and 1 fistula). Conclusion Our results support the feasibility of safely performing LSG surgery at bariatric centres completing fewer than 125 procedures annually. PMID:27007089

  9. Long-term (30 days) toxicity of NiO nanoparticles for adult zebrafish Danio rerio

    PubMed Central

    Kovrižnych, Jevgenij A.; Zeljenková, Dagmar; Rollerová, Eva; Szabová, Elena

    2014-01-01

    Nickel oxide in the form of nanoparticles (NiO NPs) is extensively used in different industrial branches. In a test on adult zebrafish, the acute toxicity of NiO NPs was shown to be low, however longlasting contact with this compound can lead to its accumulation in the tissues and to increased toxicity. In this work we determined the 30-day toxicity of NiO NPs using a static test for zebrafish Danio rerio. We found the 30-day LC50 value to be 45.0 mg/L, LC100 (minimum concentration causing 100% mortality) was 100.0 mg/L, and LC0 (maximum concentration causing no mortality) was 6.25 mg/L for adult individuals of zebrafish. Considering a broad use of Ni in the industry, NiO NPs chronic toxicity may have a negative impact on the population of aquatic organisms and on food web dynamics in aquatic systems. PMID:26038672

  10. Work capacity during 30 days of bed rest with isotonic and isokinetic exercise training

    NASA Technical Reports Server (NTRS)

    Greenleaf, J. E.; Bernauer, E. M.; Ertl, A. C.; Trowbridge, T. S.; Wade, C. E.

    1989-01-01

    Results are presented from a study to determine whether or not short-term variable intensity isotonic and intermittent high-intensity isokinetic short-duration leg exercise is effective for the maintenance of peak O2 (VO2) uptake and muscular strength and endurance, respectively, during 30 days of -6 deg head-down bed rest deconditioning. The results show no significant changes in leg peak torque, leg mean total work, arm total peak torque, or arm mean total work for members of the isotonic, isokinetic, and controls groups. Changes are observed, however, in peak VO2 levels. The results suggest that near-peak variabile intensity, isotonic leg excercise maintains peak VO2 during 30 days of bed rest, while peak intermittent, isokinetic leg excercise protocol does not.

  11. Phonetic Pause Unites Phonology and Semantics against Morphology and Syntax

    ERIC Educational Resources Information Center

    Sakarna, Ahmad Khalaf; Mobaideen, Adnan

    2012-01-01

    The present study investigates the phonological effect triggered by the different types of phonetic pause used in Quran on morphology, syntax, and semantics. It argues that Quranic pause provides interesting evidence about the close relation between phonology and semantics, from one side, and semantics, morphology, and syntax, from the other…

  12. Using Habit Reversal to Decrease Filled Pauses in Public Speaking

    ERIC Educational Resources Information Center

    Mancuso, Carolyn; Miltenberger, Raymond G.

    2016-01-01

    This study evaluated the effectiveness of simplified habit reversal in reducing filled pauses that occur during public speaking. Filled pauses consist of "uh," "um," or "er"; clicking sounds; and misuse of the word "like." After baseline, participants received habit reversal training that consisted of…

  13. Influence of psychiatric comorbidity on 30-day readmissions for heart failure, myocardial infarction, and pneumonia

    PubMed Central

    Ahmedani, Brian K.; Solberg, Leif I.; Copeland, Laurel; Fang, Ying; Stewart, Christine; Hu, Jianhui; Nerenz, David R.; Williams, L. Keoki; Cassidy-Bushrow, Andrea E.; Waxmonsky, Jeanette; Lu, Christine Y.; Waitzfelder, Beth E.; Owen-Smith, Ashli A.; Coleman, Karen J.; Lynch, Frances L.; Ahmed, Ameena T.; Beck, Arne L.; Rossom, Rebecca C.; Simon, Gregory E.

    2014-01-01

    Objective The Centers for Medicare and Medicaid Services (CMS) implemented a policy in 2012 that penalizes hospitals for ‘excessive’ all-cause hospital readmissions within 30 days after discharge for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. The aim of this study is to investigate the influence of psychiatric comorbidities on 30-day all-cause readmissions for heart failure, acute myocardial infarction, and pneumonia. Methods Longitudinal study from 2009-2011 within 11 Mental Health Research Network (MHRN) affiliated health systems. Data were derived from the HMO Research Network Virtual Data Warehouse. Participants were individuals admitted to the hospital for HF, AMI, and pneumonia. All index inpatient hospitalizations for HF, AMI and pneumonia were captured (n=160,169 patient index admissions). Psychiatric diagnoses were measured for the year prior to admission. All-cause readmissions within 30 days of discharge were the outcome variable. Results Approximately 18% of all individuals with these conditions were readmitted within 30-days. The rate was 5% greater for individuals with a past-year psychiatric comorbidity (21.7%) than for those without (16.5%; p<.001). Depression, anxiety, and dementia were associated with more readmissions for those with index hospitalizations for all three conditions independently and combined (p<.05). Substance use and bipolar disorders were linked with higher readmissions for those with initial HF and pneumonia hospitalizations (p<.05). Readmission rates declined overall from 2009-2011. Conclusions Individuals with HF, AMI, and pneumonia experience high rates of readmission, but psychiatric comorbidities appear to increase that risk. Future readmission interventions should consider adding mental health components. PMID:25642610

  14. Incidence, Causes and Predictors of 30-Day Readmission After Shoulder Arthroplasty

    PubMed Central

    Westermann, Robert W; Anthony, Chris A.; Duchman, Kyle R.; Pugely, Andrew J.; Gao, Yubo; Hettrich, Carolyn M.

    2016-01-01

    Background The Center for Medicare and Medicaid Service has identified several quality metrics, including unplanned readmission within 30 days of surgery, to assess and compare surgeons and hospitals. The purpose of this study was to identify the incidence, causes and risk factors for unplanned 30-day readmission after total shoulder arthroplasty. Methods We identified patients undergoing primary elective shoulder arthroplasty performed at American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participating hospitals in 2013. Cases were stratified by readmission status. Univariate and multivariate analyses were employed to assess patient demographics, comorbidities and operative variables predicting unplanned readmission. Results 2779 patients undergoing shoulder arthroplasty were identified, with 74 (2.66%) requiring unplanned readmissions within 30 days of surgery. The most common surgical causes for unplanned readmission were surgical site infections (18.6%), dislocations (16.3%) and venous thromboembolism (14.0%). Medical causes for readmission were responsible for 51% of unplanned readmissions. Multivariate analysis identified patient age >75 (OR 2.62, 95% CI: 1.27 - 5.41), and ASA class of 3 (OR 1.79, 95% CI: 1.01 - 3.18) or 4 (OR 3.63, 95% CI: 1.31 - 10.08) as independent risk factors for unplanned readmission. Predictive modeling estimated that patients with ASA class of 4 and age >75 are 17.4 times more likely (95% CI 1.77-171.09) to be readmitted within 30 days of shoulder arthroplasty. Conclusion Unplanned readmission after shoulder arthroplasty is infrequent and medical complications account for more than 50% of occurrences. The risk of readmission exponentially increases when age and preoperative comorbidity burden are increased. PMID:27528839

  15. 30-Day Readmission Among Elderly Medicare Beneficiaries with Type 2 Diabetes

    PubMed Central

    Zhou, Steve; Wei, Wenhui; Bhattacharjee, Sandipan; Miao, Raymond; Sambamoorthi, Usha

    2015-01-01

    Abstract This study retrospectively assessed rates and risk factors for all-cause hospital readmission among elderly Medicare beneficiaries with type 2 diabetes mellitus (T2DM) aged ≥65 years. Associations between 30-day readmission and patients' demographic, insurance, index hospital, and clinical characteristics; patient complexities specific to the elderly; and health care utilization were examined using multivariable logistic regressions. Of 202,496 elderly Medicare beneficiaries, 52% were female, 76% were white, the mean age was 75.8 years, and 13.2% had all-cause 30-day readmissions. Elderly patients with cognitive impairment (adjusted odds ratio [aOR]=1.06, 95% confidence interval [CI]=1.01–1.12), falls and falls risk (aOR=1.15, 95% CI=1.08–1.22), polypharmacy (aOR=1.20, 95% CI=1.14–1.27), and urinary incontinence (aOR=1.08, 95% CI=1.01–1.15) were at higher risk for all-cause 30-day readmission than their counterparts without these complexities. As elderly-specific complexities are associated with greater risk for readmission, intervention programs to reduce readmission risk among elderly patients with T2DM should be tailored to suit the needs of elderly patients with extensive complexities. (Population Health Management 2015;18:256–264) PMID:25608114

  16. Return to the System Within 30 Days of Discharge after Pediatric Appendectomy.

    PubMed

    Short, Heather L; Sarda, Samir; Heiss, Kurt F; Chern, Joshua J; Raval, Mehul V

    2016-07-01

    Postprocedural revisits, readmissions, and reoperations are commonly tracked quality metrics and have reimbursement and hospital-level comparison implications. Our purpose was to document these rates after pediatric appendectomy and to identify patient factors related to these metrics. This study included 3756 appendectomies performed at a single institution from 2009 to 2013. Data were prospectively collected and clinical events within 30 days of discharge were analyzed. Regression models identified factors associated with each metric. There were 328 returns to the emergency department (8.7%), 128 readmissions (3.4%), and 41 reoperations (1.0%). The main source of readmission was the emergency department (n = 118, 92%). Nearly two-thirds of readmissions were nonoperative (n = 87, 68%) and 12.5 per cent of readmissions were not related to the index appendectomy. Factors associated with readmission include procedure length >70 minutes [odds ratio (OR) 1.89, P = 0.043] and failed nonoperative management of perforated appendicitis (OR 2.97, P = 0.041). The most common indication for reoperation was intra-abdominal abscess (n = 20, 49%), 55 per cent of which were managed with image-guided drainage. In conclusion, although 30-day revisit, readmission, and reoperation rates after appendectomy are low, there are opportunities for improvement. Furthermore, many 30-day readmissions are not related to the index procedure and must be clearly identified to avoid inaccuracies with reimbursement and quality rankings. PMID:27457862

  17. The 10-30-day intraseasonal variation of the East Asian winter monsoon: The temperature mode

    NASA Astrophysics Data System (ADS)

    Yao, Suxiang; Sun, Qingfei; Huang, Qian; Chu, Peng

    2016-09-01

    East Asia is known for its monsoon characteristics, but little research has been performed on the intraseasonal time scale of the East Asian winter monsoon (EAWM). In this paper, the extended reanalysis (ERA)-Interim sub-daily data are used to study the surface air temperature intraseasonal oscillation (ISO) of the EAWM. The results show that the air temperature (2-m level) of the EAWM has a dominant period of 10-30 days. Lake Baikal and south China are the centers of the air temperature ISO. An anomalous low frequency (10-30-day filtered) anticyclone corresponds to the intraseasonal cold air. The 10-30-day filtered cold air spreads from Novaya Zemlya to Lake Baikal and even to South China. The ISO of the Arctic Oscillation (AO) index influences the temperature of the EAWM by stimulating Rossby waves in middle latitude, causing meridional circulation, and eventually leads to the temperature ISO of the EAWM. RegCM4 has good performance for the simulation of the air temperature ISO. The simulated results indicate that the plateau is responsible for the southward propagation of the intraseasonal anticyclone. The anticyclone could not reach South China when there was no plateau in western China and its upper reaches.

  18. PBMA Pause and Learn Video Nuggets Transcript

    NASA Technical Reports Server (NTRS)

    Rogers, Ed

    2006-01-01

    This document is a transcript for a video about a practice practiced at Goddard Space Flight Center called Pause and Learn (PaL). The PaL process is intended to, first of all, help the team learn. So, the team that was involved in the activity, the group that actually did the work, that handled the review, or ran the tests, or developed the piece of equipment, they sit down and actually say, "What did we learn from this exercise?" The idea is to create a learning environment at various key milestones in the execution of a process, rather than wait until the end of the given process, be it a launch or a mission.

  19. Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions

    PubMed Central

    Emons, M F; Bae, J P; Hoogwerf, B J; Kindermann, S L; Taylor, R J; Nathanson, B H

    2016-01-01

    Objective Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. Research design and methods 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes. Results 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of all-cause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25–34 and 35–44 (OR 2.334 and 1.996, respectively, compared with age 65–74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35–44 (OR 3.484, compared with age 65–74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). Conclusions Factors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and

  20. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    PubMed Central

    Lam, Chun Nok; Arora, Sanjay; Menchine, Michael

    2016-01-01

    Introduction Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED) as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino). Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds) of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds) of hospital readmission, compared to non-homeless, non-mental health (NHNM) patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3.7% chance of hospital

  1. Responses and pauses: discrimination and a choice catastrophe.

    PubMed Central

    Zeiler, M D; Solano, J M

    1982-01-01

    Pigeons produced a stimulus change either by responding or by not responding for a specified time period (by pausing). They then had to choose between two responses to obtain food. One choice was correct if the first component had been completed by a response; the other was correct if the component had been completed by a pause. The pigeons usually chose correctly, thereby indicating that they used their own prior behavior as a discriminative stimulus. Fixed pause requirements did not produce equal first component completions by a response and by a pause. To obtain equality, the pause requirement was titrated as a function of current performance. Titration resulted in equal completions and also produced accurate discrimination. In addition to showing that pigeons discriminated whether they had responded or paused, the data displayed and discontinuous functions predicted by catastrophe theory. Another procedure used forced choice rather than titration to produce equal completions by pausing and responding and also showed accurate discrimination of behavior. PMID:7069360

  2. Organization of Hospital Nursing and 30-day Readmissions in Medicare Patients Undergoing Surgery

    PubMed Central

    Ma, Chenjuan; McHugh, Matthew D; Aiken, Linda H

    2014-01-01

    Background Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing - a critical organizational component of hospital service system - in relation to readmissions. Objectives To determine the relationships between hospital nursing factors - nurse work environment, nurse staffing, and nurse education - and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. Method and Design We linked Medicare patient discharge data, multi-state nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in four states (CA, FL, NJ, & PA). Risk-adjusted robust logistic regressions were used for analyses. Results The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03, 95% CI: 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97, 95% CI: 0.95-0.99). Administrative support to nursing practice (OR=0.96, 95% CI: 0.94-0.99) and nurse-physician relations (OR=0.97, 95% CI: 0.95-0.99) were two main attributes of the work environment that were associated with readmissions. Conclusions Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties. PMID:25373404

  3. Neighborhood Socioeconomic Disadvantage and 30 Day Rehospitalizations: An Analysis of Medicare Data

    PubMed Central

    Kind, Amy JH; Jencks, Steve; Brock, Jane; Yu, Menggang; Bartels, Christie; Ehlenbach, William; Greenberg, Caprice; Smith, Maureen

    2014-01-01

    Background Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of US neighborhood socioeconomic disadvantage are more readily available, although rarely employed clinically. Objective To evaluate the association between neighborhood socioeconomic disadvantage at the census block-group level, as measured by Singh’s validated Area Deprivation Index (ADI), and 30-day rehospitalization. Design Retrospective cohort study Setting United States Patients Random 5% national sample of fee-for-service Medicare patients discharged with congestive heart failure, pneumonia or myocardial infarction, 2004–2009 (N = 255,744) Measurements 30-day rehospitalizations. Medicare data were linked to 2000 Census data to construct an ADI for each patient’s census block-group, which were then sorted into percentiles by increasing ADI. Relationships between neighborhood ADI grouping and rehospitalization were evaluated using multivariate logistic regression models, controlling for patient sociodemographics, comorbidities/severity, and index hospital characteristics. Results The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate=21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates rose from 22% to 27% with worsening ADI. This relationship persisted after full adjustment, with the most disadvantaged neighborhoods having a rehospitalization risk (adjusted risk ratio = 1.09, confidence interval 1.05–1.12) similar to that of chronic pulmonary disease (1.06, 1.04–1.08) and greater than that of diabetes (0.95, 0.94–0.97). Limitations No direct markers of care quality, access Conclusions Residence within a disadvantaged US neighborhood is a rehospitalization predictor of magnitude similar to chronic pulmonary

  4. Risk Prediction of Emergency Department Revisit 30 Days Post Discharge: A Prospective Study

    PubMed Central

    Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhao, Yifan; Zhu, Chunqing; Li, Zhen; Hu, Zhongkai; Fu, Changlin; Ji, Jun; Wang, Yong; Zhao, Yingzhen; Dai, Dorothy; Culver, Devore S.; Alfreds, Shaun T.; Rogow, Todd; Stearns, Frank; Sylvester, Karl G.; Widen, Eric; Ling, Xuefeng B.

    2014-01-01

    Background Among patients who are discharged from the Emergency Department (ED), about 3% return within 30 days. Revisits can be related to the nature of the disease, medical errors, and/or inadequate diagnoses and treatment during their initial ED visit. Identification of high-risk patient population can help device new strategies for improved ED care with reduced ED utilization. Methods and Findings A decision tree based model with discriminant Electronic Medical Record (EMR) features was developed and validated, estimating patient ED 30 day revisit risk. A retrospective cohort of 293,461 ED encounters from HealthInfoNet (HIN), Maine's Health Information Exchange (HIE), between January 1, 2012 and December 31, 2012, was assembled with the associated patients' demographic information and one-year clinical histories before the discharge date as the inputs. To validate, a prospective cohort of 193,886 encounters between January 1, 2013 and June 30, 2013 was constructed. The c-statistics for the retrospective and prospective predictions were 0.710 and 0.704 respectively. Clinical resource utilization, including ED use, was analyzed as a function of the ED risk score. Cluster analysis of high-risk patients identified discrete sub-populations with distinctive demographic, clinical and resource utilization patterns. Conclusions Our ED 30-day revisit model was prospectively validated on the Maine State HIN secure statewide data system. Future integration of our ED predictive analytics into the ED care work flow may lead to increased opportunities for targeted care intervention to reduce ED resource burden and overall healthcare expense, and improve outcomes. PMID:25393305

  5. Changes in size and compliance of the calf after 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Convertino, Victor A.; Doerr, Donald F.; Stein, Stewart L.

    1989-01-01

    The hypothesis that reducing muscle compartment by a long-term exposure to microgravity would cause increased leg venous compliance was tested in eight men who were assessed for vascular compliance and for serial circumferences of the calf before and after 30 days of continuous 6-deg head-down bed rest. It was found that head-down bed rest caused decreases in the calculated calf volume and the calf-muscle compartment, as well as increases in calf compliance. The percent increases in calf compliance correlated significantly with decreases in calf muscle compartment.

  6. The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure

    PubMed Central

    Giuliano, Karen K.; Danesh, Valerie; Funk, Marjorie

    2016-01-01

    OBJECTIVE The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. BACKGROUND Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. METHODS A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report “Best Hospitals” survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. RESULTS A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. CONCLUSION These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes. PMID:26579974

  7. Development and Implementation of a Real-Time 30-Day Readmission Predictive Model

    PubMed Central

    Cronin, Patrick R.; Greenwald, Jeffrey L.; Crevensten, Gwen C.; Chueh, Henry C.; Zai, Adrian H.

    2014-01-01

    Hospitals are under great pressure to reduce readmissions of patients. Being able to reliably predict patients at increased risk for rehospitalization would allow for tailored interventions to be offered to them. This requires the creation of a functional predictive model specifically designed to support real-time clinical operations. A predictive model for readmissions within 30 days of discharge was developed using retrospective data from 45,924 MGH admissions between 2/1/2012 and 1/31/2013 only including factors that would be available by the day after admission. It was then validated prospectively in a real-time implementation for 3,074 MGH admissions between 10/1/2013 and 10/31/2013. The model developed retrospectively had an AUC of 0.705 with good calibration. The real-time implementation had an AUC of 0.671 although the model was overestimating readmission risk. A moderately discriminative real-time 30-day readmission predictive model can be developed and implemented in a large academic hospital. PMID:25954346

  8. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale for future delivery is trading on a designated contract market, registered derivatives...

  9. 76 FR 20688 - Guidance for Industry and Food and Drug Administration Staff; 30-Day Notices, 135-Day Premarket...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-13

    ... February 25, 1998 (63 FR 9570). This guidance describes the user fees authorized, updates the previous... the guidance entitled ``30-Day Notices, 135-Day Premarket Approval (PMA) Supplements and 75-Day... of a guidance for industry entitled ``30-Day Notices, 135-Day Premarket Approval (PMA)...

  10. 78 FR 65696 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... October 25, 2013 at 78 FR 64145 HUD published a 30 day notice of proposed information collection. This... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing... Collection Title of Information Collection: Housing Finance Agency Risk- Sharing Program. OMB Approval...

  11. 76 FR 6794 - 30-Day Submission Period for Requests for ONC-Approved Accreditor (ONC-AA) Status

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-08

    ... Program for Health Information Technology, 76 FR 1262 (Jan. 7, 2011) (the ``Permanent Certification... HUMAN SERVICES 30-Day Submission Period for Requests for ONC-Approved Accreditor (ONC-AA) Status AGENCY... ONC-Approved Accreditor (ONC-AA) status. Authority: 42 U.S.C. 300jj-11. DATES: The 30-day...

  12. Vocalization and pauses in fast-paced reading.

    PubMed

    Breznitz, Z

    1990-04-01

    Previous research (Breznitz, 1987a) indicated that prompting first-graders to read faster than usual increases their comprehension. The present study was conducted to clarify which of the speech elements that comprise reading time is affected when reading pace is accelerated. First-graders (N = 76) read aloud three parallel forms of a comprehension test, at self- and fast-paced rates consecutively, followed by a second self-paced reading. Vocalization time, pause time, pause frequency, and the average length of vocalizations and pauses were determined with an automatic vocal transaction analyzer. During fast-paced reading, children made fewer and shorter pauses, vocalized at a faster rate, and tended to speak in longer units. The speech characteristics indicative of fast-paced reading were significantly correlated with reading comprehension, even during self-paced reading, and can serve as indicators of effective reading. PMID:2366048

  13. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials

    PubMed Central

    Leppin, Aaron L.; Gionfriddo, Michael R.; Kessler, Maya; Brito, Juan Pablo; Mair, Frances S.; Gallacher, Katie; Wang, Zhen; Erwin, Patricia J.; Sylvester, Tanya; Boehmer, Kasey; Ting, Henry H.; Murad, M. Hassan; Shippee, Nathan D.; Montori, Victor M.

    2014-01-01

    Importance Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving healthcare quality. The Cumulative Complexity Model conceptualizes patient context. It predicts that highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions. Objectives To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features—including their impact on treatment burden and on patients’ capacity to enact post-discharge self-care—that might explain their varying effects. Data Sources We searched electronic databases (1990 until April 1st, 2013), contacted experts, and reviewed bibliographies. Study Selection Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients admitted to the hospital for a medical or surgical cause for > 24 hours and discharged to home. Data extraction and Synthesis Reviewer pairs extracted trial characteristics and used an activity-based coding strategy to characterize the interventions; fidelity was confirmed with authors. Blinded to trial outcomes, reviewers noted the extent to which interventions placed additional work on patients after discharge or supported their capacity for self-care in accordance with the Cumulative Complexity Model. Main Outcome Relative risk of all-cause or unplanned readmission with or without out of hospital deaths at 30 days post-discharge. Results In 42 trials, the tested interventions prevented early readmissions [pooled random effects relative risk (RR) 0.82, 95% CI 0.73 to 0.91; p=.03; I2= 32%], a finding that was consistent across patient subgroups. Trials published before 2002 reported interventions that were 1.6 times more effective than those tested later (pinteraction = .01). In exploratory subgroup analyses, interventions with many components (pinteraction <.01), involving

  14. Correspondence between hair cortisol concentrations and 30-day integrated daily salivary and weekly urinary cortisol measures.

    PubMed

    Short, Sarah J; Stalder, Tobias; Marceau, Kristine; Entringer, Sonja; Moog, Nora K; Shirtcliff, Elizabeth A; Wadhwa, Pathik D; Buss, Claudia

    2016-09-01

    Characterization of cortisol production, regulation and function is of considerable interest and relevance given its ubiquitous role in virtually all aspects of physiology, health and disease risk. The quantification of cortisol concentration in hair has been proposed as a promising approach for the retrospective assessment of integrated, long-term cortisol production. However, human research is still needed to directly test and validate current assumptions about which aspects of cortisol production and regulation are reflected in hair cortisol concentrations (HCC). Here, we report findings from a validation study in a sample of 17 healthy adults (mean±SD age: 34±8.6 yrs). To determine the extent to which HCC captures cumulative cortisol production, we examined the correspondence of HCC, obtained from the first 1cm scalp-near hair segment, assumed to retrospectively reflect 1-month integrated cortisol secretion, with 30-day average salivary cortisol area-under-the curve (AUC) based on 3 samples collected per day (on awakening, +30min, at bedtime) and the average of 4 weekly 24-h urinary free cortisol (UFC) assessments. To further address which aspects of cortisol production and regulation are best reflected in the HCC measure, we also examined components of the salivary measures that represent: (1) production in response to the challenge of awakening (using the cortisol awakening response [CAR]), and (2) chronobiological regulation of cortisol production (using diurnal slope). Finally, we evaluated the test-retest stability of each cortisol measure. Results indicate that HCC was most strongly associated with the prior 30-day integrated cortisol production measure (average salivary cortisol AUC) (r=0.61, p=0.01). There were no significant associations between HCC and the 30-day summary measures using CAR or diurnal slope. The relationship between 1-month integrated 24-h UFC and HCC did not reach statistical significance (r=0.30, p=0.28). Lastly, of all cortisol

  15. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  16. The Pausing Principle: Increasing the Efficiency of Memory for Ongoing Events.

    ERIC Educational Resources Information Center

    Di Vesta, Francis J.; Smith, Deborah A.

    1979-01-01

    The effectiveness of pausing for learning from lectures was investigated. Pause location and kind of activity conducted during the pause were varied. Free-recall and cued-recall tests were administered immediately after the lecture and two weeks later. Interspersed pauses coupled with group discussion was the most efficient procedure. (Author/RD)

  17. Development of Lightweight Material Composites to Insulate Cryogenic Tanks for 30-Day Storage in Outer Space

    NASA Technical Reports Server (NTRS)

    Krause, D. R.

    1972-01-01

    A conceptual design was developed for an MLI system which will meet the design constraints of an ILRV used for 7- to 30-day missions. The ten tasks are briefly described: (1) material survey and procurement, material property tests, and selection of composites to be considered; (2) definition of environmental parameters and tooling requirements, and thermal and structural design verification test definition; (3) definition of tanks and associated hardware to be used, and definition of MLI concepts to be considered; (4) thermal analyses, including purge, evacuation, and reentry repressurization analyses; (5) structural analyses (6) thermal degradation tests of composite and structural tests of fastener; (7) selection of MLI materials and system; (8) definition of a conceptual MLI system design; (9) evaluation of nondestructive inspection techniques and definition of procedures for repair of damaged areas; and (10) preparation of preliminary specifications.

  18. Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates.

    PubMed

    Poston, Kristen M; Dumas, Bonnie P; Edlund, Barbara J

    2014-01-01

    The purpose of this quality improvement project was to determine whether use of aspects of a transitional care model by nurse navigators would affect 30-day readmission rates in hospitalized ischemic stroke patients discharged home with self-care. Thirty-day readmission rates and emergency department (ED) visits were compared before, during, and after the implementation of the revised discharge process. Comparative analysis demonstrated reductions in readmissions and in ED visits. Thirty-day readmission rates to our hospital decreased from 9.39% to 3.24% when comparing pre- with postintervention data. Thirty-day ED visit rates to all state hospitals decreased from 16.36% to 12.08% when comparing pre- with postintervention data. PMID:24322371

  19. The Gravity of LBNP Exercise: Lessons Learned from Identical Twins in Bed for 30 Days

    NASA Technical Reports Server (NTRS)

    Hargens, Alan R.; Groppo, Eli R.; Lee, Stuart M. C.; Watenpaugh, Donald; Schneider, Suzanne; O'Leary, Deborah; Smith, Scott M.; Steinbach, Gregory C.; Tanaka, Kunihiko; Kimura, Shinji; Meyer, R. Scott

    2002-01-01

    Microgravity leads to cardiovascular deconditioning in humans, which is manifested by post-flight reduction of orthostatic tolerance and upright exercise capacity. During upright posture on Earth, blood pressures are greater in the feet than at heart or head levels due to gravity's effects on columns of blood in the body. During exposure to Microgravity, all gravitational blood pressures disappear. Presently, there is no exercise hardware available for space flight to provide gravitational blood pressures to tissues of the lower body. We hypothesized that 40 minutes of supine treadmill running per day in a LBNP chamber at 1.0 to 1.2 body weight (approximately 50 - 60 mm Hg LBNP) with a 5 min resting, nonexercise LBNP exposure at 50 mm Hg after the exercise session will maintain aerobic fitness orthostatic tolerance, and selected parameters of musculoskeletal function during 30 days of bed rest (simulated microgravity). This paper is an interim report of some of our findings on 16 subjects.

  20. Continuous 30-day measurements utilizing the monkey metabolism pod. [study of weightlessness effects

    NASA Technical Reports Server (NTRS)

    Pace, N.; Kodama, A. M.; Mains, R. C.; Rahlmann, D. F.; Grunbaum, B. W.

    1977-01-01

    A fiberglass system was previously described, using which quantitative physiological measurements could be made to study the effects of weightlessness on 10 to 14 kg adult monkeys maintained in comfortable restraint under space flight conditions. Recent improvements in the system have made it possible to obtain continuous measurements of respiratory gas exchange, cardiovascular function, and mineral balance for periods of up to 30 days on pig-tailed monkeys. It has also been possible to operate two pods which share one set of instrumentation, thereby permitting simultaneous measurements to be made on two animals by commutating signal outputs from the pods. In principle, more than two pods could be operated in this fashion. The system is compatible with Spacelab design. Representative physiological data from ground tests of the system are presented.

  1. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest

    PubMed Central

    Morgan, Jennifer L. L.; Zwart, Sara R.; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen

    2012-01-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25–49 yr) who participated in a 30-day −6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ∼20% (P < 0.001), and serum parathyroid hormone decreased ∼25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ∼20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = −0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration. PMID:22995395

  2. The cost of clinical mastitis in the first 30 days of lactation: An economic modeling tool.

    PubMed

    Rollin, E; Dhuyvetter, K C; Overton, M W

    2015-12-01

    Clinical mastitis results in considerable economic losses for dairy producers and is most commonly diagnosed in early lactation. The objective of this research was to estimate the economic impact of clinical mastitis occurring during the first 30 days of lactation for a representative US dairy. A deterministic partial budget model was created to estimate direct and indirect costs per case of clinical mastitis occurring during the first 30 days of lactation. Model inputs were selected from the available literature, or when none were available, from herd data. The average case of clinical mastitis resulted in a total economic cost of $444, including $128 in direct costs and $316 in indirect costs. Direct costs included diagnostics ($10), therapeutics ($36), non-saleable milk ($25), veterinary service ($4), labor ($21), and death loss ($32). Indirect costs included future milk production loss ($125), premature culling and replacement loss ($182), and future reproductive loss ($9). Accurate decision making regarding mastitis control relies on understanding the economic impacts of clinical mastitis, especially the longer term indirect costs that represent 71% of the total cost per case of mastitis. Future milk production loss represents 28% of total cost, and future culling and replacement loss represents 41% of the total cost of a case of clinical mastitis. In contrast to older estimates, these values represent the current dairy economic climate, including milk price ($0.461/kg), feed price ($0.279/kg DM (dry matter)), and replacement costs ($2,094/head), along with the latest published estimates on the production and culling effects of clinical mastitis. This economic model is designed to be customized for specific dairy producers and their herd characteristics to better aid them in developing mastitis control strategies. PMID:26596651

  3. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest.

    PubMed

    Morgan, Jennifer L L; Zwart, Sara R; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen; Smith, Scott M

    2012-11-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25-49 yr) who participated in a 30-day -6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ~20% (P < 0.001), and serum parathyroid hormone decreased ~25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ~20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = -0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration. PMID:22995395

  4. Kinetics of paused ribosome recycling in Escherichia coli

    PubMed Central

    Janssen, Brian D.; Hayes, Christopher S.

    2009-01-01

    Summary The bacterial tmRNA•SmpB system recycles stalled translation complexes in a process termed ‘ribosome rescue’. tmRNA•SmpB specifically recognizes ribosomes that are paused at or near the 3′ end of truncated mRNA, and therefore nucleolytic mRNA processing is required before paused ribosomes can be rescued from full-length transcripts. Here, we examine the recycling of ribosomes paused on both full-length and truncated mRNAs. Peptidyl-tRNAs corresponding to each paused translation complex were identified, and their turnover kinetics used to estimate the half-lives of paused ribosomes in vivo. Ribosomes were paused at stop codons on full-length mRNA using a nascent peptide motif that interferes with translation termination and elicits tmRNA•SmpB activity. Peptidyl-tRNA turnover from these termination-paused ribosomes was slightly more rapid in tmRNA+ cells (T1/2 = 22 ± 2.2 s), compared to ΔtmRNA cells (T1/2 = 32 ± 1.6 s). Overexpression of release factor-1 (RF-1) greatly accelerated peptidyl-tRNA turnover from termination-paused ribosomes in both tmRNA+ and ΔtmRNA cells, whereas other termination factors had little or no effect on recycling. In contrast to inefficient translation termination, ribosome recycling from truncated transcripts lacking in-frame stop codons was dramatically accelerated by tmRNA•SmpB. However, peptidyl-tRNA still turned over from nonstop-paused ribosomes at a significant rate (t1/2 = 61 ± 7.3 s) in ΔtmRNA cells. Overexpression of RF-1, RF-3, and ribosome recycling factor (RRF) in ΔtmRNA cells failed to accelerate ribosome recycling from nonstop mRNA. These results indicate that tmRNA•SmpB activity is rate-limited by mRNA cleavage, and that RF-3 and RRF do not constitute a tmRNA-independent rescue pathway as previously suggested. Peptidyl-tRNA turnover from nonstop-paused ribosomes in ΔtmRNA cells suggests the existence of another uncharacterized ribosome rescue pathway. PMID:19761774

  5. Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

    PubMed

    Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

    2016-09-01

    OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p < 0.001 for each). Postoperative pneumonia (OR 4.294, p < 0.001), urinary tract infection (OR 4.262, p < 0.001), and sepsis (OR 2.616, p = 0.006) also independently increased the readmission risk. Independent patient risk factors for unplanned readmission included Native American race (OR 2.363, p = 0.019), steroid use > 10 days (OR 1.411, p = 0

  6. 78 FR 52557 - 30-Day Notice of Proposed Information Collection: Section 811 Project Rental Assistance (PRA) for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Section 811 Project Rental... Information Collection: Section 811 Project Rental Assistance (PRA) for Persons with Disabilities....

  7. An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

    PubMed Central

    Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

    2011-01-01

    Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

  8. Are Purkinje Cell Pauses Drivers of Classically Conditioned Blink Responses?

    PubMed

    Jirenhed, Dan-Anders; Hesslow, Germund

    2016-08-01

    Several lines of evidence show that classical or Pavlovian conditioning of blink responses depends on the cerebellum. Recordings from cerebellar Purkinje cells that control the eyelid and the conditioned blink show that during training with a conditioning protocol, a Purkinje cell develops a pause response to the conditional stimulus. This conditioned cellular response has many of the properties that characterise the overt blink. The present paper argues that the learned Purkinje cell pause response is the memory trace and main driver of the overt conditioned blink and that it explains many well-known behavioural phenomena. PMID:26400585

  9. 30-day Mortality after Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery

    PubMed Central

    Smith, Mark D.; Patterson, Emma; Wahed, Abdus S.; Belle, Steven H.; Berk, Paul D.; Courcoulas, Anita P.; Dakin, Gregory F.; Flum, David R.; Machado, Laura; Mitchell, James E.; Pender, John; Pomp, Alfons; Pories, Walter; Ramanathan, Ramesh; Schrope, Beth; Staten, Myrlene; Ude, Akuezunkpa; Wolfe, Bruce M.

    2011-01-01

    Purpose Mortality following bariatric surgery is a rare event in contemporary series, making it difficult for any single center to draw meaningful conclusions as to cause of death. Nevertheless, much of the published mortality data come from single center case series and reviews of administrative databases. These sources tend to produce lower mortality estimates than those obtained from controlled clinical trials. Furthermore, information about the causes of death and how they were determined is not always available. The aim of the present report is to describe in detail all deaths occurring within 30-days of surgery in the Longitudinal Assessment of Bariatric Surgery (LABS). Methods LABS is a 10-center observational cohort study of bariatric surgical outcomes. Data were collected prospectively for bariatric surgeries performed between March 2005 and April 2009. All deaths occurring within 30-days of surgery were identified, and cause of death assigned by an independent Adjudication Subcommittee, blinded to operating surgeon and site. Results 6118 patients underwent primary bariatric surgery. 18 deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%) and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information. Conclusions This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths. PMID:21866378

  10. Clinical review is essential to evaluate 30-day mortality after trauma

    PubMed Central

    2014-01-01

    Background Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We examined the proportion of trauma patients dying within 30 days from causes not related to the injury and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics, injury characteristics, cause of death and time to death in patients admitted to our trauma center who died within 30 days, between 2007-2011. Methods Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of all patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and low energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and other/unknown). Results Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to the injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians). Fifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality rate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury mechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI accounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths. Patients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared to those who died after penetrating and blunt trauma (all P < 0.01). Conclusions Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly affected the unadjusted mortality rate, ISS, median age and time to death

  11. Analysis of risk factors, localization and 30-day prognosis of intracerebral hemorrhage.

    PubMed

    Smajlović, Dzevdet; Salihović, Denisa; C Ibrahimagić, Omer; Sinanović, Osman; Vidović, Mirjana

    2008-05-01

    Intracerebral hemorrhage is the deadliest, most disabling and least treatable form of stroke despite progression in medical science. The aim of the study was to analyze the frequency, risk factors, localization and 30-day prognosis in patients with intracerebral hemorrhage. We analyzed 352 patients with intracerebral hemorrhage (ICH) hospitalized at the Department of Neurology Tuzla during a three-year follow up. The following data were collected for all patients in a computerized database: age, sex, risk factors (hypertension, heart diseases, diabetes and smoking) and CT findings. Stroke severity was estimated with Scandinavian Stroke Scale, ICH topography was specified by CT, and outcome at 1st month after onset included information on vital status and disability (modified Rankin Scale, mRS). The most frequent risk factors were hypertension (84%), heart diseases (31%), cigarette smoking (28%) and diabetes mellitus (14%). The most frequent localization of ICH was multilobar (38%), internal capsule/basal ganglia region (36%) and lobar (17%). Within first month died 147 patients (42%). The highest mortality rate was in patients with brain stem (83%) and multilobar hemorrhage (64%). Factors independently associated with mortality were age (odds ratio 1,05 (95% confidence interval 1,02 to 1,08); p=0,001), stroke severity (OR 0,93 (0,92 to 0,95); p<0,0001), multilobar hemorrhage (OR 5,4 (3,0 to 9,6); p<0,0001) and intraventricular hemorrhage (OR 3,9 (2,2 to 7,1); p<0,0001). Favorable outcome at first month (mRS < or = 2) had 45% of the surviving patients with ICH. The best outcome was for the patients with cerebellar hemorrhage (63%), while only 40% of the patients with hemorrhage in internal capsule/basal ganglia region had Rankin scale 2 or less. Hypertension is the most frequent risk factor in patients with ICH. ICHs are mainly localized in lobar and internal capsule/basal ganglia regions. Independent predictors of mortality following ICH are age, hypertension

  12. Bion M1. Peculiarities of life activities of microbes in 30-day spaceflight

    NASA Astrophysics Data System (ADS)

    Viacheslav, Ilyin; Korshunov, Denis; Morozova, Julia; Voeikova, Tatiana; Tyaglov, Boris; Novikova, Liudmila; Krestyanova, Irina; Emelyanova, Lydia

    The aim of this work was to analyze the influence of space flight factors ( SFF) to microorganism strains , exposed inside unmanned spacecraft Bion M-1 during the 30- day space flight. Objectives of the work - the study of the influence of the SFF exchange chromosomal DNA in crosses microorganisms of the genus Streptomyces; the level of spontaneous phage induction of lysogenic strains fS31 from Streptomyces lividans 66 and Streptomyces coelicolor A3 ( 2 ) on the biosynthesis of the antibiotic tylosin strain of Streptomyces fradiae; survival electrogenic bacteria Shewanella oneidensis MR- 1 is used in the microbial fuel cell As a result of this work it was found that the SFF affect the exchange of chromosomal DNA by crossing strains of Streptomyces. Was detected polarity crossing , expressed in an advantageous contribution chromosome fragment of one of the parent strains in recombinant offspring. This fact may indicate a more prolonged exposure of cells in microgravity and , as a consequence, the transfer of longer fragments of chromosomal DNA This feature is the transfer of genetic material in microgravity could lead to wider dissemination and horizontal transfer of chromosomal and plasmid DNA of symbiotic microflora astronauts and other strains present in the spacecraft. It was shown no effect on the frequency of recombination PCF and the level of mutation model reversion of auxotrophic markers to prototrophy It was demonstrated that PCF increase the level of induction of cell actinophage fS31 lysogenic strain of S. lividans 66, but did not affect the level of induction of this phage cells S. coelicolor A3 ( 2). It is shown that the lower the level of synthesis PCF antibiotic aktinorodina (actinorhodin) in lysogenic strain S. coelicolor A3 ( 2). 66 Strains of S. lividans and S. coelicolor A3 ( 2 ) can be used as a biosensor for studying the effect on microorganisms PCF It is shown that the effect of the PCF reduces synthesis of tylosin and desmicosyn S. fradiae at

  13. The Effects of the Pause Procedure on Classroom Engagement

    ERIC Educational Resources Information Center

    Korvick, Lynn Marie

    2010-01-01

    Scope and Method of Study: The purpose of this study was to examine an instructional strategy intended to enhance engagement in the college classroom. The effects of the pause procedure on classroom engagement and cognitive load were studied. The relationships between levels of classroom engagement and near-term learning outcomes, as well as…

  14. Code-Switching and Pausing: An Interdisciplinary Study

    ERIC Educational Resources Information Center

    Gardner-Chloros, Penelope; McEntee-Atalianis, Lisa; Paraskeva, Marilena

    2013-01-01

    This study considers code-switching (CS) and pausing in two sociolinguistically distinct groups in London and Cyprus, bilingual in Greek-Cypriot Dialect (GCD) and English. The characteristics of their speech are examined both in monolingual and bilingual modes (Grosjean, 2001). It was hypothesised that in London Greek-Cypriots, where CS is a…

  15. RNA polymerase pausing regulates translation initiation by providing additional time for TRAP-RNA interaction.

    PubMed

    Yakhnin, Alexander V; Yakhnin, Helen; Babitzke, Paul

    2006-11-17

    RNA polymerase (RNAP) pause sites have been identified in several prokaryotic genes. Although the presumed biological function of RNAP pausing is to allow synchronization of RNAP position with regulatory factor binding and/or RNA folding, a direct causal link between pausing and changes in gene expression has been difficult to establish. RNAP pauses at two sites in the Bacillus subtilis trpEDCFBA operon leader. Pausing at U107 and U144 participates in transcription attenuation and trpE translation control mechanisms, respectively. Substitution of U144 caused a substantial pausing defect in vitro and in vivo. These mutations led to increased trp operon expression that was suppressed by overproduction of TRAP, indicating that pausing at U144 provides additional time for TRAP to bind to the nascent transcript and promote formation of an RNA structure that blocks translation of trpE. These results establish that pausing is capable of playing a role in regulating translation in bacteria. PMID:17114058

  16. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Kheirbek, Raya E.; Fletcher, Ross D.; Bakitas, Marie A.; Fonarow, Gregg C.; Parvataneni, Sridivya; Bearden, Donna; Bailey, F. Amos; Morgan, Charity J.; Singh, Steven; Blackman, Marc R.; Zile, Michael R.; Patel, Kanan; Ahmed, Momanna B.; Tucker, Rodney O.; Brown, Cynthia J.; Love, Thomas E.; Aronow, Wilbert S.; Roseman, Jeffrey M.; Rich, Michael W.; Allman, Richard M.; Ahmed, Ali

    2015-01-01

    Background Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998–2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post-discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years, 58% women, 18% African American). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio {HR} associated with hospice referral, 0.12; 95% confidence interval {CI}, 0.06–0.24). HRs (95% CIs) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post-discharge were 0.03 (0.04–0.21) and 0.17 (0.08–0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% vs. 27%), it was similar at 90 days (64% vs. 67% among hospice-eligible patients). Conclusions A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized HF patients. However, most HF patients who died within 6 months of hospital discharge did not receive a discharge hospice referral. PMID:26019151

  17. POSTOPERATIVE DELIRIUM

    PubMed Central

    Whitlock, Elizabeth L.; Vannucci, Andrea; Avidan, Michael S.

    2013-01-01

    Delirium is an unfortunately common complication seen during the postoperative course. Because of its significant association with physical and cognitive morbidity, clinicians should be aware of evidence-based practices relating to the diagnosis, treatment, and prevention of postoperative delirium. Here, we review selected recent literature pertaining to the epidemiology and impact of the condition, perioperative risk factors for its development and/or exacerbation, and strategies for management of delirium, with additional attention to the intensive care unit population. PMID:21483389

  18. 76 FR 17734 - 30-Day Notice of Proposed Information Collection: Form DS-1998E, Foreign Service Officer Test...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    ... information collection request to the Office of Management and Budget (OMB) for ] approval in accordance with.... Originating Office: Human Resources, HR/REE/BEX. Form Number: DS-1998E. Respondents: Registrants for the... Office of Management and Budget (OMB) for up to 30 days from March 30, 2011. ADDRESSES: Direct...

  19. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  20. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  1. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  2. 76 FR 34122 - 30-Day Notice of Proposed Information Collection: NEA/PI Online Performance Reporting System (PRS)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: NEA/PI Online Performance Reporting System (PRS) ACTION... Collection: NEA/PI Online Performance Reporting System (PRS). OMB Control Number: 1405-0183. Type of...

  3. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore.

    PubMed

    Low, Lian Leng; Lee, Kheng Hock; Hock Ong, Marcus Eng; Wang, Sijia; Tan, Shu Yun; Thumboo, Julian; Liu, Nan

    2015-01-01

    The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. PMID:26682212

  4. 78 FR 42090 - Submission for OMB Review; 30-day Comment Request; NIH Office of Intramural Training & Education...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-15

    ... on or after October 1, 1995, unless it displays a currently valid OMB control number. Direct Comments... Survey--Race-Ethnicity-Gender-Birth Year (25% 3,073.0 1.0 3/60 153.65 Response Rate) Survey--Time to... HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request;...

  5. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Indexes underlying futures contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) GENERAL RULES AND REGULATIONS, SECURITIES EXCHANGE ACT OF 1934 Rules and Regulations Under...

  6. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  7. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  8. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  9. 78 FR 40313 - 30-Day Notice of Proposed Information Collection: Monthly Report of Excess Income and Annual...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Monthly Report of Excess Income and Annual Report of Uses of Excess Income AGENCY: Office of the Chief Information Officer, HUD. ACTION..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  10. 78 FR 59047 - 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report--Local Contracting Agencies (HUD Programs) AGENCY: Office of the Chief Information Officer...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451...

  11. 78 FR 40312 - 30-Day Notice of Proposed Information Collection: FHA TOTAL (Technology Open to Approved Lenders...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: FHA TOTAL (Technology Open to... Information Collection: FHA TOTAL (Technology Open to Approved Lenders) Mortgage Scorecard. OMB Approval... real estate finance industries that are grounded in an open process to develop, promote and...

  12. 77 FR 32710 - 30-Day Notice of Proposed Information Collection: DS 5507, Affidavit of Physical Presence or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-01

    .... Department of State, SA-29, 4th Floor, Washington, DC 20520 or at ASKPRI@state.gov . SUPPLEMENTARY... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day... of proposed collection of information. SUMMARY: The Department of State has submitted the...

  13. 77 FR 73731 - 30-Day Notice of Proposed Information Collection: Application Under the Hague Convention on the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-11

    ...The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995 we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public comment. DATES: Submit comments directly to......

  14. 75 FR 39577 - 30-Day Notice of Intention To Request Clearance of Collection of Information; Opportunity for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-09

    ... comments on these information collection requirements on January 29, 2010 (75 FR 4838). The comment period... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service 30-Day Notice of Intention To Request Clearance of Collection of...

  15. 75 FR 32961 - 30-Day Federal Register Notice of Intention To Request Clearance of Collection of Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-10

    ... solicit comments on this proposed information collection on April 5, 2010 (75 FR 17152-17153). No comments... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service 30-Day Federal Register Notice of Intention To Request Clearance of Collection...

  16. 75 FR 14180 - 30-Day Notice of Intention To Request Clearance of Collection of Information; Opportunity for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service 30-Day Notice of Intention To Request Clearance of Collection of Information; Opportunity for Public Comment AGENCY: Department of the Interior; National Park Service. ACTION: Notice...

  17. 76 FR 28499 - 30-Day Notice of Proposed Information Collection: Form DS-6561, Pre-Assignment for Overseas Duty...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Form DS-6561, Pre-Assignment for Overseas Duty, OMB 1405-XXXX... Collection: Pre-Assignment for Overseas Duty. OMB Control Number: 1405-XXXX. Type of Request:...

  18. 78 FR 64145 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing..., 2013. A. Overview of Information Collection Title of Information Collection: Housing Finance Agency... Secretary to implement risk sharing with State and local housing finance agencies (HFAs). Under this...

  19. 78 FR 56901 - Submission for OMB Review; 30-day Comment Request: Family Life, Activity, Sun, Health, and Eating...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request: Family Life, Activity, Sun, Health, and Eating (FLASHE) Study (NCI) SUMMARY: Under the provisions of...

  20. 78 FR 15958 - Submission for OMB Review; 30-day Comment Request: Pediatric Palliative Care Campaign Pilot Survey

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-13

    ... HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request: Pediatric Palliative Care Campaign Pilot Survey SUMMARY: Under the provisions of Section 3507(a)(1)(D) of.... Proposed Collection: Pediatric Palliative Care Campaign Pilot Survey, ] 0925-New--National Institute...

  1. 78 FR 70958 - 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: HUD has... Continuum of Care Program. OMB Approval Number: 2506--New. Type of Request: New collection. Form...

  2. 77 FR 47690 - 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing Electronic Form... Database In-Processing Electronic Form. OMB Control Number: 1405-0168. Type of Request: Extension of...

  3. 78 FR 55264 - Submission for OMB Review; 30-Day Comment Request: Awareness and Beliefs About Cancer Survey...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ...: Awareness and Beliefs About Cancer Survey, National Cancer Institute (NCI) SUMMARY: Under the provisions of... to allow an additional 30 days for public comment. The National Cancer Institute (NCI), National... information on the proposed project, contact: Sarah Kobrin, Division of Cancer Control and Population...

  4. 78 FR 15799 - 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ...The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995 we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public...

  5. 75 FR 39322 - 30-Day Notice of Proposed Information Collection: Retail Price Schedule, DS-2020 Parts 1-4, DS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ...The Department of State is seeking Office of Management and Budget (OMB) approval for the information collection described below. The purpose of this notice is to allow 30 days for public comment in the Federal Register preceding submission to OMB. We are conducting this process in accordance with the Paperwork Reduction Act of 1995. Title of Information Collection: Retail Price......

  6. 78 FR 66040 - 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate-Sales Contract and Addendums

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... Contract and Addendums AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: On October 25, 2013 at 78 FR 64145, HUD inadvertently published a 30 day notice of proposed information collection entitled HUD-Owned Real Estate-Sales Contract and Addendums (2502-0306). HUD will republish...

  7. 78 FR 36562 - 30-Day Notice of Proposed Information Collection: Application and Re-certification Packages for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Application and Re-certification... Title of Information Collection: Application and Re-certification Packages for Approval of...

  8. 78 FR 31999 - 30-Day Notice of Proposed Information Collection: Young Turkey/Young America Evaluation (YTYA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Young Turkey/ Young America Evaluation (YTYA) Survey ACTION... Collection: Young Turkey/Young America Evaluation (YTYA) Survey. OMB Control Number: None. Type of...

  9. 78 FR 69077 - Notice of 30-Day Public Review Period and Availability of Final Environmental Assessment and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... of No Significant Impact (FONSI) for the Department of Navy's (DoN) transfer of excess property at... VA's implementation and monitoring of the mitigation measures identified in the FONSI, would not have... infrastructure at the former NAS Alameda. The FONSI is available for public review for 30 days before...

  10. 78 FR 67385 - 30-Day Notice of Proposed Information Collection: FHA PowerSaver Pilot Program (Title I Property...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-12

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: FHA PowerSaver Pilot Program (Title I Property Improvement and Title II--203(k) Rehabilitation Mortgage Insurance) AGENCY: Office of the... Collection Title of Information Collection: FHA PowerSaver Pilot Program (Title I Property Improvement...

  11. 78 FR 55083 - Submission for OMB Review; 30-day Comment Request; Genomics and Society Public Surveys in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ... and Society Public Surveys in Conjunction With Smithsonian Museum of Natural History Genome Exhibit... an additional 30 days for public comment. The National Human Genome Research Institute (NHGRI...: Genomics and Society Public Surveys in Conjunction with National Museum of Natural History Genome...

  12. 78 FR 60008 - 30-Day Notice of Proposed Information Collection: Application for a U.S. Passport

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-30

    .... 1401-1504), the 14th Amendment to the Constitution of the United States, other applicable treaties and... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day... State has submitted the information collection described below to the Office of Management......

  13. 78 FR 42795 - Submission for OMB review; 30-Day Comment Request: Evaluation of the Brain Disorders in the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-17

    ... HUMAN SERVICES National Institutes of Health Submission for OMB review; 30-Day Comment Request: Evaluation of the Brain Disorders in the Developing World Program of the John E. Fogarty International Center... plans and instruments must be requested in writing. Proposed Collection: Evaluation of the...

  14. 76 FR 13443 - 30-Day Notice of Proposed Information Collection: Form DS-0064, Statement Regarding a Lost or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-11

    ... the Office of Management and Budget (OMB) for approval in accordance with the Paperwork Reduction Act.... DATES: Submit comments to the Office of Management and Budget (OMB) for up to 30 days from March 11... and Regulatory Affairs at the Office of Management and Budget (OMB). You may submit comments by...

  15. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore

    PubMed Central

    Low, Lian Leng; Lee, Kheng Hock; Hock Ong, Marcus Eng; Wang, Sijia; Tan, Shu Yun; Thumboo, Julian; Liu, Nan

    2015-01-01

    The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. PMID:26682212

  16. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010

    PubMed Central

    Brown, Katherine L; Crowe, Sonya; Franklin, Rodney; McLean, Andrew; Cunningham, David; Barron, David; Tsang, Victor; Pagel, Christina; Utley, Martin

    2015-01-01

    Objectives To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix. Methods, setting and participants Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged <16 years. The χ2 test for trend was used to retrospectively analyse the proportion of surgical episodes ending in 30-day mortality and with various case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations. Main outcome measure 30-day mortality for an episode of surgical management. Results Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (p<0.01). The raw national 30-day mortality rate fell over the period of review from 4.3% (95% CI 3.5% to 5.1%) in 2000 to 2.6% (95% CI 2.2% to 3.0%) in 2009/2010 (p<0.01). The case mix became more complex in terms of the percentage of patients <2.5 kg (p=0.05), with functionally univentricular hearts (p<0.01) and higher risk diagnoses (p<0.01). In the later time era, there was significant improvement in 30-day mortality for arterial switch with ventricular septal defect (VSD) repair, patent ductus arteriosus ligation, Fontan-type operation, tetralogy of Fallot and VSD repair, and the mean age of patients fell for a range of operations performed in infancy. Conclusions The raw 30-day mortality rate for paediatric cardiac surgery fell over a decade despite a rise in the national case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects. PMID:25893099

  17. Responsible gambling tools: pop-up messages and pauses on video lottery terminals.

    PubMed

    Cloutier, Martin; Ladouceur, Robert; Sévigny, Serge

    2006-09-01

    The authors examined the effect of messages and pauses, presented on video lottery terminal screens, on erroneous beliefs and persistence to play. At posttest, the strength of erroneous beliefs was lower for participants who received messages conveying information about randomness in gambling as compared to those who received pauses. Pauses also diminished the strength of erroneous beliefs, and there was no difference between the effects of pauses and messages on the number of games played. The authors discuss these results in terms of the use of messages and pauses on video lottery terminals as a strategy for promoting responsible gambling. PMID:17066750

  18. Evaluation of 30-Day Hospital Readmission After Surgery for Advanced-Stage Ovarian Cancer in a Medicare Population

    PubMed Central

    Eskander, Ramez N.; Chang, Jenny; Ziogas, Argyrios; Anton-Culver, Hoda; Bristow, Robert E.

    2014-01-01

    Purpose To analyze rate, risk factors, and costs associated with 30-day readmission after ovarian cancer surgery. Patients and Methods The SEER-Medicare linked database (1992 to 2010) was used to evaluate readmission rates within 30 days of index surgery in patients with stage IIIC/IV ovarian, primary peritoneal, or fallopian tube cancer. Multivariable logistic regression was used to identify factors associated with readmission. Results Of 5,152 eligible patients, 1,003 (19.5%) were readmitted within 30 days of discharge. Mean patient age was 75 years. Diagnoses associated with readmission included infection (34.7%), dehydration (34.3%), ileus/obstruction (26.2%), metabolic/electrolyte derangements (23.1%), and anemia (12.3%). In multivariable analysis, year of discharge was significantly associated with 30-day readmission (1996 to 2000: odds ratio [OR], 1.32; 95% CI, 1.01 to 1.71; 2001 to 2005: OR, 1.58; 95% CI, 1.24 to 2.0; 2006 to 2010: OR, 1.73; 95% CI, 1.35 to 2.21; referent years 1992 to 1995), as were length of index hospital stay more than 8 days (OR, 1.39; 95% CI, 1.18 to 1.64) and discharge to a skilled nursing facility (OR, 1.3; 95% CI, 1.04 to 1.63). Patients readmitted within 30 days had a significantly greater 1-year mortality rate compared with patients not readmitted (41.1% v 25.1%, respectively; P < .001). The median cost of readmission hospital stay was $9,220 in year 2010 dollars, with a total cost of $9.3 million over the study period. Conclusion Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs. PMID:25385738

  19. The solsticial pause on Mars: 1. A planetary wave reanalysis

    NASA Astrophysics Data System (ADS)

    Lewis, Stephen R.; Mulholland, David P.; Read, Peter L.; Montabone, Luca; Wilson, R. John; Smith, Michael D.

    2016-01-01

    Large-scale planetary waves are diagnosed from an analysis of profiles retrieved from the Thermal Emission Spectrometer aboard the Mars Global Surveyor spacecraft during its scientific mapping phase. The analysis is conducted by assimilating thermal profiles and total dust opacity retrievals into a Mars global circulation model. Transient waves are largest throughout the northern hemisphere autumn, winter and spring period and almost absent during the summer. The southern hemisphere exhibits generally weaker transient wave behaviour. A striking feature of the low-altitude transient waves in the analysis is that they show a broad subsidiary minimum in amplitude centred on the winter solstice, a period when the thermal contrast between the summer hemisphere and the winter pole is strongest and baroclinic wave activity might be expected to be strong. This behaviour, here called the 'solsticial pause,' is present in every year of the analysis. This strong pause is under-represented in many independent model experiments, which tend to produce relatively uniform baroclinic wave activity throughout the winter. This paper documents and diagnoses the transient wave solsticial pause found in the analysis; a companion paper investigates the origin of the phenomenon in a series of model experiments.

  20. A positioned +1 nucleosome enhances promoter-proximal pausing

    PubMed Central

    Jimeno-González, Silvia; Ceballos-Chávez, María; Reyes, José C.

    2015-01-01

    Chromatin distribution is not uniform along the human genome. In most genes there is a promoter-associated nucleosome free region (NFR) followed by an array of nucleosomes towards the gene body in which the first (+1) nucleosome is strongly positioned. The function of this characteristic chromatin distribution in transcription is not fully understood. Here we show in vivo that the +1 nucleosome plays a role in modulating RNA polymerase II (RNAPII) promoter-proximal pausing. When a +1 nucleosome is strongly positioned, elongating RNAPII has a tendency to stall at the promoter-proximal region, recruits more negative elongation factor (NELF) and produces less mRNA. The nucleosome-induced pause favors pre-mRNA quality control by promoting the addition of the cap to the nascent RNA. Moreover, the uncapped RNAs produced in the absence of a positioned nucleosome are degraded by the 5′-3′ exonuclease XRN2. Interestingly, reducing the levels of the chromatin remodeler ISWI factor SNF2H decreases +1 nucleosome positioning and increases RNAPII pause release. This work demonstrates a function for +1 nucleosome in regulation of transcription elongation, pre-mRNA processing and gene expression. PMID:25735750

  1. Return periods of global climate fluctuations and the pause

    NASA Astrophysics Data System (ADS)

    Lovejoy, S.

    2014-07-01

    An approach complementary to General Circulation Models (GCMs), using the anthropogenic CO2 radiative forcing as a linear surrogate for all anthropogenic forcings [Lovejoy], was recently developed for quantifying human impacts. Using preindustrial multiproxy series and scaling arguments, the probabilities of natural fluctuations at time lags up to 125 years were determined. The hypothesis that the industrial epoch warming was a giant natural fluctuation was rejected with 99.9% confidence. In this paper, this method is extended to the determination of event return times. Over the period 1880-2013, the largest 32 year event is expected to be 0.47 K, effectively explaining the postwar cooling (amplitude 0.42-0.47 K). Similarly, the "pause" since 1998 (0.28-0.37 K) has a return period of 20-50 years (not so unusual). It is nearly cancelled by the pre-pause warming event (1992-1998, return period 30-40 years); the pause is no more than natural variability.

  2. African Easterly Waves in 30-day High-Resolution Global Simulations: A Case Study During the 2006 NAMMA Period

    NASA Technical Reports Server (NTRS)

    Shen, Bo-Wen; Tao, Wei-Kuo; Wu, Man-Li C.

    2010-01-01

    In this study, extended -range (30 -day) high-resolution simulations with the NASA global mesoscale model are conducted to simulate the initiation and propagation of six consecutive African easterly waves (AEWs) from late August to September 2006 and their association with hurricane formation. It is shown that the statistical characteristics of individual AEWs are realistically simulated with larger errors in the 5th and 6th AEWs. Remarkable simulations of a mean African easterly jet (AEJ) are also obtained. Nine additional 30 -day experiments suggest that although land surface processes might contribute to the predictability of the AEJ and AEWs, the initiation and detailed evolution of AEWs still depend on the accurate representation of dynamic and land surface initial conditions and their time -varying nonlinear interactions. Of interest is the potential to extend the lead time for predicting hurricane formation (e.g., a lead time of up to 22 days) as the 4th AEW is realistically simulated.

  3. Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

    PubMed

    Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

    2013-01-01

    In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors. PMID:23550215

  4. 30 Days Wild: Development and Evaluation of a Large-Scale Nature Engagement Campaign to Improve Well-Being

    PubMed Central

    Richardson, Miles; Cormack, Adam; McRobert, Lucy; Underhill, Ralph

    2016-01-01

    There is a need to increase people’s engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature. PMID:26890891

  5. Evaluation of a Pharmacist-Specific Intervention on 30-Day Readmission Rates for High-Risk Patients with Pneumonia

    PubMed Central

    Carroll, Douglas N.; Pinner, Nathan A.

    2015-01-01

    Background: Pharmacist interventions have been shown to have an impact on reducing readmission rates, however further research is necessary to target resources to high-risk populations and determine the most effective bundle of interventions. Objective: To evaluate the effect of a pharmacist-bundled intervention on 30-day readmission rates for high-risk patients with pneumonia. Methods: A pilot study with a historical control conducted at a community, teaching-affiliated medical center. Up to 65 selected subjects were included if they had pneumonia and any of the following high-risk criteria: admission within 6 months, at least 5 scheduled home medications, chronic obstructive pulmonary disease (COPD), or heart failure. A retrospective chart review was conducted to compile the historical control group that received usual care between June and November 2013. Patients admitted from December 2013 through March 2014 were reviewed to receive a bundled intervention. The primary outcome was 30-day readmission rates. Risk factors and reasons for readmission, pharmacist clinical interventions, and the time interval between discharge and readmission were also evaluated. Results: A trend toward a reduced 30-day readmission rate was observed in the intervention group (n = 43) compared to those who received usual care (n = 65) (27.9% vs 40.0%; relative risk [RR], 0.6977; 95% CI, 0.3965–1.2278; P = .2119). The most commonly identified high-risk inclusion criteria were having at least 5 scheduled home medications and COPD. The time interval between discharge and readmission did not considerably differ between groups (10.8 vs 10.6 days). Conclusions: The pharmacist-bundled intervention was associated with a reduced 30-day readmission rate for high-risk patients with pneumonia. PMID:26823619

  6. Marijuana use motives: concurrent relations to frequency of past 30-day use and anxiety sensitivity among young adult marijuana smokers.

    PubMed

    Bonn-Miller, Marcel O; Zvolensky, Michael J; Bernstein, Amit

    2007-01-01

    The present investigation examined two theoretically relevant aspects of marijuana motives using the Marijuana Motives Measure (MMM) [Simons, J., Correia, C. J., Carey, K. B., & Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology 45, 265-273] among 141 (78 female) young adults (M(age)=20.17, S.D.=3.34). The first objective was to evaluate the incremental validity of marijuana motives in relation to frequency of past 30-day use after controlling for the theoretically relevant factors of the number of years using marijuana (lifetime), current levels of alcohol, as well as tobacco smoking use. As expected, coping, enhancement, social, and expansion motives each were uniquely and significantly associated with past 30-day marijuana use over and above the covariates; conformity motives were not a significant predictor. A second aim was to explore whether coping, but no other marijuana motive, was related to the emotional vulnerability individual difference factor of anxiety sensitivity (fear of anxiety). As hypothesized, after controlling for number of years using marijuana (lifetime), past 30-day marijuana use, current levels of alcohol consumption, and cigarettes smoked per day, anxiety sensitivity was incrementally and uniquely related to coping motives for marijuana use, but not other motives. These results are discussed in relation to the clinical implications of better understanding the role of motivation for marijuana use among emotionally vulnerable young adults. PMID:16647822

  7. Characteristics of patients dying within 30 days of diagnosis of breast or colorectal cancer in Scotland, 2003–2007

    PubMed Central

    Brewster, D H; Clark, D I; Stockton, D L; Munro, A J; Steele, R J C

    2011-01-01

    Background: Recent research has shown that most of the excess risk of death following breast and colorectal cancer in England compared with Norway and Sweden occurs in older age groups during the first year, and especially in the first month of follow-up. The aim of this study was to explore the characteristics of patients dying within 30 days of being diagnosed with one of these cancers in Scotland during 2003–2007. Methods: Anonymised cancer registry records linked to hospital discharge and death records were extracted. The study population was divided into patients who died within 30 days of diagnosis (cases) and those who survived beyond this threshold (controls). Differences in patient-, tumour-, and health service-related characteristics were assessed using the χ2-test and logistic regression. Results: Patients dying within 30 days were more likely to be elderly and to have experienced emergency admission to non-surgical specialities. Their tumours were less likely to have been verified microscopically, but they appeared more likely to be of high grade and advanced in stage. A substantial number of patients died from causes other than their cancer. Conclusion: These results suggest that early mortality after a diagnosis of breast or colorectal cancer may be partly due to comorbidity and lifestyle factors, as well as due to more advanced disease. Further research is required to determine the precise explanation for these findings and, in particular, if any potentially avoidable factors such as delays in presentation, referral, or diagnosis exist. PMID:21206498

  8. What 50 Years of Research Tell Us About Pausing Under Ratio Schedules of Reinforcement

    PubMed Central

    Schlinger, Henry D; Derenne, Adam; Baron, Alan

    2008-01-01

    Textbooks in learning and behavior commonly describe performance on fixed-ratio schedules as “break and run,” indicating that after reinforcement subjects typically pause and then respond quickly to the next reinforcement. Performance on variable-ratio schedules, on the other hand, is described as steady and fast, with few long pauses. Beginning with Ferster and Skinner's magnum opus, Schedules of Reinforcement (1957), the literature on pausing under ratio schedules has identified the influences on pausing of numerous important variables, in particular ratio size and reinforcement magnitude. As a result, some previously held assumptions have been called into question. For example, research has shown that the length of the pause is controlled not only by the preceding ratio, as Ferster and Skinner and others had assumed (and as implied by the phrase postreinforcement pause), but by the upcoming ratio as well. Similarly, despite the commonly held belief that ratio pausing is unique to the fixed-ratio schedule, there is evidence that pausing also occurs under variable-ratio schedules. If such widely held beliefs are incorrect, then what about other assumptions? This article selectively examines the literature on pausing under ratio schedules over the past 50 years and concludes that although there may indeed be some common patterns, there are also inconsistencies that await future resolution. Several accounts of pausing under ratio schedules are discussed along with the implications of the literature for human performances, most notably the behaviors termed procrastination. PMID:22478501

  9. Cerebellar Nuclear Neurons Use Time and Rate Coding to Transmit Purkinje Neuron Pauses.

    PubMed

    Sudhakar, Shyam Kumar; Torben-Nielsen, Benjamin; De Schutter, Erik

    2015-12-01

    Neurons of the cerebellar nuclei convey the final output of the cerebellum to their targets in various parts of the brain. Within the cerebellum their direct upstream connections originate from inhibitory Purkinje neurons. Purkinje neurons have a complex firing pattern of regular spikes interrupted by intermittent pauses of variable length. How can the cerebellar nucleus process this complex input pattern? In this modeling study, we investigate different forms of Purkinje neuron simple spike pause synchrony and its influence on candidate coding strategies in the cerebellar nuclei. That is, we investigate how different alignments of synchronous pauses in synthetic Purkinje neuron spike trains affect either time-locking or rate-changes in the downstream nuclei. We find that Purkinje neuron synchrony is mainly represented by changes in the firing rate of cerebellar nuclei neurons. Pause beginning synchronization produced a unique effect on nuclei neuron firing, while the effect of pause ending and pause overlapping synchronization could not be distinguished from each other. Pause beginning synchronization produced better time-locking of nuclear neurons for short length pauses. We also characterize the effect of pause length and spike jitter on the nuclear neuron firing. Additionally, we find that the rate of rebound responses in nuclear neurons after a synchronous pause is controlled by the firing rate of Purkinje neurons preceding it. PMID:26630202

  10. Applied force provides insight into transcriptional pausing and its modulation by transcription factor NusA

    PubMed Central

    Zhou, Jing; Ha, Kook Sun; Porta, Arthur La; Landick, Robert; Block, Steven M.

    2011-01-01

    Summary Transcriptional pausing by RNA polymerase (RNAP) plays an essential role in gene regulation. Pausing is modified by various elongation factors, including prokaryotic NusA, but the mechanisms underlying pausing and NusA function remain unclear. Alternative models for pausing invoke blockade events that precede translocation (on-pathway), enzyme backtracking (off-pathway), or isomerization to a non-backtracked, elemental pause state (off-pathway). We employed an optical-trapping assay to probe the motions of individual RNAP molecules transcribing a DNA template carrying tandem repeats encoding the his pause, subjecting these enzymes to controlled forces. NusA significantly decreased the pause-free elongation rate of RNAP while increasing the probability of entry into short- and long-lifetime pauses, in a manner equivalent to exerting a ~19 pN force opposing transcription. The effects of force and NusA on pause probabilities and lifetimes support a reaction scheme where non-backtracked, elemental pauses branch off the elongation pathway from the pre-translocated state of RNAP. PMID:22099310

  11. Pathologic apnea and brief respiratory pauses in preterm infants: relation to sleep state.

    PubMed

    Holditch-Davis, D; Edwards, L J; Wigger, M C

    1994-01-01

    The development of pathologic apnea, respiratory pauses, and periodic respiration was examined in 71 high-risk preterm infants, observed weekly. Respiration was recorded every 10 seconds; apnea length and periodic respiration were scored from a tape. All subjects had respiratory pauses, and 36 had pathologic apnea. The mean length of respiratory pauses was longer in quiet sleep, and the frequency of respiratory pauses was greater in active sleep. The mean length of respiratory pauses and probability of pathologic apnea in both sleep states and frequency of pauses in quiet sleep decreased with age. Sex, theophylline treatment, race, and length of mechanical ventilation affected the developmental trajectories of some apnea variables. Apnea in preterm infants cannot be considered a unitary phenomenon. PMID:7937176

  12. Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study

    PubMed Central

    Smolina, Kate; Wright, Frances L.; Rayner, Mike

    2012-01-01

    Background: There are limited national population-based epidemiological data on acute myocardial infarction (AMI) in England, making the current burden of disease, and clinical prognosis, difficult to quantify. The aim of this study was to provide national estimates of incidence and 30-day case fatality rate (CFR) for first and recurrent AMI in England. Methods: Population-based study using person-linked routine hospital and mortality data on 79 896 individuals of any age, who were admitted to hospital for AMI or who died suddenly from AMI in 2010. Results: Of 82 252 AMI events in 2010, 83% were first. Age-standardized incidence of first AMI per 100 000 population was 130 (95% CI 129–131) in men and 55.9 (95% CI 55.3–56.6) in women. Age-standardized 30-day overall CFRs including sudden AMI deaths for men and women, respectively, were 32.4% (95% CI 32.0–32.9) and 30.3% (95% CI 29.8–30.9) for first AMI and 29.7% (95% CI 28.7–30.7) and 26.7% (95% CI 25.5–27.9) for recurrent AMI. Age-standardized hospitalized 30-day CFR was 12.0% (95% CI 11.6–12.3) for men and 12.3% (95% CI 11.9–12.7) for women. Conclusions: While the majority of AMIs are not fatal, of those that are, two-thirds occur as sudden AMI deaths. About one in six of all AMIs are recurrent events. These findings reinforce the importance of primary and secondary prevention in reducing AMI morbidity and mortality. PMID:22241758

  13. Effects of leg strength and bicycle ergometry exercise on cardiovascular deconditioning after 30-day head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wu, Bin; Liu, Yusheng; Sun, Hongyi; Zhao, Dongming; Wang, Yue; Wu, Ping; Ni, Chengzhi

    2010-10-01

    The purpose of this study is to determine if the intermittent leg muscular strength exercise and bicycle ergometry exercise could attenuate cardiovascular deconditioning induced by prolonged -6° head-down bed rest (HDBR). Fifteen male subjects were randomly allocated into group A ( n=5, 30 days HDBR without exercise), group B ( n=5, 30 days HDBR with leg muscular strength exercise) and group C ( n=5, 30 days HDBR with bicycle ergometry exercise). The orthostatic tolerance (OT) was determined by +75°/20 min head-up tilt (HUT) test and the submaximal exercise capacity was determined by bicycle ergometry before and after HDBR. The results were as follows: (1) Compared with that before HDBR, OT time decreased dramatically by 57.6% ( p<0.001) after HDBR in group A, while it decreased by 36.4% ( p=0.084) in group B and by 34.7% ( p=0.062) in group C. (2) Compared with that before HDBR, the submaximal exercise time decreased significantly by 17.7% ( p<0.05) and 21.1% ( p<0.05) in groups A and B, respectively, after HDBR. However, it had no change (+1.3%, p>0.77) in group C. (3) compared with that before HDBR, the changes of heart rate (HR) and blood pressure were slightly improved in group B and C, while deteriorated in group A during orthostatic test and exercise test after HDBR. The results indicate that leg muscular strength exercise and bicycle ergometry exercise could partially attenuate the cardiovascular deconditioning induced by 30 d HDBR, and the latter exercise training could fully provide the protection for the loss of exercise capacity.

  14. Management of paroxysmal ectopic atrial tachycardia with long sinus pauses in a teenager.

    PubMed

    Balaji, Seshadri

    2015-01-01

    Sinus pauses in the setting of supraventricular tachycardia is rare in children. We describe an asymptomatic teen with irregular heart rate detected during an incidental exam who was found to have short runs of a slow ectopic atrial tachycardia on electrocardiogram and prolonged sinus pauses on routine ambulatory ECG. Successful catheter ablation of the ectopic atrial tachycardia led to resolution of the sinus pauses. PMID:27134442

  15. Management of paroxysmal ectopic atrial tachycardia with long sinus pauses in a teenager

    PubMed Central

    Balaji, Seshadri

    2016-01-01

    Sinus pauses in the setting of supraventricular tachycardia is rare in children. We describe an asymptomatic teen with irregular heart rate detected during an incidental exam who was found to have short runs of a slow ectopic atrial tachycardia on electrocardiogram and prolonged sinus pauses on routine ambulatory ECG. Successful catheter ablation of the ectopic atrial tachycardia led to resolution of the sinus pauses. PMID:27134442

  16. Kinetic modeling of molecular motors: pause model and parameter determination from single-molecule experiments

    NASA Astrophysics Data System (ADS)

    Morin, José A.; Ibarra, Borja; Cao, Francisco J.

    2016-05-01

    Single-molecule manipulation experiments of molecular motors provide essential information about the rate and conformational changes of the steps of the reaction located along the manipulation coordinate. This information is not always sufficient to define a particular kinetic cycle. Recent single-molecule experiments with optical tweezers showed that the DNA unwinding activity of a Phi29 DNA polymerase mutant presents a complex pause behavior, which includes short and long pauses. Here we show that different kinetic models, considering different connections between the active and the pause states, can explain the experimental pause behavior. Both the two independent pause model and the two connected pause model are able to describe the pause behavior of a mutated Phi29 DNA polymerase observed in an optical tweezers single-molecule experiment. For the two independent pause model all parameters are fixed by the observed data, while for the more general two connected pause model there is a range of values of the parameters compatible with the observed data (which can be expressed in terms of two of the rates and their force dependencies). This general model includes models with indirect entry and exit to the long-pause state, and also models with cycling in both directions. Additionally, assuming that detailed balance is verified, which forbids cycling, this reduces the ranges of the values of the parameters (which can then be expressed in terms of one rate and its force dependency). The resulting model interpolates between the independent pause model and the indirect entry and exit to the long-pause state model

  17. A space maintainability experiment aboard the Ben Franklin submersible during the 30-day Gulf Stream drift mission.

    NASA Technical Reports Server (NTRS)

    Kappler, J. R.; May, C. B.

    1972-01-01

    In the summer of 1969, a deep submersible drifted for 30 days below the surface of the Gulf Stream, while operated by a six man crew. The main purpose of the mission was oceanographic research. The crew's activities and completely self-contained environment resembled those of a space station such as Skylab. Because of these similarities aspects of onboard vehicle maintenance during the actual conduct of a scientific mission were investigated. The maintainability study was accomplished in six distinct phases. Two useful plots of manpower distribution were developed. A maintenance action summary is presented in a table.

  18. Preferential interaction of the his pause RNA hairpin with RNA polymerase β subunit residues 904–950 correlates with strong transcriptional pausing

    PubMed Central

    Wang, Daguang; Severinov, Konstantin; Landick, Robert

    1997-01-01

    RNA secondary structures (hairpins) that form as the nascent RNA emerges from RNA polymerase are important components of many signals that regulate transcription, including some pause sites, all ρ-independent terminators, and some antiterminators. At the his leader pause site, a 5-bp-stem, 8-nt-loop pause RNA hairpin forms 11 nt from the RNA 3′ end and stabilizes a transcription complex conformation slow to react with NTP substrate. This stabilization appears to depend at least in part on an interaction with RNA polymerase. We tested for RNA hairpin interaction with the paused polymerase by crosslinking 5-iodoUMP positioned specifically in the hairpin loop. In the paused conformation, strong and unusual crosslinking of the pause hairpin to β904–950 replaced crosslinking to β′ and to other parts of β that occurred in nonpaused complexes prior to hairpin formation. These changes in nascent RNA interactions may inhibit reactive alignment of the RNA 3′ end in the paused complex and be related to events at ρ-independent terminators. PMID:9237994

  19. Pauses During Autobiographical Discourse Reflect Episodic Memory Processes in Early Alzheimer's Disease.

    PubMed

    Pistono, Aurélie; Jucla, Mélanie; Barbeau, Emmanuel J; Saint-Aubert, Laure; Lemesle, Béatrice; Calvet, Benjamin; Köpke, Barbara; Puel, Michèle; Pariente, Jérémie

    2015-01-01

    There is a large body of research on discourse production in Alzheimer's disease (AD). Some studies have focused on pause production, revealing that patients make extensive use of pauses during speech. This has been attributed to lexical retrieval difficulties, but pausing may also reflect other forms of cognitive impairment as it increases with cognitive load. The aim of the present study was to analyze autobiographical discourse impairment in AD from a broad perspective, looking at pausing behavior (frequency, duration, and location). Our first objective was to characterize discourse changes in mild cognitive impairment (MCI) due to AD. Our second objective was to determine the cognitive and neuroanatomical correlates of these changes. Fifteen patients with MCI due to AD and 15 matched cognitively normal controls underwent an ecological episodic memory task, a full neuropsychological assessment, and a 3D T1-weighted MRI scans. Autobiographical discourse collected from the ecological episodic memory task was recorded, transcribed, and analyzed, focusing on pausing. Intergroup comparisons showed that although patients did not produce more pauses than controls overall, they did make more between-utterance pauses. The number of these specific pauses was positively correlated with patients' episodic memory performance. Furthermore, neuroimaging analysis showed that, in the patient group, their use was negatively correlated with frontopolar area (BA 10) grey matter density. This region may therefore play an important role in the planning of autobiographical discourse production. These findings demonstrate that pauses in early AD may reflect a compensatory mechanism for improving mental time travel and memory retrieval. PMID:26757034

  20. Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

    PubMed Central

    Guerrero, Mónica; Crisafulli, Ernesto; Liapikou, Adamantia; Huerta, Arturo; Gabarrús, Albert; Chetta, Alfredo; Soler, Nestor; Torres, Antoni

    2016-01-01

    Background and Objective Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients. Methods The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years. Results Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5). Conclusion In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death. PMID:26943928

  1. Reduce Driveline Trauma Through Stabilization and Exit Site Management: 30 Days Feasibility Results from the Multicenter RESIST Study.

    PubMed

    Stahovich, Marcia; Sundareswaran, Kartik S; Fox, Sarah; Hallinan, William; Blood, Peggy; Chen, Leway; Pamboukian, Salpy V; Chinn, Raymond; Farrar, David J; Pagani, Francis D; Blue, Laura

    2016-01-01

    The percutaneous lead management kit (PLMK) was developed for the HeartMate 2 (HM2) left ventricular assist device (LVAD) to reduce trauma at the exit site and to maintain a clean environment. REduce Driveline Trauma through StabIlization and Exit Site ManagemenT (RESIST) was a multicenter, prospective, nonrandomized study designed to evaluate the feasibility of the PLMK for managing the HM2 driveline exit site. Fifty patients were enrolled at five sites at a median of 495 days post-HM2 implant; 92% (46 of 50) of patients used the PLMK for a minimum of 30 days. At 30 days, more patients found the PLMK to be extremely comfortable (80% vs. 37%, p < 0.001) and extremely effective at stabilizing the driveline (82% vs. 40%, p < 0.001) compared with each center's standard of care. Frequency of dressing changes was 6-7 days or higher for 85% of the patients with PLMK. Three patients developed driveline infection while on PLMK (6%, 0.15 events per patient year), and 35 patients continued to use the PLMK after 6 months. The PLMK is easy to use, increases patient comfort, and increases driveline stability with a dressing change frequency of 6-7 days. PMID:27111738

  2. Pharmacokinetic and Genomic Effects of Arsenite in Drinking Water on Mouse Lung in a 30-Day Exposure

    PubMed Central

    Chilakapati, Jaya; Wallace, Kathleen; Hernandez-Zavala, Araceli; Moore, Tanya; Ren, Hongzu

    2015-01-01

    The 2 objectives of this subchronic study were to determine the arsenite drinking water exposure dependent increases in female C3H mouse liver and lung tissue arsenicals and to characterize the dose response (to 0, 0.05, 0.25, 1, 10, and 85 ppm arsenite in drinking water for 30 days and a purified AIN-93M diet) for genomic mouse lung expression patterns. Mouse lungs were analyzed for inorganic arsenic, monomethylated, and dimethylated arsenicals by hydride generation atomic absorption spectroscopy. The total lung mean arsenical levels were 1.4, 22.5, 30.1, 50.9, 105.3, and 316.4 ng/g lung tissue after 0, 0.05, 0.25, 1, 10, and 85 ppm, respectively. At 85 ppm, the total mean lung arsenical levels increased 14-fold and 131-fold when compared to either the lowest noncontrol dose (0.05 ppm) or the control dose, respectively. We found that arsenic exposure elicited minimal numbers of differentially expressed genes (DEGs; 77, 38, 90, 87, and 87 DEGs) after 0.05, 0.25, 1, 10, and 85 ppm, respectively, which were associated with cardiovascular disease, development, differentiation, apoptosis, proliferation, and stress response. After 30 days of arsenite exposure, this study showed monotonic increases in mouse lung arsenical (total arsenic and dimethylarsinic acid) concentrations but no clear dose-related increases in DEG numbers. PMID:26674514

  3. Modulation of HLA-DR in dry eye patients following 30 days of treatment with a lubricant eyedrop solution

    PubMed Central

    Fernandez, Karen B; Epstein, Seth P; Raynor, Geoffrey S; Sheyman, Alan T; Massingale, Morgan L; Dentone, Peter G; Landegger, Lukas D; Asbell, Penny A

    2015-01-01

    Purpose To determine the changes in dry eye disease (DED) severity and the percentage of cells expressing HLA-DR on the ocular surface following treatment with lubricant eyedrops containing polyethylene glycol and propylene glycol (PEG/PG) and the gelling agent hydroxypropyl guar (HP-Guar). Patients and methods Nineteen patients with DED used PEG/PG + HP-Guar eyedrops four times per day for 30 days. Assessments included DED severity (Ocular Surface Disease Index [OSDI], corneal staining, conjunctival staining, tear film break-up time [TFBUT], and Schirmer testing) and impression cytology of the conjunctiva with masked flow cytometry at baseline and at 30 days. Results There was a significant decrease in corneal staining (P<0.01), OSDI (P=0.02), and TFBUT (P<0.01) following treatment with PEG/PG + HP-Guar. Results from flow cytometry revealed a significant decrease in cells expressing HLA-DR (P=0.02). Conclusion Treatment with PEG/PG + HP-Guar eyedrops showed improvement in dry eye severity and reduction in surface inflammation as indicated by a reduction in HLA-DR expression. PMID:26170605

  4. HIV care engagement within 30 days after hospital discharge among patients from a Thai tertiary-care centre.

    PubMed

    Ayudhya, Daruni Phalakawong Na; Khawcharoenporn, Thana

    2015-06-01

    A cohort study was conducted to assess the rate of follow-up visit within 30 days after hospital discharge and to determine factors associated with no follow-up among Thai HIV-infected adults during the period from November 2012 to October 2013. Of the 120 eligible patients, 76 (63%) were males, median age was 40 years, and 57 (48%) were newly diagnosed with HIV infection. The rate of follow-up within 30 days after hospital discharge was 69%. Independent factors associated with no follow-up were no caregiver (adjusted odds ratio [aOR] 7.82; p = 0.002), age (aOR 1.06; p = 0.007 for each year younger), being immigrant (aOR 5.10; p = 0.03) and monthly household income less than $US 300 (aOR 2.99; p = 0.04). These findings suggest the need for interventions to improve care engagement including close monitoring for follow-up, pre-discharge financial and medical coverage planning, assessment for the need for caregiver and patient education about the importance of care engagement. PMID:25015932

  5. What 50 Years of Research Tell Us about Pausing under Ratio Schedules of Reinforcement

    ERIC Educational Resources Information Center

    Schlinger, H. D.; Derenne, A.; Baron, A.

    2008-01-01

    Textbooks in learning and behavior commonly describe performance on fixed-ratio schedules as "break and run," indicating that after reinforcement subjects typically pause and then respond quickly to the next reinforcement. Performance on variable-ratio schedules, on the other hand, is described as steady and fast, with few long pauses. Beginning…

  6. Reducing Vocalized Pauses in Public Speaking Situations Using the VP Card

    ERIC Educational Resources Information Center

    Ramos Salazar, Leslie

    2014-01-01

    This article describes a speaking problem very common in today's world--"vocalized pauses" (VP). Vocalized pauses are defined as utterances such as "uh," "like," and "um" that occur between words in oral sentences. This practice of everyday speech can affect how a speaker's intentions are…

  7. Pausing Preceding and Following "Que" in the Production of Native Speakers of French

    ERIC Educational Resources Information Center

    Genc, Bilal; Mavasoglu, Mustafa; Bada, Erdogan

    2011-01-01

    Pausing strategies in read and spontaneous speech have been of significant interest for researchers since in literature it was observed that read speech and spontaneous speech pausing patterns do display some considerable differences. This, at least, is the case in the English language as it was produced by native speakers. As to what may be the…

  8. Quiet is the new loud: pausing and focus in child and adult Dutch.

    PubMed

    Romøren, Anna Sara H; Chen, Aoju

    2015-03-01

    In a number of languages, prosody is used to highlight new information (or focus). In Dutch, focus is marked by accentuation, whereby focal constituents are accented and post-focal constituents are de-accented. Even if pausing is not traditionally seen as a cue to focus in Dutch, several previous studies have pointed to a possible relationship between pausing and information structure. Considering that Dutch-speaking 4 to 5 year olds are not yet completely proficient in using accentuation for focus and that children generally pause more than adults, we asked whether pausing might be an available parameter for children to manipulate for focus. Sentences with varying focus structure were elicited from 10 Dutch-speaking 4 to 5 year olds and 9 Dutch-speaking adults by means of a picture-matching game. Comparing pause durations before focal and non-focal targets showed pre-target pauses to be significantly longer when the targets were focal than when they were not. Notably, the use of pausing was more robust in the children than in the adults, suggesting that children exploit pausing to mark focus more generally than adults do, at a stage where their mastery of the canonical cues to focus is still developing. PMID:25935935

  9. Effect of a 30-day isolation stress on calcium, phosphorus and other excretory products in an unrestrained chimpanzee.

    NASA Technical Reports Server (NTRS)

    Sabbot, I. M.; Mcnew, J. J.; Hoshizaki, T.; Sedgwick, C. J.; Adey, W. R.

    1972-01-01

    An unrestrained chimpanzee was studied in an isolation chamber and in his home cage environment. The study consisted of 49 urine collection days (14 days pre-, 5 days post- and 30 days of isolation), and then of 10 days in the home cage. Dietary intake, urine and fecal data were obtained. The effect of isolation on various excretory parameters was studied. Urine samples were analyzed for volume, osmolarity, creatinine, creatine, urea-N, 17-hydroxy corticosteroids, VMA, calcium and inorganic phosphorus. One way analyses of variance performed on the urinary excretion parameters showed all except creatinine excretion to vary significantly during periods of the study. The changes observed in calcium and phosphorus were highly significant. The data suggests that the calcium to phosphorus excretion ratio might serve as a physiological stress indicator of Selye's adaptation syndrome (period of resistance).

  10. Can the American College of Surgeons Risk Calculator Predict 30-Day Complications After Knee and Hip Arthroplasty?

    PubMed

    Edelstein, Adam I; Kwasny, Mary J; Suleiman, Linda I; Khakhkhar, Rishi H; Moore, Michael A; Beal, Matthew D; Manning, David W

    2015-09-01

    Accurate risk stratification of patients undergoing total hip (THA) and knee (TKA) arthroplasty is essential in the highly scrutinized world of pay-for-performance, value-driven healthcare. We assessed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator's ability to predict 30-day complications using 1066 publicly-reported Medicare patients undergoing primary THA or TKA. Risk estimates were significantly associated with complications in the categories of any complication (P = .005), cardiac complication (P < .001), pneumonia (P < .001) and discharge to skilled nursing facility (P < .001). However, predictability of complication occurrence was poor for all complications assessed. To facilitate the equitable provision and reimbursement of patient care, further research is needed to develop accurate risk stratification tools in TKA and THA surgery. PMID:26165953

  11. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    PubMed

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families. PMID:26575502

  12. 30-Day In-vivo Performance of a Wearable Artificial Pump-Lung for Ambulatory Respiratory Support

    PubMed Central

    Wu, Zhongjun J; Zhang, Tao; Bianchi, Giacomo; Wei, Xufeng; Son, Ho-Sung; Zhou, Kang; Sanchez, Pablo; Garcia, Jose; Griffith, Bartley P

    2011-01-01

    Background The purpose of this study was to evaluate the long-term in-vivo hemodynamics, gas transfer and biocompatibility of an integrated artificial pump-lung (APL) developed for ambulatory respiratory support. Methods The study was conducted in an ovine model by surgically placing the APL between the right atrium and pulmonary artery. Nine sheep were implanted. Heparin was infused as an anticoagulant. The device flow, gas transfer and plasma free hemoglobin (PFH) were measured daily. Hematological data, platelet activation and blood biochemistry were assessed twice a week. After 30 days, the sheep were euthanized for necropsy. The explanted devices were examined for gross thrombosis. Results Five sheep survived for 29 to 31 days and were electively terminated. Four sheep expired or were terminated early due to mechanical failure of IV lines or device. The APL devices in the five long-term animals were capable of delivering an oxygen transfer rate of 148±18 ml/min at a flow rate of 2.99±0.46 l/min with blood oxygen saturation of 96.7±1.3%. The device flow and oxygen transfer were stable over 30 days. The animals had normal end-organ functions except for surgery-related transient alteration in kidney function, liver function, and cell and tissue injury. There was no hemolysis. The device flow path and membrane surface were free of gross thrombus. Conclusions The APL exhibited the capability of providing respiratory support with excellent biocompatibility, long-term reliability and the potential for bridging to lung transplant. PMID:22115337

  13. Study on the kinetic characteristics of trace harmful gases for a two-person-30-day integrated CELSS test.

    PubMed

    Guo, Shuangsheng; Ai, Weidang; Fei, Jinxue; Xu, Guoxin; Zeng, Gu; Shen, Yunze

    2015-05-01

    A two-person-30-day controlled ecological life support system (CELSS) integrated test was carried out, and more than 30 kinds of trace harmful gases including formaldehyde, benzene, and ammonia were measured and analyzed dynamically. The results showed that the kinds and quantities of the trace harmful gases presented a continuously fluctuating state during the experimental period, but none of them exceed the spacecraft maximum allowable concentration (SMAC). The results of the Pre-Test (with two persons without plants for 3 days) and the Test (with two persons and four kinds of plants for 30 days) showed that there are some notable differences for the compositions of the trace harmful gases; the volatile organic compounds (VOCs) such as toluene, hexane, and acetamide were searched out in the Pre-Test, but were not found in the Test. Moreover, the concentrations of the trace harmful gases such as acetic benzene, formaldehyde, and ammonia decreased greatly in the Test more than those in the Pre-Test, which means that the plants can purify these gases efficiently. In addition, the VOCs such as carbon monoxide, cyclopentane, and dichloroethylene were checked out in the Test but none in the Pre-Test, which indicates that these materials might be from the crew's metabolites or those devices in the platform. Additionally, the ethylene released specially by plants accumulated in the later period and its concentration reached nearly ten times of 0.05 mg m(-3) (maximum allowed concentration for plant growth, which must have promoted the later withering of plants). We hoped that the work can play a referring function for controlling VOCs effectively so that future more CELSS integrating tests can be implemented smoothly with more crew, longer period, and higher closure. PMID:25483969

  14. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    NASA Astrophysics Data System (ADS)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  15. Postoperative hyperkalemia.

    PubMed

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided. PMID:25698564

  16. Robust G2 pausing of adult stem cells in Hydra.

    PubMed

    Buzgariu, Wanda; Crescenzi, Marco; Galliot, Brigitte

    2014-01-01

    Hydra is a freshwater hydrozoan polyp that constantly renews its two tissue layers thanks to three distinct stem cell populations that cannot replace each other, epithelial ectodermal, epithelial endodermal, and multipotent interstitial. These adult stem cells, located in the central body column, exhibit different cycling paces, slow for the epithelial, fast for the interstitial. To monitor the changes in cell cycling in Hydra, we established a fast and efficient flow cytometry procedure, which we validated by confirming previous findings, as the Nocodazole-induced reversible arrest of cell cycling in G2/M, and the mitogenic signal provided by feeding. Then to dissect the cycling and differentiation behaviors of the interstitial stem cells, we used the AEP_cnnos1 and AEP_Icy1 transgenic lines that constitutively express GFP in this lineage. For the epithelial lineages we used the sf-1 strain that rapidly eliminates the fast cycling cells upon heat-shock and progressively becomes epithelial. This study evidences similar cycling patterns for the interstitial and epithelial stem cells, which all alternate between the G2 and S-phases traversing a minimal G1-phase. We also found interstitial progenitors with a shorter G2 that pause in G1/G0. At the animal extremities, most cells no longer cycle, the epithelial cells terminally differentiate in G2 and the interstitial progenitors in G1/G0. At the apical pole ~80% cells are post-mitotic differentiated cells, reflecting the higher density of neurons and nematocytes in this region. We discuss how the robust G2 pausing of stem cells, maintained over weeks of starvation, may contribute to regeneration. PMID:24703763

  17. Effect of 30-day orbital flight BION M1 on excretion of expired endogenous CO in mice

    NASA Astrophysics Data System (ADS)

    Shulagin, Yury; Tatarkin, Sergey; Dyachenko, Alexander

    It is known that increased destruction of hem structures is accompanied by increase of the endogenous carbon monoxide excretion rate with respiration (VCO). Changes VCO preceded the observed changes in the blood composition [D’yachenko A. et al., 2010]. Changes in blood composition, i.e. rise of red blood cells content and reduction of reticulocytes content was detected after a 12-day orbital flight (OF) in mice C57BL/6 [Gridley D.et al., 2003]. The purpose of this study was to investigate the effect of 30-day OF on excretion of endogenous CO. The method and apparatus for simultaneous measurement of VCO, and O2 and CO2 exchange were developed. The research consisted of three parts: 1). Measurement of VCO in five C57BL/6 mice after 30-day OF on the Russian satellite BION M1. 2). Measurement of VCO in six C57BL/6 mice after 30-day ground-based experiment (GBE) with simulated flight telemetry environment of BION M1. 3). Measurement of VCO in seven C57BL/6 mice in vivarium The results: Mice weight after OF was 24.3+-3.3 (mean +-SD) with minimal weight 18.1 g, and maximal weight 29.9 g. Vivarium mice weight was 27.0+-1.8 g. KGE mice weight was 25.0+-1.3 g. Mice age in all three groups was the same. We measured and estimated VCO and total CO excretion (MCO) for two gas mixtures ventilated mouse camera: atmospheric CO-contained air and then CO-free air(30 min). The results showed that the average MCO allocated GBE and vivarium mice did not significantly differ. Average MCO in mice after OF was significantly higher then in vivarium group (T=-2,74; p=0.02). MCO after GBE was between the vivarium and OF groups. MCO in OF and KGE groups did not differ ( T=-1,93; p=0,085). Blood tests in mice after OF was not carried out, because the recovery after the OF was studied in this group. The largest excretion of CO was observed in a mouse N39 after the OF. The weight of this mouse was only 18.1 g, i.e. much less than mean weight. Increase of VCO in food-restricted animal is known

  18. Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review

    PubMed Central

    Zhou, Huaqiong; Della, Phillip R; Roberts, Pamela; Goh, Louise; Dhaliwal, Satvinder S

    2016-01-01

    Objective To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design Systematic review. Setting/data source CINAHL, Embase, MEDLINE from 2011 to 2015. Participants All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions. Conclusions The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative

  19. Immunohistochemical study of motoneurons in lumbar spinal cord of c57black/6 mice after 30-days space flight

    NASA Astrophysics Data System (ADS)

    Tyapkina, Oksana; Islamov, Rustem; Nurullin, Leniz; Petrov, Konstantin.; Rezvyakov, Pavel; Nikolsky, Evgeny

    To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported

  20. Prosodic Planning: Effects of Phrasal Length and Complexity on Pause Duration

    PubMed Central

    Krivokapi, Jelena

    2007-01-01

    Research on pause duration has mainly focused on the impact of syntactic structure on the duration of pauses within an utterance and on the impact of syntax, discourse, and prosodic structure on the likelihood of pause occurrence. Relatively little is known about what factors play a role in determining the duration of pauses between utterances or phrases. Two experiments examining the effect of prosodic structure and phrase length on pause duration are reported. Subjects read sentences varying along the following parameters: a) the length in syllables of the intonational phrase preceding and following the pause, and b) the prosodic structure of the intonational phrase preceding and following the pause, specifically whether or not the intonational phrase branches into smaller phrases. In order to minimize variability due to speech rate and individual differences, speakers read sentences synchronously in dyads. The results showed a significant post-boundary effect of prosodic branching and significant pre- and post-boundary phrase length effects. The results are discussed in terms of production units. PMID:18379639

  1. Integrated in vivo and in vitro nascent chain profiling reveals widespread translational pausing

    PubMed Central

    Chadani, Yuhei; Niwa, Tatsuya; Chiba, Shinobu; Taguchi, Hideki; Ito, Koreaki

    2016-01-01

    Although the importance of the nonuniform progression of elongation in translation is well recognized, there have been few attempts to explore this process by directly profiling nascent polypeptides, the relevant intermediates of translation. Such approaches will be essential to complement other approaches, including ribosome profiling, which is extremely powerful but indirect with respect to the actual translation processes. Here, we use the nascent polypeptide's chemical trait of having a covalently attached tRNA moiety to detect translation intermediates. In a case study, Escherichia coli SecA was shown to undergo nascent polypeptide-dependent translational pauses. We then carried out integrated in vivo and in vitro nascent chain profiling (iNP) to characterize 1,038 proteome members of E. coli that were encoded by the first quarter of the chromosome with respect to their propensities to accumulate polypeptidyl–tRNA intermediates. A majority of them indeed undergo single or multiple pauses, some occurring only in vitro, some occurring only in vivo, and some occurring both in vivo and in vitro. Thus, translational pausing can be intrinsically robust, subject to in vivo alleviation, or require in vivo reinforcement. Cytosolic and membrane proteins tend to experience different classes of pauses; membrane proteins often pause multiple times in vivo. We also note that the solubility of cytosolic proteins correlates with certain categories of pausing. Translational pausing is widespread and diverse in nature. PMID:26831095

  2. Mechanisms and Developmental Roles of Promoter-proximal Pausing of RNA Polymerase II

    PubMed Central

    Robinson, Christine; Lowe, Matthew; Schwartz, Amanda; Kikyo, Nobuaki

    2016-01-01

    RNA polymerase II (Pol II) temporarily stops transcription after synthesizing 30–50 bases, and resumes elongation only after stimulations by various signaling molecules and developmental cues. This phenomenon, called promoter-proximal pausing, is observed in 10–50% of the entire genes from Drosophila embryos to human cells. Release of paused Pol II is primarily mediated by the activated form of positive transcription elongation factor b (P-TEFb) initially sequestered in the inhibitory 7SK small nuclear ribonucleoprotein (7SK snRNP) complex. Many proteins and RNAs have been discovered and studied in detail to explain the process of the pausing and release of Pol II in relation to P-TEFb. At the functional level, promoter-proximal pausing regulates genes involved in stimulus-response and development in Drosophila. In mammalian stem cell biology, pausing is important for proliferation and signaling in embryonic stem cells and the formation of induced pluripotent stem cells. Other than this, however, little is known about the biological significance of pausing in mammalian cell differentiation. Further study on pausing mechanisms as well as its functions will contribute to the development of stem cell biology and its clinical applications. PMID:27158559

  3. Chronic Kidney Disease, Hemodynamic Instability, and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding

    PubMed Central

    Lee, Yoo Jin; Hah, Yu Jin; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2013-01-01

    The results of studies that evaluated predictive factors for rebleeding in non-variceal upper gastrointestinal bleeding are inconsistent. The aim of this study was to investigate predictive factors for 30-day rebleeding in these patients. A consecutive 312 patients presenting symptoms and signs of gastrointestinal bleeding were enrolled in this prospective, observational study. Clinical and demographic characteristics and endoscopic findings were evaluated for potential factors associated with 30-day rebleeding using logistic regression analysis. Overall, 176 patients were included (male, 80.1%; mean age, 59.7±16.0 yr). Rebleeding within 7 and 30 days occurred in 21 (11.9%) and 27 (15.3%) patients, respectively. We found that chronic kidney disease (CKD) (OR, 10.29; 95% CI, 2.84-37.33; P<0.001), tachycardia (pulse>100 beats/min) during the admission (OR, 3.79; 95% CI, 1.25-11.49; P=0.019), and Forrest classes I, IIa, and IIb (OR, 6.14; 95% CI, 1.36-27.66; P=0.018) were significant independent predictive factors for 30-day rebleeding. However, neither Rockall nor Blatchford scores showed statistically significant relationships with 30-day rebleeding in a multivariate analysis. CKD, hemodynamic instability during hospitalization, and an endoscopic high-risk appearance are significantly independent predictors of 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. These factors may be useful for clinical management of such patients. PMID:24133356

  4. Structure of the cortical cytoskeleton in fibers of postural muscles and cardiomyocytes of mice after 30-day 2-g centrifugation.

    PubMed

    Ogneva, Irina V; Gnyubkin, V; Laroche, N; Maximova, M V; Larina, I M; Vico, L

    2015-03-01

    Altered external mechanical loading during spaceflights causes negative effects on muscular and cardiovascular systems. The aim of the study was estimation of the cortical cytoskeleton statement of the skeletal muscle cells and cardiomyocytes. The state of the cortical cytoskeleton in C57BL6J mice soleus, tibialis anterior muscle fibers, and left ventricle cardiomyocytes was investigated after 30-day 2-g centrifugation ("2-g" group) and within 12 h after its completion ("2-g + 12-h" group). We used atomic force microscopy for estimating cell's transverse stiffness, Western blotting for measuring protein content, and RT-PCR for estimating their expression level. The transverse stiffness significantly decreased in cardiomyocytes (by 16%) and increased in skeletal muscles fibers (by 35% for soleus and by 29% for tibialis anterior muscle fibers) in animals of the 2-g group (compared with the control group). For cardiomyocytes, we found that, in the 2-g + 12-h group, α-actinin-1 content decreased in the membranous fraction (by 27%) and increased in cytoplasmic fraction (by 28%) of proteins (compared with the levels in the 2-g group). But for skeletal muscle fibers, similar changes were noted for α-actinin-4, but not for α-actinin-1. In conclusion, we showed that the different isoforms of α-actinins dissociate from cortical cytoskeleton under increased/decreased of mechanical load. PMID:25539936

  5. Effects of 30 day simulated microgravity and recovery on fluid homeostasis and renal function in the rat

    NASA Technical Reports Server (NTRS)

    Tucker, Bryan J.; Mendonca, Margarida M.

    1995-01-01

    Transition from a normal gravitational environment to that of microgravity eventually results in decreased plasma and blood volumes, increasing with duration of exposure to microgravity. This loss of vascular fluid is presumably due to negative fluid and electrolyte balance and most likely contributes to the orthostatic intolerance associated with the return to gravity. The decrease in plasma volume is presumed to be a reflection of a concurrent decrease in extracellular fluid volume with maintenance of normal plasma-interstitial fluid balance. In addition, the specific alterations in renal function contributing to these changes in fluid and electrolyte homeostasis are potentially responding to neuro-humoral signals that are not consistent with systemic fluid volume status. We have previously demonstrated an early increase in both glomerular filtration rate and extracellular fluid volume and that this decreases towards control values by 7 days of simulated microgravity. However, longer duration studies relating these changes to plasma volume alterations and the response to return to orthostasis have not been fully addressed. Male Wistar rats were chronically cannulated, submitted to 30 days heat-down tilt (HDT) and followed for 7 days after return to orthostasis from HDT. Measurements of renal function and extracellular and blood volumes were performed in the awake rat.

  6. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks.

    PubMed

    Schulte, Laura H; May, Arne

    2016-07-01

    Functional imaging using positron emission tomography and later functional magnetic resonance imaging revealed a particular brainstem area that is believed to be specifically activated in migraine during, but not outside of the attack, and consequently has been coined the 'migraine generator'. However, the pathophysiological concept behind this term is not undisputed and typical migraine premonitory symptoms such as fatigue and yawning, but also a typical association of attacks to circadian and menstrual cycles, all make the hypothalamus a possible regulating region of migraine attacks. Neuroimaging studies investigating native human migraine attacks however are scarce and for methodological but also clinical reasons there are currently no studies investigating the last 24 h before headache onset. Here we report a migraine patient who had magnetic resonance imaging every day for 30 days, always in the morning, to cover, using functional imaging, a whole month and three complete, untreated migraine attacks. We found that hypothalamic activity as a response to trigeminal nociceptive stimulation is altered during the 24 h prior to pain onset, i.e. increases towards the next migraine attack. More importantly, the hypothalamus shows altered functional coupling with the spinal trigeminal nuclei and the region of the migraine generator, i.e. the dorsal rostral pons during the preictal day and the pain phase of native human migraine attacks. These data suggest that although the brainstem is highly linked to the migraine biology, the real driver of attacks might be the functional changes in hypothalamo-brainstem connectivity. PMID:27190019

  7. Human performance profiles for planetary analog extra-vehicular activities: 120 day and 30 day analog missions

    NASA Astrophysics Data System (ADS)

    Swarmer, Tiffany M.

    Understanding performance factors for future planetary missions is critical for ensuring safe and successful planetary extra-vehicular activities (EVAs). The goal of this study was to gain operational knowledge of analog EVAs and develop biometric profiles for specific EVA types. Data was collected for a 120 and 30 day analog planetary exploration simulation focusing on EVA type, pre and post EVA conditions, and performance ratings. From this five main types of EVAs were performed: maintenance, science, survey/exploratory, public relations, and emergency. Each EVA type has unique characteristics and performance ratings showing specific factors in chronological components, environmental conditions, and EVA systems that have an impact on performance. Pre and post biometrics were collected to heart rate, blood pressure, and SpO2. Additional data about issues and specific EVA difficulties provide some EVA trends illustrating how tasks and suit comfort can negatively affect performance ratings. Performance decreases were noted for 1st quarter and 3rd quarter EVAs, survey/exploratory type EVAs, and EVAs requiring increased fine and gross motor function. Stress during the simulation is typically higher before the EVA and decreases once the crew has returned to the habitat. Stress also decreases as the simulation nears the end with the 3rd and 4th quarters showing a decrease in stress levels. Operational components and studies have numerous variable and components that effect overall performance, by increasing the knowledge available we may be able to better prepare future crews for the extreme environments and exploration of another planet.

  8. Increased in vivo glucose utilization in 30-day-old obese Zucker rat: Role of white adipose tissue

    SciTech Connect

    Krief, S.; Bazin, R.; Dupuy, F.; Lavau, M. )

    1988-03-01

    In vivo whole-body glucose utilization and uptake in multiple individual tissues were investigated in conscious 30-day-old Zucker rats, which when obese are hyperphagic, hyperinsulinemic, and normoglycemic. Whole-body glucose metabolism (assessed by (3-{sup 3}H)glucose) was 40% higher in obese (fa/fa) than in lean (Fa/fa) rats, suggesting that obese rats were quite responsive to their hyperinsulinemia. In obese compared with lean rats, tissue glucose uptake was increased by 15, 12, and 6 times in dorsal, inguinal, perigonadal white depots, respectively; multiplied by 2.5 in brown adipose tissue; increased by 50% in skin from inguinal region but not in that from cranial, thoracic, or dorsal area; and increased twofold in diaphragm but similar in heart in proximal intestine, and in total muscular mass of limbs. The data establish that in young obese rats the hypertrophied white adipose tissue was a major glucose-utilizing tissue whose capacity for glucose disposal compared with that of half the muscular mass. Adipose tissue could therefore play an important role in the homeostasis of glucose in obese rats in the face of their increased carbohydrate intake.

  9. Pauses During Autobiographical Discourse Reflect Episodic Memory Processes in Early Alzheimer’s Disease

    PubMed Central

    Pistono, Aurélie; Jucla, Mélanie; Barbeau, Emmanuel J.; Saint-Aubert, Laure; Lemesle, Béatrice; Calvet, Benjamin; Köpke, Barbara; Puel, Michèle; Pariente, Jérémie

    2015-01-01

    There is a large body of research on discourse production in Alzheimer’s disease (AD). Some studies have focused on pause production, revealing that patients make extensive use of pauses during speech. This has been attributed to lexical retrieval difficulties, but pausing may also reflect other forms of cognitive impairment as it increases with cognitive load. The aim of the present study was to analyze autobiographical discourse impairment in AD from a broad perspective, looking at pausing behavior (frequency, duration, and location). Our first objective was to characterize discourse changes in mild cognitive impairment (MCI) due to AD. Our second objective was to determine the cognitive and neuroanatomical correlates of these changes. Fifteen patients with MCI due to AD and 15 matched cognitively normal controls underwent an ecological episodic memory task, a full neuropsychological assessment, and a 3D T1-weighted MRI scans. Autobiographical discourse collected from the ecological episodic memory task was recorded, transcribed, and analyzed, focusing on pausing. Intergroup comparisons showed that although patients did not produce more pauses than controls overall, they did make more between-utterance pauses. The number of these specific pauses was positively correlated with patients’ episodic memory performance. Furthermore, neuroimaging analysis showed that, in the patient group, their use was negatively correlated with frontopolar area (BA 10) grey matter density. This region may therefore play an important role in the planning of autobiographical discourse production. These findings demonstrate that pauses in early AD may reflect a compensatory mechanism for improving mental time travel and memory retrieval. PMID:26757034

  10. Pauses enhance chunk recognition in song element strings by zebra finches.

    PubMed

    Spierings, Michelle; de Weger, Anouk; Ten Cate, Carel

    2015-07-01

    When learning a language, it is crucial to know which syllables of a continuous sound string belong together as words. Human infants achieve this by attending to pauses between words or to the co-occurrence of syllables. It is not only humans that can segment a continuous string. Songbirds learning their song tend to copy 'chunks' from one or more tutors' songs and combine these into their own song. In the tutor songs, these chunks are often separated by pauses and a high co-occurrence of elements, suggesting that these features affect chunking and song learning. We examined experimentally whether the presence of pauses and element co-occurrence affect the ability of adult zebra finches to discriminate strings of song elements. Using a go/no-go design, two groups of birds were trained to discriminate between two strings. In one group (Pause-group), pauses were inserted between co-occurring element triplets in the strings, and in the other group (No-pause group), both strings were continuous. After making a correct discrimination, an individual proceeded to a reversal training using string segments. Segments were element triplets consistent in co-occurrence, triplets that were partly consistent in composition and triplets consisting of elements that did not co-occur in the strings. The Pause-group was faster in discriminating between the two strings. This group also responded differently to consistent triplets in the reversal training, compared to inconsistent triplets. The No-pause group did not differentiate among the triplet types. These results indicate that pauses in strings of song elements aid song discrimination and memorization of co-occurring element groups. PMID:25771964

  11. Mitochondrial transcription termination factor 1 directs polar replication fork pausing

    PubMed Central

    Shi, Yonghong; Posse, Viktor; Zhu, Xuefeng; Hyvärinen, Anne K.; Jacobs, Howard T.; Falkenberg, Maria; Gustafsson, Claes M.

    2016-01-01

    During replication of nuclear ribosomal DNA (rDNA), clashes with the transcription apparatus can cause replication fork collapse and genomic instability. To avoid this problem, a replication fork barrier protein is situated downstream of rDNA, there preventing replication in the direction opposite rDNA transcription. A potential candidate for a similar function in mitochondria is the mitochondrial transcription termination factor 1 (MTERF1, also denoted mTERF), which binds to a sequence just downstream of the ribosomal transcription unit. Previous studies have shown that MTERF1 prevents antisense transcription over the ribosomal RNA genes, a process which we here show to be independent of the transcription elongation factor TEFM. Importantly, we now demonstrate that MTERF1 arrests mitochondrial DNA (mtDNA) replication with distinct polarity. The effect is explained by the ability of MTERF1 to act as a directional contrahelicase, blocking mtDNA unwinding by the mitochondrial helicase TWINKLE. This conclusion is also supported by in vivo evidence that MTERF1 stimulates TWINKLE pausing. We conclude that MTERF1 can direct polar replication fork arrest in mammalian mitochondria. PMID:27112570

  12. Redundancy of the genetic code enables translational pausing

    PubMed Central

    D'Onofrio, David J.; Abel, David L.

    2014-01-01

    The codon redundancy (“degeneracy”) found in protein-coding regions of mRNA also prescribes Translational Pausing (TP). When coupled with the appropriate interpreters, multiple meanings and functions are programmed into the same sequence of configurable switch-settings. This additional layer of Ontological Prescriptive Information (PIo) purposely slows or speeds up the translation-decoding process within the ribosome. Variable translation rates help prescribe functional folding of the nascent protein. Redundancy of the codon to amino acid mapping, therefore, is anything but superfluous or degenerate. Redundancy programming allows for simultaneous dual prescriptions of TP and amino acid assignments without cross-talk. This allows both functions to be coincident and realizable. We will demonstrate that the TP schema is a bona fide rule-based code, conforming to logical code-like properties. Second, we will demonstrate that this TP code is programmed into the supposedly degenerate redundancy of the codon table. We will show that algorithmic processes play a dominant role in the realization of this multi-dimensional code. PMID:24904640

  13. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales

    PubMed Central

    McAllister, Katherine S.L.; Ludman, Peter F.; Hulme, William; de Belder, Mark A.; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A.; Sperrin, Matthew; Buchan, Iain E.

    2016-01-01

    Background The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. Methods and results The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. Conclusion We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. PMID:26942330

  14. The statistical extended-range (10-30-day) forecast of summer rainfall anomalies over the entire China

    NASA Astrophysics Data System (ADS)

    Zhu, Zhiwei; Li, Tim

    2016-03-01

    The extended-range (10-30-day) rainfall forecast over the entire China was carried out using spatial-temporal projection models (STPMs). Using a rotated empirical orthogonal function analysis of intraseasonal (10-80-day) rainfall anomalies, China is divided into ten sub-regions. Different predictability sources were selected for each of the ten regions. The forecast skills are ranked for each region. Based on temporal correlation coefficient (TCC) and Gerrity skill score, useful skills are found for most parts of China at a 20-25-day lead. The southern China and the mid-lower reaches of Yangtze River Valley show the highest predictive skills, whereas southwestern China and Huang-Huai region have the lowest predictive skills. By combining forecast results from ten regional STPMs, the TCC distribution of 8-year (2003-2010) independent forecast for the entire China is investigated. The combined forecast results from ten STPMs show significantly higher skills than the forecast with just one single STPM for the entire China. Independent forecast examples of summer rainfall anomalies around the period of Beijing Olympic Games in 2008 and Shanghai World Expo in 2010 are presented. The result shows that the current model is able to reproduce the gross pattern of the summer intraseasonal rainfall over China at a 20-day lead. The present study provides, for the first time, a guide on the statistical extended-range forecast of summer rainfall anomalies for the entire China. It is anticipated that the ideas and methods proposed here will facilitate the extended-range forecast in China.

  15. NusG Is a Sequence-specific RNA Polymerase Pause Factor That Binds to the Non-template DNA within the Paused Transcription Bubble.

    PubMed

    Yakhnin, Alexander V; Murakami, Katsuhiko S; Babitzke, Paul

    2016-03-01

    NusG, referred to as Spt5 in archaeal and eukaryotic organisms, is the only transcription factor conserved in all three domains of life. This general transcription elongation factor binds to RNA polymerase (RNAP) soon after transcription initiation and dissociation of the RNA polymerase σ factor. Escherichia coli NusG increases transcription processivity by suppressing RNAP pausing, whereas Bacillus subtilis NusG dramatically stimulates pausing at two sites in the untranslated leader of the trpEDCFBA operon. These two regulatory pause sites participate in transcription attenuation and translational control mechanisms, respectively. Here we report that B. subtilis NusG makes sequence-specific contacts with a T-rich sequence in the non-template DNA (ntDNA) strand within the paused transcription bubble. NusG protects T residues of the recognition sequence from permanganate oxidation, and these T residues increase the affinity of NusG to the elongation complex. Binding of NusG to RNAP does not require interaction with RNA. These results indicate that bound NusG prevents forward movement of RNA polymerase by simultaneously contacting RNAP and the ntDNA strand. Mutational studies indicate that amino acid residues of two short regions within the NusG N-terminal domain are primarily responsible for recognition of the trp operon pause signals. Structural modeling indicates that these two regions are adjacent to each another in the protein. We propose that recognition of specific sequences in the ntDNA and stimulation of RNAP pausing is a conserved function of NusG-like transcription factors. PMID:26742846

  16. Ribosomal pausing at a frameshifter RNA pseudoknot is sensitive to reading phase but shows little correlation with frameshift efficiency.

    PubMed

    Kontos, H; Napthine, S; Brierley, I

    2001-12-01

    Here we investigated ribosomal pausing at sites of programmed -1 ribosomal frameshifting, using translational elongation and ribosome heelprint assays. The site of pausing at the frameshift signal of infectious bronchitis virus (IBV) was determined and was consistent with an RNA pseudoknot-induced pause that placed the ribosomal P- and A-sites over the slippery sequence. Similarly, pausing at the simian retrovirus 1 gag/pol signal, which contains a different kind of frameshifter pseudoknot, also placed the ribosome over the slippery sequence, supporting a role for pausing in frameshifting. However, a simple correlation between pausing and frameshifting was lacking. Firstly, a stem-loop structure closely related to the IBV pseudoknot, although unable to stimulate efficient frameshifting, paused ribosomes to a similar extent and at the same place on the mRNA as a parental pseudoknot. Secondly, an identical pausing pattern was induced by two pseudoknots differing only by a single loop 2 nucleotide yet with different functionalities in frameshifting. The final observation arose from an assessment of the impact of reading phase on pausing. Given that ribosomes advance in triplet fashion, we tested whether the reading frame in which ribosomes encounter an RNA structure (the reading phase) would influence pausing. We found that the reading phase did influence pausing but unexpectedly, the mRNA with the pseudoknot in the phase which gave the least pausing was found to promote frameshifting more efficiently than the other variants. Overall, these experiments support the view that pausing alone is insufficient to mediate frameshifting and additional events are required. The phase dependence of pausing may be indicative of an activity in the ribosome that requires an optimal contact with mRNA secondary structures for efficient unwinding. PMID:11713298

  17. High Precision Analysis of Translational Pausing by Ribosome Profiling in Bacteria Lacking EFP

    PubMed Central

    Woolstenhulme, Christopher J.; Guydosh, Nicholas R.; Green, Rachel; Buskirk, Allen R.

    2015-01-01

    Summary Ribosome profiling is a powerful method for globally assessing the activity of ribosomes in a cell. Despite its application in many organisms, ribosome profiling studies in bacteria have struggled to obtain the resolution necessary to precisely define translational pauses. Here we report improvements that yield much higher resolution in E. coli profiling data, enabling us to more accurately assess ribosome pausing and refine earlier studies of the impact of polyproline motifs on elongation. We comprehensively characterize pausing at proline-rich motifs in the absence of elongation factor EFP. We find that only a small fraction of genes with strong pausing motifs have reduced ribosome density downstream and identify features that explain this phenomenon. These features allow us to predict which proteins likely have reduced output in the efp knockout strain. PMID:25843707

  18. STS-40 MS Seddon pauses during fire fighting training at JSC's Fire Pit

    NASA Technical Reports Server (NTRS)

    1990-01-01

    STS-40 Columbia, Orbiter Vehicle (OV) 102, Mission Specialist (MS) M. Rhea Seddon, smiling, pauses during fire fighting training exercises conducted at JSC's Fire Training Pit across from the Gilruth Center Bldg 207.

  19. Pausing of RNA polymerase II Disrupts DNA-specified Nucleosome Organization to Enable Precise Gene Regulation

    PubMed Central

    Gilchrist, Daniel A.; Santos, Gilberto Dos; Fargo, David C.; Xie, Bin; Gao, Yuan; Li, Leping; Adelman, Karen

    2010-01-01

    Metazoan transcription is controlled either through coordinated recruitment of transcription machinery to the gene promoter, or through regulated pausing of RNA polymerase II (Pol II) in early elongation. We report that a striking difference between genes that use these distinct regulatory strategies lies in the “default” chromatin architecture specified by their DNA sequences. Pol II pausing is prominent at highly-regulated genes whose sequences inherently disfavor nucleosome formation within the gene, but favor occlusion of the promoter by nucleosomes. In contrast, housekeeping genes that lack pronounced Pol II pausing show higher nucleosome occupancy downstream, but their promoters are deprived of nucleosomes regardless of polymerase binding. Our results indicate that a key role of paused Pol II is to compete with nucleosomes for occupancy of highly-regulated promoters, thereby preventing the formation of repressive chromatin architecture to facilitate further or future gene activation. PMID:21074046

  20. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  1. Pausing-Time Distribution of Anomalous Diffusion of Hydrogen with Random Energy

    NASA Astrophysics Data System (ADS)

    Hikita, Harumi; Morigaki, Kazuo

    2014-01-01

    It has been empirically known that the disordered system exhibits a power-law behavior. We show from calculation the power law t-1-α for the pausing-time distribution of thermal diffusion of hydrogen in the exponential density of states. This power law of the pausing-time distribution is examined by the Monte Carlo simulation. The results agree with those obtained by analytical calculation. We discuss the power law in terms of random walk in fractal structure (Cantor ensemble).

  2. Effects of Deep Brain Stimulation on Pausing During Spontaneous Speech in Parkinson’s Disease

    PubMed Central

    Ahn, Ji Sook; Van Lancker Sidtis, Diana; Sidtis, John J.

    2016-01-01

    The present study examined pausing patterns in spontaneous speech as a measure of the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on parkinsonian speech. Pauses reflect various aspects of speech and language processes, including motor initiation and linguistic planning. Relatively little attention has been given to pauses in determining the effect of STN-DBS. An examination of pausing may be helpful to understanding how this form of therapy affects these behaviors. Seven individuals with Parkinson’s disease who received surgery for bilateral STN-DBS participated. Spontaneous speech samples were elicited in both the ON and OFF STN-DBS condition. Findings indicated that long pauses (250–3000 ms) in spontaneous speech were significantly shorter and more frequent in the STN-DBS ON condition. Furthermore, the proportion of nonlinguistic boundary pauses was significantly greater with stimulation. The findings support previous studies suggesting that speech motor control and lexical retrieval may be affected by STN-DBS. PMID:26848252

  3. Identification of Pauses during Formation of HIV-1 Virus Like Particles

    PubMed Central

    Ku, Pei-I; Miller, Anna K.; Ballew, Jeff; Sandrin, Virginie; Adler, Frederick R.; Saffarian, Saveez

    2013-01-01

    HIV Gag polymerizes on the plasma membrane to form virus like particles (VLPs) that have similar diameters to wild-type viruses. We use multicolor, dual-penetration depth, total internal reflection fluorescence microscopy, which corrects for azimuthal movement, to image the assembly of individual VLPs from the time of nucleation to the recruitment of VPS4 (a component of the endosomal sorting complexes required for transport, and which marks the final stage of VLP assembly). Using a mathematical model for assembly and maximum-likelihood comparison of fits both with and without pauses, we detect pauses during Gag polymerization in 60% of VLPs. Pauses range from 2 to 20 min, with an exponentially distributed duration that is independent of cytosolic Gag concentration. VLPs assembled with late domain mutants of Gag (which do not recruit the key endosomal sorting complexes required for transport proteins Alix or TSG101) exhibit similar pause distributions. These pauses indicate that a single rate-limiting event is required for continuation of assembly. We suggest that pauses are either related to incorporation of defects in the hexagonal Gag lattice during VLP assembly or are caused by shortcomings in interactions of Gag with essential and still undefined cellular components during formation of curvature on the plasma membrane. PMID:24268138

  4. Multiple P-TEFbs cooperatively regulate the release of promoter-proximally paused RNA polymerase II.

    PubMed

    Lu, Xiaodong; Zhu, Xinxing; Li, You; Liu, Min; Yu, Bin; Wang, Yu; Rao, Muhua; Yang, Haiyang; Zhou, Kai; Wang, Yao; Chen, Yanheng; Chen, Meihua; Zhuang, Songkuan; Chen, Lin-Feng; Liu, Runzhong; Chen, Ruichuan

    2016-08-19

    The association of DSIF and NELF with initiated RNA Polymerase II (Pol II) is the general mechanism for inducing promoter-proximal pausing of Pol II. However, it remains largely unclear how the paused Pol II is released in response to stimulation. Here, we show that the release of the paused Pol II is cooperatively regulated by multiple P-TEFbs which are recruited by bromodomain-containing protein Brd4 and super elongation complex (SEC) via different recruitment mechanisms. Upon stimulation, Brd4 recruits P-TEFb to Spt5/DSIF via a recruitment pathway consisting of Med1, Med23 and Tat-SF1, whereas SEC recruits P-TEFb to NELF-A and NELF-E via Paf1c and Med26, respectively. P-TEFb-mediated phosphorylation of Spt5, NELF-A and NELF-E results in the dissociation of NELF from Pol II, thereby transiting transcription from pausing to elongation. Additionally, we demonstrate that P-TEFb-mediated Ser2 phosphorylation of Pol II is dispensable for pause release. Therefore, our studies reveal a co-regulatory mechanism of Brd4 and SEC in modulating the transcriptional pause release by recruiting multiple P-TEFbs via a Mediator- and Paf1c-coordinated recruitment network. PMID:27353326

  5. Activity-dependent plasticity of spike pauses in cerebellar Purkinje cells

    PubMed Central

    Grasselli, Giorgio; He, Qionger; Wan, Vivian; Adelman, John P.; Ohtsuki, Gen; Hansel, Christian

    2016-01-01

    Summary Plasticity of intrinsic excitability has been described in several types of neurons, but the significance of non-synaptic mechanisms in brain plasticity and learning remains elusive. Cerebellar Purkinje cells are inhibitory neurons that spontaneously fire action potentials at high frequencies and regulate activity in their target cells in the cerebellar nuclei by generating a characteristic spike burst–pause sequence upon synaptic activation. Using patch-clamp recordings from mouse Purkinje cells, we find that depolarization-triggered intrinsic plasticity enhances spike firing and shortens the duration of spike pauses. Pause plasticity is absent from mice lacking SK2-type potassium channels (SK2−/− mice) and in occlusion experiments using the SK channel blocker apamin, while apamin wash-in mimics pause reduction. Our findings demonstrate that spike pauses can be regulated through an activity-dependent, exclusively non-synaptic, SK2 channel-dependent mechanism and suggest that pause plasticity—by altering the Purkinje cell output—may be crucial to cerebellar information storage and learning. PMID:26972012

  6. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission

    PubMed Central

    Horwitz, Leora I.; Partovian, Chohreh; Lin, Zhenqiu; Grady, Jacqueline N.; Herrin, Jeph; Conover, Mitchell; Montague, Julia; Dillaway, Chloe; Bartczak, Kathleen; Suter, Lisa G.; Ross, Joseph S.; Bernheim, Susannah M.; Krumholz, Harlan M.; Drye, Elizabeth E.

    2014-01-01

    Background Existing publicly-reported readmission measures are condition-specific, representing < 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation. Objective To develop an all-condition, hospital-wide readmission measure. Design Measure development Setting 4,821 US hospitals. Patients Medicare Fee for Service (FFS) beneficiaries ≥ 65 years. Measurements Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare FFS claims and is a composite of five specialty-based risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology cohorts. We randomly split the 2007–2008 admissions for development and validation. Models were adjusted for age, principal diagnosis and comorbidity. We examined calibration in Medicare and all-payer data, and compared hospital rankings in the development and validation samples. Results The development dataset contained 8,018,949 admissions associated with 1,276,165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range 11.6–21.9). The five specialty cohort models accurately predicted readmission risk in both Medicare and all-payer datasets for average risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (p=0.7 for difference in rank) and 76% of hospitals’ validation set rankings were within two deciles of the development rank (24% >2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within two deciles (10% >2 deciles), and 82% remained within one decile (18% > 1 decile). Limitations Risk-adjustment was limited to that available in claims data. Conclusions We developed a claims-based hospital-wide unplanned readmission measure for profiling hospitals that produced reasonably

  7. Using multiple household food inventories to measure food availability in the home over 30 days: a pilot study

    PubMed Central

    2010-01-01

    Background The consumption of foods, especially by children, may be determined by the types of foods that are available in the home. Because most studies use a single point of data collection to determine the types of foods in the home, which can miss the change in availability when resources are not available, the primary objective of this study was to determine the extent to which the weekly availability of household food items changed over one month by 1) developing the methodology for the direct observation of the presence and amount of food items in the home; 2) conducting five in-home household food inventories over a thirty-day period in a small convenience sample; and 3) determining the frequency that food items were present in the participating households. Methods After the development and pre-testing of the 251-item home observation guide that used direct observation to determine the presence and amount of food items in the home (refrigerator, freezer, pantry, elsewhere), two trained researchers recruited a convenience sample of 9 households (44.4% minority); administered a baseline questionnaire (personal info, shopping habits, food resources, and food security); and conducted 5 in-home assessments (7-day interval) over a 30-day period. Each in-home assessment included food-related activities since the last assessment, and an observational survey of types and amounts of foods present. Results Complete data were collected from all 9 women (32.8 y ± 6.0; 3 married; 4 ± 1.6 adults/children in household; 4 received food assistance; and 6 had very low food security) and their households. Weekly grocery purchases (place, amount, and purpose) varied from once (n = 1) to every week (n = 5); 4 used fast food 2-3 times/wk for 4 weeks. The weekly presence and amounts of fresh and processed fruits and vegetables and dairy varied. Conclusions The feasibility of conducting multiple in-home assessments was confirmed with 100% retention of participants through 5 in

  8. Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange

    PubMed Central

    Hao, Shiying; Wang, Yue; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Zheng, Le; Luo, Jin; Hu, Zhongkai; Fu, Changlin; Dai, Dorothy; Wang, Yicheng; Culver, Devore S.; Alfreds, Shaun T.; Rogow, Todd; Stearns, Frank; Sylvester, Karl G.; Widen, Eric; Ling, Xuefeng B.

    2015-01-01

    Objectives Identifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups. Methods Our objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients. Results A risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0–30), intermediate (score of 30–70) and high (score of 70–100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates. Conclusions The risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient’s risk of readmission score may be useful to providers

  9. Oxygenation, EMG and position sense during computer mouse work. Impact of active versus passive pauses.

    PubMed

    Crenshaw, A G; Djupsjöbacka, M; Svedmark, A

    2006-05-01

    We investigated the effects of active versus passive pauses implemented during computer mouse work on muscle oxygenation and EMG of the forearm extensor carpi radialis muscle, and on wrist position sense. Fifteen healthy female subjects (age: 19-24 years) performed a 60-min mouse-operated computer task, divided into three 20 min periods, on two occasions separated by 3-6 days. On one occasion a passive pause (subjects resting) was implemented at the end of each 20-min period, and on another occasion an active pause (subjects performed a number of high intensity extensions of the forearm) was implemented. Also at the end of each 20-min period, test contractions were conducted and subjective ratings of fatigue and stress were obtained. Another parameter of interest was total haemoglobin calculated as the summation of oxy-and deoxy-haemoglobin, since it reflects blood volume changes. The most interesting findings were an overall increasing trend in total haemoglobin throughout the mouse work (P<0.001), and that this trend was greater for the active pause as compared to the passive pause (P<0.01). These data were accompanied by an overall increase in oxygen saturation (P<0.001), with a tendency, albeit not significant, toward a higher increase for the active pause (P=0.13). EMG amplitude and median frequency tended to decrease (P=0.08 and 0.05, respectively) during the mouse work but was not different between pause types. Borg ratings of forearm fatigue showed an overall increase during the activity (P<0.001), but the perceptions of stress did not change. Position sense did not change due to the mouse work for either pause type. While increasing trends were found for both pause types, the present study lends support to the hypothesis of an enhancement in oxygenation and blood volume for computer mouse work implemented with active pauses. However, a presumption of an association between this enhancement and attenuated fatigue during the mouse work was not supported

  10. What do pauses in narrative production reveal about the nature of word retrieval deficits in PPA?

    PubMed

    Mack, Jennifer E; Chandler, Sarah D; Meltzer-Asscher, Aya; Rogalski, Emily; Weintraub, Sandra; Mesulam, M-Marsel; Thompson, Cynthia K

    2015-10-01

    Naming and word-retrieval deficits, which are common characteristics of primary progressive aphasia (PPA), differentially affect production across word classes (e.g., nouns, verbs) in some patients. Individuals with the agrammatic variant (PPA-G) often show greater difficulty producing verbs whereas those with the semantic variant (PPA-S) show greater noun deficits and those with logopenic PPA (PPA-L) evince no clear-cut differences in production of the two word classes. To determine the source of these production patterns, the present study examined word-finding pauses as conditioned by lexical variables (i.e., word class, frequency, length) in narrative speech samples of individuals with PPA-S (n=12), PPA-G (n=12), PPA-L (n=11), and cognitively healthy controls (n=12). We also examined the relation between pause distribution and cortical atrophy (i.e., cortical thickness) in nine left hemisphere regions of interest (ROIs) linked to word production. Results showed higher overall pause rates for PPA compared to unimpaired controls; however, greater naming severity was not associated with increased pause rate. Across all groups, more pauses were produced before lower vs. higher frequency words, with no independent effects of word length after controlling for frequency. With regard to word class, the PPA-L group showed a higher rate of pauses prior to production of nouns compared to verbs, consistent with noun-retrieval deficits arising at the lemma level of word production. Those with PPA-G and PPA-S, like controls, produced similar pause rates across word classes; however, lexical simplification (i.e., production of higher-frequency and/or shorter words) was evident in the more-impaired word class: nouns for PPA-S and verbs for PPA-G. These patterns are consistent with conceptual and/or lemma-level impairments for PPA-S, predominantly affecting objects/nouns, and a lemma-level verb-retrieval deficit for PPA-G, with a concomitant impairment in phonological encoding

  11. The association of culling and death rate within 30 days after calving with productivity or reproductive performance in dairy herds in Fukuoka, Southern Japan

    PubMed Central

    GOTO, Akira; NAKADA, Ken; KATAMOTO, Hiromu

    2015-01-01

    The incidence of peripartum disorders in dairy herds negatively influences productivity and reproductive performance. Concrete data from local areas are helpful for explaining the importance of peripartum management to dairy farmers. This study was conducted to clarify the association of culling and death rate within 30 days after calving with productivity or reproductive performance in 179 dairy herds in Fukuoka, Southern Japan. A database was compiled from the records of the Livestock Improvement Association of Japan, the Dairy Cooperative Association and the Federation of Agricultural Mutual Relief Association. In this study, we created a comprehensive database of dairy farm production data for epidemiological analysis and used a general linear mixed model to analyze the association of culling and death rate within 30 days after calving with milk production or reproductive performance. The database can be used to describe, analyze and predict the risk of production. A cross-sectional analysis with contrasts was applied to investigate the association of cows served by AI/all cows, pregnant cows/cows served by AI, days open, milk yield and somatic cell counts with culling and death rate within 30 days after calving. The days open value significantly increased with increasing rate of culling and death within 30 days after calving (P for trend <0.001). No significant differences were found for the other comparisons. Our data suggest that proper feeding and management in the dry period may lead to improved postpartum reproductive performance in this dairy cow cohort. PMID:26666177

  12. The association of culling and death rate within 30 days after calving with productivity or reproductive performance in dairy herds in Fukuoka, Southern Japan.

    PubMed

    Goto, Akira; Nakada, Ken; Katamoto, Hiromu

    2016-05-01

    The incidence of peripartum disorders in dairy herds negatively influences productivity and reproductive performance. Concrete data from local areas are helpful for explaining the importance of peripartum management to dairy farmers. This study was conducted to clarify the association of culling and death rate within 30 days after calving with productivity or reproductive performance in 179 dairy herds in Fukuoka, Southern Japan. A database was compiled from the records of the Livestock Improvement Association of Japan, the Dairy Cooperative Association and the Federation of Agricultural Mutual Relief Association. In this study, we created a comprehensive database of dairy farm production data for epidemiological analysis and used a general linear mixed model to analyze the association of culling and death rate within 30 days after calving with milk production or reproductive performance. The database can be used to describe, analyze and predict the risk of production. A cross-sectional analysis with contrasts was applied to investigate the association of cows served by AI/all cows, pregnant cows/cows served by AI, days open, milk yield and somatic cell counts with culling and death rate within 30 days after calving. The days open value significantly increased with increasing rate of culling and death within 30 days after calving (P for trend <0.001). No significant differences were found for the other comparisons. Our data suggest that proper feeding and management in the dry period may lead to improved postpartum reproductive performance in this dairy cow cohort. PMID:26666177

  13. 75 FR 77901 - 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-14

    ... in the Federal Register on July 27, 2006 (FR 71, 144:42664-42665). The National Park Service Office... National Park Service 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List and Potential Additions to the U.S. World Heritage Tentative List AGENCY: National...

  14. DNA Replication Forks Pause at Silent Origins near the HML Locus in Budding Yeast

    PubMed Central

    Wang, Yangzhou; Vujcic, Marija; Kowalski, David

    2001-01-01

    Chromosomal replicators in budding yeast contain an autonomously replicating sequence (ARS) that functions in a plasmid, but certain ARSs are silent as replication origins in their natural chromosomal context. In chromosome III, the HML ARS cluster (ARS302-ARS303-ARS320) and ARS301 flank the transcriptionally silent mating-type locus HML, and all of these ARSs are silent as replication origins. ARS301 and ARS302 function in transcriptional silencing mediated by the origin recognition complex (ORC) and a heterochromatin structure, while the functions of ARS303 and ARS320 are not known. In this work, we discovered replication fork pause sites at the HML ARS cluster and ARS301 by analyzing DNA replication intermediates from the chromosome via two-dimensional gel electrophoresis. The replication fork pause at the HML ARS cluster was independent of cis- and trans-acting mutations that abrogate transcriptional silencing at HML. Deletion of the HML ARS cluster led to loss of the pause site. Insertion of a single, heterologous ARS (ARS305) in place of the HML ARS cluster reconstituted the pause site, as did multiple copies of DNA elements (A and B1) that bind ORC. The orc2-1 mutation, known to alter replication timing at origins, did not detectably affect the pause but activated the silent origin at the HML ARS cluster in a minority of cells. Delaying the time of fork arrival at HML led to the elimination of the pause sites at the HML ARS cluster and at the copy of ARS305 inserted in place of the cluster. Loss of the pause sites was accompanied by activation of the silent origins in the majority of cells. Thus, replication fork movement near HML pauses at a silent origin which is competent for replication initiation but kept silent through Orc2p, a component of the replication initiator. Possible functions for replication fork pause sites in checkpoints, S-phase regulation, mating-type switching, and transcriptionally silent heterochromatin are discussed. PMID:11438651

  15. Early Dynamic Risk Stratification with Baseline Troponin Levels and 90-minute ST Segment Resolution to Predict 30 Day Cardiovascular Mortality in STEMI: Analysis from CLARITY TIMI-28

    PubMed Central

    Sherwood, Matthew W.; Morrow, David A.; Scirica, Benjamin M.; Jiang, Songtao; Bode, Christoph; Rifai, Nader; Gerszten, Robert E.; Gibson, C. Michael; Cannon, Christopher P.; Braunwald, Eugene; Sabatine, Marc S.

    2010-01-01

    Background Troponin is the preferred biomarker for risk stratification in non-ST-elevation ACS. The incremental prognostic utility of the initial magnitude of troponin elevation and its value in conjunction with ST segment resolution (STRes) in STEMI is less well-defined. Methods Troponin T (TnT) was measured in 1250 patients at presentation undergoing fibrinolysis for STEMI in CLARITY-TIMI 28. STRes was measured at 90 minutes. Multivariable logistic regression was used to examine the independent association between TnT levels, STRes, and 30-day cardiovascular (CV) mortality. Results Patients were classified into undetectable TnT at baseline (n=594), detectable but below the median of 0.12 ng/ml (n=330), and above the median (n=326). Rates of 30-day CV death were 1.5%, 4.5%, and 9.5% respectively (P<0.0001). Compared with those with undetectable levels and adjusting for baseline factors, the odds ratios for 30-day CV death were 4.56 (1.72-12.08, P=0.002) and 5.81 (2.29-14.73, P=0.0002) for those below and above the median, respectively. When combined with STRes, there was a significant gradient of risk, and in a multivariable model both baseline TnT (P=0.004) and STRes (P=0.003) were significant predictors of 30-day CV death. The addition of TnT and STRes to clinical risk factors significantly improved the C-statistic (0.86 to 0.90, P=0.02) and the integrated discriminative improvement 7.1% (P=0.0009). Conclusions Baseline TnT and 90-minute STRes are independent predictors of 30-day CV death in patients with STEMI. Use of these two simple, readily available tools can aid clinicians in early risk stratification. PMID:20569707

  16. Mechanical Ventilation in Patients with the Acute Respiratory Distress Syndrome and Treated with Extracorporeal Membrane Oxygenation: Impact on Hospital and 30 Day Postdischarge Survival.

    PubMed

    Modrykamien, Ariel M; Hernandez, Omar O; Im, Yunhee; Walters, Ryan W; Schrader, Caleb L; Smith, Lauren E; Lima, Brian

    2016-01-01

    Mechanical ventilation support for acute respiratory distress syndrome (ARDS) patients involves the use of low tidal volumes and positive end-expiratory pressure. Nevertheless, the optimal ventilator strategy for ARDS patients undergoing extracorporeal membrane oxygenation (ECMO) therapy remains unknown. A retrospective analysis of a consecutive series of adult ARDS patients treated with V-V ECMO from October 2012 to May 2015 was performed. Mechanical ventilation data, as well as demographic and clinical data, were collected. We assessed the association between ventilator data and outcomes of interest. The primary outcome was hospital survival. Secondary outcome was 30 day survival posthospital discharge. Sixty-four ARDS patients were treated with ECMO. Univariate analysis showed that plateau pressure was independently associated with hospital survival. Tidal volume, positive end-expiratory pressure (PEEP), and plateau were independently associated with 30 day survival. Multivariate analysis, after controlling for covariates, revealed that a 1 unit increase in plateau pressure was associated with a 21% decrease in the odds of hospital survival (95% confidence interval [CI] = 6.39-33.42%, p = 0.007). In regards to 30 day survival postdischarge, a 1 unit increase in plateau pressure was associated with a 14.4% decrease in the odds of achieving the aforementioned outcome (95% CI = 1.75-25.4%, p = 0.027). Also, a 1 unit increase in PEEP was associated with a 36.2% decrease in the odds of 30 day survival (95% CI = 10.8-54.4%, p = 0.009). Among ARDS patients undergoing ECMO therapy, only plateau pressure is associated with hospital survival. Plateau pressure and PEEP are both associated with 30 day survival posthospital discharge. PMID:27347707

  17. The AFFORD Clinical Decision Aid To Identify Emergency Department Patients With Atrial Fibrillation At Low Risk For 30-Day Adverse Events

    PubMed Central

    Barrett, Tyler W.; Storrow, Alan B.; Jenkins, Cathy A.; Abraham, Robert L.; Liu, Dandan; Miller, Karen F.; Moser, Kelly M.; Russ, Stephan; Roden, Dan M.; Harrell, Frank E.; Darbar, Dawood

    2015-01-01

    There is wide variation in the management of emergency department (ED) patients with atrial fibrillation (AF). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated, tertiary-care, ED. Patients were enrolled from June 9, 2010 to February 28, 2013 and followed for 30 days. We enrolled a convenience sample of ED patients presenting with symptomatic AF. Candidate predictors were based on ED data available in the first two hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We utilized an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients, respectively. The decision aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement); medical history (heart failure, home sotalol use, prior percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms); ED data (2 hour heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid’s c-statistic in predicting any 30-day adverse event was 0.7 (95% CI, 0.65, 0.76). In conclusion, among ED patients with AF, AFFORD provides the first evidence based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. PMID:25633190

  18. Stable pausing by RNA polymerase II provides an opportunity to target and integrate regulatory signals

    PubMed Central

    Henriques, Telmo; Gilchrist, Daniel A.; Nechaev, Sergei; Bern, Michael; Muse, Ginger W.; Burkholder, Adam; Fargo, David C.; Adelman, Karen

    2013-01-01

    SUMMARY Metazoan gene expression is often regulated after the recruitment of RNA polymerase II (Pol II) to promoters, through the controlled release of promoter-proximally paused Pol II into productive RNA synthesis. Despite the prevalence of paused Pol II, very little is known about the dynamics of these early elongation complexes or the fate of short transcription start site-associated (tss) RNAs they produce. Here, we demonstrate that paused elongation complexes can be remarkably stable, with half-lives exceeding 15 minutes at genes with inefficient pause release. Promoter-proximal termination by Pol II is infrequent and released tssRNAs are targeted for rapid degradation. Further, we provide evidence that the predominant tssRNA species observed are nascent RNAs held within early elongation complexes. We propose that stable pausing of polymerase provides a temporal window of opportunity for recruitment of factors to modulate gene expression and that the nascent tssRNA represents an appealing target for these interactions. PMID:24184211

  19. Transcriptional pausing coordinates folding of the aptamer domain and the expression platform of a riboswitch

    PubMed Central

    Perdrizet, George A.; Artsimovitch, Irina; Furman, Ran; Sosnick, Tobin R.; Pan, Tao

    2012-01-01

    Riboswitches are cis-acting elements that regulate gene expression by affecting transcriptional termination or translational initiation in response to binding of a metabolite. A typical riboswitch is made of an upstream aptamer domain and a downstream expression platform. Both domains participate in the folding and structural rearrangement in the absence or presence of its cognate metabolite. RNA polymerase pausing is a fundamental property of transcription that can influence RNA folding. Here we show that pausing plays an important role in the folding and conformational rearrangement of the Escherichia coli btuB riboswitch during transcription by the E. coli RNA polymerase. This riboswitch consists of an approximately 200 nucleotide, coenzyme B12 binding aptamer domain and an approximately 40 nucleotide expression platform that controls the ribosome access for translational initiation. We found that transcriptional pauses at strategic locations facilitate folding and structural rearrangement of the full-length riboswitch, but have minimal effect on the folding of the isolated aptamer domain. Pausing at these regulatory sites blocks the formation of alternate structures and plays a chaperoning role that couples folding of the aptamer domain and the expression platform. Pausing at strategic locations may be a general mechanism for coordinated folding and conformational rearrangements of riboswitch structures that underlie their response to environmental cues. PMID:22331895

  20. Coinciding decreases in discharge rate suggest that spontaneous pauses in firing of external pallidum neurons are network driven.

    PubMed

    Schechtman, Eitan; Adler, Avital; Deffains, Marc; Gabbay, Hila; Katabi, Shiran; Mizrahi, Aviv; Bergman, Hagai

    2015-04-29

    The external segment of the globus pallidus (GPe) is one of the core nuclei of the basal ganglia, playing a major role in normal control of behavior and in the pathophysiology of basal ganglia-related disorders such as Parkinson's disease. In vivo, most neurons in the GPe are characterized by high firing rates (50-100 spikes/s), interspersed with long periods (∼0.6 s) of complete silence, which are termed GPe pauses. Previous physiological studies of single and pairs of GPe neurons have failed to fully disclose the physiological process by which these pauses originate. We examined 1001 simultaneously recorded pairs of high-frequency discharge GPe cells recorded from four monkeys during task-irrelevant periods, considering the activity in one cell while the other is pausing. We found that pauses (n = 137,278 pauses) coincide with a small yet significant reduction in firing rate (0.78 ± 0.136 spikes/s) in other GPe cells. Additionally, we found an increase in the probability of the simultaneously recorded cell to pause during the pause period of the "trigger" cell. Importantly, this increase in the probability to pause at the same time does not account for the reduction in firing rate by itself. Modeling of GPe cells as class 2 excitability neurons (Hodgkin, 1948) with common external inputs can explain our results. We suggest that common inputs decrease the GPe discharge rate and lead to a bifurcation phenomenon (pause) in some of the GPe neurons. PMID:25926452

  1. A pause-in-speech deletion technique of delay-allowable communication systems

    NASA Astrophysics Data System (ADS)

    Yoshida, T.; Ueda, J.

    1983-07-01

    The technique outlined here makes it possible, after the detection of a voice segment, to go backward some tens of milliseconds before the voice segment and turn on a voice switch. In a delay-allowable communication system, this allows efficient compression of the pause in speech while maintaining minimum quality degradation; it can be an effective method of reducing costs. Consideration is given to the possibility of a backward hangover process with pause deletion and to the rewriting of voice segments in pause segments in the buffering process using addressing control. Experimental results show that the backward hangover process (hangover time, approximately 32-64 ms) requires less voice deletion than the ordinary hangover process; this is especially true at word fronts, which are essential to quality reproduction. It is shown that the cost of the system can be reduced without speech quality degradation by applying the backward hangover process and addressing control at buffering.

  2. The CD14 rs2569190 TT Genotype Is Associated with an Improved 30-Day Survival in Patients with Sepsis: A Prospective Observational Cohort Study

    PubMed Central

    Mansur, Ashham; Liese, Benjamin; Steinau, Maximilian; Ghadimi, Michael; Bergmann, Ingo; Tzvetkov, Mladen; Popov, Aron Frederik; Beissbarth, Tim; Bauer, Martin; Hinz, José

    2015-01-01

    According to previous investigations, CD14 is suggested to play a pivotal role in initiating and perpetuating the pro-inflammatory response during sepsis. A functional polymorphism within the CD14 gene, rs2569190, has been shown to impact the pro-inflammatory response upon stimulation with lipopolysaccharide, a central mediator of inflammation in sepsis. In this study, we hypothesized that the strong pro-inflammatory response induced by the TT genotype of CD14 rs2569190 may have a beneficial effect on survival (30-day) in patients with sepsis. A total of 417 adult patients with sepsis (and of western European descent) were enrolled into this observational study. Blood samples were collected for rs2569190 genotyping. Patients were followed over the course of their stay in the ICU, and the 30-day mortality risk was recorded as the primary outcome parameter. Sepsis-related organ failure assessment (SOFA) scores were quantified at sepsis onset and throughout the observational period to monitor organ failure as a secondary variable. Moreover, organ support-free days were evaluated as a secondary outcome parameter. TT-homozygous patients were compared to C-allele carriers. Kaplan-Meier survival analysis revealed a higher 30-day mortality risk among C-allele carriers compared with T homozygotes (p = 0.0261). To exclude the effect of potential confounders (age, gender, BMI and type of infection) and covariates that varied at baseline with a p-value < 0.2 (e.g., comorbidities), we performed multivariate Cox regression analysis to examine the survival time. The CD14 rs2569190 C allele remained a significant covariate for the 30-day mortality risk in the multivariate analysis (hazard ratio, 2.11; 95% CI, 1.08-4.12; p = 0.0282). The 30-day mortality rate among C allele carriers was 23%, whereas the T homozygotes had a mortality rate of 13%. Additionally, an analysis of organ-specific SOFA scores revealed a significantly higher SOFA-Central nervous system score among patients

  3. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness

    PubMed Central

    Joshi, Roshni; Myles, Puja R.

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52–0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55–0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  4. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness.

    PubMed

    Joshi, Roshni; Venkatesan, Sudhir; Myles, Puja R

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52-0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55-0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  5. Validation of the Risk Estimator Decision aid for Atrial Fibrillation (RED-AF) for Predicting 30-Day Adverse Events in Emergency Department Patients With Atrial Fibrillation

    PubMed Central

    Barrett, Tyler W.; Jenkins, Cathy A.; Self, Wesley H.

    2014-01-01

    Objective Nearly 70% of emergency departments (ED) visits for atrial fibrillation (AF) result in hospitalization. The incidence of serious 30-day adverse events following an ED evaluation for AF remains low. This study’s goal was to prospectively validate our previously reported Risk Estimator Decision aid for AF (RED-AF) model for estimating a patient’s risk of experiencing a 30-day adverse event. Methods This was a prospective cohort study, which enrolled a convenience sample of ED patients presenting with AF. RED-AF, previously derived from a retrospective cohort of 832 patients, assigns points based on age, sex, coexisting disease (heart failure, hypertension, chronic obstructive pulmonary disease), smoking, home medications (beta blocker, diuretic), physical examination findings (dyspnea, palpitations, peripheral edema), and adequacy of ED ventricular rate control. Primary outcome was occurrence of ≥1 AF-related adverse outcome (ED visits, rehospitalization, cardiovascular complications, death) within 30 days. We identified a clinically relevant threshold and measured RED-AF’s performance in this prospective cohort, assessing its calibration, discrimination, and diagnostic accuracy. Results The study enrolled 497 patients between June 2010 and February 2013. Of these, 120 (24%) had ≥1 adverse event within 30 days. A RED-AF score of 87 was identified as an optimal threshold, resulting in sensitivity (95% CI) and specificity (95%CI) of 96% (91–98) and 19% (15–23), respectively. Positive and negative predictive values were 27% (23–32) and 93% (85–97), respectively. The c-statistic for RED-AF was 0.65 (95% CI, 0.59 to 0.71). Conclusion In this separate validation cohort, RED-AF performed moderately well and similar to the original derivation cohort for identifying the risk of short-term AF-related adverse events in ED patients diagnosed with AF. PMID:25245277

  6. [STRUCTURAL-FUNCTIONAL STATUS OF THE LYMPH TISSUE OF MICE LYMPHATIC NODES FOLLOWING THE 30-DAY FLIGHT ONBOARD SPACECRAFT BION-M1].

    PubMed

    Bulekbaeva, L E; Demchenko, G A; Ilyin, E A; Erofeeva, L M

    2015-01-01

    The article reports the results of studying the lymph tissue of mesenteric and cervical lymphatic nodes in C57BL/6N mice after the 30-day orbital flight onboard biosatellite Bion-M1. Histological and morphometric investigations revealed changes in the ratio of the nodes structural-functional zones and microstructure. Reductions in reticular cells, plasmocytes, macrophages and blasts in the nodes point to degradation of both humoral and cellular immunity. PMID:26554128

  7. Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

    PubMed Central

    Ou, Lixin; Chen, Jack; Assareh, Hassan; Hollis, Stephanie J.; Hillman, Ken; Flabouris, Arthas

    2014-01-01

    Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the

  8. An Investigation of the Effects of Different Types of Activities during Pauses in a Segmented Instructional Animation

    ERIC Educational Resources Information Center

    Cheon, Jongpil; Chung, Sungwon; Crooks, Steven M.; Song, Jaeki; Kim, Jeakyeong

    2014-01-01

    Since the complex and transient information in instructional animations requires more cognitive resources, the segmenting principle has been proposed to reduce cognitive overload by providing smaller chunks with pauses between segments. This study examined the effects of different types of activities during pauses in a segmented animation. Four…

  9. Extended Pausing by Humans on Multiple Fixed-Ratio Schedules with Varied Reinforcer Magnitude and Response Requirements

    ERIC Educational Resources Information Center

    Williams, Dean C.; Saunders, Kathryn J.; Perone, Michael

    2011-01-01

    We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only…

  10. Use of complementary DNA oligomers to probe trp leader transcript secondary structures involved in transcription pausing and termination.

    PubMed Central

    Fisher, R; Yanofsky, C

    1984-01-01

    DNA oligomers were synthesized that are perfectly complementary to different segments of the tryptophan (trp) operon leader transcript. These 15 nucleotide long oligomers were used as probes of the involvement of transcript secondary structures in two processes: transcription pausing at the pause site located near base pair 90 in the leader region, and transcription termination at the attenuator. The 15-mers were complementary to the four segments of the trp leader transcript which have been shown to form the alternative secondary structures that are believed to be responsible for pausing, termination, and antitermination. Oligomers complementary to RNA segments 1 and 3 relieved termination while the 15-mer complementary to RNA segment 1 relieved pausing. 15-mers complementary to segment 2 had no effect on pausing and the oligomer complementary to segment 4 had virtually no effect on termination. PMID:6201827

  11. RNA polymerase II pauses at the 5 prime end of the transcriptionally induced Drosophila hsp70 gene

    SciTech Connect

    O'Brien, T.; Lis, J.T. )

    1991-10-01

    An RNA polymerase II molecule is associated with the 5{prime} end of the Drosophila melanogaster hsp70 gene under non-heat shock conditions. This polymerase is engaged in transcription but has paused, or arrested, after synthesizing about 25 nucleotides. Resumption of elongation by this paused polymerase appears to be the rate-limiting step in hsp70 transcription in uninduced cells. Here the authors report results of nuclear run-on assays that measure the distribution of elongating and paused RNA polymerase molecules on the hsp70 gene in induced cells. Pausing of polymerase was detected at the 5{prime} end of hsp70 was transcribed approximately five times during the 25-min heat shock that they used. Therefore, once the hsp70 gene is induced to an intermediate level, initiation of transcription by RNA polymerase II remains more rapid than the resumption of elongation by a paused polymerase molecule.

  12. SAYP and Brahma are important for 'repressive' and 'transient' Pol II pausing.

    PubMed

    Vorobyeva, Nadezhda E; Nikolenko, Julia V; Nabirochkina, Elena N; Krasnov, Alexey N; Shidlovskii, Yulii V; Georgieva, Sofia G

    2012-08-01

    Drosophila SAYP, a homologue of human PHF10/BAF45a, is a metazoan coactivator associated with Brahma and essential for its recruitment on the promoter. The role of SAYP in DHR3 activator-driven transcription of the ftz-f1 gene, a member of the ecdysone cascade was studied. In the repressed state of ftz-f1 in the presence of DHR3, the Pol II complex is pre-recruited on the promoter; Pol II starts transcription but is paused 1.5 kb downstream of the promoter, with SAYP and Brahma forming a 'nucleosomal barrier' (a region of high nucleosome density) ahead of paused Pol II. SAYP depletion leads to the removal of Brahma, thereby eliminating the nucleosomal barrier. During active transcription, Pol II pausing at the same point correlates with Pol II CTD Ser2 phosphorylation. SAYP is essential for Ser2 phosphorylation and transcription elongation. Thus, SAYP as part of the Brahma complex participates in both 'repressive' and 'transient' Pol II pausing. PMID:22638575

  13. What Makes Speech Sound Fluent? The Contributions of Pauses, Speed and Repairs

    ERIC Educational Resources Information Center

    Bosker, Hans Rutger; Pinget, Anne-France; Quene, Hugo; Sanders, Ted; de Jong, Nivja H.

    2013-01-01

    The oral fluency level of an L2 speaker is often used as a measure in assessing language proficiency. The present study reports on four experiments investigating the contributions of three fluency aspects (pauses, speed and repairs) to perceived fluency. In Experiment 1 untrained raters evaluated the oral fluency of L2 Dutch speakers. Using…

  14. Unusually long-lived pause required for regulation of a Rho-dependent transcription terminator

    PubMed Central

    Hollands, Kerry; Sevostiyanova, Anastasia; Groisman, Eduardo A.

    2014-01-01

    Up to half of all transcription termination events in bacteria rely on the RNA-dependent helicase Rho. However, the nucleic acid sequences that promote Rho-dependent termination remain poorly characterized. Defining the molecular determinants that confer Rho-dependent termination is especially important for understanding how such terminators can be regulated in response to specific signals. Here, we identify an extraordinarily long-lived pause at the site where Rho terminates transcription in the 5′-leader region of the Mg2+ transporter gene mgtA in Salmonella enterica. We dissect the sequence elements required for prolonged pausing in the mgtA leader and establish that the remarkable longevity of this pause is required for a riboswitch to stimulate Rho-dependent termination in the mgtA leader region in response to Mg2+ availability. Unlike Rho-dependent terminators described previously, where termination occurs at multiple pause sites, there is a single site of transcription termination directed by Rho in the mgtA leader. Our data suggest that Rho-dependent termination events that are subject to regulation may require elements distinct from those operating at constitutive Rho-dependent terminators. PMID:24778260

  15. Academic Writers On-Line: Investigating Pausing in the Production of Text.

    ERIC Educational Resources Information Center

    Miller, Kristyan Spelman

    2000-01-01

    Describes an approach to the study of writing processes based on the analysis of temporal aspects of the writing event. The approach involves recording the keystroke presses made during production of a text using a word processor, and analyzing such features as pausing, fluency, and revision activity. (Author/VWL)

  16. GC skew defines distinct RNA polymerase pause sites in CpG island promoters.

    PubMed

    Kellner, Wendy A; Bell, Joshua S K; Vertino, Paula M

    2015-11-01

    CpG islands (CGIs) are associated with over half of human gene promoters and are characterized by a unique chromatin environment and high levels of bidirectional transcriptional activity relative to surrounding genomic regions, suggesting that RNA polymerase (Pol II) progression past the CGI boundaries is restricted. Here we describe a novel transcriptional regulatory step wherein Pol II encounters an additional barrier to elongation distinct from the promoter-proximal pause and occurring at the downstream boundary of the CGI domain. For most CGI-associated promoters, Pol II exhibits a dominant pause at either the promoter-proximal or this distal site that correlates, both in position and in intensity, with local regions of high GC skew, a sequence feature known to form unique secondary structures. Upon signal-induced gene activation, long-range enhancer contacts at the dominant pause site are selectively enhanced, suggesting a new role for enhancers at the downstream pause. These data point to an additional level of control over transcriptional output at a subset of CGI-associated genes that is linked to DNA sequence and the integrity of the CGI domain. PMID:26275623

  17. In the Pause and Listening to the Little People: A Folk Healer's Journey

    ERIC Educational Resources Information Center

    Robbins, Rockey; Hong, Ji; Jennings, Aaron M.

    2012-01-01

    This article employs a qualitative case study approach to describe the views and perspectives of a folk healer (White Bear) regarding spiritual healing. White Bear argues for a mobile, in-the-moment form of diagnosis and a "pause," in which the mind ceases to tyrannize and the healer is no longer absorbed in his or her emotions. He contends that a…

  18. Changes in transcriptional pausing modify the folding dynamics of the pH-responsive RNA element

    PubMed Central

    Nechooshtan, Gal; Elgrably-Weiss, Maya; Altuvia, Shoshy

    2014-01-01

    Previously, we described a novel pH-responsive RNA element in Escherichia coli that resides in the 5′ untranslated region of the alx gene and controls its translation in a pH-dependent manner. Under normal growth conditions, this RNA region forms a translationally inactive structure, but when transcribed under alkaline conditions, it forms an active structure producing the Alx protein. We identified two distinct transcriptional pause sites and proposed that pausing at these sites interfered with the formation of the inactive structure while facilitating folding of the active one. Alkali increases the longevity of pausing at these sites, thereby promoting folding of the translationally active form of alx RNA. We show here that mutations that modify the extent and/or position of pausing, although silent with regard to structure stability per se, greatly influence the dynamics of folding and thereby translation. Our data illustrate the mechanistic design of alx regulation, relying on precise temporal and spatial characteristics. We propose that this unique design provides an opportunity for environmental signals such as pH to introduce structural changes in the RNA and thereby modulate expression. PMID:24078087

  19. Neural correlates of prosodic boundary perception in German preschoolers: If pause is present, pitch can go.

    PubMed

    Männel, Claudia; Friederici, Angela D

    2016-02-01

    Children׳s perception of prosodic phrasing provides a head start into the discovery of speech structure. Based on the close prosody-syntax correspondence, children can infer the underlying syntactic structure from the acoustic modulations of prosodic boundaries, typically consisting of co-occurring pitch changes, preboundary lengthening, and pausing. Previous electrophysiological studies revealed that listeners are to some degree flexible in the detection of major prosodic boundaries that are not marked with all three of the suprasegmental cues. Adults and 6-year-olds still showed the brain response for prosodic boundary perception, the Closure Positive Shift (CPS), when pauses marking boundaries were deleted. In contrast, younger children at 3 years did not show this ability yet, but required pausing to complement the other boundary cues. Following the hypothesis that German weights duration cues more heavily than pitch cues, we here examined 3-year-olds׳ brain responses to prosodic phrasing, testing the role of boundary-related pitch changes. Results revealed that children at this age even showed the CPS in response to pitch-neutralized boundaries with only pausing and preboundary lengthening being present. These results indicate differential roles of acoustic cues in boundary perception, with a preferential reliance on duration cues over pitch changes in 3-year-olds. This preference likely results from the characteristics of the German intonation system and furthers the discussion of cross-linguistic differences in the weighting of prosodic boundary cues. PMID:26683081

  20. GC skew defines distinct RNA polymerase pause sites in CpG island promoters

    PubMed Central

    Kellner, Wendy A.; Bell, Joshua S.K.; Vertino, Paula M.

    2015-01-01

    CpG islands (CGIs) are associated with over half of human gene promoters and are characterized by a unique chromatin environment and high levels of bidirectional transcriptional activity relative to surrounding genomic regions, suggesting that RNA polymerase (Pol II) progression past the CGI boundaries is restricted. Here we describe a novel transcriptional regulatory step wherein Pol II encounters an additional barrier to elongation distinct from the promoter-proximal pause and occurring at the downstream boundary of the CGI domain. For most CGI-associated promoters, Pol II exhibits a dominant pause at either the promoter-proximal or this distal site that correlates, both in position and in intensity, with local regions of high GC skew, a sequence feature known to form unique secondary structures. Upon signal-induced gene activation, long-range enhancer contacts at the dominant pause site are selectively enhanced, suggesting a new role for enhancers at the downstream pause. These data point to an additional level of control over transcriptional output at a subset of CGI-associated genes that is linked to DNA sequence and the integrity of the CGI domain. PMID:26275623

  1. Impact of Typical Aging and Parkinson's Disease on the Relationship among Breath Pausing, Syntax, and Punctuation

    ERIC Educational Resources Information Center

    Huber, Jessica E.; Darling, Meghan; Francis, Elaine J.; Zhang, Dabao

    2012-01-01

    Purpose: The present study examines the impact of typical aging and Parkinson's disease (PD) on the relationship among breath pausing, syntax, and punctuation. Method: Thirty young adults, 25 typically aging older adults, and 15 individuals with PD participated. Fifteen participants were age- and sex-matched to the individuals with PD.…

  2. Explaining the Segmentation Effect in Learning from Animations: The Role of Pausing and Temporal Cueing

    ERIC Educational Resources Information Center

    Spanjers, Ingrid A. E.; van Gog, Tamara; Wouters, Pieter; van Merrienboer, Jeroen J. G.

    2012-01-01

    Segmentation of animations, that is presenting them in pieces rather than as a continuous stream of information, has been shown to have a beneficial effect on cognitive load and learning for novices. Two different explanations of this segmentation effect have been proposed. Firstly, pauses are usually inserted between the segments, which may give…

  3. Pause and Utterance Duration in Child-Directed Speech in Relation to Child Vocabulary Size

    ERIC Educational Resources Information Center

    Marklund, Ulrika; Marklund, Ellen; Lacerda, Francisco; Schwarz, Iris-Corinna

    2015-01-01

    This study compares parental pause and utterance duration in conversations with Swedish speaking children at age 1;6 who have either a large, typical, or small expressive vocabulary, as measured by the Swedish version of the McArthur-Bates CDI. The adjustments that parents do when they speak to children are similar across all three vocabulary…

  4. Heat-induced ribosome pausing triggers mRNA co-translational decay in Arabidopsis thaliana.

    PubMed

    Merret, Rémy; Nagarajan, Vinay K; Carpentier, Marie-Christine; Park, Sunhee; Favory, Jean-Jacques; Descombin, Julie; Picart, Claire; Charng, Yee-Yung; Green, Pamela J; Deragon, Jean-Marc; Bousquet-Antonelli, Cécile

    2015-04-30

    The reprogramming of gene expression in heat stress is a key determinant to organism survival. Gene expression is downregulated through translation initiation inhibition and release of free mRNPs that are rapidly degraded or stored. In mammals, heat also triggers 5'-ribosome pausing preferentially on transcripts coding for HSC/HSP70 chaperone targets, but the impact of such phenomenon on mRNA fate remains unknown. Here, we provide evidence that, in Arabidopsis thaliana, heat provokes 5'-ribosome pausing leading to the XRN4-mediated 5'-directed decay of translating mRNAs. We also show that hindering HSC/HSP70 activity at 20°C recapitulates heat effects by inducing ribosome pausing and co-translational mRNA turnover. Strikingly, co-translational decay targets encode proteins with high HSC/HSP70 binding scores and hydrophobic N-termini, two characteristics that were previously observed for transcripts most prone to pausing in animals. This work suggests for the first time that stress-induced variation of translation elongation rate is an evolutionarily conserved process leading to the polysomal degradation of thousands of 'non-aberrant' mRNAs. PMID:25845591

  5. Comparison of Pausing Behavior in Children Who Stutter and Children Who Have Asperger Syndrome

    ERIC Educational Resources Information Center

    Beltrame, Jessica Monique; Viera, Renata Alves Torello; Tamanaha, Ana Carina; Arcuri, Claudia Fassin; Osborn, Ellen; Perissinoto, Jacy; Schiefer, Ana Maria

    2011-01-01

    Purpose: The objective of this research was to compare the number and types of grammatical and non-grammatical silent pauses presented by stutterers and subjects with Asperger syndrome in their narratives. Method: Ten children who stutter and four participants with Asperger syndrome (mean ages of both groups 10 years) were assessed at the Speech…

  6. An Exploratory Study of Pauses in Computer-Assisted EFL Writing

    ERIC Educational Resources Information Center

    Xu, Cuiqin; Ding, Yanren

    2014-01-01

    The advance of computer input log and screen-recording programs over the last two decades has greatly facilitated research into the writing process in real time. Using Inputlog 4.0 and Camtasia 6.0 to record the writing process of 24 Chinese EFL writers in an argumentative task, this study explored L2 writers' pausing patterns in…

  7. Postoperative Spine Infections.

    PubMed

    Pawar, Abhijit Yuvaraj; Biswas, Samar Kumar

    2016-02-01

    Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475

  8. Postoperative Spine Infections

    PubMed Central

    Biswas, Samar Kumar

    2016-01-01

    Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475

  9. Profiling Speech and Pausing in Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia (FTD)

    PubMed Central

    Yunusova, Yana; Graham, Naida L.; Shellikeri, Sanjana; Phuong, Kent; Kulkarni, Madhura; Rochon, Elizabeth; Tang-Wai, David F.; Chow, Tiffany W.; Black, Sandra E.; Zinman, Lorne H.; Green, Jordan R.

    2016-01-01

    Objective This study examines reading aloud in patients with amyotrophic lateral sclerosis (ALS) and those with frontotemporal dementia (FTD) in order to determine whether differences in patterns of speaking and pausing exist between patients with primary motor vs. primary cognitive-linguistic deficits, and in contrast to healthy controls. Design 136 participants were included in the study: 33 controls, 85 patients with ALS, and 18 patients with either the behavioural variant of FTD (FTD-BV) or progressive nonfluent aphasia (FTD-PNFA). Participants with ALS were further divided into 4 non-overlapping subgroups—mild, respiratory, bulbar (with oral-motor deficit) and bulbar-respiratory—based on the presence and severity of motor bulbar or respiratory signs. All participants read a passage aloud. Custom-made software was used to perform speech and pause analyses, and this provided measures of speaking and articulatory rates, duration of speech, and number and duration of pauses. These measures were statistically compared in different subgroups of patients. Results The results revealed clear differences between patient groups and healthy controls on the passage reading task. A speech-based motor function measure (i.e., articulatory rate) was able to distinguish patients with bulbar ALS or FTD-PNFA from those with respiratory ALS or FTD-BV. Distinguishing the disordered groups proved challenging based on the pausing measures. Conclusions and Relevance This study demonstrated the use of speech measures in the identification of those with an oral-motor deficit, and showed the usefulness of performing a relatively simple reading test to assess speech versus pause behaviors across the ALS—FTD disease continuum. The findings also suggest that motor speech assessment should be performed as part of the diagnostic workup for patients with FTD. PMID:26789001

  10. Surface pauses in relation to dive duration in imperial cormorants; how much time for a breather?

    PubMed

    Wilson, Rory P; Quintana, Flavio

    2004-05-01

    Air-breathing animals diving to forage can optimize time underwater by diving with just enough oxygen for the projected performance underwater. By so doing they surface with minimal body oxygen levels, which leads to maximal rates of oxygen uptake. We examined whether imperial cormorants Phalacrocorax atriceps adhere to this by examining dive:pause ratios in birds diving for extended, continuous periods to constant depths, assuming that the oxygen used underwater was exactly replenished by the periods at the surface. Examination of the cumulative time spent in surface pauses relative to the cumulative time spent in diving showed that surface pauses increase according to a power curve function of time spent in the dive or water depth. In a simplistic model we considered the rate at which birds expended energy underwater to be constant and that the rate of oxygen replenishment during the surface pause was directly proportional to the oxygen deficit. We then worked out values for the rate constant for the surface pause before using this constant to examine bird body oxygen levels immediately pre- and post dive. The model predicted that imperial cormorants do not submerge with just enough oxygen to cover their projected dive performance but rather dive with substantial reserves, although these reserves decrease with increasing dive depth/duration. We speculate that these oxygen reserves may be used to enhance bird survival when rare events, such as the appearance of predators or discovery of large prey requiring extended handling time, occur. The form of the oxygen saturation curve over time at the surface means that the time costs for maintaining constant oxygen reserves become particularly onerous for long, deep dives, so the observed decrease in reserves with increasing dive duration is expected in animals benefiting by optimizing for time. PMID:15107434

  11. Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1 year of surgery: a data linkage study using the NJR data set

    PubMed Central

    Zaidi, Razi; Macgregor, Alexander J; Goldberg, Andy

    2016-01-01

    Objective To report on the rate of 30-day readmission and the rate of additional or revision surgery within 12 months following total ankle replacement (TAR). Design A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. These two databases were linked in a deterministic fashion. HES episodes 12 months following the index procedure were isolated and analysed. Logistic regression was used to model predictors of reoperation and revision for primary ankle replacement. Participants All patients who underwent primary and revision ankle replacements according to the NJR between February 2008 and February 2013. Results The rate of 30-day readmission following primary and revision ankle replacement was 2.2% and 1.3%, respectively. In the 12 months following primary and revision ankle replacements, the revision rate (where implants needed to be removed) was 1.2% with increased odds in those orthopaedic units preforming <20 ankle replacements per year and patients with a preoperative fixed equinus deformity. The reoperation other than revision (where implants were not removed) in the 12 months following primary and revision TARs was 6.6% and 9.3%, respectively. Rheumatoid arthritis, cemented prosthesis and high ASA grade significantly increased the odds of reoperation. Conclusions TAR has a 30-day readmission rate of 2.2%, which is similar to that of knee replacement but lower than that of total hip replacement. 6.6% of patients undergoing primary TAR require a reoperation within 12 months of the index procedure. Early revision rates are significantly higher in low-volume centres. PMID:27217286

  12. Predictors of 30-Day Mortality and 90-Day Functional Recovery after Primary Intracerebral Hemorrhage : Hospital Based Multivariate Analysis in 585 Patients

    PubMed Central

    2009-01-01

    Objective The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. Methods Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. Results Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. Conclusion The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decision-making, when advising patients or family members about the prognosis of PICH and when planning intervention trials. PMID:19609417

  13. Life sciences payload definition and integration study. Volume 4: Appendix, costs, and data management requirements of the dedicated 30-day laboratory. [carry-on laboratory for Spacelab

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The results of the updated 30-day life sciences dedicated laboratory scheduling and costing activities are documented, and the 'low cost' methodology used to establish individual equipment item costs is explained in terms of its allowances for equipment that is commerical off-the-shelf, modified commercial, and laboratory prototype; a method which significantly lowers program costs. The costs generated include estimates for non-recurring development, recurring production, and recurring operations costs. A cost for a biomedical emphasis laboratory and a Delta cost to provide a bioscience and technology laboratory were also generated. All cost reported are commensurate with the design and schedule definitions available.

  14. Effectiveness of using thyrocalcitonin for the prevention of a calcium metabolic disorder in the mineralized tissues of rabbits with 30 days hypokinesia

    NASA Technical Reports Server (NTRS)

    Volozhin, A. I.; Shashkov, V. S.; Dmitriyev, B. S.; Yegorov, B. B.; Lobachik, V. I.; Brishin, A. I.

    1980-01-01

    A 30 day hypokinesia in rabbits led to a considerable lag in weight gain for the skeletal bones, reduction in Ca45 uptake, and an increase in isotope resorption rate in the rapidly metabolized fraction of extremity bones. On the other hand, Ca45 content in the teeth and maxillae increased, which may be explained by redistribution of isotope among the various mineralized tissues. Injection of thyrocalcitonin (50 IU/day) produced a distinct normalizing effect on Ca45 uptake and resorption in the mineralized tissues of rabbits kept hypokinetic.

  15. The effect of pause time upon the communicative interactions of young people who use augmentative and alternative communication.

    PubMed

    Mathis, Hilary; Sutherland, Dean; McAuliffe, Megan

    2011-10-01

    This study investigated the effect of variation in partner-initiated pause time on the expressive communication of young people who use Augmentative and Alternative Communication (AAC). Eight participants aged 8;11-20;08 years (mean 16;02 years) participated in the study. Three pause time conditions (2, 10, and 45 seconds) were trialled during a scripted shared storybook reading task. A total of 27 turn opportunities were provided for participants during the task. Participant interactions were analysed for the percentage of responses made to a turn opportunity, mean length of utterance in words (MLU), percentage of assertive conversational acts made, and the modes of communication used. Findings indicated that participants were more likely to respond to a turn opportunity when their communication partner provided a longer pause time. Additionally, a longer pause time resulted in longer MLUs. Participants did not use more assertive conversational acts and continued to use a variety of communication modes when provided with a longer pause time. Results indicate that increasing pause time is an effective strategy to support the development of expressive communication for young people who use AAC. This suggests the need for professionals providing AAC services to encourage communication partners to provide extended pauses during interactions. PMID:21888558

  16. Trigger-helix folding pathway and SI3 mediate catalysis and hairpin-stabilized pausing by Escherichia coli RNA polymerase

    PubMed Central

    Windgassen, Tricia A.; Mooney, Rachel Anne; Nayak, Dhananjaya; Palangat, Murali; Zhang, Jinwei; Landick, Robert

    2014-01-01

    The conformational dynamics of the polymorphous trigger loop (TL) in RNA polymerase (RNAP) underlie multiple steps in the nucleotide addition cycle and diverse regulatory mechanisms. These mechanisms include nascent RNA hairpin-stabilized pausing, which inhibits TL folding into the trigger helices (TH) required for rapid nucleotide addition. The nascent RNA pause hairpin forms in the RNA exit channel and promotes opening of the RNAP clamp domain, which in turn stabilizes a partially folded, paused TL conformation that disfavors TH formation. We report that inhibiting TH unfolding with a disulfide crosslink slowed multiround nucleotide addition only modestly but eliminated hairpin-stabilized pausing. Conversely, a substitution that disrupts the TH folding pathway and uncouples establishment of key TH–NTP contacts from complete TH formation and clamp movement allowed rapid catalysis and eliminated hairpin-stabilized pausing. We also report that the active-site distal arm of the TH aids TL folding, but that a 188-aa insertion in the Escherichia coli TL (sequence insertion 3; SI3) disfavors TH formation and stimulates pausing. The effect of SI3 depends on the jaw domain, but not on downstream duplex DNA. Our results support the view that both SI3 and the pause hairpin modulate TL folding in a constrained pathway of intermediate states. PMID:25336618

  17. Coinciding Decreases in Discharge Rate Suggest That Spontaneous Pauses in Firing of External Pallidum Neurons Are Network Driven

    PubMed Central

    Adler, Avital; Deffains, Marc; Gabbay, Hila; Katabi, Shiran; Mizrahi, Aviv; Bergman, Hagai

    2015-01-01

    The external segment of the globus pallidus (GPe) is one of the core nuclei of the basal ganglia, playing a major role in normal control of behavior and in the pathophysiology of basal ganglia-related disorders such as Parkinson's disease. In vivo, most neurons in the GPe are characterized by high firing rates (50–100 spikes/s), interspersed with long periods (∼0.6 s) of complete silence, which are termed GPe pauses. Previous physiological studies of single and pairs of GPe neurons have failed to fully disclose the physiological process by which these pauses originate. We examined 1001 simultaneously recorded pairs of high-frequency discharge GPe cells recorded from four monkeys during task-irrelevant periods, considering the activity in one cell while the other is pausing. We found that pauses (n = 137,278 pauses) coincide with a small yet significant reduction in firing rate (0.78 ± 0.136 spikes/s) in other GPe cells. Additionally, we found an increase in the probability of the simultaneously recorded cell to pause during the pause period of the “trigger” cell. Importantly, this increase in the probability to pause at the same time does not account for the reduction in firing rate by itself. Modeling of GPe cells as class 2 excitability neurons (Hodgkin, 1948) with common external inputs can explain our results. We suggest that common inputs decrease the GPe discharge rate and lead to a bifurcation phenomenon (pause) in some of the GPe neurons. PMID:25926452

  18. Postoperative pain management.

    PubMed

    Nett, Michael P

    2010-09-01

    Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal. PMID:20839719

  19. North vs south differences in acute peptic ulcer hemorrhage in Croatia: hospitalization incidence trends, clinical features, and 30-day case fatality

    PubMed Central

    Ljubičić, Neven; Pavić, Tajana; Budimir, Ivan; Puljiz, Željko; Bišćanin, Alen; Bratanić, Andre; Nikolić, Marko; Hrabar, Davor; Troskot, Branko

    2014-01-01

    Aim To assess the seven-year trends of hospitalization incidence due to acute peptic ulcer hemorrhage (APUH) and associated risk factors, and examine the differences in these trends between two regions in Croatia. Methods The study collected sociodemographic, clinical, and endoscopic data on 2204 patients with endoscopically confirmed APUH who were admitted to the Clinical Hospital Center “Sestre Milosrdnice,” Zagreb and Clinical Hospital Center Split between January 1, 2005 and December 31, 2011. We determined hospitalization incidence rates, 30-day case fatality rate, clinical outcomes, and incidence-associated factors. Results No differences were observed in APUH hospitalization incidence rates between the regions. Age-standardized one-year cumulative APUH hospitalization incidence rate calculated using the European Standard Population was significantly higher in Zagreb than in Split region (43.2/100 000 vs 29.2/100,000). A significantly higher APUH hospitalization incidence rates were observed in the above 65 years age group. Overall 30-day case fatality rate was 4.9%. Conclusion The hospitalization incidence of APUH in two populations did not change over the observational period and it was significantly higher in the Zagreb region. The incidence of acute duodenal ulcer hemorrhage also remained unchanged, whereas the incidence of acute gastric ulcer hemorrhage increased. The results of this study allow us to monitor epidemiological indicators of APUH and compare data with other countries. PMID:25559836

  20. Metal ion release and surface composition of the Cu 18Ni 20Zn nickel silver during 30 days immersion in artificial sweat

    NASA Astrophysics Data System (ADS)

    Milošev, Ingrid; Kosec, Tadeja

    2007-11-01

    In order to study nickel ion release associated with nickel allergy, Cu-18Ni-20Zn nickel-silver alloy was immersed in artificial sweat and Ringer physiological solution for 30 days. Dissolution of metal ions was measured as a function of time, and the characteristics of the solid surface layer formed after 30 days were studied by SEM/EDS and XPS. The dissolution of nickel prevails over dissolution of copper and zinc. Nickel release in artificial sweat is approximately 10 times higher than in Ringer physiological solution and in both solutions the nickel release exceeds 0.5 μg cm -2 week -1, the threshold above which the allergy is triggered. Evidence of selective nickel dissolution is reported. The composition of the surface layer formed in artificial sweat and in Ringer physiological solution differs in the content of nickel and chlorine. In artificial sweat, the major constituents of the surface layer are dominantly oxides, Cu 2O and ZnO, with traces of chlorine. In Ringer physiological solution, the composition of the surface layer changes to a mixture of oxides, chlorides and/or oxychlorides. Two components peaks were detected in the Cl 2p 3/2 peak; however, it was not possible to distinguish the exact nature of the chloride compound formed. The mechanism of nickel release is discussed as a function of the composition of the solution.

  1. A Multicenter, Prospective Study of a Novel Nasal EPAP Device in the Treatment of Obstructive Sleep Apnea: Efficacy and 30-Day Adherence

    PubMed Central

    Rosenthal, Leon; Massie, Clifford A.; Dolan, Diana C.; Loomas, Bryan; Kram, Jerrold; Hart, Robert W.

    2009-01-01

    Study Objectives: Evaluate the efficacy of a novel device placed in the nares that imposes an expiratory resistance for the treatment of obstructive sleep apnea (OSA) and evaluate adherence to the device over a 30-day in-home trial period. Design: One diagnostic and 3 treatment polysomnograms were administered in a Latin-square design to identify the optimal expiratory resistance to be used during the 30-day in-home trial. Subjects had repeat polysomnography with the prescribed device at the end of the 30-day trial. Setting: Multicenter study. Participants: Participants (N = 34; age 27 to 67) with a baseline apnea-hypopnea index (AHI) ≥ 5. Measurements and Results: The AHI was reduced from 24.5 ± 23.6 (mean ± SD) to an average of 13.5 ± 18.7 (p < 0.001) across initial treatment nights. The AHI was 15.5 ± 18.9 (p = 0.001) for the prescribed device at the end of the 30-day trial. Of 24 subjects with an AHI > 10 at baseline, 13 achieved an AHI ≤ 10 on the initial treatment nights; 10 had a similar response on the final treatment night. Percent of the night snoring decreased from 27.5 ± 23.2 to 11.6 ± 13.7 (p < 0.001) on initial treatment nights and 14.6 ± 20.6 (p = 0.013) at the end of the trial; Epworth Sleepiness scores decreased from 8.7 ± 4.0 at baseline to 6.9 ± 4.4 (p < 0.001) at the end of the trial; the Pittsburgh Sleep Quality Index improved from 7.4 ± 3.3 to 6.5 ± 3.6 (p = 0.042). Mean oxygen saturation increased from 94.8 ± 2.0 to 95.2 ± 1.9 (p = 0.023) on initial treatment nights and 95.3 ± 1.9 (p = 0.003) at the end of the trial. Sleep architecture was not affected. Participants reported using the device all night long for 94% of nights during the in-home trial. Conclusions: Treatment with this novel device was well tolerated and accepted by the participants. An overall reduction in AHI was documented; however, therapeutic response was variable among the participants. Further research is required to identify the ideal candidates for this

  2. Music benefits on postoperative distress and pain in pediatric day care surgery.

    PubMed

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-08-12

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age. PMID:25635217

  3. Music Benefits on Postoperative Distress and Pain in Pediatric Day Care Surgery

    PubMed Central

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-01-01

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age. PMID:25635217

  4. Influence of Pause Duration and Nod Response Timing in Dialogue between Human and Communication Robot

    NASA Astrophysics Data System (ADS)

    Takasugi, Shoji; Yoshida, Shohei; Okitsu, Kengo; Yokoyama, Masanori; Yamamoto, Tomohito; Miyake, Yoshihiro

    The purpose of this study is to clarify the influence from timing of utterance and body motion in dialogue between human and robot. We controlled pause duration and nod response timing in robot-side, and analyzed impression of communication in human-side by using Scheffe's Paired Comparison method. The results revealed that the impression of communication significantly modified by changing the pause duration and nod response timing. And, timing pattern of the impression altered diversely in elderly people than in younger, indicating that elderly generation uses various timing control mechanisms. From these results, it was suggested that timing control and impression of communication are mutually influenced, and this mechanism is thought to be useful to realize human-robot communication system for elderly generation.

  5. The solsticial pause on Mars: 2 modelling and investigation of causes

    NASA Astrophysics Data System (ADS)

    Mulholland, David P.; Lewis, Stephen R.; Read, Peter L.; Madeleine, Jean-Baptiste; Forget, Francois

    2016-01-01

    The martian solsticial pause, presented in a companion paper (Lewis et al., 2016), was investigated further through a series of model runs using the UK version of the LMD/UK Mars Global Climate Model. It was found that the pause could not be adequately reproduced if radiatively active water ice clouds were omitted from the model. When clouds were used, along with a realistic time-dependent dust opacity distribution, a substantial minimum in near-surface transient eddy activity formed around solstice in both hemispheres. The net effect of the clouds in the model is, by altering the thermal structure of the atmosphere, to decrease the vertical shear of the westerly jet near the surface around solstice, and thus reduce baroclinic growth rates. A similar effect was seen under conditions of large dust loading, implying that northern midlatitude eddy activity will tend to become suppressed after a period of intense flushing storm formation around the northern cap edge. Suppression of baroclinic eddy generation by the barotropic component of the flow and via diabatic eddy dissipation were also investigated as possible mechanisms leading to the formation of the solsticial pause but were found not to make major contributions. Zonal variations in topography were found to be important, as their presence results in weakened transient eddies around winter solstice in both hemispheres, through modification of the near-surface flow. The zonal topographic asymmetry appears to be the primary reason for the weakness of eddy activity in the southern hemisphere relative to the northern hemisphere, and the ultimate cause of the solsticial pause in both hemispheres. The meridional topographic gradient was found to exert a much weaker influence on near-surface transient eddies.

  6. Mutagenicity and pausing of HIV reverse transcriptase during HIV plus-strand DNA synthesis.

    PubMed Central

    Ji, J; Hoffmann, J S; Loeb, L

    1994-01-01

    The unusually high frequency of misincorporation by HIV-1 reverse transcriptase (HIV RT) is likely to be the major factor in the rapid accumulation of viral mutations in AIDS, especially in the env gene. To investigate the ability of HIV RT to copy the env gene, we subcloned an HIV env gene fragment into a single-stranded DNA vector and measured the progression of synthesis by HIV RT. We observed that HIV RT, but not RT from avian myeloblastosis virus, DNA polymerase-alpha or T7 DNA polymerase, pauses specifically at poly-deoxyadenosine stretches within the env gene. The frequency of bypassing the polyadenosine stretches by HIV RT is enhanced by increasing the ratio of enzyme to template. We measured the fidelity of DNA synthesis within a segment of the hypervariable region 1 of the env gene (V-1) containing a poly-deoxyadenosine sequence by repetitively copying the DNA by HIV RT, and then cloning and sequencing the copied fragments. We found that 27% of the errors identified in V-1 sequence were frameshift mutations opposite the poly-adenosine tract, a site where strong pausing was observed. Pausing of HIV RT at the polyadenosine tract could be enhanced by either distamycin A or netropsin, (A-T)-rich minor groove binding peptides. Moreover, netropsin increases the frequency of frameshift mutations in experiments in which HIV RT catalyzes gap filling synthesis within the lacZ gene in double-stranded circular M13mp2 DNA. These combined results suggest that the enhanced mutation frequency may be due to increased pausing at netropsin-modified polyadenosine tracts. Therefore, netropsin and related A-T binding chemicals may selectively enhance frameshift mutagenesis induced by HIV RT and yield predominantly non-viable virus. Images PMID:7510388

  7. Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence.

    PubMed

    Copeland, Darcy; Liska, Heather

    2016-01-01

    This project arose out of a need to address two issues at our hospital: we lacked a formal debriefing process for code/trauma events and the emergency department wanted to address the psychological and spiritual needs of code/trauma responders. We developed a debriefing process for code/trauma events that intentionally included mechanisms to facilitate recognition, acknowledgment, and, when needed, responses to the psychological and spiritual needs of responders. A post-code pause process was implemented in the emergency department with the aims of standardizing a debriefing process, encouraging a supportive team-based culture, improving transition back to "normal" activities after responding to code/trauma events, and providing responders an opportunity to express reverence for patients involved in code/trauma events. The post-code pause process incorporates a moment of silence and the addition of two simple questions to a traditional operational debrief. Implementation of post-code pauses was feasible despite the fast paced nature of the department. At the end of the 1-year pilot period, staff members reported increases in feeling supported by peers and leaders, their ability to pay homage to patients, and having time to regroup prior to returning to their assignment. There was a decrease in the number of respondents reporting having thoughts or feelings associated with the event within 24 hr. The pauses create a mechanism for operational team debriefing, provide an opportunity for staff members to honor their work and their patients, and support an environment in which the psychological and spiritual effects of responding to code/trauma events can be acknowledged. PMID:26953532

  8. Regulation of transcriptional pausing through the secondary channel of RNA polymerase.

    PubMed

    Esyunina, Daria; Agapov, Aleksei; Kulbachinskiy, Andrey

    2016-08-01

    Transcriptional pausing has emerged as an essential mechanism of genetic regulation in both bacteria and eukaryotes, where it serves to coordinate transcription with other cellular processes and to activate or halt gene expression rapidly in response to external stimuli. Deinococcus radiodurans, a highly radioresistant and stress-resistant bacterium, encodes three members of the Gre family of transcription factors: GreA and two Gre factor homologs, Gfh1 and Gfh2. Whereas GreA is a universal bacterial factor that stimulates RNA cleavage by RNA polymerase (RNAP), the functions of lineage-specific Gfh proteins remain unknown. Here, we demonstrate that these proteins, which bind within the RNAP secondary channel, strongly enhance site-specific transcriptional pausing and intrinsic termination. Uniquely, the pause-stimulatory activity of Gfh proteins depends on the nature of divalent ions (Mg(2+) or Mn(2+)) present in the reaction and is also modulated by the nascent RNA structure and the trigger loop in the RNAP active site. Our data reveal remarkable plasticity of the RNAP active site in response to various regulatory stimuli and highlight functional diversity of transcription factors that bind inside the secondary channel of RNAP. PMID:27432968

  9. Intragenic pausing and anti-sense transcription within the murine c-myc locus.

    PubMed Central

    Nepveu, A; Marcu, K B

    1986-01-01

    We present a detailed analysis of strand-specific transcription in different regions of the murine c-myc locus. In normal and transformed cell lines, RNA polymerase II directed transcription occurs in the sense and anti-sense direction. Three noncontiguous regions show a high level of transcription in the anti-sense orientation: upstream of the first exon, within the first intron and in the 3' part of the gene (intron 2 and exon 3). In a cell line carrying a c-myc amplification (54c12), anti-sense transcription is not uniformly increased throughout the locus and is differentially affected by inhibition of protein synthesis. These results suggest that anti-sense transcription in various parts of the locus is independently regulated. In the sense orientation, transcriptional activity is higher in the first exon than in the rest of the gene indicating that transcription pauses near the 3' end of the first exon. The extent of this intragenic pausing varies among different cell lines and is most severe in cells with a c-myc amplification. Transcription initiation and pausing are both negatively regulated by labile proteins. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:3024965

  10. Balloon Dilatation of Pediatric Subglottic Laryngeal Stenosis during the Artificial Apneic Pause: Experience in 5 Children

    PubMed Central

    Lisý, J.; Groh, D.; Chovanec, M.; Marková, M.; Suchánek, V.; Polášková, P.; Trávníček, M.

    2014-01-01

    Introduction. Balloon dilatation is a method of choice for treatment of laryngeal stenosis in children. The aim of procedure in apneic pause is to avoid new insertion of tracheostomy cannula. Patients and Methods. The authors performed balloon dilatation of subglottic laryngeal strictures (SGS) in 5 children (3 girls and 2 boys) without tracheotomy. Two of them with traumatic and inflammatory SGS had a tracheal cannula removed in the past. The other 3 children with postintubation SGS had never had a tracheostomy before. The need for tracheostomy due to worsening stridor was imminent for all of them. Results. The total of seven laryngeal dilatations by balloon esophagoplasty catheter in apneic pause was performed in the 5 children. The procedure averted the need for tracheostomy placement in 4 of them (80%). Failure of dilatation in girl with traumatic stenosis and concomitant severe obstructive lung disease led to repeated tracheostomy. Conclusion. Balloon dilatation of laryngeal stricture could be done in the absence of tracheostomy in apneic pause. Dilatation averted threatening tracheostomy in all except one case. Early complication after the procedure seems to be a negative prognostic factor for the outcome of balloon dilatation. PMID:25013778

  11. Pauses in the narratives produced by autistic, mentally retarded, and normal children as an index of cognitive demand.

    PubMed

    Thurber, C; Tager-Flusberg, H

    1993-06-01

    This study investigated the production of different types of speech pauses and repairs in the story narratives produced by autistic, mentally retarded, and normal children, matched on verbal mental age. Ten children in each group were asked to tell the story depicted in a wordless picture book. The narratives were analyzed for frequency of grammatical (between phrase) and nongrammatical (within phrase) pauses, and for several measures of story length and complexity. The main results were that children with autism produced significantly fewer nongrammatical pauses, and that their nongrammatical pausing was correlated with measures of story length and complexity. These findings suggest that the stories told by the autistic children reflect reduced cognitive and communicative demand. The implications of this study for future research on the use of a variety of prosodic characteristics as measures of social cognitive deficit in autism are discussed. PMID:8331049

  12. Postoperative Spine Infections

    PubMed Central

    Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele

    2015-01-01

    Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication. PMID:26605028

  13. Monkeys time their pauses of movement and not their movement-kinematics during a synchronization-continuation rhythmic task.

    PubMed

    Donnet, Sophie; Bartolo, Ramon; Fernandes, José Maria; Cunha, João Paulo Silva; Prado, Luis; Merchant, Hugo

    2014-05-01

    A critical question in tapping behavior is to understand whether the temporal control is exerted on the duration and trajectory of the downward-upward hand movement or on the pause between hand movements. In the present study, we determined the duration of both the movement execution and pauses of monkeys performing a synchronization-continuation task (SCT), using the speed profile of their tapping behavior. We found a linear increase in the variance of pause-duration as a function of interval, while the variance of the motor implementation was relatively constant across intervals. In fact, 96% of the variability of the duration of a complete tapping cycle (pause + movement) was due to the variability of the pause duration. In addition, we performed a Bayesian model selection to determine the effect of interval duration (450-1,000 ms), serial-order (1-6 produced intervals), task phase (sensory cued or internally driven), and marker modality (auditory or visual) on the duration of the movement-pause and tapping movement. The results showed that the most important parameter used to successfully perform the SCT was the control of the pause duration. We also found that the kinematics of the tapping movements was concordant with a stereotyped ballistic control of the hand pressing the push-button. The present findings support the idea that monkeys used an explicit timing strategy to perform the SCT, where a dedicated timing mechanism controlled the duration of the pauses of movement, while also triggered the execution of fixed movements across each interval of the rhythmic sequence. PMID:24572098

  14. Influence of repetitive Gz acceleration on structural and metabolic profile of m. vastus lateralis in monkeys exposed to 30 day bedrest.

    PubMed

    Belozerova, I N; Matveeva, O A; Kuznetsov, S L; Nemirovskaya, T L; Shenkman, B S

    2000-07-01

    It was shown that changes in structural and metabolic indices of extensor muscles of the lower extremities were usually found in man after exposure to space flight or to bed rest. Similar changes were also observed in monkeys, space-flown on "Kosmos" biosatellites. Response to weightlessness and to restraint was found to be different in m. soleus and in m. vastus lateralis. Therefore, it is important to study structural and metabolic changes of m. vastus lateralis fibers under conditions of gravitational unloading in monkeys, who have motor apparatus similar to that of man, and are much more fruitful object of research. It is assumed that artificial gravity can serve as a countermeasure, aimed at diminishing effects of gravitational unloading. We have studied the effect of repeated gravity overloading, created by means of a centrifuge, on structural and metabolic indices of monkey m. vastus lateralis at the background of 30 day head down tilt bed rest (BR). PMID:12697551

  15. Characteristics and preliminary observations of the influence of electromyostimulation on the size and function of human skeletal muscle during 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A.; Buchanan, Paul; Gollnick, Philip A.; Dudley, Gary A.

    1989-01-01

    The effect of transcutaneous electromyostimulation (EMS) on the development of atrophy and the loss of strength in lower limb musculature in humans exposed to microgravity was determined in three subjects who received EMS twice daily in a 3-d on/1-d off cycle on their dominant leg during 30 days of bedrest. The output waveform from the stimulator was sequenced to the knee extensors, knee flexors, ankle extensors, and ankle flexors, and caused three isometric contractions of each muscle group per minute. It was found that, in the dominant leg, EMS acted to attenuate the changes caused by bedrest, such as reductions in the leg volume, muscle compartment size, cross-sectional area of slow- and fast-twitch fibers, strength, and aerobic enzyme activities, and an increase in leg compliance.

  16. NELF and GAGA Factor Are Linked to Promoter-Proximal Pausing at Many Genes in Drosophila▿ †

    PubMed Central

    Lee, Chanhyo; Li, Xiaoyong; Hechmer, Aaron; Eisen, Michael; Biggin, Mark D.; Venters, Bryan J.; Jiang, Cizhong; Li, Jian; Pugh, B. Franklin; Gilmour, David S.

    2008-01-01

    Recent analyses of RNA polymerase II (Pol II) revealed that Pol II is concentrated at the promoters of many active and inactive genes. NELF causes Pol II to pause in the promoter-proximal region of the hsp70 gene in Drosophila melanogaster. In this study, genome-wide location analysis (chromatin immunoprecipitation-microarray chip [ChIP-chip] analysis) revealed that NELF is concentrated at the 5′ ends of 2,111 genes in Drosophila cells. Permanganate genomic footprinting was used to determine if paused Pol II colocalized with NELF. Forty-six of 56 genes with NELF were found to have paused Pol II. Pol II pauses 30 to 50 nucleotides downstream from transcription start sites. Analysis of DNA sequences in the vicinity of paused Pol II identified a conserved DNA sequence that probably associates with TFIID but detected no evidence of RNA secondary structures or other conserved sequences that might directly control elongation. ChIP-chip experiments indicate that GAGA factor associates with 39% of the genes that have NELF. Surprisingly, NELF associates with almost one-half of the most highly expressed genes, indicating that NELF is not necessarily a repressor of gene expression. NELF-associated pausing of Pol II might be an obligatory but sometimes transient checkpoint during the transcription cycle. PMID:18332113

  17. Bridged filaments of histone-like nucleoid structuring protein pause RNA polymerase and aid termination in bacteria

    PubMed Central

    Kotlajich, Matthew V; Hron, Daniel R; Boudreau, Beth A; Sun, Zhiqiang; Lyubchenko, Yuri L; Landick, Robert

    2015-01-01

    Bacterial H-NS forms nucleoprotein filaments that spread on DNA and bridge distant DNA sites. H-NS filaments co-localize with sites of Rho-dependent termination in Escherichia coli, but their direct effects on transcriptional pausing and termination are untested. In this study, we report that bridged H-NS filaments strongly increase pausing by E. coli RNA polymerase at a subset of pause sites with high potential for backtracking. Bridged but not linear H-NS filaments promoted Rho-dependent termination by increasing pause dwell times and the kinetic window for Rho action. By observing single H-NS filaments and elongating RNA polymerase molecules using atomic force microscopy, we established that bridged filaments surround paused complexes. Our results favor a model in which H-NS-constrained changes in DNA supercoiling driven by transcription promote pausing at backtracking-susceptible sites. Our findings provide a mechanistic rationale for H-NS stimulation of Rho-dependent termination in horizontally transferred genes and during pervasive antisense and noncoding transcription in bacteria. DOI: http://dx.doi.org/10.7554/eLife.04970.001 PMID:25594903

  18. Exposure to microgravity for 30 days onboard Bion M1 caused muscle atrophy and decreased regeneration in the mouse femoral Quadriceps

    NASA Astrophysics Data System (ADS)

    Grigoryan, Eleonora; Radugina, Elena A.; Almeida, Eduardo; Blaber, Elizabeth; Poplinskaya, Valentina; Markitantova, Yulia

    Mechanical unloading of muscle during spaceflight in microgravity is known to cause muscular atrophy, changes in muscle fiber type composition, gene expression, and reductions in regenerative muscle growth. Although limited data exists for long-term effects of microgravity in human muscle, these processes have mostly been studied in rodents for short periods of time, up to two weeks of spaceflight. Here we report on how 30-day, long-term, mechanical unloading in microgravity affects mouse muscle of the femoral Quadriceps group. To conduct these studies we used muscle tissue from 6 mice from the NASA Biospecimen Sharing Program conducted in collaboration with the Institute for Biomedical Problems of the Russian Academy of Sciences, during the Russian Bion M1 biosatellite mission in 2013. Muscle morphology observed in histological sections shows signs of extensive atrophy and regenerative hypoplasia. Specifically, we observed a two-fold decrease in the number of myonuclei and low density of myofibrils, their separation and fragmentation. Despite obvious atrophy, muscle regeneration nevertheless appears to have continued after 30 days in microgravity as evidenced by thin and short newly formed muscle fibers. Many of them however showed evidence of apoptosis and degradation of synthesized fibrils, suggesting long-term unloading in microgravity affects late stages of myofiber differentiation. Ground asynchronous and vivarium control animals showed normal, well-developed tissue structure with sufficient blood and nerve supply and evidence of regenerative formation of new muscle fibers free of apoptotic nuclei. Myofiber nuclei stress responses in spaceflight animals was detected by positive nuclear immunolocalization of c-jun and c-myc proteins. Regenerative activity of satellite cells in muscle was localized with pax-7, MyoD and MCad immunostaining, and did not appear altered in microgravity. In summary, long-term spaceflight in microgravity causes significant atrophy

  19. Immunotoxicological Evaluation of Corn Genetically Modified with Bacillus thuringiensis Cry1Ah Gene by a 30-Day Feeding Study in BALB/c Mice

    PubMed Central

    Song, Yan; Liang, Chunlai; Wang, Wei; Fang, Jin; Sun, Nana; Jia, Xudong; Li, Ning

    2014-01-01

    This study was to investigate the immunotoxicological potential of corn genetically modified (GM) with Bacillus thuringiensis (Bt) Cry1Ah gene in BALB/c mice. Female BALB/c mice were randomly assigned to one of the four groups: the negative control group, the parental corn group, the GM corn group and the positive control group with 10 mice per group. Mice in the GM corn group and the parental corn group were fed with diets containing 70% corresponding corn for 30 days. Mice in the negative control group and the positive control group were fed with AIN93G diet, administered with saline or 200 mg/kg of cyclophosphamide (CY) via intraperitoneal injection 24 h before the termination of the study, respectively. At the end of the study, the immunotoxicological effects of the GM corn were evaluated through immunopathology parameters including body and organ weights, hematology and clinical chemistry parameters, histological examination, peripheral blood lymphocytes phenotype; humoral immunity including antibody plaque-forming cell, serum immunoglobulin, cytokine and half hemolysis value; cellular immunity such as mitogen-induced splenocyte proliferation, cytotoxic T-lymphocyte reaction, delayed-type hypersensitivity reaction; non-specific immunity including phagocytic activities of phagocytes, natural killer cell activity. A single dose of cyclophosphamide (200 mg/kg bw) was found to have significant adverse effects on immunopathology, cellular immunity, and humoral immunity in mice. The corn genetically modified with Bt Cry1Ah gene is considered consistent with the parental corn in terms of immunopathology, humoral immunity, cellular immunity and non-specific immunity. No adverse immunotoxicological effects of GM corn with Bt Cry1Ah gene were found when feeding mice for 30 days. PMID:24520311

  20. Function of the Bacillus subtilis transcription elongation factor NusG in hairpin-dependent RNA polymerase pausing in the trp leader.

    PubMed

    Yakhnin, Alexander V; Yakhnin, Helen; Babitzke, Paul

    2008-10-21

    NusA and NusG are transcription elongation factors that bind to RNA polymerase (RNAP) after sigma subunit release. Escherichia coli NusA (NusA(Ec)) stimulates intrinsic termination and RNAP(Ec) pausing, whereas NusG(Ec) promotes Rho-dependent termination and pause escape. Both Nus factors also participate in the formation of RNAP(Ec) antitermination complexes. We showed that Bacillus subtilis NusA (NusA(Bs)) stimulates intrinsic termination and RNAP(Bs) pausing at U107 and U144 in the trpEDCFBA operon leader. Pausing at U107 and U144 participates in the transcription attenuation and translational control mechanisms, respectively, presumably by providing additional time for trp RNA-binding attenuation protein (TRAP) to bind to the nascent trp leader transcript. Here, we show that NusG(Bs) causes modest pause stimulation at U107 and dramatic pause stimulation at U144. NusA(Bs) and NusG(Bs) act synergistically to increase the U107 and U144 pause half-lives. NusG(Bs)-stimulated pausing at U144 requires RNAP(Bs), whereas NusA(Bs) stimulates pausing of RNAP(Bs) and RNAP(Ec) at the U144 and E. coli his pause sites. Although NusG(Ec) does not stimulate pausing at U144, it competes with NusG(Bs)-stimulated pausing, suggesting that both proteins bind to the same surface of RNAP(Bs). Inactivation of nusG results in the loss of RNAP pausing at U144 in vivo and elevated trp operon expression, whereas plasmid-encoded NusG complements the mutant defects. Overexpression of nusG reduces trp operon expression to a larger extent than overexpression of nusA. PMID:18852477

  1. Management of Postoperative Respiratory Failure.

    PubMed

    Mulligan, Michael S; Berfield, Kathleen S; Abbaszadeh, Ryan V

    2015-11-01

    Despite best efforts, postoperative complications such as postoperative respiratory failure may occur and prompt recognition of the process and management is required. Postoperative respiratory failure, such as postoperative pneumonia, postpneumonectomy pulmonary edema, acute respiratory distress-like syndromes, and pulmonary embolism, are associated with high morbidity and mortality. The causes of these complications are multifactorial and depend on preoperative, intraoperative, and postoperative factors, some of which are modifiable. The article identifies some of the risk factors, causes, and treatment strategies for successful management of the patient with postoperative respiratory failure. PMID:26515943

  2. Behavior-related pauses in simple-spike activity of mouse Purkinje cells are linked to spike rate modulation.

    PubMed

    Cao, Ying; Maran, Selva K; Dhamala, Mukesh; Jaeger, Dieter; Heck, Detlef H

    2012-06-20

    Purkinje cells (PCs) in the mammalian cerebellum express high-frequency spontaneous activity with average spike rates between 30 and 200 Hz. Cerebellar nuclear (CN) neurons receive converging input from many PCs, resulting in a continuous barrage of inhibitory inputs. It has been hypothesized that pauses in PC activity trigger increases in CN spiking activity. A prediction derived from this hypothesis is that pauses in PC simple-spike activity represent relevant behavioral or sensory events. Here, we asked whether pauses in the simple-spike activity of PCs related to either fluid licking or respiration, play a special role in representing information about behavior. Both behaviors are widely represented in cerebellar PC simple-spike activity. We recorded PC activity in the vermis and lobus simplex of head-fixed mice while monitoring licking and respiratory behavior. Using cross-correlation and Granger causality analysis, we examined whether short interspike intervals (ISIs) had a different temporal relationship to behavior than long ISIs or pauses. Behavior-related simple-spike pauses occurred during low-rate simple-spike activity in both licking- and breathing-related PCs. Granger causality analysis revealed causal relationships between simple-spike pauses and behavior. However, the same results were obtained from an analysis of surrogate spike trains with gamma ISI distributions constructed to match rate modulations of behavior-related Purkinje cells. Our results therefore suggest that the occurrence of pauses in simple-spike activity does not represent additional information about behavioral or sensory events that goes beyond the simple-spike rate modulations. PMID:22723707

  3. Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

    PubMed Central

    Snider, Julia Thornton; Linthicum, Mark T.; Hegazi, Refaat A.; Partridge, Jamie S.; LaVallee, Chris; Lakdawalla, Darius N.; Wischmeyer, Paul E.

    2015-01-01

    BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS: Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. PMID:25357165

  4. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant

    PubMed Central

    Hansen, Laura Sommer; Hjortdal, Vibeke Elisabeth; Andreasen, Jan Jesper; Mortensen, Poul Erik; Jakobsen, Carl-Johan

    2015-01-01

    Introduction: European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. Methods: A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). Results: During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA), and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test). The total EuroSCORE increased from 4.67 to 5.68 while the residual EuroSCORE decreased from 2.64 to 1.83. Thirty-day mortality decreased from 4.07% in 1999–2000 to 2.44% in 2011–2012 (P = 0.0056; Chi-square test), while 1-year mortality was unchanged (6.50% in 1999–2000 vs. 6.25% in 2011–2012 [P = 0.8086; Chi-square test]). Discussion: The study demonstrates that both co-morbidity and age has a great impact on 30-day mortality. However, with time the impact of co-morbidity seems less. Thus, age is more important than co-morbidity in late mortality. The various developments in short and long-term mortality are not readily explained. Conclusion: Although 30-day mortality of CABG and valve surgery patients has decreased during the 12-year period, the 1-year mortality remains the same. PMID:25849679

  5. A Job Pause Service under LAM/MPI+BLCR for Transparent Fault Tolerance

    SciTech Connect

    Wang, Chao; Mueller, Frank; Engelmann, Christian; Scott, Steven L

    2007-01-01

    Checkpoint/restart (C/R) has become a requirement for long-running jobs in large-scale clusters due to a meantime- to-failure (MTTF) in the order of hours. After a failure, C/R mechanisms generally require a complete restart of an MPI job from the last checkpoint. A complete restart, however, is unnecessary since all but one node are typically still alive. Furthermore, a restart may result in lengthy job requeuing even though the original job had not exceeded its time quantum. In this paper, we overcome these shortcomings. Instead of job restart, we have developed a transparent mechanism for job pause within LAM/MPI+BLCR. This mechanism allows live nodes to remain active and roll back to the last checkpoint while failed nodes are dynamically replaced by spares before resuming from the last checkpoint. Our methodology includes LAM/MPI enhancements in support of scalable group communicationwith fluctuating number of nodes, reuse of network connections, transparent coordinated checkpoint scheduling and a BLCR enhancement for job pause. Experiments in a cluster with the NAS Parallel Benchmark suite show that our overhead for job pause is comparable to that of a complete job restart. A minimal overhead of 5.6% is only incurred in case migration takes place while the regular checkpoint overhead remains unchanged. Yet, our approach alleviates the need to reboot the LAM run-time environment, which accounts for considerable overhead resulting in net savings of our scheme in the experiments. Our solution further provides full transparency and automation with the additional benefit of reusing existing resources. Executing continues after failures within the scheduled job, i.e., the application staging overhead is not incurred again in contrast to a restart. Our scheme offers additional potential for savings through incremental checkpointing and proactive diskless live migration, which we are currently working on.

  6. Efficient stripping of photoresist on metallized wafers by a pause flow of supercritical fluid.

    PubMed

    Chao, Mu-Rong; Chen, Jian-Lian

    2009-09-30

    Utilization of supercritical fluids (SCFs) is studied here on the premises of a saving of hazardous organic solvents and of the specification for stripping the photoresist (PR) on metallization layers, which is one of the integrated circuit processing modules. By using factorial experimental designs with five factors and four level ranges, this research focuses on determining an optimized recipe with high stripping efficiency and to determine the stripping mechanism. In the case of PR on an aluminum layer, the initial use of the pulse flow mode could increase the extraction ratio remarkably when compared to the conventional continuous flow mode. Based on the limitation of a total volume of 30 mL purging SCF-CO(2) for economical considerations, the optimum conditions can be summarized as follows: 120 degrees C, oven temperature; 350 atm, CO(2) pressure; 0.2 mL of ethylacetate spiking to SCF-CO(2); 2.0 min, static equilibrium time; and five cycles of dynamic flow pausing. A recovery of 94.6% (n=3, RSD=6.5%) was obtained, while the diffusion of stripped PR from substrate matrix prevailed over the dissolution of binding PR into the SCF medium. In the case of copper, the optimum parameters in a pause flow mode were 140 degrees C, oven temperature; 500 atm, CO(2) pressure; 0.75 mL, ethylacetate spiking volume; 5.0 min, static time; and six cycles of flow pausing. These extreme parameters still did not produce an SCF environment suitable for diffusion or dissolution mass transfer, and thus a recovery of 76.2% (n=3, RSD=7.5%) was only obtained. Removing PR coated on a Cu layer was harder than that on an Al layer. PMID:19376650

  7. [Desmin content and transversal stiffness of the left ventricle mouse cardiomyocytes and skeletal muscle fibers after a 30-day space flight on board "BION-M1" biosatellite].

    PubMed

    Ogneva, I V; Maximova, M V; Larina, I M

    2014-01-01

    The aim of this study was to determine the transversal stiffness of the cortical cytoskeleton and the cytoskeletal protein desmin content in the left ventricle cardiomyocytes, fibers of the mouse soleus and tibialis anterior muscle after a 30-day space flight on board the "BION-M1" biosatellite (Russia, 2013). The dissection was made after 13-16.5 h after landing. The transversal stiffness was measured in relaxed and calcium activated state by, atomic force microscopy. The desmin content was estimated by western blotting, and the expression level of desmin-coding gene was detected using real-time PCR. The results indicate that, the transversal stiffness of the left ventricle cardiomyocytes and fibers of the soleus muscle in relaxed and activated states did not differ from the control. The transversal stiffness of the tibialis muscle fibers in relaxed and activated state was increased in the mice group after space flight. At the same time, in all types of studied tissues the desmin content and the expression level of desmin-coding gene did not differ from the control level. PMID:25730983

  8. Isoform composition and gene expression of thick and thin filament proteins in striated muscles of mice after 30-day space flight.

    PubMed

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft "BION-M" number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from "Flight" group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the "Flight" group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from "Flight" and "Control" groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness. PMID:25664316

  9. Patients more likely to engage in treatment at 30 days when given buprenorphine in the ED, referred for follow-up.

    PubMed

    2015-08-01

    A new randomized trial shows patients who present to the ED with opioid dependence are much more likely to engage in treatment when they receive buprenorphine along with coordinated follow-up than when they just receive a brief intervention and a facilitated referral for treatment or just screening and referral. However, barriers to prescribing are robust, and many ED leaders are not persuaded they should be in the business of providing treatment for addiction. In the trial, at 30 days 78% of patients in the buprenorphine group (89 of 114 patients) were engaged in addiction treatment, compared with just 45% of the patients in the brief intervention group (50 of 111 patients) and 37% of patients in the referral group (38 of 102 patients). To prescribe buprenorphine for addiction disease, providers must undergo training and pass a test to obtain a DEA waiver; they are limited to treating 100 patients. While experts note there are not enough providers to prescribe buprenorphine and provide the follow-up needed to patients with addiction disease, they also acknowledge concerns about drug diversion as well as potential problems with capacity if EDs take a larger role in treating addiction. PMID:26258203

  10. Improving temperature monitoring in the vaccine cold chain at the periphery: an intervention study using a 30-day electronic refrigerator temperature logger (Fridge-tag).

    PubMed

    Kartoğlu, Umit; Nelaj, Erida; Maire, Denis

    2010-05-28

    This intervention study was conducted in Albania to establish the superiority of the Fridge-tag (30-day electronic refrigerator temperature logger) against thermometers. Intervention sites used Fridge-tag and a modified temperature control record sheet, while control sites continued with their routine operation with thermometers. All refrigerators in both groups were equipped with downloadable electronic data loggers to record temperatures for reference. Focus group sessions were conducted with involved staff to discuss temperature monitoring, Fridge-tag use and its user-friendliness. Significant discrepancies were observed between thermometer readings and the electronic data loggers in control sites, while all alarms from Fridge-tag were confirmed in the intervention group. Thermometers are not sufficient to monitor temperatures in refrigerators since they miss the great majority of low and high alarms. Fridge-tag has proven to be an effective tool in providing health workers with the information they need to take the necessary actions when there are refrigerator temperature variations. PMID:20398615

  11. The 2013 German-Russian BION-M1 Joint Flight Project: Skeletal Muscle and Neuromuscular Changes in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Blottner, Dieter; Shenkman, Boris; Salanova, Michele

    Exposure to microgravity results in various structural, biochemical and molecular changes of the skeletal neuromuscular system. The BION Joint Flight Proposal between the Charité Berlin Center of Space Medicine (www.zwmb.de) in Berlin, and the Institute of Biomedical Problem (IMBP) in Moscow, provided an exciting opportunity for a more detailed analysis of neuromuscular changes in mice (C57/bl6) exposed to real microgravity housed for 30 days in a BION M1 biosatellite on orbit. The mice from the BION flight group (n=5) were compared to three different on-ground control groups (Flight control, BION-ground and Vivarium, each n=5 mice). We started to analyse various skeletal muscles from the hind limbs or trunk. Apart from routine structural and biochemical analysis (fiber size and type distribution, slow/fastMyHC) we test the hypothesis for the presence of a microgravity-induced sarcolemma-cytosolic protein shift of nitric oxide synthase (NOS) and partial loss in neuromuscular synapse scaffold protein (Homer) immunoexpression known to be prone to disuse in mice or humans (hind limb unloading, bed rest) as previously shown (Sandonà D et al., PLoS One, 2012, Salanova M et al., FASEB J, 2011). National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121); Contract RAS-IMBP/Charité Berlin # Bion-M1/2013

  12. Isoform Composition and Gene Expression of Thick and Thin Filament Proteins in Striated Muscles of Mice after 30-Day Space Flight

    PubMed Central

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft “BION-M” number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from “Flight” group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the “Flight” group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from “Flight” and “Control” groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness. PMID:25664316

  13. Postoperative pain management

    PubMed Central

    Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

    2015-01-01

    Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

  14. Tolerance to cocaine's effects on schedule-controlled behavior: role of delay between pause-ending responses and reinforcement.

    PubMed

    Macaskill, Anne C; Branch, Marc N

    2012-01-01

    The schedule of reinforcement under which behavior is maintained is an important contributor to whether tolerance to the behavioral effects of cocaine develops. Schedule parameter value (for example, fixed-ratio size) has been shown to affect the development of tolerance under some schedule types but not others, but the specific procedural variables causing this effect remain to be identified. To date, schedule-parameter-related tolerance has developed when a longer pause after reinforcement does not lead to a shorter delay between the response that ends the pause and reinforcement. The current study investigated the importance of this variable in pigeons using a multiple chained Fixed-Ratio 1, Fixed-Time x schedule, in which the first key peck in a trial produced a stimulus change and initiated a delay at the end of which food was presented regardless of whether or not additional pecks were made during the delay. Dose-response curves were assessed before, during and after chronic (daily) administration of cocaine. Tolerance to the pause-increasing effects of cocaine occurred to a similar degree regardless of the scheduled time between the end of the pause and reinforcement. Therefore, the relationship between pause length and delay to reinforcement does not provide an explanation for schedule-parameter-related tolerance. PMID:22079348

  15. Face lift postoperative recovery.

    PubMed

    Mottura, A Aldo

    2002-01-01

    The purpose of this paper is to describe what I have studied and experienced, mainly regarding the control and prediction of the postoperative edema; how to achieve an agreeable recovery and give positive support to the patient, who in turn will receive pleasant sensations that neutralize the negative consequences of the surgery.After the skin is lifted, the drainage flow to the flaps is reversed abruptly toward the medial part of the face, where the flap bases are located. The thickness and extension of the flap determines the magnitude of the post-op edema, which is also augmented by medial surgeries (blepharo, rhino) whose trauma obstruct their natural drainage, increasing the congestion and edema. To study the lymphatic drainage, the day before an extended face lift (FL) a woman was infiltrated in the cheek skin with lynfofast (solution of tecmesio) and the absorption was observed by gamma camera. Seven days after the FL she underwent the same study; we observed no absorption by the lymphatic, concluding that a week after surgery, the lymphatic network was still damaged. To study the venous return during surgery, a fine catheter was introduced into the external jugular vein up to the mandibular border to measure the peripheral pressure. Following platysma plication the pressure rose, and again after a simple bandage, but with an elastic bandage it increased even further, diminishing considerably when it was released. Hence, platysma plication and the elastic bandage on the neck augment the venous congestion of the face. There are diseases that produce and can prolong the surgical edema: cardiac, hepatic, and renal insufficiencies, hypothyroidism, malnutrition, etc. According to these factors, the post-op edema can be predicted, the surgeon can choose between a wide dissection or a medial surgery, depending on the social or employment compromises the patient has, or the patient must accept a prolonged recovery if a complex surgery is necessary. Operative

  16. Enhancer-bound LDB1 regulates a corticotrope promoter-pausing repression program

    PubMed Central

    Zhang, Feng; Tanasa, Bogdan; Merkurjev, Daria; Lin, Chijen; Song, Xiaoyuan; Li, Wenbo; Tan, Yuliang; Liu, Zhijie; Zhang, Jie; Ohgi, Kenneth A.; Krones, Anna; Skowronska-Krawczyk, Dorota; Rosenfeld, Michael G.

    2015-01-01

    Substantial evidence supports the hypothesis that enhancers are critical regulators of cell-type determination, orchestrating both positive and negative transcriptional programs; however, the basic mechanisms by which enhancers orchestrate interactions with cognate promoters during activation and repression events remain incompletely understood. Here we report the required actions of LIM domain-binding protein 1 (LDB1)/cofactor of LIM homeodomain protein 2/nuclear LIM interactor, interacting with the enhancer-binding protein achaete-scute complex homolog 1, to mediate looping to target gene promoters and target gene regulation in corticotrope cells. LDB1-mediated enhancer:promoter looping appears to be required for both activation and repression of these target genes. Although LDB1-dependent activated genes are regulated at the level of transcriptional initiation, the LDB1-dependent repressed transcription units appear to be regulated primarily at the level of promoter pausing, with LDB1 regulating recruitment of metastasis-associated 1 family, member 2, a component of the nucleosome remodeling deacetylase complex, on these negative enhancers, required for the repressive enhancer function. These results indicate that LDB1-dependent looping events can deliver repressive cargo to cognate promoters to mediate promoter pausing events in a pituitary cell type. PMID:25605944

  17. Real-time interleaved photoacoustic/ultrasound (PAUS) imaging for interventional procedure guidance

    NASA Astrophysics Data System (ADS)

    Wei, Chen-wei; Nguyen, Thu-Mai; Xia, Jinjun; Arnal, Bastien; Pelivanov, Ivan; O'Donnell, Matthew

    2015-03-01

    Ultrasound-guided photoacoustic imaging has shown great potential for many clinical applications including vascular visualization, detection of nanoprobes sensing molecular profiles, and guidance of interventional procedures. However, bulky and costly lasers are usually required to provide sufficient pulse energies for deep imaging. The low pulse repetition rate also limits potential real-time applications of integrated photoacoustic/ultrasound (PAUS) imaging. With a compact and low-cost laser operating at a kHz repetition rate, we aim to integrate photoacoustics (PA) into a commercial ultrasound (US) machine utilizing an interleaved scanning approach for clinical translation, with imaging depth up to a few centimeters and frame rates > 30 Hz. Multiple PA sub-frames are formed by scanning laser firings covering a large scan region with a rotating galvo mirror, and then combined into a final frame. Ultrasound pulse-echo beams are interleaved between laser firings/PA receives. The approach was implemented with a diode-pumped laser, a commercial US scanner, and a linear array transducer. Insertion of an 18-gauge needle into a piece of chicken tissue, with subsequent injection of an absorptive agent into the tissue, was imaged with an integrated PAUS frame rate of 30 Hz, covering a 2.8 cm × 2.8 cm imaging plane. Given this real-time image rate and high contrast (> 40 dB at more than 1-cm depth in the PA image), we have demonstrated that this approach is potentially attractive for clinical procedure guidance.

  18. RNA Polymerase II Pausing as a Context-Dependent Reader of the Genome

    PubMed Central

    Scheidegger, Adam; Nechaev, Sergei

    2015-01-01

    Summary The RNA polymerase II (Pol II) transcribes all mRNA genes in eukaryotes and is among the most highly regulated enzymes in the cell. The classic model of mRNA gene regulation involves recruitment of the RNA polymerase to gene promoters in response to environmental signals. Higher eukaryotes have an additional ability to generate multiple cell types. This extra level of regulation enables each cell to interpret the same genome by committing to one of the many possible transcription programs and executing it in a precise and robust manner. Whereas multiple mechanisms are implicated in cell type-specific transcriptional regulation, how one genome can give rise to distinct transcriptional programs and what mechanisms activate and maintain the appropriate program in each cell remains unclear. This review focuses on the process of promoter-proximal Pol II pausing during early transcription elongation as a key step in context-dependent interpretation of the metazoan genome. We highlight aspects of promoter-proximal Pol II pausing, including its interplay with epigenetic mechanisms, that may enable cell type-specific regulation, and emphasize some of the pertinent questions that remain unanswered and open for investigation. PMID:26555214

  19. A novel phage-encoded transcription antiterminator acts by suppressing bacterial RNA polymerase pausing

    PubMed Central

    Berdygulova, Zhanna; Esyunina, Daria; Miropolskaya, Nataliya; Mukhamedyarov, Damir; Kuznedelov, Konstantin; Nickels, Bryce E.; Severinov, Konstantin; Kulbachinskiy, Andrey; Minakhin, Leonid

    2012-01-01

    Gp39, a small protein encoded by Thermus thermophilus phage P23–45, specifically binds the host RNA polymerase (RNAP) and inhibits transcription initiation. Here, we demonstrate that gp39 also acts as an antiterminator during transcription through intrinsic terminators. The antitermination activity of gp39 relies on its ability to suppress transcription pausing at poly(U) tracks. Gp39 also accelerates transcription elongation by decreasing RNAP pausing and backtracking but does not significantly affect the rates of catalysis of individual reactions in the RNAP active center. We mapped the RNAP-gp39 interaction site to the β flap, a domain that forms a part of the RNA exit channel and is also a likely target for λ phage antiterminator proteins Q and N, and for bacterial elongation factor NusA. However, in contrast to Q and N, gp39 does not depend on NusA or other auxiliary factors for its activity. To our knowledge, gp39 is the first characterized phage-encoded transcription factor that affects every step of the transcription cycle and suppresses transcription termination through its antipausing activity. PMID:22238378

  20. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

    SciTech Connect

    Wang, Jingya; Wei, Caimiao; Tucker, Susan L.; Myles, Bevan; Palmer, Matthew; Hofstetter, Wayne L.; Swisher, Stephen G.; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing; Lin, Steven H.

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  1. Early processing variations in selective attention to the color and direction of moving stimuli during 30 days head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wang, Lin-Jie; He, Si-Yang; Niu, Dong-Bin; Guo, Jian-Ping; Xu, Yun-Long; Wang, De-Sheng; Cao, Yi; Zhao, Qi; Tan, Cheng; Li, Zhi-Li; Tang, Guo-Hua; Li, Yin-Hui; Bai, Yan-Qiang

    2013-11-01

    Dynamic variations in early selective attention to the color and direction of moving stimuli were explored during a 30 days period of head-down bed rest. Event-related potentials (ERPs) were recorded at F5, F6, P5, P6 scalp locations in seven male subjects who attended to pairs of bicolored light emitting diodes that flashed sequentially to produce a perception of movement. Subjects were required to attend selectively to a critical feature of the moving target, e.g., color or direction. The tasks included: a no response task, a color selective response task, a moving direction selective response task, and a combined color-direction selective response task. Subjects were asked to perform these four tasks on: the 3rd day before bed rest; the 3rd, 15th and 30th day during the bed rest; and the 5th day after bed rest. Subjects responded quickly to the color than moving direction and combined color-direction response. And they had a longer reaction time during bed rest on the 15th and 30th day during bed rest after a relatively quicker response on the 3rd day. Using brain event-related potentials technique, we found that in the color selective response task, the mean amplitudes of P1 and N1 for target ERPs decreased in the 3rd day during bed rest and 5th day after bed rest in comparison with pre-bed rest, 15th day and 30th day during bed rest. In the combined color-direction selective response task, the P1 latencies for target ERPs on the 3rd and 30th day during bed rest were longer than on the 15th day during bed rest. As 3rd day during bed rest was in the acute adaptation period and 30th day during bed rest was in the relatively adaptation stage of head-down bed rest, the results help to clarify the effects of bed rest on different task loads and patterns of attention. It was suggested that subjects expended more time to give correct decision in the head-down tilt bed rest state. A difficulty in the recruitment of brain resources was found in feature selection task

  2. Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study

    PubMed Central

    Morita, Plinio P; Picton, Peter; Seto, Emily; Zbib, Ahmad; Cafazzo, Joseph A

    2016-01-01

    Background Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F 8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0

  3. Coat and claws as new matrices for noninvasive long-term cortisol assessment in dogs from birth up to 30 days of age.

    PubMed

    Veronesi, M C; Comin, A; Meloni, T; Faustini, M; Rota, A; Prandi, A

    2015-09-15

    The last stage of fetal development and the neonatal period represent the most critical phases for the mammals' offspring. In the dog, the knowledge about the final intrauterine fetal development and biology, as well as about the neonatal physiology, remains scarce. Hormonal changes occurring in the last intrauterine fetal phase and during the early neonatal age are still not completely clear, probably because of the invasiveness related to the collection of the more common biological matrix, represented by circulating blood. Toward term of pregnancy, during parturition, and after birth, the hypothalamic-pituitary-adrenal axis is a key system regulating several physiological processes, and its activity was previously investigated by blood analysis, considered an invasive procedure providing a single-point measurement. In respect to animal welfare, and for a more correct long-term retrospective investigation, noninvasive hormonal studies were performed firstly on the hair of humans and coat of animals and, more recently, in the nails of human beings. This study was aimed to assess cortisol (COR) in coat and claws of newborn puppies and to evaluate the possible influence of the newborn gender, breed body size, and age on coat and claws COR concentrations. The results obtained from 165 newborn puppies evidenced that coat and claws COR levels were highly correlated each other (P < 0.0001), although the COR accumulation in the two matrices was different in relation to the class of age. Moreover, the puppies age influenced both coat and claws COR concentrations (P < 0.05), with premature puppies showing higher values when compared to term born-dead puppies or puppies dead between 1 and 30 days of age. The present study reported that COR is quantifiable in coat and claws of newborn dogs. Moreover, both matrices appear as useful tools for new, noninvasive, long-term perinatal and neonatal researches also in canine species. PMID:26081135

  4. Postoperative circadian disturbances.

    PubMed

    Gögenur, Ismail

    2010-12-01

    An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where these endogenous rhythms have been investigated in relation to surgery we performed a series of studies exploring different endogenous rhythms and factors affecting these rhythms. We also wanted to examine whether the disturbances in the postoperative circadian rhythms could be correlated to postoperative recovery parameters, and if pharmacological administration of chronobiotics could improve postoperative recovery. Circadian rhythm disturbances were found in all the examined endogenous rhythms. A delay was found in the endogenous rhythm of plasma melatonin and excretion of the metabolite of melatonin (AMT6s) in urine the first night after both minor and major surgery. This delay after major surgery was correlated to the duration of surgery. The amplitude in the melatonin rhythm was unchanged the first night but increased in the second night after major surgery. The amplitude in AMT6s was reduced the first night after minimally invasive surgery. The core body temperature rhythm was disturbed after both major and minor surgery. There was a change in the sleep wake cycle with a significantly increased duration of REM-sleep in the day and evening time after major surgery compared with preoperatively. There was also a shift in the autonomic nervous balance after major surgery with a significantly increased number of myocardial ischaemic episodes during the nighttime period. The

  5. Postoperative conversion disorder.

    PubMed

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations. PMID:27041258

  6. Postoperative pain in children.

    PubMed

    Goddard, J M; Pickup, S E

    1996-06-01

    An audit project was designed to assess and improve the provision of postoperative analgesia in a children's hospital. Pain assessment for all children and analgesia standards for our institution were introduced prior to data collection. Data were collected on consecutive samples of 316 and 325 children undergoing surgery as inpatients during 10-week periods. Change was initiated between the two periods in response to our findings; our action plan involved education, changes to documentation, the widespread use of diclofenac in children over 2 years of age and recommendations for the prescription of analgesia. The initial prescription of analgesia increased from 95% to 98% (p = 0.019), administration of analgesia to children experiencing bad or severe pain increased from 57% to 71% (p = 0.032) and the number of children experiencing severe pain reduced from 17% to 11% (p = 0.050). Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia. PMID:8694218

  7. [Retroperitoneal postoperative necrotizing fasciitis].

    PubMed

    Fichev, G; Poromanski, I; Marina, M

    2000-01-01

    This is a report on clinical experience had with 17 patients presenting necrotizing fasciitis--a complication ever more frequently encountered. The case material is distributed in two group differing by origin and clinical course of the complication. In group one (n = 11) it is a matter of postoperative development of postoperative complication, consistent with the classical "per continuitatem" and "per contiguitatem" mechanisms, while in group two (n = 6) the process originates, evolves and speads within the retroperitoneal space proper. Comprehensive microbiological examinations performed in 13 cases show that in either group different microorganisms are identified. In group one aerobic-anaerobic mixed infection is documented in all patients, with predominance of Enterobacteroidaceae among aerobic ones. In group two, anaerobic bacterial species, mainly Clostridium sp, prevail in all the isolates. The clinical study points to a substantial difference in the time of septic complication occurrence, as well as between the clinical picture of the two species. Accordingly, the final results are radically different--in group one survivorship amounts to 62.6%, whereas in group two--to 16.6% only. PMID:11692928

  8. Mechanical properties of non-sarcomeric cytoskeleton of mice cardiomyocytes and skeletal muscle fibers after 30-day spaceflight biosatellite BION-M1

    NASA Astrophysics Data System (ADS)

    Ogneva, Irina; Maximova, Maria; Larina, Irina

    The aim of this study was to determine transversal stiffness of the cortical cytoskeleton and cytoskeletal protein desmin content of the left ventricle cardiomyocytes, soleus and tibialis anterior muscle fibers of the mice after 30-days space flight biosatellite «BION-M1» (Russia, 2013). The dissection was made after 13-16.5 hours after landing. Transversal stiffness was measured in relaxed and calcium activated state by atomic force microscope. Desmin content was estimated by using western-blot, expression level of the gene, coding desmin, - by real time PCR. The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles (as measured using the atomic force microscopy) did not differ significantly within the study groups in comparison to the vivarium control group, except for its slight increase in tibialis anterior fibers muscle in the post-flight group of animals. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes (as detected using the western blot technique) did not differ significantly within all study groups and correlated with the transversal stiffness. Similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle, as well as correlation with the transversal stiffness of their cortical cytoskeleton was noted. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues in comparison to the control levels in the post-flight group, as well as lowered beta-actin gene expression rates in the post-flight group of animals (as detected using the RT-PCR technique). After completion of the space flight, content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins of mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this

  9. Characteristics and Preliminary Observations of the Influence of Electromyostimulation on the Size and Function of Human Skeletal Muscle During 30 Days of Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A; Buchanan, Paul; Gollinick, Philip D.; Dudley, Gary A.

    1989-01-01

    During 30 days (d) of bedrest, the practicality of using Elec- troMyoStimulation (EMS) as a deterrent to atrophy and strength loss of lower limb musculature was examined. An EMS system was developed that provided variable but quantifiable levels of EMS, and measured torque. The dominant log of three male subjects was stimulated twice daily in a 3-d on/1-d off cycle during bedrest. The non-dominant leg of each subject acted as a control. A stimulator, using a 0.3 ms monophasic 60 Hz pulse waveform, activated muscle tissue for 4 s. The output waveform from the stimulator was sequenced to the Knee Extensors (KE), Knee Flex- ors (KF), Ankle Extensors (AE), and Ankle Flexors (AF), and caused three isometric contractions of each muscle group per minute. Subject tolerance determined EMS Intensity. Each muscle group received four 5-min bouts of EMS each session with a 10 -min rest between bouts. EMS and torque levels for each muscle action were recorded directly an a computer. Overall average EMS Intensity was 197, 197, 195, and 188 mA for the KE, KF, AF, and AE, respectively. Overall average torque development for these muscle groups was 70, 16, 12, and 27 Nm, respectively. EMS intensity doubled during the study, and average torque increased 2.5 times. Average maximum torque throughout a session reached 54% of maximal voluntary for the KE and 29% for the KF. Reductions in leg volume, muscle compartment size, cross-sectional area of slow and fast-twitch fibers, strength, and aerobic enzyme activities, and increased log compliance were attenuated in the legs which received EMS during bedrest. These results indicate that similar EMS levels induce different torques among different muscle groups and that repeated exposure to EMS increases tolerance and torque development. Longer orien- tation periods, therefore, may enhance its effectiveness. Our preliminary data suggest that the efficacy of EMS as an effective countermeasure for muscle atrophy and strength loss during long

  10. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians

    PubMed Central

    Kim, Young Wan; Kim, Ik Yong

    2016-01-01

    Purpose To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69−14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8−9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13−8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07−18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43−9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15−6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44−8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39−14.09], P=0.012) were significant prognostic factors for 1-year mortality. Conclusion Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality. PMID:27279741

  11. Pausing of reverse transcriptase on retroviral RNA templates is influenced by secondary structures both 5' and 3' of the catalytic site.

    PubMed Central

    Harrison, G P; Mayo, M S; Hunter, E; Lever, A M

    1998-01-01

    In the most extensive examination to date of the relationship between the pausing of reverse transcrip-tase (RT) and RNA secondary structures, pause events were found to be correlated to inverted repeats both ahead of, and behind the catalytic site in vitro. In addition pausing events were strongly associated with polyadenosine sequences and to a lesser degree diadenosines and monoadenosine residues. Pausing was also inversely proportional to the potential bond strength between the nascent strand and the template at the point of termination, for both mono and dinucleotides. A run of five adenosine and four uridine residues caused most pausing on the HIV-1 template, a region which is the site of much sequence heterogeneity in HIV-1. We propose that homopolyadenosine tracts can act as termination signals for RT in the context of inverted repeats as they do for certain RNA polymerases. PMID:9649630

  12. YAP Drives Growth by Controlling Transcriptional Pause Release from Dynamic Enhancers.

    PubMed

    Galli, Giorgio G; Carrara, Matteo; Yuan, Wei-Chien; Valdes-Quezada, Christian; Gurung, Basanta; Pepe-Mooney, Brian; Zhang, Tinghu; Geeven, Geert; Gray, Nathanael S; de Laat, Wouter; Calogero, Raffaele A; Camargo, Fernando D

    2015-10-15

    The Hippo/YAP signaling pathway is a crucial regulator of tissue growth, stem cell activity, and tumorigenesis. However, the mechanism by which YAP controls transcription remains to be fully elucidated. Here, we utilize global chromatin occupancy analyses to demonstrate that robust YAP binding is restricted to a relatively small number of distal regulatory elements in the genome. YAP occupancy defines a subset of enhancers and superenhancers with the highest transcriptional outputs. YAP modulates transcription from these elements predominantly by regulating promoter-proximal polymerase II (Pol II) pause release. Mechanistically, YAP interacts and recruits the Mediator complex to enhancers, allowing the recruitment of the CDK9 elongating kinase. Genetic and chemical perturbation experiments demonstrate the requirement for Mediator and CDK9 in YAP-driven phenotypes of overgrowth and tumorigenesis. Our results here uncover the molecular mechanisms employed by YAP to exert its growth and oncogenic functions, and suggest strategies for intervention. PMID:26439301

  13. Sinus pauses and high-grade atrioventricular block in Albright's hereditary osteodystrophy with pseudopseudohypoparathyroidism

    PubMed Central

    Rahmat, N; Venables, P

    2013-01-01

    Albright's hereditary osteodystrophy (AHO) is a rare inherited syndrome involving the molecular defects in the gene encoding the α subunit of the stimulatory G protein (Gsα). AHO has several variants, mainly pseudohypoparathyroidism (PHP) and pseudopseudohypoparathyroidism (PPHP). We present a family that share the same inactivating GNAS1 mutation, the daughter being affected by PPHP and her late father with PHP. The daughter, in her late teens, presented with a long history of presyncopal and syncopal attacks. Her father died suddenly in his mid-40 s. As expected, her laboratory tests to date have shown normal biochemistry and hormonal levels. Subsequently, an implantable loop recorder was inserted. This demonstrated extreme sinus pauses of >11 s and also high-grade atrioventricular block. A dual-chamber pacemaker was therefore inserted. PMID:23814007

  14. CO2 elimination at varying inspiratory pause in acute lung injury.

    PubMed

    Aboab, J; Niklason, L; Uttman, L; Kouatchet, A; Brochard, L; Jonson, B

    2007-01-01

    Previous studies have indicated that, during mechanical ventilation, an inspiratory pause enhances gas exchange. This has been attributed to prolonged time during which fresh gas of the tidal volume is present in the respiratory zone and is available for distribution in the lung periphery. The mean distribution time of inspired gas (MDT) is the mean time during which fractions of fresh gas are present in the respiratory zone. All ventilators allow setting of pause time, T(P), which is a determinant of MDT. The objective of the present study was to test in patients the hypothesis that the volume of CO(2) eliminated per breath, V(T)CO(2), is correlated to the logarithm of MDT as previously found in animal models. Eleven patients with acute lung injury were studied. When T(P) increased from 0% to 30%, MDT increased fourfold. A change of T(P) from 10% to 0% reduced V(T)CO(2) by 14%, while a change to 30% increased V(T)CO(2) by 19%. The relationship between V(T)CO(2) and MDT was in accordance with the logarithmic hypothesis. The change in V(T)CO(2) reflected to equal extent changes in airway dead space and alveolar PCO(2) read from the alveolar plateau of the single breath test for CO(2). By varying T(P), effects are observed on V(T)CO(2), airway dead space and alveolar PCO(2). These effects depend on perfusion, gas distribution and diffusion in the lung periphery, which need to be further elucidated. PMID:17204030

  15. Syntactic and Lexical Context of Pauses and Hesitations in the Discourse of Alzheimer Patients and Healthy Elderly Subjects

    ERIC Educational Resources Information Center

    Gayraud, Frederique; Lee, Hye-Ran; Barkat-Defradas, Melissa

    2011-01-01

    Psycholinguistic studies dealing with Alzheimer's disease (AD) commonly consider verbal aspects of language. In this article, we investigated both verbal and non-verbal aspects of speech production in AD. We used pauses and hesitations as markers of planning difficulties and hypothesized that AD patients show different patterns in the process of…

  16. Development of Key-Pecking, Pause, and Ambulation during Extended Exposure to a Fixed-Interval Schedule of Reinforcement

    ERIC Educational Resources Information Center

    Berry, Meredith S.; Kangas, Brian D.; Branch, Marc N.

    2012-01-01

    Six pigeons key-pecked under a fixed-interval (FI) 3-min schedule of food presentation. Each pigeon was studied for 200 daily sessions with 15 intervals per session (3,000 total food presentations). Analyses included the examination of latency to first peck (pause), mean rate of key pecking, and ambulation. Characterizations of stable performance…

  17. Keratoplasty postoperative treatment update.

    PubMed

    Shimmura-Tomita, Machiko; Shimmura, Shigeto; Satake, Yoshiyuki; Shimazaki-Den, Seika; Omoto, Masahiro; Tsubota, Kazuo; Shimazaki, Jun

    2013-11-01

    Immunosuppressive therapy is the main postoperative treatment for keratoplasty, but there are considerable differences in protocols for the use of steroids and other immunosuppressants. Therefore, we conducted 2 prospective randomized clinical trials and 1 prospective nonrandomized clinical trial on keratoplasty postoperative treatment. One study evaluated the efficacy and safety of long-term topical corticosteroids after a penetrating keratoplasty was performed. Patients who underwent keratoplasty and maintained graft clarity for >1 year were randomly assigned to either a steroid or a no-steroid group. At the 12-month follow-up, the no-steroid group developed significantly more endothelial rejection than did the steroid group. A second study elucidated the effectiveness and safety of systemic cyclosporine in high-risk corneal transplantation. The patients were assigned to a systemic cyclosporine or control group. At a mean follow-up of 42.7 months, no difference was observed in the endothelial rejection rates and graft clarity loss between the 2 groups. A third study elucidated the effectiveness and the safety of systemic tacrolimus in high-risk corneal transplantation. Of 11 consecutive eyes decompensated despite systemic cyclosporine treatment, there was no irreversible rejection in eyes treated with tacrolimus, which was significantly better than in previous penetrating keratoplasty with systemic cyclosporine treatment. Prognosis after keratoplasty in patients with keratoconus is relatively good, but special attention is required for patients with atopic dermatitis. Postkeratoplasty atopic sclerokeratitis (PKAS) is a severe form of sclerokeratitis after keratoplasty in atopic patients. Our retrospective study showed that 35 eyes of 29 patients from a total of 247 keratoconus eyes undergoing keratoplasty were associated with atopic dermatitis, of which 6 eyes of 5 patients developed PKAS. Eyes with PKAS had a significantly higher incidence of atopic blepharitis

  18. The Impact of Preoperative Serum anti-TNFα Therapy Levels on Early Postoperative Outcomes in Inflammatory Bowel Disease Surgery

    PubMed Central

    Lau, Cheryl; Dubinsky, Marla; Melmed, Gil; Vasiliauskas, Eric; Berel, Dror; McGovern, Dermot; Ippoliti, Andrew; Shih, David; Targan, Stephan; Fleshner, Phillip

    2016-01-01

    Objective Assess the impact of preoperative serum anti-TNFα drug levels on 30-day postoperative morbidity in inflammatory bowel disease patients. Summary Background Data Studies on the association of anti-TNFα drugs and postoperative outcomes in IBD are conflicting due to variable pharmacokinetics of anti-TNFα drugs.. It remains to be seen whether preoperative serum anti-TNFα drug levels correlate with postoperative morbidity. Methods 30 days postoperative outcomes of consecutive IBD surgical patients with serum drawn within 7 days pre-operatively, were studied. The total serum level of 3 anti-TNF-α drugs (infliximab, adalimumab, certolizumab) was measured, with ≥0.98 µg/ml considered as detected. Data was also reviewed according to a clinical cut off value of 3 µg/ml. Results 217 patients (123 Crohn’s disease (CD) and 94 ulcerative colitis (UC)) were analyzed. 75 of 150 (50%) treated with anti-TNFα therapy did not have detected levels at the time of surgery. In the UC cohort, adverse postoperative outcomes rates between the undetectable and detectable groups were similar when stratified according to type of UC surgery. In the CD cohort, there was a higher but statistically insignificant rate of adverse outcomes in the detectable vs undetectable groups. Using acut-off level of 3 µg/ml, postoperative morbidity (OR=2.5, p=0.03) and infectious complications (OR=3.0, p=0.03) were significantly higher in the ≥ 3 µg/ml group. There were higher rates of postoperative morbidity (p=0.047) and hospital readmissions (p=0.04) in the ≥ 8 µg/ml compared to < 3 µg/ml group. Conclusion Increasing preoperative serum anti-TNFα drug levels are associated with adverse postoperative outcomes in CD but not UC patients. PMID:24950263

  19. Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: assessment of 30-day morbidity using the NSQIP dataset.

    PubMed

    Kim, Bobby D; Ver Halen, Jon P; Mlodinow, Alexei S; Kim, John Y S

    2014-02-01

    Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes. Upon bivariate and multivariate analyses, IOT was significantly associated with higher rates of overall complications (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.12-3.63), medical complications (OR, 3.35; 95% CI, 1.75-6.42), postoperative transfusion (OR, 6.02; 95% CI, 2.02-17.97), and reoperation (OR, 2.24; 95% CI, 1.24-4.04). IOT was not associated with either surgical complications or free flap loss. IOT significantly increases risk for adverse overall and medical complications. However, IOT was not associated with surgical complications or free flap loss. Transfusion practices in the operating room should be reevaluated to improve overall outcomes. PMID:24114710

  20. Postoperative Peritoneal Adhesions

    PubMed Central

    Ryan, Graeme B.; Grobéty, Jocelyne; Majno, Guido

    1971-01-01

    This paper describes an experimental model of peritoneal adhesions, in the rat, based on two relatively minor accidents that may occur during abdominal surgery in man: drying of the serosa, and bleeding. Drying alone had little effect; drying plus bleeding consistently produced adhesions to the dried area. Fresh blood alone produced adhesions between the three membranous structures [omentum and pelvic fat bodies (PFBs)]. The formation of persistent adhesions required whole blood. Preformed clots above a critical size induced adhesions even without previous serosal injury; they were usually captured by the omentum and PFBs. If all three membranous structures were excised, the clots caused visceral adhesions. The protective role of the omentum, its structure, and the mechanism of omental adhesions, are discussed. These findings are relevant to the pathogenesis of post-operative adhesions in man. ImagesFig 3Fig 4Fig 5Fig 6Fig 7Fig 12Fig 13Fig 1Fig 2Fig 14Fig 15Fig 8Fig 9Fig 10Fig 11 PMID:5315369

  1. Influence of postoperative enteral nutrition on postsurgical infections.

    PubMed Central

    Beier-Holgersen, R; Boesby, S

    1996-01-01

    BACKGROUND: This study was undertaken to test the hypothesis that early enteral nutrition might reduce the incidence of serious complications after major abdominal surgery. METHODS: In a randomised double blind prospective trial 30 patients received Nutri-drink and 30 patients received placebo through a nasoduodenal feeding tube. On the day of operation the patients were given median 600 ml of either nutrition or placebo, 60 ml per hour. On the first postoperative day the patients received either 1000 ml (median) of nutrition or placebo, on day 2 1200 ml (median) nutrition, 1400 ml placebo, on day 3 1000 ml (median) nutrition, 1150 ml placebo, and on day 4 1000 ml (median) nutrition, 800 ml placebo. All patients were followed up for 30 days by the same investigator. RESULTS: The two groups were similar with regard to nutritional status and type of operation. The rate of postoperative infectious complications was significantly lower in the nutrition group, two of 30 compared with 14 of 30 in the placebo group (p = 0.0009). CONCLUSION: Early enteral nutrition given to patients after major abdominal surgery results in an important reduction in infectious complications. PMID:9038665

  2. Filled Pause Refinement Based on the Pronunciation Probability for Lecture Speech

    PubMed Central

    Long, Yan-Hua; Ye, Hong

    2015-01-01

    Nowadays, although automatic speech recognition has become quite proficient in recognizing or transcribing well-prepared fluent speech, the transcription of speech that contains many disfluencies remains problematic, such as spontaneous conversational and lecture speech. Filled pauses (FPs) are the most frequently occurring disfluencies in this type of speech. Most recent studies have shown that FPs are widely believed to increase the error rates for state-of-the-art speech transcription, primarily because most FPs are not well annotated or provided in training data transcriptions and because of the similarities in acoustic characteristics between FPs and some common non-content words. To enhance the speech transcription system, we propose a new automatic refinement approach to detect FPs in British English lecture speech transcription. This approach combines the pronunciation probabilities for each word in the dictionary and acoustic language model scores for FP refinement through a modified speech recognition forced-alignment framework. We evaluate the proposed approach on the Reith Lectures speech transcription task, in which only imperfect training transcriptions are available. Successful results are achieved for both the development and evaluation datasets. Acoustic models trained on different styles of speech genres have been investigated with respect to FP refinement. To further validate the effectiveness of the proposed approach, speech transcription performance has also been examined using systems built on training data transcriptions with and without FP refinement. PMID:25860959

  3. Relationship between attack and pause in world taekwondo championship contests: effects of gender and weight category

    PubMed Central

    Santos, Victor Gustavo Ferreira; de Oliveira Pires, Flavio; Bertuzzi, Romulo; Frachini, Emerson; da Silva-Cavalcante, Marcos David; Peduti Dal Molin Kiss, Maria Augusta; Lima-Silva, Adriano Eduardo

    2014-01-01

    Summary Background: the aim of this study was to compare between weight and gender categories the attack and pause times during the 2007 Taekwondo World Championship. Methods: a total of 88 rounds (47 male and 41 female contests) were analyzed. Results: there was no difference in attack/balancing times ratio between genders (0.13 ± 0.06 vs 0.13 ± 0.06, P > 0.05). The attack number was significantly higher in round 3 than in round 1 for all categories and genders. The balancing time was lower during the round 3 than round 1 for low-weight male and high-weight female categories. The delta of change from round 1 to 3 (round 3 - round 1) for attack time and attack/balancing times ratio were lower in male than female. Conclusions: female seems to intensify more the combat in the last round than male, and this seems be related to the weight division. PMID:25332922

  4. Clues cue the smooze: rhyme, pausing, and prediction help children learn new words from storybooks

    PubMed Central

    Read, Kirsten

    2014-01-01

    Rhyme, which is ubiquitous in the language experiences of young children, may be especially facilitative to vocabulary learning because of how it can support active predictions about upcoming words. In two experiments, we tested whether rhyme, when used to help children anticipate new words would make those words easier to learn. Two- to 4-year-old children heard rhyming stanzas naming novel monsters under three conditions: A non-rhyme condition in which novel monster names appeared as unrhymed elements within a rhymed stanza, a non-predictive rhyme condition in which the novel names were the rhymed element in the first line of a stanza, and a predictive rhyme condition in which the monster name came as the rhymed element in the last line of the stanza after a description of the features that distinguished him. In tests of retention and identification children showed greatest novel name learning in the predictive rhyme condition in both between-subjects (Experiment 1) and within-subjects (Experiment 2) comparisons. Additionally, when parents acted as the storybook readers in Experiment 2, many of them distinctly paused before target words in the predictive rhyme condition and for their children a stronger predictive rhyme advantage surfaced. Thus rhyme is not only facilitative for learning, but when the novel vocabulary is specifically in a position where it is predictable from the rhymes, it is most accessible. PMID:24600431

  5. Pausing and activating thread state upon pin assertion by external logic monitoring polling loop exit time condition

    DOEpatents

    Chen, Dong; Giampapa, Mark; Heidelberger, Philip; Ohmacht, Martin; Satterfield, David L; Steinmacher-Burow, Burkhard; Sugavanam, Krishnan

    2013-05-21

    A system and method for enhancing performance of a computer which includes a computer system including a data storage device. The computer system includes a program stored in the data storage device and steps of the program are executed by a processer. The processor processes instructions from the program. A wait state in the processor waits for receiving specified data. A thread in the processor has a pause state wherein the processor waits for specified data. A pin in the processor initiates a return to an active state from the pause state for the thread. A logic circuit is external to the processor, and the logic circuit is configured to detect a specified condition. The pin initiates a return to the active state of the thread when the specified condition is detected using the logic circuit.

  6. Guanosine tetraphosphate as a global regulator of bacterial RNA synthesis: a model involving RNA polymerase pausing and queuing.

    PubMed

    Bremer, H; Ehrenberg, M

    1995-05-17

    A recently reported comparison of stable RNA (rRNA, tRNA) and mRNA synthesis rates in ppGpp-synthesizing and ppGpp-deficient (delta relA delta spoT) bacteria has suggested that ppGpp inhibits transcription initiation from stable RNA promoters, as well as synthesis of (bulk) mRNA. Inhibition of stable RNA synthesis occurs mainly during slow growth of bacteria when cytoplasmic levels of ppGpp are high. In contrast, inhibition of mRNA occurs mainly during fast growth when ppGpp levels are low, and it is associated with a partial inactivation of RNA polymerase. To explain these observations it has been proposed that ppGpp causes transcriptional pausing and queuing during the synthesis of mRNA. Polymerase queuing requires high rates of transcription initiation in addition to polymerase pausing, and therefore high concentrations of free RNA polymerase. These conditions are found in fast growing bacteria. Furthermore, the RNA polymerase queues lead to a promoter blocking when RNA polymerase molecules stack up from the pause site back to the (mRNA) promoter. This occurs most frequently at pause sites close to the promoter. Blocking of mRNA promoters diverts RNA polymerase to stable RNA promoters. In this manner ppGpp could indirectly stimulate synthesis of stable RNA at high growth rates. In the present work a mathematical analysis, based on the theory of queuing, is presented and applied to the global control of transcription in bacteria. This model predicts the in vivo distribution of RNA polymerase over stable RNA and mRNA genes for both ppGpp-synthesizing and ppGpp-deficient bacteria in response to different environmental conditions. It also shows how small changes in basal ppGpp concentrations can produce large changes in the rate of stable RNA synthesis. PMID:7539631

  7. Real-Time Integrated Photoacoustic and Ultrasound (PAUS) Imaging System to Guide Interventional Procedures: Ex Vivo Study

    PubMed Central

    Wei, Chen-Wei; Nguyen, Thu-Mai; Xia, Jinjun; Arnal, Bastien; Wong, Emily Y.; Pelivanov, Ivan M.; O’Donnell, Matthew

    2015-01-01

    Because of depth-dependent light attenuation, bulky, low-repetition-rate lasers are usually used in most photoacoustic (PA) systems to provide sufficient pulse energies to image at depth within the body. However, integrating these lasers with real-time clinical ultrasound (US) scanners has been problematic because of their size and cost. In this paper, an integrated PA/US (PAUS) imaging system is presented operating at frame rates >30 Hz. By employing a portable, low-cost, low-pulse-energy (~2 mJ/pulse), high-repetition-rate (~1 kHz), 1053-nm laser, and a rotating galvo-mirror system enabling rapid laser beam scanning over the imaging area, the approach is demonstrated for potential applications requiring a few centimeters of penetration. In particular, we demonstrate here real-time (30 Hz frame rate) imaging (by combining multiple single-shot sub-images covering the scan region) of an 18-gauge needle inserted into a piece of chicken breast with subsequent delivery of an absorptive agent at more than 1-cm depth to mimic PAUS guidance of an interventional procedure. A signal-to-noise ratio of more than 35 dB is obtained for the needle in an imaging area 2.8 × 2.8 cm (depth × lateral). Higher frame rate operation is envisioned with an optimized scanning scheme. PMID:25643081

  8. Essential Roles of the Smc5/6 Complex in Replication through Natural Pausing Sites and Endogenous DNA Damage Tolerance.

    PubMed

    Menolfi, Demis; Delamarre, Axel; Lengronne, Armelle; Pasero, Philippe; Branzei, Dana

    2015-12-17

    The essential functions of the conserved Smc5/6 complex remain elusive. To uncover its roles in genome maintenance, we established Saccharomyces cerevisiae cell-cycle-regulated alleles that enable restriction of Smc5/6 components to S or G2/M. Unexpectedly, the essential functions of Smc5/6 segregated fully and selectively to G2/M. Genetic screens that became possible with generated alleles identified processes that crucially rely on Smc5/6 specifically in G2/M: metabolism of DNA recombination structures triggered by endogenous replication stress, and replication through natural pausing sites located in late-replicating regions. In the first process, Smc5/6 modulates remodeling of recombination intermediates, cooperating with dissolution activities. In the second, Smc5/6 prevents chromosome fragility and toxic recombination instigated by prolonged pausing and the fork protection complex, Tof1-Csm3. Our results thus dissect Smc5/6 essential roles and reveal that combined defects in DNA damage tolerance and pausing site-replication cause recombination-mediated DNA lesions, which we propose to drive developmental and cancer-prone disorders. PMID:26698660

  9. Genome-wide dynamics of Pol II elongation and its interplay with promoter proximal pausing, chromatin, and exons.

    PubMed

    Jonkers, Iris; Kwak, Hojoong; Lis, John T

    2014-01-01

    Production of mRNA depends critically on the rate of RNA polymerase II (Pol II) elongation. To dissect Pol II dynamics in mouse ES cells, we inhibited Pol II transcription at either initiation or promoter-proximal pause escape with Triptolide or Flavopiridol, and tracked Pol II kinetically using GRO-seq. Both inhibitors block transcription of more than 95% of genes, showing that pause escape, like initiation, is a ubiquitous and crucial step within the transcription cycle. Moreover, paused Pol II is relatively stable, as evidenced from half-life measurements at ∼3200 genes. Finally, tracking the progression of Pol II after drug treatment establishes Pol II elongation rates at over 1000 genes. Notably, Pol II accelerates dramatically while transcribing through genes, but slows at exons. Furthermore, intergenic variance in elongation rates is substantial, and is influenced by a positive effect of H3K79me2 and negative effects of exon density and CG content within genes.DOI: http://dx.doi.org/10.7554/eLife.02407.001. PMID:24843027

  10. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  11. Postoperative psychosis after heart surgery.

    PubMed

    Sveinsson, I S

    1975-10-01

    One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state. The following factors tended to be related to the occurrence of delirium and perceptual disturbances: history of preoperative psychiatric illness, advanced age, severity of preoperative and postoperative illness, and time spent in the intensive-care unit. Sleep deprivation consistently preceded onset of these symptoms with one exception. Operative factors did not seem to be of major importance. While postoperative delirium probably has multidetermined causes, the author believes that sleep deprivation superimposed on the other contributory condition is a common precipitating factor. Suggestions about the prevention and treatment of delirium are made. PMID:1177486

  12. TbRGG2 facilitates kinetoplastid RNA editing initiation and progression past intrinsic pause sites.

    PubMed

    Ammerman, Michelle L; Presnyak, Vladimir; Fisk, John C; Foda, Bardees M; Read, Laurie K

    2010-11-01

    TbRGG2 is an essential kinetoplastid RNA editing accessory factor that acts specifically on pan-edited RNAs. To understand the mechanism of TbRGG2 action, we undertook an in-depth analysis of edited RNA populations in TbRGG2 knockdown cells and an in vitro examination of the biochemical activities of the protein. We demonstrate that TbRGG2 down-regulation more severely impacts editing at the 5' ends of pan-edited RNAs than at their 3' ends. The initiation of editing is reduced to some extent in TbRGG2 knockdown cells. In addition, TbRGG2 plays a post-initiation role as editing becomes stalled in TbRGG2-depleted cells, resulting in an overall decrease in the 3' to 5' progression of editing. Detailed analyses of edited RNAs from wild-type and TbRGG2-depleted cells reveal that TbRGG2 facilitates progression of editing past intrinsic pause sites that often correspond to the 3' ends of cognate guide RNAs (gRNAs). In addition, noncanonically edited junction regions are either absent or significantly shortened in TbRGG2-depleted cells, consistent with impaired gRNA transitions. Sequence analysis further suggests that TbRGG2 facilitates complete utilization of certain gRNAs. In vitro RNA annealing and in vivo RNA unwinding assays demonstrate that TbRGG2 can modulate RNA-RNA interactions. Collectively, these data are consistent with a model in which TbRGG2 facilitates initiation and 3' to 5' progression of editing through its ability to affect gRNA utilization, both during the transition between specific gRNAs and during usage of certain gRNAs. PMID:20855539

  13. TbRGG2 facilitates kinetoplastid RNA editing initiation and progression past intrinsic pause sites

    PubMed Central

    Ammerman, Michelle L.; Presnyak, Vladimir; Fisk, John C.; Foda, Bardees M.; Read, Laurie K.

    2010-01-01

    TbRGG2 is an essential kinetoplastid RNA editing accessory factor that acts specifically on pan-edited RNAs. To understand the mechanism of TbRGG2 action, we undertook an in-depth analysis of edited RNA populations in TbRGG2 knockdown cells and an in vitro examination of the biochemical activities of the protein. We demonstrate that TbRGG2 down-regulation more severely impacts editing at the 5′ ends of pan-edited RNAs than at their 3′ ends. The initiation of editing is reduced to some extent in TbRGG2 knockdown cells. In addition, TbRGG2 plays a post-initiation role as editing becomes stalled in TbRGG2-depleted cells, resulting in an overall decrease in the 3′ to 5′ progression of editing. Detailed analyses of edited RNAs from wild-type and TbRGG2-depleted cells reveal that TbRGG2 facilitates progression of editing past intrinsic pause sites that often correspond to the 3′ ends of cognate guide RNAs (gRNAs). In addition, noncanonically edited junction regions are either absent or significantly shortened in TbRGG2-depleted cells, consistent with impaired gRNA transitions. Sequence analysis further suggests that TbRGG2 facilitates complete utilization of certain gRNAs. In vitro RNA annealing and in vivo RNA unwinding assays demonstrate that TbRGG2 can modulate RNA–RNA interactions. Collectively, these data are consistent with a model in which TbRGG2 facilitates initiation and 3′ to 5′ progression of editing through its ability to affect gRNA utilization, both during the transition between specific gRNAs and during usage of certain gRNAs. PMID:20855539

  14. [Surgical controversy. Limiting postoperative scarring].

    PubMed

    Lachkar, Y

    2005-06-01

    Postoperative follow-up of glaucoma surgery must be rigorous and carried out over the long term. Data acquired on the make-up of the filtering bleb justifies using postoperative anti-inflammatory drugs, even if the eye is clinically quiet. When using antimetabolites, the risk factors for failure must be well known and either 5-fluorouracile or mitomycin should be chosen depending on the level of risk of scarring. Their use in needle revision must be adapted case by case. anti-TGF-beta-2 antibody, currently being investigated, may prove advantageous in the very near future. PMID:16208245

  15. The Effect of Compressor-administered Defibrillation on Peri-shock Pauses in a Simulated Cardiac Arrest Scenario

    PubMed Central

    Glick, Joshua; Lehman, Erik; Terndrup, Thomas

    2014-01-01

    Introduction Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. Methods This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Results Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47–0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35–1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58–2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08–4.43). Conclusion Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits. PMID:24672620

  16. Shuttle flight experiment 30-day summary report

    NASA Technical Reports Server (NTRS)

    1985-01-01

    A total of 12 AFT training sessions were administered to SL 3 Payload Specialists over a 7 month period. Nine of these sessions were 2 hours in duration and three were 3 hours in duration. A total of three rotating chair tests were conducted in this time frame with four subjects. The performance of these crewmen across tests is shown. Test 1, a baseline motion sickness test, was conducted approximately 10 months prior to the mission, before any AFT was administered. Test 2 was administered after 2 hours of AFT, test 3 after 4 hours and test 4 after 6 hours (total) of training in symptom control. Improvement in performance is reflected by a subject's ability to tolerate a greater number of rotations across tests. Additional training for crewman was not possible within the constraints of the mission. Results of the mission indicate that, as predicted preflight, subject #32 was relatively symptom free inflight while subject #33 was not. Other preflight and postflight tests and analyses are reported.

  17. Postoperative Care of the Facial Laceration

    PubMed Central

    Medel, Nicholas; Panchal, Neeraj; Ellis, Edward

    2010-01-01

    The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations. PMID:22132257

  18. Neuroimaging of the Postoperative Spine.

    PubMed

    Bellini, Matteo; Ferrara, Marco; Grazzini, Irene; Cerase, Alfonso

    2016-08-01

    Operative treatments of the spine are becoming increasingly more common for the availability of a wide range of surgical and minimally invasive procedures. MR imaging allows for excellent evaluation of both normal and abnormal findings in the postoperative spine. This article provides the basic tools to evaluate complications after different operative procedures and offers an overview on the main topics a radiologist may encounter during his or her professional carrier. PMID:27417403

  19. Isolation of ribosome bound nascent polypeptides in vitro to identify translational pause sites along mRNA.

    PubMed

    Jha, Sujata S; Komar, Anton A

    2012-01-01

    The rate of translational elongation is non-uniform. mRNA secondary structure, codon usage and mRNA associated proteins may alter ribosome movement on the message(for review see 1). However, it's now widely accepted that synonymous codon usage is the primary cause of non-uniform translational elongation rates(1). Synonymous codons are not used with identical frequency. A bias exists in the use of synonymous codons with some codons used more frequently than others(2). Codon bias is organism as well as tissue specific(2,3). Moreover, frequency of codon usage is directly proportional to the concentrations of cognate tRNAs(4). Thus, a frequently used codon will have higher multitude of corresponding tRNAs, which further implies that a frequent codon will be translated faster than an infrequent one. Thus, regions on mRNA enriched in rare codons (potential pause sites) will as a rule slow down ribosome movement on the message and cause accumulation of nascent peptides of the respective sizes(5-8). These pause sites can have functional impact on the protein expression, mRNA stability and protein folding(for review see 9). Indeed, it was shown that alleviation of such pause sites can alter ribosome movement on mRNA and subsequently may affect the efficiency of co-translational (in vivo) protein folding(1,7,10,11). To understand the process of protein folding in vivo, in the cell, that is ultimately coupled to the process of protein synthesis it is essential to gain comprehensive insights into the impact of codon usage/tRNA content on the movement of ribosomes along mRNA during translational elongation. Here we describe a simple technique that can be used to locate major translation pause sites for a given mRNA translated in various cell-free systems(6-8). This procedure is based on isolation of nascent polypeptides accumulating on ribosomes during in vitro translation of a target mRNA. The rationale is that at low-frequency codons, the increase in the residence time of the

  20. Risk factors for postoperative ileus

    PubMed Central

    Kutun, Suat; Ulucanlar, Haluk; Tarcan, Oguz; Demir, Abdullah; Cetin, Abdullah

    2011-01-01

    Purpose This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. Methods This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. Results Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. Conclusion Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility. PMID:22111079

  1. [Postoperative pulmonary complications: prophylaxis after noncardiac surgery].

    PubMed

    Hofer, S; Plachky, J; Fantl, R; Schmidt, J; Bardenheuer, H J; Weigand, M A

    2006-04-01

    Postoperative pulmonary complications are a major problem after upper abdominal or thoracoabdominal surgery. They lead to a prolonged ICU stay as well as increased costs and are one of the main causes of early postoperative mortality. Even after uncomplicated operations, postoperative hypoxemia occurs in 30-50% of patients. Acute respiratory failure involves a disturbance in gas exchange. The mortality ranges from 10 to 60% according to the severity of respiratory failure. The most important complications are interstitial and alveolar pulmonary edema, atelectasis, postoperative pneumonia, hypoventilation, and aspiration. Preoperative optimization, postoperative prophylaxis according to a stepwise approach, and early mobilization decrease the rate of complications. PMID:16575614

  2. Utility of Early Post-operative High Resolution Volumetric MR Imaging after Transsphenoidal Pituitary Tumor Surgery

    PubMed Central

    Patel, Kunal S.; Kazam, Jacob; Tsiouris, Apostolos J.; Anand, Vijay K.; Schwartz, Theodore H.

    2014-01-01

    Objective Controversy exists over the utility of early post-operative magnetic resonance imaging (MRI) after transsphenoidal pituitary surgery for macroadenomas. We investigate whether valuable information can be derived from current higher resolution scans. Methods Volumetric MRI scans were obtained in the early (<10 days) and late (>30 days) post-operative periods in a series of patients undergoing transsphenoidal pituitary surgery. The volume of the residual tumor, resection cavity, and corresponding visual field tests were recorded at each time point. Statistical analyses of changes in tumor volume and cavity size were calculated using the late MRI as the gold standard. Results 40 patients met the inclusion criteria. Pre-operative tumor volume averaged 8.8 cm3. Early postoperative assessment of average residual tumor volume (1.18 cm3) was quite accurate and did not differ statistically from late post-operative volume (1.23 cm3, p=.64), indicating the utility of early scans to measure residual tumor. Early scans were 100% sensitive and 91% specific for predicting ≥ 98% resection (p<.001, Fisher’s exact test). The average percent decrease in cavity volume from pre-operative MRI (tumor volume) to early post-operative imaging was 45% with decreases in all but 3 patients. There was no correlation between the size of the early cavity and the visual outcome. Conclusions Early high resolution volumetric MRI is valuable in determining the presence or absence of residual tumor. Cavity volume almost always decreases after surgery and a lack of decrease should alert the surgeon to possible persistent compression of the optic apparatus that may warrant re-operation. PMID:25045791

  3. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study

    PubMed Central

    Priola, Adriano Massimiliano; Priola, Sandro Massimo; Boccuzzi, Francesco; Dervishi, Najada; Lisi, Elena; Veltri, Andrea; Ardissone, Francesco

    2016-01-01

    In the post-operative course of the interventions of lung resection for primary tumor, complications of different nature and severity can arise, recognizing different pathogenetic mechanisms and differing according to the type of resection performed and to the time elapsed after surgery. The low diagnostic accuracy of chest radiography requires a thorough knowledge of the radiologist about all radiographic findings, both normal and pathological, which can be found in the immediate post-operative period (within 30 days after surgery). This article aims to describe the incidence, the clinical features and the radiological aspects of immediate complications following pulmonary resections, with specific reference to those in which the diagnostic imaging provides a fundamental contribution. PMID:27621893

  4. Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System.

    PubMed

    Koff, Matthew D; Brown, Jeremiah R; Marshall, Emily J; O'Malley, A James; Jensen, Jens T; Heard, Stephen O; Longtine, Karen; O'Neill, Melissa; Longtine, Jaclyn; Houston, Donna; Robison, Cindy; Moulton, Eric; Patel, Hetal M; Loftus, Randy W

    2016-08-01

    BACKGROUND Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development. OBJECTIVE To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events. DESIGN Randomized, prospective study. SETTING Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts. PATIENTS Patients undergoing surgery. METHODS Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections. RESULTS A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82-1.40], P=.626). CONCLUSIONS The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy. Infect Control Hosp Epidemiol 2016;37:888-895. PMID:27267310

  5. Postoperative analgesia in elderly patients.

    PubMed

    Falzone, Elisabeth; Hoffmann, Clément; Keita, Hawa

    2013-02-01

    Elderly people represent the fastest-growing segment of our society and undergo surgery more frequently than other age groups. Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients. However, management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Physiological changes related to aging need to be carefully considered because aging is individualized and progressive. Assessment of pain management needs to include chronological age, biological age with regard to renal, liver and cardiac functions, and the individual profile of pathology and prescribed medications. In addition, ways in which pain should be assessed, particularly in patients with cognitive impairment, must be considered. Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale (VAS), verbal rating scale (VRS), numeric rating scale (NRS) and facial pain scale (FPS). VRS and NRS are the most appropriate pain scales for the elderly. In older patients with mild to moderate cognitive impairment, the VRS is a better tool. For severe cognitively impaired older patients, behavioural scales validated in the postoperative context, such as Doloplus-2 or Algoplus, are appropriate. For postoperative pain treatment, most drugs (e.g. paracetamol, nonsteroidal anti-inflammatory drugs, nefopam, tramadol, codeine, morphine, local anaesthetics), techniques (e.g. intravenous morphine titration, subcutaneous morphine, intravenous or epidural patient-controlled analgesia, intrathecal morphine, peripheral nerve block) and strategies (e.g. anticipated intraoperative analgesia or multimodal analgesia) used for acute pain management can be used in older patients. However, in view of pharmacokinetic

  6. Who pressed the pause button on global warming: is the answer in the past?

    NASA Astrophysics Data System (ADS)

    Tan, Ming

    2014-05-01

    Although there is coverage bias in the HadCRUT4 temperature series (Cotan and Way, 2013) or in other global surface temperature sequences, IPCC-AR5 still claimed that "much interest has focused on the period since 1998 and an apparent flattening ('hiatus') in trends". According to statistical principle, in fact, this flattening trend is unlikely to be changed by adding the missing 16% area-weighed regional data. In addition, if the "warming hiatus" could not be attributed to the solar output, volcanic eruptions and the green house gases when comparing them to the rhythm of the temperature, then the question arise: who pressed the pause button on global warming? However, it would be a golden opportunity to further understand the ocean as a fundamental role in controlling climate change. The current hypothesis attributed this "hiatus" to a La Niña-like decadal cooling occurring in the central and eastern equatorial Pacific (Kosaka and Die, 2013). Here we separate the global surface temperature into land surface air temperature (LSAT, adopt from HadCRUT4) and sea surface temperatures (SSTs, adopt from different original data). Obviously, the decadal cooling of the central and eastern equatorial Pacific occurred in 1987, a decade earlier than the beginning of the LSAT flattening (1998), whereas the SSTs of the west Pacific warm pool (WPWP), the Indian Ocean (IO, 20S-20N, 40-110E) and the North Atlantic (NA, here its variation is represented by the Atlantic multi-decadal oscillation or hereafter referred to as AMO) are exactly in phase with the LSAT. The combined data (SSTs, arithmetic mean) of the three ocean areas has the highest correlation with the LSAT (0.91), but the correlation coefficient is reduced (0.54) if adding the decadal variation in the central and eastern equatorial Pacific (here it is represented by the Pacific decadal oscillation or hereafter referred to as PDO). Therefore, the tree ocean areas (WPWP, IO and NA) could be regarded as the key ocean

  7. Who pressed the pause button on global warming: is the answer in the past?

    NASA Astrophysics Data System (ADS)

    Tan, Ming

    2014-05-01

    Although there is coverage bias in the HadCRUT4 temperature series (Cotan and Way, 2013) or in other global surface temperature sequences, IPCC-AR5 still claimed that "much interest has focused on the period since 1998 and an apparent flattening ('hiatus') in trends". According to statistical principle, in fact, this flattening trend is unlikely to be changed by adding the missing 16% area-weighed regional data. In addition, if the "warming hiatus" could not be attributed to the solar output, volcanic eruptions and the green house gases when comparing them to the rhythm of the temperature, then the question arise: who pressed the pause button on global warming? However, it would be a golden opportunity to further understand the ocean as a fundamental role in controlling climate change. The current hypothesis attributed this "hiatus" to a La Niña-like decadal cooling occurring in the central and eastern equatorial Pacific (Kosaka and Die, 2013). Here we separate the global surface temperature into land surface air temperature (LSAT, adopt from HadCRUT4) and sea surface temperatures (SSTs, adopt from different original data). Obviously, the decadal cooling of the central and eastern equatorial Pacific occurred in 1987, a decade earlier than the beginning of the LSAT flattening (1998), whereas the SSTs of the west Pacific warm pool (WPWP), the Indian Ocean (IO, 20S-20N, 40-110E) and the North Atlantic (NA, here its variation is represented by the Atlantic multi-decadal oscillation or hereafter referred to as AMO) are exactly in phase with the LSAT. The combined data (SSTs, arithmetic mean) of the three ocean areas has the highest correlation with the LSAT (0.91), but the correlation coefficient is reduced (0.54) if adding the decadal variation in the central and eastern equatorial Pacific (here it is represented by the Pacific decadal oscillation or hereafter referred to as PDO). Therefore, the tree ocean areas (WPWP, IO and NA) could be regarded as the key ocean

  8. Postoperative endophthalmitis by Flavimonas oryzihabitans.

    PubMed

    Tsai, Chien-Kuang; Liu, Chi-Chang; Kuo, Hsi-Kung

    2004-11-01

    A 55-year-old man suffered from blurred vision of the left eye (visual acuity was counting fingers/5-10 cm) 8 days after undergoing cataract surgery. After thorough ophthalmologic examinations with gram-negative bacillus justified on smear of vitreous specimen, postoperative endophthalmitis (os) was impressed. Intravitreous injection of 1.0 mg of vancomycin, 0.4 mg of amikacin, and 0.4 mg of dexamethasone was given twice and vitreous fluid culture was also performed. However, the inflammatory condition was not well controlled. Because the results of vitreous fluid culture revealed Flavimonas oryzihabitans infection which is sensitive to piperacillin, we performed the 3rd intravitreous injection of 1.0 mg of piperacillin and 0.4 mg of dexamethasone. The inflammatory condition was under control and the visual acuity of left eye improved. For patients with ocular diseases, postoperative endophthalmitis by Flavimonas oryzihabitans is a rare condition. According to the results of this case, intravitreous injection of piperacillin was effective against the pathogen. PMID:15796259

  9. [Postoperative radiotherapy of prostate cancer].

    PubMed

    Guérif, S; Latorzeff, I; Lagrange, J-L; Hennequin, C; Supiot, S; Garcia, A; François, P; Soulié, M; Richaud, P; Salomon, L

    2014-10-01

    Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery. PMID:25195116

  10. Postreinforcement Pause Duration Varies within a Session and with a Variable Response Requirement but Not as a Function of Prior Revolutions

    ERIC Educational Resources Information Center

    Belke, Terry W.

    2011-01-01

    The current study examined the variables that influence postreinforcement pause (PRP) duration in rats when wheel running serves as the reinforcing consequence. The relationship between revolutions and PRP duration when revolutions were manipulated within a session and the effect of changing the response requirement from fixed to variable on PRP…

  11. A Comparison between the Occurrence of Pauses, Repetitions and Recasts under Conditions of Face-to-Face and Computer-Mediated Communication: A Preliminary Study

    ERIC Educational Resources Information Center

    Cabaroglu, Nese; Basaran, Suleyman; Roberts, Jon

    2010-01-01

    This study compares pauses, repetitions and recasts in matched task interactions under face-to-face and computer-mediated conditions. Six first-year English undergraduates at a Turkish University took part in Skype-based voice chat with a native speaker and face-to-face with their instructor. Preliminary quantitative analysis of transcripts showed…

  12. Nurses management of post-operative pain.

    PubMed

    Buckley, H

    2000-06-01

    Nurses have the responsibility of adequately managing patients' post-operative pain. This literature review assesses whether nurses' management of post-operative pain is adequate or not, according to the literature findings. The findings reveal that nurses' management of patients' post-operative pain is not adequate and implies the concurrent need for improved nurse education and practice. The findings also indicate a need for ongoing research of this phenomenon. PMID:11855003

  13. Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture

    PubMed Central

    Gregersen, Merete; Borris, Lars C; Damsgaard, Else Marie

    2015-01-01

    Background and purpose Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. There is often postoperative blood loss and the hemoglobin (Hb) threshold for red blood cell (RBC) transfusions in these patients is unknown. We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery. Patients and methods We enrolled 284 consecutive post-surgical HF patients (aged ≥ 65 years) with Hb levels < 11.3 g/dL (7 mmol/L) who had been admitted from nursing homes or sheltered housing. Allocation was stratified by residence. The patients were randomly assigned to either restrictive (Hb < 9.7 g/dL; < 6 mmol/L) or liberal (Hb < 11.3 g/dL; < 7 mmol/L) RBC transfusions given within the first 30 days postoperatively. Follow-up was at 90 days. Results No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (where 27% died) and the liberal group (where 21% died). Per-protocol 30-day mortality was higher with the restrictive strategy (hazard ratio (HR) = 2.4, 95% CI: 1.1–5.2; p = 0.03). The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group (36%) than for those in the liberal group (20%) (HR = 2.0, 95% CI: 1.1–3.6; p = 0.01). Interpretation According to our Hb thresholds, recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival. PMID:25586270

  14. Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion.

    PubMed

    Joseph, Jacob R; Smith, Brandon W; Mummaneni, Praveen V; La Marca, Frank; Park, Paul

    2016-09-01

    Anterior cervical fusion (ACF) after discectomy and/or corpectomy is a common procedure with traditionally good patient outcomes. Though typically mild, postoperative dysphagia can result in significant patient morbidity. In this study, we examine the relationship between postoperative dysphagia and in-hospital outcomes, readmissions, and overall costs. The University HealthSystem Consortium (UHC) database was utilized to perform a retrospective cohort study of all adults who underwent a principal procedure of ACF of the anterior column (International Classification of Diseases, Ninth Revision [ICD-9] procedure code 81.02) between 2013 and 2015. Patients with a diagnosis of dysphagia (ICD-9 78720-78729) were compared to those without. Patient demographics, length of stay, in-hospital mortality, 30-day readmissions, and direct costs were recorded. A total of 49,300 patients who underwent ACF were identified. Mean age was 54.5years and 50.2% were male. Dysphagia was documented in 3,137 patients (6.4%) during their hospital stay. Patients with dysphagia had an average 2.1 comorbidities, while patients without dysphagia had 1.5 (p<0.01). Mean length of stay was 6.38days in patients with dysphagia, and 2.13days in those without (p<0.01). In-hospital mortality was 0.10% in patients without dysphagia, and 0.61% in those with dysphagia (p<0.01). Direct costs were $13,099 in patients without dysphagia, and $21,245 in those with dysphagia (p<0.01). Thirty-day readmission rate was 2.9% in patients without dysphagia, and 5.3% in those with dysphagia (p=0.01). In summary, dysphagia in patients who undergo ACF correlates with significantly increased length of stay, 30-day readmissions, and in-hospital mortality. Direct costs are similarly increased as a result. PMID:27234612

  15. Anxiolytic use in the postoperative care unit.

    PubMed

    Jellish, W Scott; O'Rourke, Michael

    2012-09-01

    Postoperative anxiety has received less attention historically than preoperative anxiety. Recognition that anxiety occurs throughout the perioperative period has led to increased interest in identifying and treating anxiety in the postoperative period. This article outlines the causes of postoperative anxiety, how it is classified, the effects of anxiety on outcomes after surgery, and some of the clinical procedures that produce the highest levels of anxiety for patients. In addition, an attempt is made to delineate the major risk factors for developing postoperative anxiety and the classic therapeutic modalities used to reduce symptoms and treat the psychological manifestations of anxiety. PMID:22989589

  16. Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study).

    PubMed

    Mamas, Mamas A; Fath-Ordoubadi, Farzin; Danzi, Gian B; Spaepen, Erik; Kwok, Chun Shing; Buchan, Iain; Peek, Niels; de Belder, Mark A; Ludman, Peter F; Paunovic, Dragica; Urban, Philip

    2015-08-01

    Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors. PMID:26037294

  17. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program.

    PubMed

    Lukasiewicz, Adam M; Grant, Ryan A; Basques, Bryce A; Webb, Matthew L; Samuel, Andre M; Grauer, Jonathan N

    2016-03-01

    OBJECT Surgery for subdural hematoma (SDH) is a commonly performed neurosurgical procedure. This study identifies patient characteristics associated with adverse outcomes and prolonged length of stay (LOS) in patients who underwent surgical treatment for SDH. METHODS All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) who were treated via craniotomy or craniectomy for SDH between 2005 and 2012 were identified. Patient demographics, comorbidities, and 30-day outcomes were described. Multivariate regression was used to identify predictors of adverse events. RESULTS A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk [RR] = 0.47, p = 0.017). Increased mortality was associated with gangrene (RR = 3.5, p = 0.044), ascites (RR = 3.00, p = 0.006), American Society of Anesthesiologists (ASA) Class 4 or higher (RR = 2.34, p = 0.002), coma (RR = 2.25, p < 0.001), and bleeding disorders (RR = 1.87, p = 0.003). Return to the OR was associated with pneumonia (RR = 3.86, p = 0.044), male sex (RR = 1.85, p = 0.015), and delirium (RR = 1.75, p = 0.016). Serious adverse events were associated with ventilator dependence preoperatively (RR = 1.86, p < 0.001), dialysis (RR = 1.44, p = 0.028), delirium (RR = 1.40, p = 0.005), ASA Class 4 or higher (RR = 1.36, p = 0.035), and male sex (RR = 1.29, p = 0.037). Similarly, LOS was increased in ventilator dependent patients by 1.56-fold (p = 0.002), in patients with ASA Class 4 or higher by

  18. Ethics of treating postoperative pain.

    PubMed

    Jones, James W; McCullough, Laurence B

    2012-02-01

    You received a call advising that Mr S. H. Irk was in the emergency room having considerable wound pain following an above-knee amputation you performed 6 months ago. You discharged him from your clinic 6 weeks postoperatively to his primary care physician, still complaining of more pain than usual. Your examination, clinical lab tests, and X-rays do not reveal any serious problems, but he is writhing in pain and begging for relief. Mr Irk has been to a number of different physicians in the interlude including a chiropractor, a pain specialist, several primary care physicians, and a psychiatrist without relief. He has braced up with increasing amounts of analgesics, the latest of which was oral Dilaudid. His last source of pain meds on the street has dried up. You admit him with orders for analgesics. What should your treatment plan be? PMID:22264808

  19. Comparative evaluation of honey, chlorhexidine gluconate (0.2%) and combination of xylitol and chlorhexidine mouthwash (0.2%) on the clinical level of dental plaque: A 30 days randomized control trial

    PubMed Central

    Jain, Ankita; Bhaskar, Dara John; Gupta, Devanand; Agali, Chandan; Gupta, Vipul; Gupta, Rajendra Kumar; Yadav, Priyanka; Lavate, Akash B.; Chaturvedi, Mudita

    2015-01-01

    Aim: To compare the effect of honey, chlorhexidine mouthwash and combination of xylitol chewing gum and chlorhexidine mouthwash on the dental plaque level. Materials and Methods: Ninety healthy dental students, both male and female, aged between 21 to 25 years participated in the study. The subjects were randomly divided into three groups, i.e. the honey group, the chlorhexidine gluconate mouthwash group and the combination of xylitol chewing gum and chlorhexidine (CHX) mouthwash group. The data was collected at the baseline, 15th day and 30th day; the plaque was disclosed using disclosing solution and their scores were recorded at six sites per tooth using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Statistical analysis was carried out later to compare the effect of all the three groups. P ≤ 0.05 was considered as statistically significant. Results: Our result showed that all the three groups were effective in reducing the plaque but post-hoc LSD (Least Significant Difference) showed that honey group and chlorhexidine + xylitol group were more effective than chlorhexidine group alone. The results demonstrated a significant reduction of plaque indices in honey group and chlorhexidine + xylitol group over a period of 15 and 30 days as compared to chlorhexidine. PMID:25657903

  20. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  1. Improving the management of postoperative pain.

    PubMed

    Layzell, Mandy

    Despite developments in knowledge of pain control, many patients still experience unnecessary postoperative pain. This article reports on an audit of postoperative pain and its management in one trust. The results led to the development of a new system using standard prescriptions to empower nurses to manage patients' pain. PMID:16010842

  2. Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study

    PubMed Central

    Sharpe, Sarah; Murnaghan, M Lucas; Theodoropoulos, John; Metcalfe, Kelly A

    2015-01-01

    Background Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications. Objective The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting. Methods We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device. Results All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency. Conclusions The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required. PMID:25679749

  3. Postoperative recurrence of cystic hydatidosis

    PubMed Central

    Prousalidis, John; Kosmidis, Christophoros; Anthimidis, Georgios; Kapoutzis, Konstantinos; Karamanlis, Eleutherios; Fachantidis, Epaminondas

    2012-01-01

    Background Surgical management is the basic treatment for hydatid disease. Overall, the recurrence rate appears to be high (4.6%–22.0%). The purpose of this study was to report our results in the management of recurrent hydatid disease, evaluating the methods for identifying recurrence, prognostic factors and therapeutic options. Methods We retrospectively reviewed the medical records of patients who underwent surgery for cystic hydatidosis between 1970 and 2003. Results Of the 584 patients who underwent surgery during our study period, follow-up was complete for 484 (82.8%). Cysts recurred in 51 patients (8.7%). Abdominal ultrasonography and computed tomography appeared to be efficient for diagnosing recurrence. The 2 most important determinants for recurrence were minute spillage of the hydatid cyst and inadequate treatment owing to missing cysts or incomplete pericystectomy. All but 2 recurrences required surgery. There were 14 postoperative complications for a rate of 27.0%. Thirteen re-recurrences were observed in the follow-up of these patients and also required surgery. Conclusion Avoidance of minute spillage of cyst contents and cautious removal of the parasite with as much of the pericyst as possible are fundamental objectives of primary hydatid surgery. Conservative surgery (removal of the cyst contents plus partial pericystectomy with drainage when necessary) plus chemotherapy and local sterilization is suggested for both primary and secondary operations and appears to achieve satisfactory long-term results. Radical surgery (resection, cystopericystectomy) is preferred only in select patients. PMID:21939605

  4. The 2013 German-Russian Bion-M1 Joint Flight Project: Altered cAMP/PKA Signaling Pathway in Skeletal Muscle during Exposure to Real Microgravity in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Salanova, Michele; Blottner, Dieter; Shenkman, Boris S.; Lomonosova, Yulia

    Exposure to real microgravity (muG) results in an impaired skeletal muscle structure and function. We here hypothesized that the cAMP/PKA cell signaling pathway, which triggers a multitude of intracellular effects in response to a variety of extracellular stimuli and which further promote muscle growth, play an important role during Spaceflight- induced disuse atrophy. Particularly, we hypothesized that different effectors of the cAMP-PKA signaling machinery, which are highly compartmentalized into subcellular functional microdomains in order to guarantee signal specificity, are altered after long term exposure to real µG. Taking advantage of the Bion-M1 Spaceflight program which provided us an excellent opportunity to explore mice skeletal muscle exposed for 30 days to real µG, by investigating at the cAMP-dependent protein kinase A (PKA) subcellular localization we compared muscle soleus (SOL) and extensor digitorum longus (EDL) of C57/black mice of a Bion-flight (n=5) group with a Bion-ground control (n=5) group and a ground control (n=5) group which was housed in a standard cage considered as vivarium control. Preliminary results of our experiments showed that different cAMP-PKA micro pools were normally detectable using high-resolution images of immunofluorescence experiments in different subcellular compartments of both SOL and EDL of Bion-ground and ground control groups which were not any longer detectable in Bion-flight group. In summary, our data indicate that an efficient organization in microdomains of the cAMP/PKA pathway may exist in skeletal muscle on ground and that such compartmentalization may be altered in response to prolonged exposure to real muG. National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121 to DB); Contract RAS-IMPB/Charité Berlin # Bion-M1/2013

  5. The association of subclinical hypocalcemia, negative energy balance and disease with bodyweight change during the first 30 days post-partum in dairy cows milked with automatic milking systems.

    PubMed

    Caixeta, L S; Ospina, P A; Capel, M B; Nydam, D V

    2015-05-01

    In a prospective cohort study, the daily bodyweight (BW) and milk production of 92 cows were recorded using automatic milking systems. The objectives were to characterize calcium serum concentration variability on days 1-3 post-partum and to evaluate the association between subclinical hypocalcemia (SHPC) and change in BW over the first 30 days in milk (DIM) in Holstein dairy cows, while controlling for concurrent disease and negative energy balance (NEB). SHPC was defined as total serum calcium concentration between 6 and 8 mg/dL, NEB was defined as non-esterified fatty acids (NEFA) > 0.7 mEq/L or β-hydroxybutyrate (BHB) ≥ 1.2 mmol/L. The peak incidence of SHPC was at 1 DIM for all groups (11%, 42% and 60% for parities 1, 2, and ≥3, respectively). All parity groups lost weight (21, 33, and 34 kg) during the first 30 DIM. Parity 1 animals with disease compared with those without disease lost the most weight (2.6 kg/day BW loss vs. <1.9 kg/day, respectively). Normocalcemic parity 2 animals with either NEB or disease lost the most weight (>5 kg/day) compared with those in the SHPC group (≤4.5 kg/day). In parity ≥ 3 animals, SHPC was an important factor for BW loss; SHPC animals lost the most weight (>3.7 kg/day) vs. normocalcemic cows (≤3.3 kg/day) regardless of NEB or disease status. Even though all animals lost weight during early lactation the effect of disease, NEB, and SHPC on BW loss was different in each parity group. PMID:25819756

  6. Association of Coronary Stent Indication With Postoperative Outcomes Following Noncardiac Surgery

    PubMed Central

    Holcomb, Carla N.; Hollis, Robert H.; Graham, Laura A.; Richman, Joshua S.; Valle, Javier A.; Itani, Kamal M.; Maddox, Thomas M.; Hawn, Mary T.

    2016-01-01

    IMPORTANCE Current guidelines for delaying surgery after coronary stent placement are based on stent type. However, the indication for the stent may be an important risk factor for postoperative major adverse cardiac events (MACE). OBJECTIVE To determine whether the clinical indication for a coronary stent is associated with postoperative MACE. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in patients at US Veterans Affairs hospitals who had a coronary stent placed between January 1,2000, and December 31, 2010, and underwent noncardiac surgery within the following 24 months. The association between the indication for stent and postoperative MACE rates was examined using logistic regression to control for patient and procedure factors. EXPOSURES Three subgroups of stent indication were examined: (1) myocardial infarction (MI); (2) unstable angina; and (3) revascularization not associated with acute coronary syndrome (non-ACS). MAIN OUTCOMES AND MEASURES Composite 30-day postoperative MACE rates including all-cause mortality, MI, or revascularization. RESULTS Among 26 661 patients (median [IQR] age, 68 [61.0–76.0] years; 98.4% male; 88.1% white) who underwent 41 815 surgical procedures within 24 months following coronary stent placement, the stent indication was MI in 32.8% of the procedures, unstable angina in 33.8%, and non-ACS in 33.4%. Postoperative MACE rates were significantly higher in the MI group (7.5%) compared with the unstable angina (2.7%) and non-ACS (2.6%) groups (P < .001). When surgery was performed within 3 months of percutaneous coronary intervention, adjusted odds of MACE were significantly higher in the MI group compared with the non-ACS group (odds ratio [OR] = 5.25; 95% CI, 4.08–6.75). This risk decreased over time, although it remained significantly higher at 12 to 24 months from percutaneous coronary intervention (OR = 1.95; 95% CI, 1.58–2.40). The adjusted odds of MACE for the unstable angina group were similar to those

  7. Postoperative pain: nurses' knowledge and patients' experiences.

    PubMed

    Francis, Lavonia; Fitzpatrick, Joyce J

    2013-12-01

    The aim of this study was to determine nurses' knowledge and attitudes regarding postoperative pain and identify postoperative patients' pain intensity experiences. The assessment and management of acute postoperative pain is important in the care of postoperative surgical patients. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing. A pilot study with an exploratory design was conducted at a large teaching hospital in the eastern United States. The convenience samples included 31 nurses from the gastrointestinal and urologic surgical units and 14 first- and second-day adult postoperative open and laparoscopic gastrointestinal and urologic patients who received patient-controlled analgesia (PCA). The Knowledge and Attitudes Survey Regarding Pain was used to measure nurses' knowledge about pain management. The Short-Form McGill Pain Questionnaire (SF-MPQ) was used to measure patients' pain intensity. The nurses' mean score on the Knowledge and Attitudes Survey Regarding Pain was 69.3%. Patients experienced moderate pain, as indicated by the score on the SF-MPQ. There is a need to increase nurses' knowledge of pain management. PMID:24315258

  8. Clinical experimental studies of postoperative infusion analgesia.

    PubMed

    Knoche, E; Dick, W; Bowdler, I; Gundlach, G

    1983-01-01

    Thirty postoperative patients, after undergoing abdominal hysterectomy and standard general anesthesia, were randomly allocated to three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramide, or ketamine. The patients rated their pain on a 15-cm visual analog scale. Patients in group 1 received pentazocine. Mean dosage was 0.12 mg/kg/hr on the day of operation, 0.1 mg/kg/hr on the first postoperative day, and only 0.07 mg/kg/hr on the second postoperative day. Pentazocine blood levels averaged 50 micrograms/L. Patients in group 2 received piritramide. Mean dosage was 0.038 mg/kg/hr on the day of operation, 0.024 mg/kg/hr on the first postoperative day, and 0.019 mg/kg/hr on the second postoperative day. Blood levels of piritramide were not determined because no satisfactory assay is available. Patients in group 3 received ketamine. Mean dosage was 0.32 mg/kg/hr on the day of operation, 0.28 mg/kg/hr on the first postoperative day, and 0.29 mg/kg/hr on the second postoperative day. Ketamine blood levels ranged between 120 and 180 micrograms/L. None of the three analgesics caused any important hemodynamic or respiratory side effects. Pentazocine and piritramide were more effective analgesics than ketamine was. Ketamine also had a higher incidence of side effects. PMID:6627285

  9. Individual Pause-and-Go Motion Is Instrumental to the Formation and Maintenance of Swarms of Marching Locust Nymphs

    PubMed Central

    Ariel, Gil; Ophir, Yotam; Levi, Sagi; Ben-Jacob, Eshel; Ayali, Amir

    2014-01-01

    The principal interactions leading to the emergence of order in swarms of marching locust nymphs was studied both experimentally, using small groups of marching locusts in the lab, and using computer simulations. We utilized a custom tracking algorithm to reveal fundamental animal-animal interactions leading to collective motion. Uncovering this behavior introduced a new agent-based modeling approach in which pause-and-go motion is pivotal. The behavioral and modeling findings are largely based on motion-related visual sensory inputs obtained by the individual locust. Results suggest a generic principle, in which intermittent animal motion can be considered as a sequence of individual decisions as animals repeatedly reassess their situation and decide whether or not to swarm. This interpretation implies, among other things, some generic characteristics regarding the build-up and emergence of collective order in swarms: in particular, that order and disorder are generic meta-stable states of the system, suggesting that the emergence of order is kinetic and does not necessarily require external environmental changes. This work calls for further experimental as well as theoretical investigation of the neural mechanisms underlying locust coordinative behavior. PMID:24988464

  10. Replication fork progression is paused in two large chromosomal zones flanking the DNA replication origin in Escherichia coli.

    PubMed

    Akiyama, Masahiro Tatsumi; Oshima, Taku; Chumsakul, Onuma; Ishikawa, Shu; Maki, Hisaji

    2016-08-01

    Although the speed of nascent DNA synthesis at individual replication forks is relatively uniform in bacterial cells, the dynamics of replication fork progression on the chromosome are hampered by a variety of natural impediments. Genome replication dynamics can be directly measured from an exponentially growing cell population by sequencing newly synthesized DNA strands that were specifically pulse-labeled with the thymidine analogue 5-bromo-2'-deoxyuridine (BrdU). However, a short pulse labeling with BrdU is impracticable for bacteria because of poor incorporation of BrdU into the cells, and thus, the genomewide dynamics of bacterial DNA replication remain undetermined. Using a new thymidine-requiring Escherichia coli strain, eCOMB, and high-throughput sequencing, we succeeded in determining the genomewide replication profile in bacterial cells. We also found that fork progression is paused in two ~200-kb chromosomal zones that flank the replication origin in the growing cells. This origin-proximal obstruction to fork progression was overcome by an increased thymidine concentration in the culture medium and enhanced by inhibition of transcription. These indicate that DNA replication near the origin is sensitive to the impediments to fork progression, namely a scarcity of the DNA precursor deoxythymidine triphosphate and probable conflicts between replication and transcription machineries. PMID:27353572

  11. Depth and mineralogy of the magma source or pause region for the Carboniferous Liberty Hill pluton, South Carolina

    SciTech Connect

    Speer, J.A.

    1988-06-01

    Use of Al content geobarometry on clinopyroxene inclusions in plagioclase from the Carboniferous Liberty Hill pluton, South Carolina, yields pressure estimates of 8-10 kbar. Amphibole crystallization pressures are 3.1-4.7 kbar; contact metamorphic pressure are 4.5 kbar. Clinopyroxenes could be early crystallization products from the melt, restite crystals from the source region, xenocrysts from the magma conduit walls, or xenocrysts from a more mafic magma. Compositional uniformity of granitoid clinopyroxenes but dissimilarity with those in contemporaneous gabbroids is evidence against a xenocrystic origin. The deeper depths are interpreted as either the source region or a pausing place important in the crystallization history of the magma during its ascent to the upper crust. Early crystallization assemblage of the granitoid, and possibly the assemblage of the source region, was amphibole + clinopyroxene +/- plagioclase-bearing. An amphibolitic lower crustal source is consistent with the Sr and O isotopic and rare-earth-element studies of this and many other similar-age granitoids in the southern Appalachians.

  12. Vezf1 protein binding sites genome-wide are associated with pausing of elongating RNA polymerase II

    PubMed Central

    Gowher, Humaira; Brick, Kevin; Camerini-Otero, R. Daniel; Felsenfeld, Gary

    2012-01-01

    The protein Vezf1 plays multiple roles important for embryonic development. In Vezf1−/− mouse embryonic stem (mES) cells, our earlier data showed widespread changes in gene-expression profiles, including decreased expression of the full-length active isoform of Dnmt3b methyltransferase and concomitant genome-wide reduction in DNA methylation. Here we show that in HeLaS3 cells there is a strong genome-wide correlation between Vezf1 binding and peaks of elongating Ser2-P RNA polymerase (Pol) ll, reflecting Vezf1-dependent slowing of elongation. In WT mES cells, the elongating form of RNA pol II accumulates near Vezf1 binding sites within the dnmt3b gene and at several other Vezf1 sites, and this accumulation is significantly reduced at these sites in Vezf1−/− mES cells. Depending upon genomic location, Vezf1-mediated Pol II pausing can have different regulatory roles in transcription and splicing. We find examples of genes in which Vezf1 binding sites are located near cassette exons, and in which loss of Vezf1 leads to a change in the relative abundance of alternatively spliced messages. We further show that Vezf1 interacts with Mrg15/Mrgbp, a protein that recognizes H3K36 trimethylation, consistent with the role of histone modifications at alternatively spliced sites. PMID:22308494

  13. Plasma MicroRNA-21 Predicts Postoperative Pulmonary Complications in Patients Undergoing Pneumoresection

    PubMed Central

    Liu, Yaling; Li, Peiying; Cheng, Xinyu; Yu, Weifeng; Yang, Liqun; Zhu, Hui

    2016-01-01

    Postoperative pulmonary complication (PPC) remains the most common postoperative complication in patients undergoing noncardiac thoracic surgery. We conducted the clinical study to determine the diagnostic role of miRNA-21 in noncardiac thoracic surgery. 368 patients undergoing noncardiac thoracic surgery were recruited. Blood samples were collected before anesthesia and 2 hours after incision during surgery for RT-PCR measurement of miRNA-21. PPC occurrence, extrapulmonary complications, duration of ICU stay, and death within 1 year were evaluated. The overall rate of PPCs following surgery was 10.32%. A high relative miRNA-21 level was an independent risk factor for PPCs within 7 days (OR, 2.69; 95% CI, 1.25–5.66; and P < 0.001). High miRNA-21 was also associated with an increased risk of extrapulmonary complications (OR, 3.62; 95% CI, 2.26–5.81; and P < 0.001), prolonged ICU stay (OR, 6.54; 95% CI, 2.26–18.19; and P < 0.001), increased death within 30 days (OR, 6.17; 95% CI, 2.11–18.08; and P < 0.001), and death within 1 year (OR, 7.30; 95% CI, 2.76–19.28; and P < 0.001). In summary, plasma miRNA-21 may serve as a novel biomarker of PPCs for patients undergoing noncardiac thoracic surgery. PMID:27293316

  14. Automated Detection of Postoperative Surgical Site Infections Using Supervised Methods with Electronic Health Record Data.

    PubMed

    Hu, Zhen; Simon, Gyorgy J; Arsoniadis, Elliot G; Wang, Yan; Kwaan, Mary R; Melton, Genevieve B

    2015-01-01

    The National Surgical Quality Improvement Project (NSQIP) is widely recognized as "the best in the nation" surgical quality improvement resource in the United States. In particular, it rigorously defines postoperative morbidity outcomes, including surgical adverse events occurring within 30 days of surgery. Due to its manual yet expensive construction process, the NSQIP registry is of exceptionally high quality, but its high cost remains a significant bottleneck to NSQIP's wider dissemination. In this work, we propose an automated surgical adverse events detection tool, aimed at accelerating the process of extracting postoperative outcomes from medical charts. As a prototype system, we combined local EHR data with the NSQIP gold standard outcomes and developed machine learned models to retrospectively detect Surgical Site Infections (SSI), a particular family of adverse events that NSQIP extracts. The built models have high specificity (from 0.788 to 0.988) as well as very high negative predictive values (>0.98), reliably eliminating the vast majority of patients without SSI, thereby significantly reducing the NSQIP extractors' burden. PMID:26262143

  15. Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

    PubMed Central

    King, Joseph T.; Perkal, Melissa F.; Rosenthal, Ronnie A.; Gordon, Adam J.; Crystal, Stephen; Rodriguez-Barradas, Maria C.; Butt, Adeel A.; Gibert, Cynthia L.; Rimland, David; Simberkoff, Michael S.; Justice, Amy C.

    2016-01-01

    IMPORTANCE Antiretroviral therapy (ART) has converted human immunodeficiency virus (HIV) infection into a chronic condition, and patients now undergo a variety of surgical procedures, but current surgical outcomes are inadequately characterized. OBJECTIVE To compare 30-day postoperative mortality in patients with HIV infection receiving ART with the rates in uninfected individuals. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of nationwide electronic medical record data from the US Veterans Health Administration Healthcare System, October 1, 1996, to September 30, 2010. Common inpatient surgical procedures were grouped using the Healthcare Cost and Utilization Project Clinical Classification System to match HIV-infected and uninfected patients in a 1:2 ratio. Data on 1641 patients with HIV infection receiving combination ART who were undergoing inpatient surgery were compared with data on 3282 procedure-matched, uninfected comparators. Poisson regression models of 30-day postoperative mortality were adjusted for procedure year, age, Charlson Comorbidity Index score, hemoglobin level, albumin level, HIV infection, CD4 cell count, and HIV-1 RNA level. MAIN OUTCOMES AND MEASURES All-cause 30-day postoperative mortality. RESULTS The most common procedures in both groups were cholecystectomy (10.5%), hip arthroplasty (10.5%), spine surgery (9.8%), herniorrhaphy (7.4%), and coronary artery bypass grafting (7.0%). In patients with HIV infection, CD4 cell distributions were 80.0% with 200/µL or more, 16.3% with 50/µL to 199/µL, and 3.7% with less than 50/µL; 74.1% of patients with HIV infection had undetectable HIV-1 RNA. Human immunodeficiency virus infection was associated with higher 30-day postoperative mortality compared with the mortality in uninfected patients (3.4% [56 patients]) vs 1.6% [53]); incidence rate ratio [IRR], 2.11; 95% CI, 1.41–3.17; P < .001). CD4 cell count was inversely associated with mortality, but HIV-1 RNA provided no

  16. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures

    PubMed Central

    Jin, Jianwen; Wang, Gang; Gong, Maowei; Zhang, Hong; Liu, Junle

    2015-01-01

    Background Geriatric patients with femoral neck fracture (FNF) have unacceptably high rates of postoperative complications and mortality. The purpose of this study was to compare the effects of epidural anesthesia versus peripheral nerve block (PNB) on postoperative outcomes in elderly Chinese patients with FNF. Methods This retrospective study explored mortality and postoperative complications in geriatric patients with FNF who underwent epidural anesthesia or PNB at the Chinese People’s Liberation Army General Hospital from January 2008 to December 2012. The electronic database at the Chinese People’s Liberation Army General Hospital includes discharge records for all patients treated in the hospital. Information on patient demographics, preoperative comorbidity, postoperative complications, type of anesthesia used, and in-hospital, 30-day, and 1-year mortality after surgery was obtained from this database. Results Two hundred and fifty-eight patients were identified for analysis. The mean patient age was 79.7 years, and 71.7% of the patients were women. In-hospital, 30-day, and 1-year postoperative mortality was 4.3%, 12.4%, and 22.9%, respectively, and no differences in mortality or cardiovascular complications were found between patients who received epidural anesthesia and those who received PNB. More patients with dementia or delirium were given PNB. No statistically significant differences were found between groups for other comorbidities or intraoperative parameters. The most common complications were acute cardiovascular events (23.6%), electrolyte disturbances (20.9%), and hypoxemia (18.2%). Patients who received PNB had more postoperative delirium (P=0.027). Postoperative acute respiratory events were more common (P=0.048) and postoperative stroke was less common (P=0.018) in the PNB group. There were fewer admissions to intensive care (P=0.024) in the epidural anesthesia group. Key factors with a negative influence on mortality were acute

  17. Postoperative ultrasonography of the musculoskeletal system

    PubMed Central

    Chun, Kyung Ah; Cho, Kil-Ho

    2015-01-01

    Ultrasonography of the postoperative musculoskeletal system plays an important role in the Epub ahead of print accurate diagnosis of abnormal lesions in the bone and soft tissues. Ultrasonography is a fast and reliable method with no harmful irradiation for the evaluation of postoperative musculoskeletal complications. In particular, it is not affected by the excessive metal artifacts that appear on computed tomography or magnetic resonance imaging. Another benefit of ultrasonography is its capability to dynamically assess the pathologic movement in joints, muscles, or tendons. This article discusses the frequent applications of musculoskeletal ultrasonography in various postoperative situations including those involving the soft tissues around the metal hardware, arthroplasty, postoperative tendons, recurrent soft tissue tumors, bone unions, and amputation surgery. PMID:25971901

  18. [Management of postoperative hemorrhage following thyroid surgery].

    PubMed

    Lorenz, K; Sekulla, C; Kern, J; Dralle, H

    2015-01-01

    The incidence of postoperative hemorrhage following thyroid surgery stands at 1%-2 %. This low incidence contrasts with the significant potential complications of postoperative hemorrhage. Influencing factors and measures mentioned in the literature and own studies are discussed. Although an improvement in the postoperative hemorrhage rate was to be expected indirectly due to the increasing use of coagulation-relevant medication, there has been neither an increase in incidence nor a reduction in resultant complications, including primarily recurrent vocal cord paresis, tracheotomy and mortality. Factors that influence surgical success include a meticulous technique and caution, as well as ensuring intensive and qualified postoperative monitoring for a minimum of 4-6 h, thereby permitting immediate revision surgery at any time. PMID:25532753

  19. Forecasting Flooding in the Brahmaputra and Ganges Delta of Bangladesh on Short (1-10 days), Medium (20-30 days) and Seasonal Time Scales (1-6 months)

    NASA Astrophysics Data System (ADS)

    Webster, P. J.; Hoyos, C. D.; Hopson, T. M.; Chang, H.; Jian, J.

    2007-12-01

    Following the devastating flood years of 1998 during which 60% of Bangladesh was under water for a period of 3 months, the Climate Forecast Applications in Bangladesh (CFAB) project was formed with funding by USAID and NSF which eventually resulted in a joint project with the European Centre for Medium Range Weather Forecasting (ECMWF), the Asian Disaster Preparedness Centre (ADPC) and the Bangladesh Flood Forecasting and Warning Centre. The project was organized and developed through the Georgia Institute of Technology. The aim of CFAB was to develop innovative methods of extending the warning of flooding in Bangladesh noting that there was a unique problem: India provided no upstream discharge data to Bangladesh so that before CFAB the maximum lead time of a forecast was that given by measuring river discharge at the India-Bangladesh border: no lead-time at the border and 2 days in the southern parts of the country. Given that the Brahmaputra and Ganges catchment areas had to be regarded as essentially unguaged, it was clear that innovative techniques had to be developed. On of the basic criterion was that the system should provide probabilistic forecasts in order for the Bangladeshis to assess risk. A three-tier system was developed to allow strategic and tactical decisions to be made for agricultural purposes and disaster mitigation: seasonal (1-6 months: strategic), medium range (20-30 days: strategic/tactical) and short range (1-10 days: tactical). The system that has been developed brings together for the first time operational meteorological forecasts (ensemble forecasts from ECMWF), with satellite and discharge data and a suite of hydrological models. In addition, with ADPC and FFWC we have developed an in-country forecast dispersion system that allows a rapid dissemination. The system has proven to be rather successful, especially in the short range. The flooding events of 2004 were forecast with all forecasting tiers at the respective lead time. In

  20. [New approach to postoperative delirium treatment].

    PubMed

    Pasechnik, I N; Makhlaĭ, A V; Tepliakova, A N; Gubaĭdullin, R R; Sal'nikov, P S; Borisov, A Iu; Berezenko, M N

    2015-01-01

    The efficiency of different drugs for sedation was studied in 51 patients after large abdominal operations complicated by postoperative delirium. Diagnosis of postoperative delirium was established according to CAM-ICU criteria. Dexmedetomidine has demonstrated significantly decreased duration of delirium and hospital stay in intensive care unit in comparison with haloperidol. Besides, patients which received dexmedetomidine preserved opportunity for verbal contact. Also these patients interacted better with department's stuff. PMID:26031955

  1. Current issues in postoperative pain management.

    PubMed

    Rawal, Narinder

    2016-03-01

    Postoperative pain has been poorly managed for decades. Recent surveys from USA and Europe do not show any major improvement. Persistent postoperative pain is common after most surgical procedures, and after thoracotomy and mastectomy, about 50% of patients may experience it. Opioids remain the mainstay of postoperative pain treatment in spite of strong evidence of their drawbacks. Multimodal analgesic techniques are widely used but new evidence is disappointing. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Current evidence suggests that epidural analgesia can no longer be considered the 'gold standard'. Perineural techniques are good alternatives for major orthopaedic surgery but remain underused. Infiltrative techniques with or without catheters are useful for almost all types of surgery. Simple surgeon-delivered local anaesthetic techniques such as wound infiltration, preperitoneal/intraperitoneal administration, transversus abdominis plane block and local infiltration analgesia can play a significant role in improvement of postoperative care, and the last of these has changed orthopaedic practice in many institutions. Current postoperative pain management guidelines are generally 'one size fits all'. It is well known that pain characteristics such as type, location, intensity and duration vary considerably after different surgical procedures. Procedure-specific postoperative pain management recommendations are evidence based, and also take into consideration the role of anaesthetic and surgical techniques, clinical routines and risk-benefit aspects. The role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging. The need for upgrading the role of surgical ward nurses and collaboration with surgeons to implement enhanced recovery after surgery protocols with regular audits to improve postoperative outcome cannot be overstated. PMID:26509324

  2. Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a Veteran Affairs' administrative database study.

    PubMed

    Abou Zahr, Zaki; Spiegelman, Andrew; Cantu, Maria; Ng, Bernard

    2015-02-01

    The aim of this study was to validate a novel technique that predicts stopping of disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents (BA) from the Veterans Affairs (VA) database and compare infection risks of rheumatoid arthritis patients who stopped versus continued DMARDs/BA perioperatively. We identified 6,024 patients on 1 DMARD or BA in the perioperative period between 1999 and 2009. Time gap between medication stop date and the next start date predicted drug stoppage (X). Time gap between surgery date and stop date predicted whether stoppage was before surgery (Y). Chart review from Houston VA was used for validation. ROC analyses were performed on chart review data to obtain X and Y cutoffs. The primary endpoints were wound infections and other infections within 30 days. ROC analyses found X ≥ 33 (AUC = 0.954) and Y ≥ -11 (AUC = 0.846). Risk of postoperative infections was not different when stopping and continuing DMARDs/BA preoperatively. Stopping BA after surgery was associated with higher odds of postoperative wound (OR 14.15, 95 % CI 1.76-113.76) and general infection (OR 9.2, 95 % CI 1.99-42.60) compared to not stopping. Stopping DMARDs after surgery was associated with increased risk of postoperative general infection (OR 1.84, 95 % CI 1.07-3.16) compared with not stopping. There was positive association between stopping DMARDs after surgery and postoperative wound infection but failed to achieve statistical significance (OR 1.67, 95 % CI 0.96-2.91). There was no significant difference in postoperative infection risk when stopping or continuing DMARD/BA. Our new validated method can be utilized in the VA and other databases to predict drug stoppage. PMID:25187198

  3. TOLERANCE TO COCAINE’S EFFECTS FOLLOWING CHRONIC ADMINISTRATION OF A DOSE WITHOUT DETECTED EFFECTS ON RESPONSE RATE OR PAUSE

    PubMed Central

    Minervini, Vanessa; Branch, Marc N.

    2014-01-01

    To observe tolerance to drug effects on operant behavior, the dose that researchers have often selected for chronic administration is one that disrupts, but does not abolish, responding. Some evidence suggests that tolerance may develop after chronic administration of relatively smaller doses. The purpose of the present experiment was to assess systematically effects of chronic administration of a dose without detected effect on responding. Specifically, response rates and postreinforcement pauses of five pigeons key pecking under a three-component multiple fixed-ratio schedule of food reinforcement were observed under chronic cocaine administration. We evaluated the effects of a range of doses (1.0 mg/kg to 17.0 mg/kg) during acute administration. The largest dose that failed to alter responding acutely then was administered chronically (1.0 mg/kg for one pigeon, 3.0 mg/kg for three pigeons, and 5.6 mg/kg for one pigeon). After 30 consecutive sessions of chronic administration, smaller and larger doses occasionally were substituted for the chronic dose. Pigeons then received presession saline administration for 30 consecutive sessions, and the postchronic effects of the series of doses on responding were determined. All subjects developed tolerance to doses of cocaine that initially had caused large decreases in rate, with the magnitude of the effects varying across components of the multiple schedule and subjects. Specifically, tolerance generally was greatest in the components with smaller ratios. Following postchronic saline administration, tolerance was usually diminished. Overall, the results demonstrate that under these conditions, repeated experience with disruptive effects of cocaine on food-maintained responding is not a necessary factor in the development of tolerance. PMID:24019029

  4. Tolerance to cocaine's effects following chronic administration of a dose without detected effects on response rate or pause.

    PubMed

    Minervini, Vanessa; Branch, Marc N

    2013-11-01

    To observe tolerance to drug effects on operant behavior, the dose that researchers have often selected for chronic administration is one that disrupts, but does not abolish, responding. Some evidence suggests that tolerance may develop after chronic administration of relatively smaller doses. The purpose of the present experiment was to assess systematically effects of chronic administration of a dose without detected effect on responding. Specifically, response rates and post-reinforcement pauses of five pigeons key pecking under a three-component multiple fixed-ratio schedule of food reinforcement were observed under chronic cocaine administration. We evaluated the effects of a range of doses (1.0 mg/kg to 17.0  mg/kg) during acute administration. The largest dose that failed to alter responding acutely then was administered chronically (1.0  mg/kg for 1 pigeon, 3.0  mg/kg for 3 pigeons, and 5.6  mg/kg for 1 pigeon). After 30 consecutive sessions of chronic administration, smaller and larger doses occasionally were substituted for the chronic dose. Pigeons then received pre-session saline administration for 30 consecutive sessions, and the post-chronic effects of the series of doses on responding were determined. All subjects developed tolerance to doses of cocaine that initially had caused large decreases in rate, with the magnitude of the effects varying across components of the multiple schedule and subjects. Specifically, tolerance generally was greatest in the components with smaller ratios. Following post-chronic saline administration, tolerance was usually diminished. Overall, the results demonstrate that under these conditions, repeated experience with disruptive effects of cocaine on food-maintained responding is not a necessary factor in the development of tolerance. PMID:24019029

  5. Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome

    PubMed Central

    Ledowski, Thomas; Hillyard, Samuel; O’Dea, Brendan; Archer, Rob; Vilas-Boas, Filipe; Kyle, Barney

    2013-01-01

    Background: The aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital. Methods: Data from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer. Postoperative outcome parameters were complications in the recovery room and radiological diagnosed atelectasis or pneumonia within 30 days. Results: Data from 146 patients were analysed. Three reversal strategies were used: no reversal, neostigmine or sugammadex. The TOF ratio was less than 0.7 in 17 patients (nine no reversal, eight neostigmine) and less than 0.9 in 47 patients (24 no reversal, 19 neostigmine, four sugammadex). Those reversed with sugammadex showed fewer episodes of postoperative oxygen desaturation (15% vs. 33%; P<0.05). TOF ratios of less than 0.7 (P<0.05) and also <0.9 (P<0.01) were more likely associated with X-ray results consistent with postoperative atelectasis or pneumonia. Conclusions: Our results suggest a significant impact of residual paralysis on patient outcome. The use of sugammadex resulted in the lowest incidence of residual paralysis. PMID:23716766

  6. Extensive surgical and comprehensive postoperative medical management for cystic fibrosis chronic rhinosinusitis

    PubMed Central

    Virgin, Frank W.; Rowe, Steven M.; Wade, Mary B.; Gaggar, Amit; Leon, Kevin J.; Young, K. Randall

    2012-01-01

    Background: Chronic rhinosinusitis has a major impact on the quality of life of patients with cystic fibrosis (CF) and may contribute to progression of chronic lung disease. Despite multiple sinus surgeries, maxillary sinus involvement is a recurrent problem. The modified endoscopic medial maxillectomy (MEMM) permits debridement in the clinic, improves mucus clearance with nasal irrigations, and increases access for topical delivery of therapeutics. However, clinical outcomes of aggressive sinus surgery with regimented postoperative medical treatment have not been systematically evaluated. Methods: CF patients completed the 22-Item Sinonasal Outcome Test questionnaires before sinus surgery (and bilateral MEMM) and at sequential postoperative visits. Objective measures included Lund-Kennedy endoscopic score and pulmonary function tests (forced expiratory volume at 1 second percent [FEV1%] predicted). Culture-directed antibiotic therapy, prednisone, and topical irrigations were initiated postoperatively. Results: Twenty-two patients (mean age, 26.5 years; 4.9 prior sinus operations) underwent MEMM and sinus surgery. Symptom scores were significantly reduced at 60 days (primary outcome, 64.7 ± 18.4 presurgery versus 27.5 ± 15.3 postsurgery; p < 0.0001) and up to a year postoperatively (27.6 ± 12.6; p < 0.0001). Endoscopic scores were also reduced after surgery (10.4 ± 1.1 presurgery versus 5.7 ± 2.4 [30 days], 5.7 ± 1.4 [60 days], 5.8 ± 1.3 [120 days], and 6.0 ± 1.1 [1 year]; p < 0.0001)]. There were no differences in FEV1% predicted up to 1 year postoperatively, but hospital admissions secondary to pulmonary exacerbations significantly decreased (2.0 ± 1.4 versus 3.2 ± 2.4, respectively; p < 0.05). Conclusion: Prospective evaluation indicates sinus surgery with MEMM is associated with marked improvement in sinus disease outcomes. Additional studies are necessary to confirm whether this treatment paradigm is associated with improved CF pulmonary disease

  7. Does a skeletonized internal thoracic artery give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?

    PubMed

    Fouquet, Olivier; Tariel, François; Desulauze, Pierre; Mével, Gwenaël

    2015-05-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does a skeletonized internal thoracic artery (ITA) give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?' Altogether, 98 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Papers about patency of skeletonized versus pedicled internal thoracic artery were excluded. The analysed complications were essentially mediastinitis, superficial sternal infection, wound infection, chest pain and pulmonary function. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Grafts used were either single ITA (LITA or RITA, left or right, respectively) or bilateral ITAs (BITAs). One prospective randomized controlled trial was identified, which found that benefits of skeletonized harvesting included increased graft length, increased graft flow and decreased incidence of mediastinitis. All of the six studies concerning wound infection demonstrate fewer complications when ITA is skeletonized. One of the three papers describing postoperative mortality demonstrated lower 30-day mortality, but there was no long-term analysis. Three studies describing postoperative chest pain reported a lower score on the visual analogue scale (VAS) within 30 days. One of them indicates that the pedicled group has a significantly greater VAS, pain disability index and short-form McGill Pain questionnaire score at 1 and 3 months. The hospital stay was shorter for three studies conducted on this subject. One study about pulmonary function reported a better ratio of pre- versus postoperative values of forced vital capacity. Despite longer operating times, skeletonization leads to fewer wound infections, reduced chest pain, allows a shorter hospital stay and better

  8. Nursing documentation of postoperative pain management.

    PubMed

    Idvall, Ewa; Ehrenberg, Anna

    2002-11-01

    Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. PMID:12427178

  9. Thirty-Day Postoperative Death Rate at an Academic Medical Center

    PubMed Central

    Calland, J. Forrest; Adams, Reid B.; Benjamin, Daniel K.; O’Connor, Matthew J.; Chandrasekhara, Vinay; Guerlain, Stephanie; Jones, Rayford Scott

    2002-01-01

    Objective To improve understanding of perioperative deaths at an academic medical center. Summary Background Data Because published data have typically focused on specific patient populations, diagnoses, or procedures, there are few data regarding surgical deaths and complications in institutional or regional studies. Specifically, surgical adverse events and errors are generally not studied comprehensively. This limits the overall understanding of complications and deaths. Methods Data from all operations performed in the main operating suite of the University of Virginia Health Sciences Center from January 1 to June 30, 1999, were compared with state death records to gain a dataset of patients dying within 30 days of surgery. All clinical records from patients who died were screened for adverse events and subsequently reviewed by three surgeons who identified adverse events and errors and performed comparisons with survivors. Results One hundred nineteen deaths followed 7,379 operations performed on 6,296 patients, yielding a patient death rate of 1.9%. Patients dying within 30 days of surgery were older and had higher American Society of Anesthesiologists scores. Of 119 deaths, 86 (72.3%) were attributable to the patient’s primary disease. Twenty-three patient deaths (19.3% of all deaths, 0.37% of all patients) could not be attributed to the patient’s primary disease and thus were suspicious for an adverse event (AE) as the cause of the death. Of the 23 deaths suspicious for AE, 15 (12.6% of all deaths, and 65.2% of AE deaths) followed an error in care and thus were classified as potentially preventable, affecting 0.24% of the study population. Conclusions Overall, the 30-day postoperative death rate was low in the total surgical population at an academic medical center. Errors and AEs were associated with 12.6% and 19.3% of deaths, respectively. Retrospective review inadequately characterized the nature of AEs and failed to determine causality. Prospective

  10. Pausing at the Threshold

    ERIC Educational Resources Information Center

    Morgan, Patrick K.

    2015-01-01

    Since about 2003, the notion of threshold concepts--the central ideas in any field that change how learners think about other ideas--have become difficult to escape at library conferences and in general information literacy discourse. Their visibility will likely only increase because threshold concepts figure prominently in the Framework for…

  11. A Pregnant Pause?

    ERIC Educational Resources Information Center

    Zirkel, Perry A.

    2001-01-01

    In a case involving a swim-team student's mandatory pregnancy test and a varsity coach's mishandling of confidentiality, the Third Circuit Court of Appeals awarded the coach qualified immunity, while rejecting the student's Fourth and First Amendment claims. Discretion and legal counsel would have helped. (MLH)

  12. Biomarkers of postoperative delirium and cognitive dysfunction

    PubMed Central

    Androsova, Ganna; Krause, Roland; Winterer, Georg; Schneider, Reinhard

    2015-01-01

    Elderly surgical patients frequently experience postoperative delirium (POD) and the subsequent development of postoperative cognitive dysfunction (POCD). Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers. PMID:26106326

  13. Peppermint oil: a treatment for postoperative nausea.

    PubMed

    Tate, S

    1997-09-01

    This paper describes a research study to investigate the efficacy of peppermint oil as a treatment for postoperative nausea. It uses a three-condition experimental design using statistical analysis to compare groups. The Kruskal-Wallis test was used to establish significance and the Mann-Whitney test to differentiate significance between the groups. The control, placebo and experimental groups of gynaecological patients were compared, using variables known to affect postoperative nausea. They were found to be homogeneous for the purposes of the study. A statistically significant differences was demonstrated on the day of operation, using the Kruskal-Wallis test, P = 0.0487. Using the Mann-Whitney test the difference was shown to be between the placebo and experimental group (U = 3; P = 0.02). The experimental group also required less traditional antiemetics and received more opioid analgesia postoperatively. The total cost of the treatment was 48 pence per person. PMID:9378876

  14. Recent Advances in Postoperative Pain Management

    PubMed Central

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

    Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development. PMID:20351978

  15. MR imaging of the postoperative knee.

    PubMed

    Gnannt, Ralph; Chhabra, Avneesh; Theodoropoulos, John S; Hodler, Juerg; Andreisek, Gustav

    2011-11-01

    Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine. PMID:22002752

  16. Evaluation for postoperative recurrence of Crohn disease.

    PubMed

    Swoger, Jason M; Regueiro, Miguel

    2012-06-01

    Disease recurrence following resective surgery for Crohn disease remains a challenging clinical problem, and more studies are needed to better define risk stratification and treatment recommendations in the postoperative setting. Endoscopy remains the gold standard for the assessment of postoperative disease recurrence, and all Crohn disease patients who undergo surgery should undergo ileocolonoscopy within 6 to 12 months of surgery. The degree of endoscopic recurrence in the neoterminal ileum during this procedure provides prognostic information regarding the severity of the future disease course. WCE, MRE, and SICUS are all promising noninvasive modalities to assess for postoperative Crohn disease activity. However, further studies are needed to better define scoring systems, operating characteristics and variability, and prognostic data for each of these modalities. In patients at risk for early disease recurrence, more aggressive prophylactic therapy should be considered, in hopes of delivering true “top-down” therapy that may offer maximum impact in altering the natural history of Crohn disease. PMID:22500519

  17. Metabolic dysfunction in lymphocytes promotes postoperative morbidity.

    PubMed

    Edwards, Mark R; Sultan, Pervez; del Arroyo, Ana Gutierrez; Whittle, John; Karmali, Shamir N; Moonesinghe, S Ramani; Haddad, Fares S; Mythen, Michael G; Singer, Mervyn; Ackland, Gareth L

    2015-09-01

    Perioperative lymphopenia has been linked with an increased risk of postoperative infectious complications, but the mechanisms remain unclear. We tested the hypothesis that bioenergetic dysfunction is an important mechanism underlying lymphopenia, impaired functionality and infectious complications. In two cohorts of patients (61-82 years old) undergoing orthopaedic joint replacement (n=417 and 328, respectively), we confirmed prospectively that preoperative lymphopenia (≤1.3 x 10(9)·l(-1); <20% white cell count; prevalence 15-18%) was associated with infectious complications (relative risk 1.5 (95% confidence interval 1.1-2.0); P=0.008) and prolonged hospital stay. Lymphocyte respirometry, mitochondrial bioenergetics and function were assessed (n=93 patients). Postoperative lymphocytes showed a median 43% fall (range: 26-65%; P=0.029; n=13 patients) in spare respiratory capacity, the extra capacity available to produce energy in response to stress. This was accompanied by reduced glycolytic capacity. A similar hypometabolic phenotype was observed in lymphocytes sampled preoperatively from chronically lymphopenic patients (n=21). This hypometabolic phenotype was associated with functional lymphocyte impairment including reduced T-cell proliferation, lower intracellular cytokine production and excess apoptosis induced by a range of common stressors. Glucocorticoids, which are ubiquitously elevated for a prolonged period postoperatively, generated increased levels of mitochondrial reactive oxygen species, activated caspase-1 and mature interleukin (IL)-1β in human lymphocytes, suggesting inflammasome activation. mRNA transcription of the NLRP1 inflammasome was increased in lymphocytes postoperatively. Genetic ablation of the murine NLRP3 inflammasome failed to prevent glucocorticoid-induced lymphocyte apoptosis and caspase-1 activity, but increased NLRP1 protein expression. Our findings suggest that the hypometabolic phenotype observed in chronically lymphopenic

  18. Inflate, Pause, Erupt, Recharge: the 2008 Alu eruption in the Erta ‘Ale volcanic system (Ethiopia)

    NASA Astrophysics Data System (ADS)

    Pagli, C.; Wright, T. J.; Ebinger, C. J.; Barnie, T. D.; Ayele, A.

    2009-12-01

    saturation triggering an eruption after a pause of several weeks. This is the first time that such a process has been observed using crustal deformation data.

  19. P-TEFb, the super elongation complex and mediator regulate a subset of non-paused genes during early Drosophila embryo development.

    PubMed

    Dahlberg, Olle; Shilkova, Olga; Tang, Min; Holmqvist, Per-Henrik; Mannervik, Mattias

    2015-02-01

    Positive Transcription Elongation Factor b (P-TEFb) is a kinase consisting of Cdk9 and Cyclin T that releases RNA Polymerase II (Pol II) into active elongation. It can assemble into a larger Super Elongation Complex (SEC) consisting of additional elongation factors. Here, we use a miRNA-based approach to knock down the maternal contribution of P-TEFb and SEC components in early Drosophila embryos. P-TEFb or SEC depletion results in loss of cells from the embryo posterior and in cellularization defects. Interestingly, the expression of many patterning genes containing promoter-proximal paused Pol II is relatively normal in P-TEFb embryos. Instead, P-TEFb and SEC are required for expression of some non-paused, rapidly transcribed genes in pre-cellular embryos, including the cellularization gene Serendipity-α. We also demonstrate that another P-TEFb regulated gene, terminus, has an essential function in embryo development. Similar morphological and gene expression phenotypes were observed upon knock down of Mediator subunits, providing in vivo evidence that P-TEFb, the SEC and Mediator collaborate in transcription control. Surprisingly, P-TEFb depletion does not affect the ratio of Pol II at the promoter versus the 3' end, despite affecting global Pol II Ser2 phosphorylation levels. Instead, Pol II occupancy is reduced at P-TEFb down-regulated genes. We conclude that a subset of non-paused, pre-cellular genes are among the most susceptible to reduced P-TEFb, SEC and Mediator levels in Drosophila embryos. PMID:25679530

  20. P-TEFb, the Super Elongation Complex and Mediator Regulate a Subset of Non-paused Genes during Early Drosophila Embryo Development

    PubMed Central

    Dahlberg, Olle; Shilkova, Olga; Tang, Min; Holmqvist, Per-Henrik; Mannervik, Mattias

    2015-01-01

    Positive Transcription Elongation Factor b (P-TEFb) is a kinase consisting of Cdk9 and Cyclin T that releases RNA Polymerase II (Pol II) into active elongation. It can assemble into a larger Super Elongation Complex (SEC) consisting of additional elongation factors. Here, we use a miRNA-based approach to knock down the maternal contribution of P-TEFb and SEC components in early Drosophila embryos. P-TEFb or SEC depletion results in loss of cells from the embryo posterior and in cellularization defects. Interestingly, the expression of many patterning genes containing promoter-proximal paused Pol II is relatively normal in P-TEFb embryos. Instead, P-TEFb and SEC are required for expression of some non-paused, rapidly transcribed genes in pre-cellular embryos, including the cellularization gene Serendipity-α. We also demonstrate that another P-TEFb regulated gene, terminus, has an essential function in embryo development. Similar morphological and gene expression phenotypes were observed upon knock down of Mediator subunits, providing in vivo evidence that P-TEFb, the SEC and Mediator collaborate in transcription control. Surprisingly, P-TEFb depletion does not affect the ratio of Pol II at the promoter versus the 3’ end, despite affecting global Pol II Ser2 phosphorylation levels. Instead, Pol II occupancy is reduced at P-TEFb down-regulated genes. We conclude that a subset of non-paused, pre-cellular genes are among the most susceptible to reduced P-TEFb, SEC and Mediator levels in Drosophila embryos. PMID:25679530

  1. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

    Ong, Cliff K. S.; Seymour, R. A.

    2003-01-01

    Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain. PMID:12722900

  2. [Some immunologic aspects in postoperative peritonitis].

    PubMed

    Perfil'ev, D F

    1998-01-01

    Examination of blood serum and cellular elements of 45 patients with postoperative diffuse purulent peritonitis shows that in the majority of examined persons before and in the first days after the operation immunodepression exists. The dynamics of immunologic disturbances (antibody titers, phagocytosis, immunoglobulines, T- and B-lymphocytes) are sufficiently informative and as a rule, correlate with clinical course of peritonitis. Adequate reaction of the organism to infection resulted in a favourable outcome. Low values of immunologic indices in postoperative period necessitate the use of stimulant therapy in combined treatment of this complication. PMID:9916429

  3. A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl) for postoperative analgesia following laparoscopic surgery

    PubMed Central

    Hemsen, Lisa; Cusack, Susan L; Minkowitz, Harold S; Kuss, Michael E

    2013-01-01

    Background XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery. Methods We implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose) in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days. Results XaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours. Conclusion XaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted. PMID:23390367

  4. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy

    PubMed Central

    Jeon, Hyun Woo; Kye, Yeo Kon; Kim, Kyung Soo

    2016-01-01

    Background Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. Methods From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. Results The median age was 19 years (range, 11−34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1−10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. Conclusions Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence. PMID:26904217

  5. Postoperative nausea and vomiting following orthognathic surgery

    PubMed Central

    Phillips, C.; Brookes, C. D.; Rich, J.; Arbon, J.; Turvey, T. A.

    2015-01-01

    The purpose of this study was to assess the incidence and risk factors associated with postoperative nausea (PON) and vomiting (POV) after orthognathic surgery. A review of the clinical records of consecutively enrolled subjects (2008–2012) at a single academic institution was conducted between 9/2013 and 3/2014. Data on the occurrence of PON and POV and potential patient-related, intraoperative, and postoperative explanatory factors were extracted from the medical records. Logistic models were used for the presence/absence of postoperative nausea and vomiting separately. Data from 204 subjects were analyzed: 63% were female, 72% Caucasian, and the median age was 19 years. Thirty-three percent had a mandibular osteotomy alone, 27% a maxillary osteotomy alone, and 40% had bimaxillary osteotomies. Sixty-seven percent experienced PON and 27% experienced POV. The most important risk factors for PON in this series were female gender, increased intravenous fluids, and the use of nitrous oxide, and for POV were race, additional procedures, and morphine administration. The incidence of PON and POV following orthognathic surgery in the current cohort of patients, after the introduction of the updated 2007 consensus guidelines for the management of postoperative nausea and vomiting, has not decreased substantially from that reported in 2003–2004. PMID:25655765

  6. [Postoperative nutritional management for esophageal cancer patients].

    PubMed

    Ikeda, Kenichiro; Kimura, Y

    2008-07-01

    High incidence of malnutrition is found in esophageal cancer patients. It is well known that to maintain good nutritional preoperative condition is very important to prevent postoperative morbidity and mortality. Hence, preoperative oral or nasogastric feeding is recommended when the patient is malnourished, at a total dose of 30 kcal/kg/day. During postoperative period, enteral nutrition should be primarily performed because of its favorable effects on immune-status and intestinal integrity to avoid septic complications. It is also important to keep circulatory volume sufficient to provide oxygen demand during catabolic phase, which leads earlier recovery from critical illness. Enteral nutrition should be immediately started afterward. An initial dose of 5-10 kcal/kg/day of the enteral nutrition is performed from the 1st or 2nd postoperative day and gradually increased to the full dose at 30 kcal/kg/ day. In cases of not administering scheduled dose of the enteral nutrition, either total or peripheral parenteral nutrition is required complementing total caloric intake. When total parenteral nutrition is used, blood glucose level should be controlled less than 150 mg/dl by pertinently administering insulin or limiting glycemic intake. Immunonutrition is promising nutritional management for critical surgical patients such as those performed esophageal cancer surgery. Continuing immune-enhancing diet at a dose of 750 to 1,000 ml/day for 5 to 7 days before surgery is necessary to bring good postoperative outcome. PMID:20715418

  7. [Clinical experimental studies of postoperative infusion analgesia].

    PubMed

    Dick, W; Knoche, E; Grundlach, G; Klein, I

    1983-06-01

    30 postoperative patients, who had undergone abdominal gynaecological surgery with standard general anaesthesia were randomly divided into three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramid, or ketamine. The patients rated their pain on a 15 cm pain analogue score. Group I pentazocine: Mean dosage on the day of operation 0.12 mg/kg/h, 0.1 mg/kg/h on the first and only 0.07 mg/kg/h on the second postoperative day. Pentazocine blood levels were on average 50 micrograms/l. Group II piritramid: Mean dosage on the day of operation 0.038 mg/kg/h, 0.024 mg/kg/h on the first and 0.019 mg/kg/h on the second postoperative day. Blood levels of piritramid were not determined because there is no satisfactory assay available. Group III ketamine: mean dosage on the day of operation 0.32 mg/kg/h, 0.28 mg/kg/h on the first and 0.29 mg/kg/h on the second postoperative day. Ketamine blood levels lay between 120 and 180 micrograms/l. The three analgesics did not cause any important haemodynamic or respiratory side effects. Pentazocine and piritramid were the most effective analgesics, ketamine was the least effective with a high incidence of side effects. PMID:6412586

  8. Acute postoperative endophthalmitis by Gemella haemolysans

    PubMed Central

    Nalamada, Suma; Jalali, Subhadra; Reddy, Ashok Kumar

    2010-01-01

    Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin. PMID:20413936

  9. Postoperative sore throat: a systematic review.

    PubMed

    El-Boghdadly, K; Bailey, C R; Wiles, M D

    2016-06-01

    Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence. PMID:27158989

  10. Management of common postoperative complications: delirium.

    PubMed

    Javedan, Houman; Tulebaev, Samir

    2014-05-01

    Delirium is a common postoperative surgical complication associated with poor outcomes. The complexity of delirium demands that each patient be assessed individually and a tailored prevention and treatment regimen be put in place. Nonpharmacologic and pharmacologic strategies are available to achieve this goal. PMID:24721366

  11. Immediate postoperative feeding in urological surgery.

    PubMed

    Seidmon, E J; Pizzimenti, K V; Blumenstock, F A; Huben, R P; Wajsman, Z; Pontes, J E

    1984-06-01

    The value of immediate postoperative enteral hyperalimentation with an elemental diet (high nitrogen Vivonex, full strength) at 125 cc per hour for 4 days was assessed in patients after radical urological surgery. Of 32 patients studied 21 received an elemental diet using a Vivonex Moss tube, which is a 3-lumen tube with esophagogastric decompression and simultaneous duodenal feeding, and the remaining 11 had a nasogastric tube only without nutritional support. We have used a selected group of parameters, including serum albumin, serum transferrin, creatinine height index, weight loss, total lymphocyte count, nitrogen balance and plasma fibronectin. All patients in the Moss tube group approached or achieved positive nitrogen balance by 4 days postoperatively, whereas the nasogastric tube group remained in negative nitrogen balance. Postoperative paralytic ileus was prevented in the majority of patients in the Moss tube group while receiving full nutritional support. We have found that the use of the Moss tube is a reasonable approach for postoperative alimentation. The tube is relatively easy to insert and well tolerated, and its use is a less expensive alternative to parenteral hyperalimentation. PMID:6427479

  12. Physiopathology and control of postoperative pain.

    PubMed

    Pflug, A E; Bonica, J J

    1977-06-01

    Potent systemic (narcotic) analgesics, when given in doses sufficient to produce ample pain relief, usually also produce mental and respiratory depression and, at times, circulatory impairment, that prolong postoperative morbidity. Complications due to morphine sulfate or meperidine hydrochloride can be minimized by titrating the patient's pain with small intravenous doses of narcotics (morphine sulfate, 2 to 3 mg, or meperidine hydrochloride, 15 to 25 mg) administered slowly at 15- to 20-minute intervals until the pain is relieved. On the third or fourth postoperative day, acetaminophen tablets usually suffice to provide relief of pain with little or no risk to patients. Continuous segmental epidural block or intercostal block, with or without splanchnic block, provide excellent pain relief that, in contrast to the narcotic, is complete. These are especially useful after operations on the chest or abdomen or the lower extremity. Regional analgesia is especially indicated in patients not adequately relieved from severe postoperative pain with narcotics, or when these drugs are contraindicated by advanced pulmonary, renal, or hepatic disease. Continuous caudal analgesia is also effective to completely releive severe postoperative pain in the lower limbs and perineum. PMID:871249

  13. Postoperative adjuvant therapy of breast cancer. Oncology Overview

    SciTech Connect

    Not Available

    1984-12-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Postoperative chemotherapy; Postoperative radiotherapy; Postoperative hormone therapy; Postoperative immunotherapy and chemoimmunotherapy; Postoperative multimodal therapy; Prognostic factors in postoperative adjuvant therapy.

  14. How laser damage resistance of HfO2/SiO2 optical coatings is affected by embedded contamination caused by pausing the deposition process

    NASA Astrophysics Data System (ADS)

    Field, Ella; Bellum, John; Kletecka, Damon

    2015-07-01

    Reducing contamination is essential for producing optical coatings with high resistance to laser damage. One aspect of this principle is to make every effort to limit long interruptions during the coating's deposition. Otherwise, contamination may accumulate during the pause and become embedded in the coating after the deposition is restarted, leading to a lower laser-induced damage threshold (LIDT). However, pausing a deposition is sometimes unavoidable, despite our best efforts. For example, a sudden hardware or software glitch may require hours or even overnight to solve. In order to broaden our understanding of the role of embedded contamination on LIDT, and determine whether a coating deposited under such non-ideal circumstances could still be acceptable, this study explores how halting a deposition overnight impacts the LIDT, and whether ion cleaning can be used to mitigate any negative effects on the LIDT. The coatings investigated are a beam splitter design for high reflection at 1054 nm and high transmission at 527 nm, at 22.5° angle of incidence in S-polarization. LIDT tests were conducted in the nanosecond regime.

  15. Postoperative ventilatory and circulatory effects of heating after aortocoronary bypass surgery. Postoperative external heat supply.

    PubMed

    Joachimsson, P O; Nyström, S O; Tydén, H

    1987-08-01

    The effects of postoperative external heat supply on shivering, oxygen uptake, carbon dioxide production, ventilatory requirements and haemodynamic variables were studied postoperatively after aortocoronary bypass surgery in 24 men with stable angina pectoris. After hypothermic cardiopulmonary bypass (CPB) at 25 degrees C, the patients were rewarmed to a nasopharyngeal temperature of at least 38 degrees C, resulting in a rectal temperature of about 34 degrees C before termination of CPB. Twelve patients, forming the control group, were given no other external heat supply. In another group (n = 12), the "radiant heat supply group", additional external heat was provided postoperatively, the main source of which was a thermal ceiling supplemented with heated, humidified respiratory gases. In this latter group the postoperative rewarming was accomplished earlier and was converted into a mainly passive process. Shivering, oxygen uptake, CO2 production and ventilation volumes were significantly reduced compared with the control group. Cardiac index and stroke index were higher and systemic oxygen extraction was lower in the radiant heat supply group. Postoperative hypertension and vasoconstriction were greatly decreased, suggesting that residual hypothermia is an important cause of the postoperative vasoconstriction. PMID:3115049

  16. Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy.

    PubMed

    Newhook, Timothy E; LaPar, Damien J; Walters, Dustin M; Gupta, Shruti; Jolissaint, Joshua S; Adams, Reid B; Brayman, Kenneth L; Zaydfudim, Victor M; Bauer, Todd W

    2015-12-01

    The impact of venous thromboembolism (VTE) after hepatectomy on patient morbidity, mortality, and resource usage remains poorly defined. Better understanding of thromboembolic complications is needed to improve perioperative management and overall outcomes. About 3973 patients underwent hepatectomy within NSQIP between 2005 and 2008. Patient characteristics, operative features, and postoperative correlates of VTE were compared with identify risk factors for VTE and to assess its overall impact on postoperative outcomes. Overall incidence of postoperative VTE was 2.4 per cent. Risk factors for postoperative VTE included older age, male gender, compromised functional status, degree of intraoperative blood transfusion, preoperative albumin level (all P < 0.05), and extent of hepatectomy (P = 0.004). Importantly, major postoperative complications, including acute renal failure, pneumonia, sepsis, septic shock, reintubation, prolonged ventilation, cardiac arrest, and reoperation were all associated with higher rates of VTE (all P < 0.05). Operative mortality was increased among patients with VTE (6.5% vs 2.4%, P = 0.03), and patients with VTE had a 2-fold increase in hospital length of stay (12.0 vs 6.0 days, P < 0.001). Postoperative VTE remains a significant source of morbidity, mortality, and increased resource usage after hepatectomy in the United States. Routine aggressive VTE prophylaxis measures are imperative to avoid development of VTE among patients requiring hepatectomy. PMID:26736156

  17. Critic appraisal. Postoperative sensitivity with indirect restorations.

    PubMed

    Farias, David; Walter, Ricardo; Swift, Edward J

    2014-01-01

    Postoperative sensitivity is characterized by short and sharp pain, and often experienced after cementation of indirect restorations. Factors associated with the occurrence of post-cementation sensitivity include type of cement, removal of smear layer by acid-etching, aggressive tooth preparation, inadequate provisional restorations, and patient's age. Its prevention is based on either interfering with mechanoreceptor activity or occluding the dentinal tubules. Regarding the latter, application of dentin desensitizers may be effective for blocking the tubules and significantly reducing dentin permeability and consequently postoperative sensitivity. This Critical Appraisal will present available clinical data where traditional materials such as zinc phosphate and glass ionomer cements (GIC) as well as self-adhesive resin-based cements were used. PMID:24761824

  18. Cardiac Transplant Postoperative Management and Care.

    PubMed

    Freeman, Regi; Koerner, Erika; Clark, Courtney; Halabicky, Kathy

    2016-01-01

    Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted. PMID:27254638

  19. Post-operative pulmonary complications after thoracotomy

    PubMed Central

    Sengupta, Saikat

    2015-01-01

    Pulmonary complications are a major cause of morbidity and mortality in the post-operative period after thoracotomy. The type of complications and the severity of complications depend on the type of thoracic surgery that has been performed as well as on the patient's pre-operative medical status. Risk stratification can help in predicting the possibility of the post-operative complications. Certain airway complications are more prone to develop with thoracic surgery. Vocal cord injuries, bronchopleural fistulae, pulmonary emboli and post-thoracic surgery non-cardiogenic pulmonary oedema are some of the unique complications that occur in this subset of patients. The major pulmonary complications such as atelectasis, bronchospasm and pneumonia can lead to respiratory failure. This review was compiled after a search for search terms within ‘post-operative pulmonary complications after thoracic surgery and thoracotomy’ on search engines including PubMed and standard text references on the subject from 2000 to 2015. PMID:26556921

  20. Limited efficacy of early postoperative jejunal feeding.

    PubMed

    Hayashi, J T; Wolfe, B M; Calvert, C C

    1985-07-01

    Twenty patients underwent placement of a jejunal catheter for early postoperative feeding at the time of upper abdominal operations, and a control group of 11 patients underwent operative procedures of similar magnitude without jejunostomy. Advancement of the rate of feeding to target intake over 6 to 7 days was attempted. Complications from the feeding led to cessation or curtailment of intake in 65 percent of the patients. Specific complications included abdominal pain and distention, diarrhea, and retrograde reflux of the feeding into the stomach. No statistically significant difference in nitrogen balance was demonstrated between the fed and unfed groups, presumably due to the limitations of nutrient delivery or absorption in the fed groups or elevated breath hydrogen excretion in patients with abdominal pain and distention suggests that the nature of the nutrients, particularly complex carbohydrates, is a factor in the development of feeding complications. Caution must be exercised in advancing the rate of postoperative jejunal feeding. PMID:3925800